1) Acetabular fractures

(Serious fractures)

hip-cond-pThe acetabulum comprises the socket of the hip joint. It joins with the upper end of the thigh bone to form the hip joint. When a fracture occurs, it has to be often treated operatively to get a perfect alignment. Improperly treated acetabular fractures can lead to secondary osteoarthritis of hips

Causes
Motor vehicle accidents

Symptoms & signs
Pain, inability to walk

Primary treatment: surgical management
This is undertaken after proper assessment. Usually open reduction is performed to restore the anatomy . Plates and screws are used to fix the fracture.

Complications
Malunited fractures can lead to secondary osteo arthritis. This may require a total hip replacement or Hip resurfacing

2) Ankylosing spondylitis

(A disabling condition)
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Ankylosing spondtliyis is a disabling condition affecting young patients. It begins with pain and stiffness in the lower back and can spread to involve other joints. The hips are severely affected by middle age. Crippling secondary osteoarthritis is the end result and needs a hip replacement.

Causes
It is a sero negative arthritis. Patients have HLA B27 allogene.

Treatment of hip arthritis
When hips are invloved, movement becomes difficult. The patient is bedridden. Total hip replacement, short stem hip replacement (Proxima hip) or hip resurfacing are the options. Patients can lead a normal life afterwards.

X-rays of both hips in a patient affected by ankylosing spondylitis. There is complete fusion. This patient underwent total hip replacements.

3) Fracture neck of femur
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Fracture neck of femur occurs in elderly patients. Osteoporosis is the main cause leading to fracture. Often these fractures in the elderly result from falls at home. Rarely younger patients can also sustain this fracture after severe degree of trauma. Primary treatment is internal fixation of femoral neck fracture. Internal fixation carries a risk of non-union and avascular necrosis. Both can result from inadequate fixation. Osteotomies, bone grafting can solve the problem. However total hip replacement is often necessary to salvage this condition. In the example given below, a non union following femoral neck fracture is seen. This was treated by Total hip replacement.

 

 

4) Avascular necrosis

hip-cond-p3Avascular necrosis (also osteonecrosis, bone infarction, aseptic necrosis, ischemic bone necrosis, and AVN) is a disease where there is cellular death (necrosis) of bone components due to interruption of the blood supply. Without blood, the bone tissue dies and the bone collapses. If avascular necrosis involves the ends of bones in a joint, it often leads to destruction of the joint articular surfaces. While AVN can affect any bone, it most commonly affects the upper end of the thigh bone ( femur). Hip joint destruction is the final result of untreated AVN of the head of the femur.

Causes
Very often there are no known causes. Known causes include the following:

  • Alcoholism
  • Steroid therapy
  • Rheumatoid arthritis & SLE
  • Post trauma
  • Sickle cell disease
  • Caisson’s disease
  • Hypertension, thrombosis, embolism