The upright gait is placed in our cradle. But to be able to straighten ourselves, we need strong joints, especially in the area of the hips and knees. Joint arthrosis and wear of the cartilage layer are increasingly increasing in our society. This is partly because we are getting older and older and that often such illnesses develop with age. But more and more young people are living with an artificial hip joint. On average, the implants last ten to fifteen years before they need to be replaced. For young patients with hip osteoarthritis, ceramic prostheses are best.
What is a hip joint arthrosis?
The hip joint arthrosis is called in medical parlance Coxarthrosis and is a degenerative disease of the hip joint. In particular, the cartilage surfaces of the acetabulum and the femoral head are affected. The wear of the joint usually occurs only at an advanced age. The hip joint arthrosis represents the most common type of osteoarthritis in Germany.
In hip osteoarthritis, the cartilage layer in the joint becomes thinner over time and forms back. By reducing cartilage mass, the joint space narrows increasingly until the bones rub against each other.
The reason for arthrosis in the hip joint lies in the genes
The human hip joints are exposed to incredible stress. When racing or carrying loads they have to catch a multiple of our body weight.
Diseases of these important pivot points in our body are therefore not rare. For example, osteoarthritis can affect young people and is not a simple sign of aging.
Other causes of hip joint arthrosis
Almost every second German over 60 complains of arthritic joints, especially the hip and knee joints. Joint wear is subject to numerous factors and a complex disease process. Causes include genetic predisposition and advanced age. But even accidents or a sustained heavy stress during sports or at work can lead to hip joint arthrosis.
Other factors that can promote osteoarthritis in the hip are:
- Diabetes mellitus
- Inflammatory joint diseases such as gout
- Hereditary deformities of the hip joint (hip dysplasia)
If several of these factors come together, the risk of joint wear in the hip increases. However, it is not always possible to define an exact cause.
One thing is for sure: osteoarthritis is not a simple wear disorder, but a serious illness. So far, the slow degradation of the articular cartilage can not be stopped. But the accompanying symptoms such as pain and swelling is able to relieve the doctor.
Problems in joint metabolism
In the course of osteoarthritis, the assembly and disassembly processes in the articular cartilage get out of balance. The cartilage loses its function as a shock absorber and does not adequately cushion the affected joint. The surrounding bone is overloaded and tries to strengthen itself by irregular growth. In the process, the condyle is walled in by the excess bone production.
How is a hip joint arthrosis noticeable?
An arthrosis in the hip joint develops over years and makes only slowly noticeable. In the initial stages, the first steps after getting up are not as easy as usual and may hurt a bit. This is fast, but it happens more often.
As you progress, you may experience pain in certain movements, such as bending over, getting out of the car, or descending stairs.
Hip joint arthrosis: symptoms in advanced stages
In the advanced stage of osteoarthritis, the hip joint can then also in the resting state such as sitting or lying strong pain and mobility is increasingly limited.
In summary, the following signs indicate a hip joint arthrosis:
- Hip pain is a condition that occurs at the beginning of a movement, for example in the morning after getting up or sitting for a long time. After a while, the pain subsides
- Hip joint pain during prolonged exercise or when descending stairs
- Groin pain can also radiate over the thigh to the knee
- Altered gait pattern (limping): Due to the one-sided joint wear and to keep pain low, many affected people move away with difficulty
- Resting pain while sitting or lying down
- limited mobility: The thigh is barely stretched and pain only, bend, spread or twist
The right diagnosis leads to the right therapy
Anyone who fears suffering from joint arthrosis should have their doctor refer them to an orthopedic surgeon. He can use blood tests and X-rays to see if and what kind of joint disease is involved. Because even gout and rheumatism are not uncommon in our society.
At the beginning of the examination, the patient is interviewed by the doctor regarding his past history, lifestyle and possible similar cases in the family (anamnesis).
This is followed by a physical examination. Here, gait and posture are checked for possible malposition and joints are scanned for pressure sensitivity and swelling. Joint mobility is also examined to determine how far arthrosis has progressed.
However, the most important diagnostic finding is X-ray examination. For example, it can be seen on an X-ray image whether and how much the joint space is narrowed and whether outgrowths on the bone (osteophytes) have formed. Other signs of hip osteoarthritis include holes in the surface of the bone (rubble cysts) or a compacted bone beneath the articular surfaces (subchondral sclerosis).
As a rule, these examinations are sufficient as diagnostic measures. To exclude other diseases of the hip joint or to detect damage to the soft tissues such as ligaments and muscles, further imaging techniques such as ultrasound or magnetic resonance imaging (MRI) can be used.
Conservative therapy of hip joint arthrosis
Osteoarthritis is not curable. However, the progression of the disease can be slowed down and pain can be alleviated. Especially in the early stages of the affected person can actively help to keep the arthritis in check.
Conservative therapy focuses on pain relief and mechanical relief of the hip joint. In addition to treatment with medications such as painkillers or non-steroidal anti-inflammatory drugs (NSAIDs) can be reduced by targeted physiotherapy exercises joint blocks and maintain joint mobility or even significantly improved.
Surgical therapy of hip joint arthrosis
However, if the osteoarthritis is too advanced, often only one operation helps. There are two surgical procedures here.
- Osteotomy: This procedure corrects the position of the articular surfaces and is usually used in cases of misalignment. However, the chances of success decrease with age and advanced stage of osteoarthritis. Therefore, this operation is rarely performed today.
- Endoprosthesis: The implantation of an artificial hip joint is by far the more frequent therapeutic measure. In a total hip endoprosthesis (hip TEP), both the condyle and the acetabulum are replaced. In a partial denture, however, only the femoral head is replaced.
Artificial hip joints for young and old
So far, there is no material that is as resilient and powerful as the natural joint. But on average hip prostheses last over 15 years. Whether one should take a prosthesis made of ceramic, metal or plastic, depends on many factors and must therefore be decided individually.
The durability of a hip prosthesis depends largely on how well it is anchored in the femur. In the elderly, this is often not so stable, so the artificial hip joint is connected to the bone with a special cement.
In younger patients, the prosthesis can grow better in the thigh, which is why a cementless fixation is often used here. In addition, the artificial joint can be better replaced in such cases, if necessary.
The right material for every patient
Even artificial hip joints have to endure a lot. Especially in younger, active patients. While in older patients, diseases such as joint arthrosis are often the cause of a damaged hip joint, in younger people this important joint is primarily damaged by serious accidents during sports or on the road. Also a cancer can lead to the fact that an artificial hip joint must be used.
Proven implants are made of plastics and / or metals. They last on average 15 years before they relax and a new operation is needed. Especially suitable for young patients but the material seems to be ceramic. In a five-year study, American researchers from Chicago observed the artificial joints of over 1, 000 hip-joint patients.
Their measurements showed that the ceramic hips are up to 400 times stronger than plastic-metal-based implants. With plastic acetabular cups, even the smallest amounts of material rub off, which leads to inflammation around the implant and thus loosening. Ceramic, on the other hand, is resistant to abrasion.
Movement after surgery is the best way to long-term mobility
If the diseased joint needs to be replaced, the patient can begin mobilization exercises just days after surgery. Afterwards, the patient in the rehab learns to deal with the new mobility. Important here is the targeted muscle growth around the new joint so that it is sufficiently supported.
Whether the implant is seated correctly is determined by the orthopedist during regular examinations. X-ray images show the slightest change around the articular joint and often, with early intervention, the life of the artificial hip can be extended considerably.