This joint, which joins the thigh to the pelvic bone, is essential for walking and the good stability of the pelvis. What are the main pathologies that affect the hip? What tests can be used to diagnose them? How do treat them? The answers of Dr. Henri Lellouche, rheumatologist.
Between the femoral head and the acetabulum, there are:
- - On the one hand, fibrocartilage called acetabular bulge,
- - On the other hand, a fibrous sleeve called the joint capsule.
"There is a frequent confusion with the so-called "seamstress hip", which is much higher than the so-called surgeon's hip", says the rheumatologist. The tailor's hip is actually the crest of the iliac bone.
The roles of the hip
The hip is the central joint of the body, which allows the good stability of the pelvis on the lower limbs. This joint can move on 3 different planes, allowing a very large amplitude and variety of movements of the lower limbs:
- - The extension/flexion: which allows to bring the leg towards the chest or, on the contrary towards the back,
- - The adduction/abduction: which allows spreading or to tighten the legs,
- - External or internal rotation: which allows the rotation of the hip towards the median or lateral line of the body.
Hip pathologies
There are a large number of hip pathologies, grouped under the name of coxopathies, when the precise diagnosis has not yet been made.
- Cartilage pathologies
The main pathologies of the hip are cartilage wear pathologies, namely osteoarthritis of the hip also called coxarthrosis. It results in pain in the groin, which can radiate to the knee. It is a chronic disease that can seriously affect the daily life of the person suffering from it.
- Tendon pathologies
Hip tendonitis is an inflammation of one of the tendons that attach to the femur, namely the gluteus minimus, the gluteus medius, or the lateral blade of the gluteus medius. It is often caused by excessive walking or frequent climbing of stairs, and very often affects people living in multi-story houses. Hip tendonitis is manifested by pain of varying intensity on the lateral aspect of the upper thigh. The pain wakes up when walking and can be difficult to bear when climbing stairs.
- Pathologies of the acetabular rim
These are all meniscal lesions or tears of the hip meniscus, which can be observed after a sports trauma in young patients.
- Synovial pathology
The most frequent is synovial osteochondromatosis. This part of the joint starts to produce small cartilaginous formations, which are found in the joint and can cause blockages, pain, and stiffness of the hip.
- Pathologies of the bone
The most common is osteonecrosis of the hip, which is the death of bone cells in the joint caused by a lack of blood. Also called infarction, this disease can be caused by trauma (fracture or dislocation of the hip), prolonged use of corticosteroids or alcoholism.
- Inflammatory pathologies
Arthritis corresponds to the inflammation of the hip, which can be caused by a viral, bacterial, or fungal infection, a metabolic disorder, or by rheumatism.
- Congenital malformations
Hip dysplasia is a deformity of the hip joint, resulting from a problem in the development of the hip of the fetus during its growth. Hip dysplasia favors the development of coxarthrosis, which often progresses rapidly.
The symptoms
"Hip pathologies usually result in lameness, often accompanied by pain in the groin, thigh, buttock, and even the knee," describes Dr. Lellouche.
Sometimes the patient also doesn't feel pain but has discomfort or limited movement. "They may have difficulty climbing stairs, getting up from a chair, or having sex," adds the rheumatologist.
Diagnostic tests
- Clinical examination
When a patient consults for hip pain, the first examination is clinical of the entire lower extremity.
"It is essential not to limit the clinical examination to the hip because it often happens that hip pathologies cause pain in the knee: this is called projected pain," describes Dr. Lellouche.
The specialist begins by having the patient walk around to make sure that his or her two feet are in line with each other. Then, he invites the patient to lie down in order to mobilize his hip and check the movements in the 3 axes: flexion/extension, adduction/abduction, and internal or external rotation. "We are looking for any snap, pop, or lack of stability in the movement," says the specialist. Any pain or resistance will help guide the diagnosis.
The doctor also checks for the presence of any muscle atrophy that may be the result of osteoarthritis of the hip.
He also looks for signs of sciatica or curalgia, which can cause the same symptoms as hip pathologies.
- Standard X-ray
It is performed in case of suspicion of osteoarthritis. "It allows checking the architecture of the hip and the balance of the pelvis. It is also useful to check the possible presence of calcification deposits around the joint" explains the rheumatologist.
- MRI
It can be proposed in the second intention, to check the quality of the cartilage and the bone.
- CT scan
It can be proposed according to the clinical examination, or as a third option after X-ray and MRI.
"It is particularly interesting when it is associated with an injection of contrast medium, then it is called arthroscanner. It allows seeing all the pathologies inside the joint, such as synovial pathologies, those of the cartilage or of the padding", details Dr. Lellouche.
Treatments
Treatments for coxopathy vary according to the precise diagnosis of the pathology.
- Coxarthrosis
Symptomatic treatment is based on painkillers, and to a lesser extent on anti-inflammatory drugs - which are best avoided as far as possible.
Infiltrations can also be proposed in certain cases, as well as hyaluronic acid or platelet injections.
"But the ultimate treatment for hip osteoarthritis is hip replacement, which has revolutionized the management of osteoarthritis," insists the rheumatologist. More than 160,000 hip replacements are performed each year in France. "They have made it possible to change the way people suffering from osteoarthritis of the hip are viewed: they no longer need a cane to walk, they can resume a normal life and even play sports again," explains Dr. Lellouche.
Hip prostheses can be made in 3D to measure, and the success rate of the operation is close to 98%.
- Tendonitis
"The treatment of hip tendonitis is difficult because it is a tendonitis that tends to be rebellious" explains the rheumatologist. Physiotherapy sessions, physiotherapy - by the shock wave and ultrasound - as well as muscle maintenance are proposed to the patient.
Infiltrations can be performed under ultrasound, known as echo-guided.
"We also recommend drinking a lot of water because dehydration weakens the tendons," says the expert.
- The joint bulge and the synovium
Today, it is no longer necessary to operate openly to treat the pathologies of the joint bulge and the synovium. A minimally invasive surgical technique - called hip arthroscopy - can be used to treat a wide range of balloon and synovial pathologies. "It involves a small camera placed in the hip, which can also be used for diagnostic purposes," says the rheumatologist.
- Osteonecrosis
Osteonecrosis is usually treated surgically.
Several experimental treatments are also underway. Hip replacement is indicated for the most advanced cases.
- Fracture of the neck of the femur
A fracture of the neck of the femur is a very common fracture and is directly related to osteoporosis. It affects nearly 50,000 people each year, with a death rate of 16% within 5 months of the fracture.
"Today, it is the prevention of osteoporosis that is most important, to reduce the risk of fracture" insists Dr. Lellouche. The prosthesis is only rarely offered to elderly people because it is far too expensive, and surgical treatment is done with nails and plates, with a much more difficult recovery.
Sources :
Ameli - Arthrose de la hanche, symptôme et diagnostic
Ameli - Arthrose de la hanche : définition et facteurs favorisants
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