Hip joint arthrosis or coxarthrosis is a degenerative disease of the hip joint. It is caused by an organic illness, an accident or age-related wear. Hip joint arthrosis causes stress-dependent severe hip pain. Complaints can be permanently resolved, for example with an artificial hip joint.
The hip joints are the most heavily loaded joints. After the knee joints, the hip joints are the second largest joints in the human body creating the connection between the thighs and pelvis. As with all joints, the surfaces of the hip joint bones are covered with hyaline cartilage, which ensures low-friction mobility of the hip joints. If the cartilage of the acetabulum and/or the femoral head is damaged by illness, accident or wear, then large-scale cartilage destruction occurs in the region of the greatest pressure load, which finally leads to the exposure of the bone surface at the joint. “Bone on bone” rubbing causes inflammation and stress accompanied by severe hip pain. Often crunching in the hip joint is felt or heard.
As a result compression of the bone structure (subchondral sclerosis) occurs in the affected bone due to the mechanical overstressing The femoral head loses its spherical shape and the bones below the cartilage develop holes in the further course. To absorb the mal-loading of the bone, the body deposits bone material around the edges of the acetabular cup. This leads to joint pain and a restriction of mobility.
A distinction is made between the primary and the secondary form with coxarthrosis. Primary hip arthrosis arises without apparent cause, i.e. without a previous illness. This form occurs due to age-related wear mostly after the age of 60. Secondary hip arthrosis arises as a result of another disease. It often occurs in younger patients and on one side.
The causes of hip osteoarthritis can be femoral head necrosis (circulatory disorder due to death of part of the femoral head), hip dysplasia (congenital malocclusion and ossification disorder), gout diseases (deposits of urinary crystals in the hip joints), rheumatoid arthritis, or accidents.
Patients with hip osteoarthritis typically complain of hip pain, which initially only occurs during prolonged exercise, and become more common as the disease progresses. Pain can be localised to the groin, front thigh, hip, or buttocks, radiating to the knee and even to the lower leg. “Start-up pain”, which is pain in the first steps after getting up from sitting or lying down, and later also resting and chronic pain are typical. Furthermore, painful restriction of movement of the hip joint is often noted, which is due to the osteoarthritis-related shrinkage of the hip joint capsule and bony attachments in the joint. In addition, crunching noises are typical when moving the hips.
In addition to the medical history (anamnesis) a physical examination is important at the start. During the examination, the doctor palpates the hip joints and assesses the sensitivity to pressure and pain. Subsequently, posture and gait are checked for possible abnormalities. With advanced hip osteoarthritis bone changes can already be noticed here. In most cases, an X-ray is done if the disease is suspected. The distance in the joint space is then assessed. An ultrasound examination is also often performed. Muscles, ligaments and joint fluids can be accurately represented.
Conservative therapy aims to alleviate hip pain and favourably influence the further course of the disease. This includes activity modification with regular exercise while avoiding shock and maximum stress, physiotherapy treatment to improve mobility, drug and anti-inflammatory treatment and biological treatment by injections in the joint, which protect the cartilage and favourably affect the articular environment (e.g. hyaluron, autologous blood, etc.). However, should there be an increase in symptoms, further hip treatment needs to be discussed.
If the conservative therapy brings no improvement over time, an artificial hip joint (hip TEP) has to be considered. The artificial hip joint is the most well-known implant in humans. More than 5 million citizens suffer from arthrosis of the hip, and more than 90 percent of over-65s are affected by hip osteoarthritis (coxarthrosis). The decades of experience of our clinicians, the modern surgical procedures and the first-class quality of the implants used ensure the best medical care and safety when inserting an artificial hip joint.
Choosing the “right” hip implant requires a specialist orthopaedic surgeon with years of experience and knowledge of the market. It is also dependent on the degree of osteoarthritis and the personal circumstances of the patient.
Cemented hip endoprostheses have proven to be the safest method for older patients and have been steadily developed for almost 50 years. According to global statistics, they are just as durable as cementless implants. They are mainly used in patients over 80 years. With this method, a total hip endoprosthesis is fixed by bone cement in the thigh and in the pelvis. The cemented hip endoprostheses have the advantage of offering the patient immediate unrestricted stability even with non-ideal bone conditions (e.g. osteoporosis, aged bone). The procedure is also associated with a lower tendency of bleeding.
Cementless hip endoprostheses are ideal for patients between the ages of 60 and 80 years. Mostly the Taperloc prosthesis stem is used, which is a titanium stem that has proven itself over twenty years. The socket is a titanium screw ring with a ceramic inlay. This technology has the lowest abrasion rates on the material and no bone damage from polyethylene. Studies prove intact ceramic heads and cups even after 20 years. After 10 years, almost 97 percent of these prostheses are still functioning, and after 15 years about 95 percent.
Using hip arthroscopy (keyhole surgery), a surgeon can diagnose and treat the disease with a camera and fibre optic system. During the procedure, the surgeon can remove free joint bodies and smooth out joint lips.
Rehabilitation – Time and methods
Rehabilitation begins right after the operation, because early mobilisation helps the habituation and strengthening of the surrounding muscles. Follow-on treatment is of course still dependent on the condition of the surrounding tissue and the constitution of the patient. Walking training, stair climbing etc. are incorporated as soon as possible in the rehabilitation program. The aim of the physiotherapeutic treatment is also to correct the improper stress levels arising due to the restriction in movement over the past months and years. Many patients return to their car after 6 weeks and return to work after 12 weeks.