The hip joint is a large spherical joint that connects the head of the femur with the acetabulum, made of the three bones of the pelvis. Hip pain can occur at any age and in the course of many diseases. How does the hip joint work, what causes hip pain and how is it treated?

The hip jointallows a person to keep the body in an upright position, as well as a wide range of motion of the lower limb and move freely on two legs.

Pain in the area of ​​the hip joint may occur in people of all ages, however, the most common patients with this problem are patients over 60 years of age, whose hip pain makes it impossible to move freely, perform everyday activities and significantly reduce the quality of life .

Early diagnosis of the cause of the ailments enables quick treatment implementation and a chance to regain full physical fitness.

Hip joint: structure

The hip joint connects the head of the femur to the acetabulum of the hip joint, consisting of three pelvic bones: hip, ischial and pubic. Both articular surfaces are covered with hyaline cartilage, which is very durable, elastic and resistant to abrasion.

The labrum, which deepens the acetabulum, is also an element of the hip joint. Within the joint, there are the ilio-femoral ligament, the pubo-femoral ligament, the ischio-femoral ligament and the ligament of the femoral head, the main task of which is to strengthen the joint capsule, protect the joint against excessive movements and dislocation, and stabilize the neck of the femoral head.

From the outside, the joint is covered with a thick joint capsule, which is lined from the inside with the synovium. It produces synovial fluid to moisturize the articular surfaces and allow free, smooth movement.

The work of the joint is supported by many muscles, including the rectus muscle of the thigh, the gluteal muscles, great and medium muscles, the great adductor muscle and the iliopsoas muscle.

Hip joint: range of motion

Movement within the hip joint can be performed in 6 planes. These are flexion, extension, abduction, adduction, external rotation and internal rotation. Physiologically, the range of motion is expressed in degrees.

Movement within the hip jointRange of motion expressed in degrees
Bending110-120
Wyprost10-15
Abduction30-50
Leadership25-30
External rotation40-60
Internal rotation30-40

Hip joint: research

Diseases of the osteoarticular system are de alt with by an orthopedic specialist, who is referred to by a general practitioner. The hip joint examination consists of three key elements: viewing, palpation, and examination of the range of joint mobility.

However, one should not forget about the importance of talking to the patient and tracing the history of his illness, as well as the precise nature and location of the pain symptoms experienced by the patient before starting the physical examination.

  • watching

The first parameter to be assessed, very important for a correct diagnosis, is the observation of the way the patient moves. Hip joint diseases are most often characterized by swaying gait.

In addition, when examining the hip joint area, pay special attention to the presence of postoperative scars, muscle atrophy, as well as skin changes, bruises and swelling.

It is also important to determine the length of the lower limbs and assess their symmetry. The doctor will ask the patient to bend the limbs in the hip and knee joints, and then compare and evaluate the position of the knees in relation to each other

  • palpation

Palpation of the hip joint is an important element of the medical examination, however, it is not accurate due to the deep location of the joint.

  • examination of the range of motion of the joint

To test the range of motion in the hip joint, active, passive and resistance tests are used.

The physician should carefully note in the medical records, where painful symptoms appear during the examination, and which remain painless, as well as information about the general range of motion in the joint, tension of specific muscles, final sensation and the results of palpation of the joint during the examination. his movements.

Assessment includes flexion, extension, abduction, adduction, as well as external and internal rotation within the joint. Each parameter is compared with the physiological range of motion expressed in degrees.

  • Trendelenburg test

The Trendelenburg test is the basic diagnostic test performed on each reporting patientPain in the hip joint, especially during lower limb abduction.

The examination is painless, it consists in the doctor assessing the patient's pelvic inclination when making appropriate movements.

The patient stands on both lower limbs and is then asked to lift first one and then the other lower limb bent at the knee joint.

The dysfunction of the hip abductors muscles is evidenced by the lowering of the pelvis on the side of the raised lower limb.

Hip joint: causes of pain

Pain in the area of ​​the hip joint is one of the most common reasons why patients visit the orthopedic clinic.

Pain most often occurs in the course of osteoarthritis, arthritis, hip fractures, pelvic fractures, and also as a result of an injury or excessive overstrain of the joint.

It is worth noting that hip joints complaints much more often not only in overweight and obese patients, but also in excessive physical activity and inadequate exercise.

High weight and active sports lead to excessive strain on the joints and recurrent pain, especially in young patients.

Pain in the hip joint is usually localized by patients in the groin projection and on the inside and outside of the hip. However, it often radiates to the buttock, and even to the knee.

It is worth remembering that pain in the hip joint area does not necessarily mean a problem with the hip. It happens that it occurs in the course of degenerative changes of the femur, muscle and ligament strain, femoral hernia, cystitis, compression of peripheral nerves, sciatica, and even lesions of the sacral spine.

Hip joint: diagnosis of hip joint diseases

In order to diagnose hip joint disease, it is necessary to perform both physical examination by an experienced orthopedist and imaging examinations. To visualize the hip joint well, a pelvic X-ray is usually performed in at least two projections (anterior posterior AP and lateral).

Your doctor may decide to undergo a magnetic resonance imaging (MRI) pelvic exam when radiographs are not sufficient to make a definite diagnosis.

This is a very sensitive test in which all tissues are clearly visible. MRI of the pelvis is performed especially when muscle and tendon damage is suspectedathletes, subtle fractures found on physical examination, and not visible on X-rays of bones and joints, as well as when sterile femoral head necrosis is suspected.

The imaging tests used for the diagnosis of hip joint diseases also include computed tomography, which allows for accurate imaging of bone structures and ultrasound, which allows to visualize cartilage tissue and assess the structure of the acetabulum and its stability.

Hip joint: treatment of diseases

In the treatment of hip pain, non-steroidal anti-inflammatory and analgesic drugs in the form of oral tablets or topical ointments and creams are most often used.

The doctor should also advise you to rest and relieve the painful joint.

It is advisable to abandon strenuous physical exercise for some time in favor of rehabilitation and exercises with a physiotherapist.

Among the most commonly used rehabilitation treatments that bring patients clear pain relief are:

  • cryotherapy
  • ultrasounds
  • electrotherapy
  • laser therapy
  • magnetic field

However, it happens that conservative treatment does not bring satisfactory results to neither the doctor nor the patient, and it is recommended to perform hip arthroplasty. It is a surgical treatment that involves replacing the affected joint with an individually selected prosthesis.

Like any other surgery, it carries the risk of life-threatening complications. On the other hand, it gives patients the chance to regain full physical fitness and restore quality of life without pain.

Hip joint: the most common diseases

There are several divisions of diseases of the hip joint, however, most often they are divided according to the age group of patients in which they occur.

Congenital hip dislocation dominates among newborns, children aged 4-12 years are most often diagnosed with arthritis and sterile bone necrosis, i.e. Perthes disease, while in adolescents, muscle damage, bursitis and juvenile exfoliation are most often diagnosed femur.

The most commonly diagnosed adult patients are osteoarthritis, osteoarthritis, rheumatoid arthritis, crackling hip and bursitis.

Diseases of the hip joint in adults

Degenerative disease of the hip joints

Osteoarthritis of the hip joints, otherwise known as coxarthrosis, isa chronic disease that most often takes years to develop. It mainly occurs in elderly people over 65.

A characteristic feature of this unit is premature, gradual and irreversible wear of the articular cartilage covering the head and the acetabulum. The changed cartilage tissue ceases to adequately protect the articular surfaces and cushion them.

Moreover, the disease causes the formation of bone spurs and subchondral cysts within the hip joint, which increase bone friction and significantly limit its mobility.

As the disease progresses, the joint space gradually narrows until it is eliminated. The consequence of untreated osteoarthritis may be total loss of mobility in the joint, secondary atrophy of the surrounding muscles and permanent disability.

  • Symptoms of hip degeneration

The first symptom for patients to see their GP is a sharp, stabbing pain felt anywhere in the thigh, in the hip projection, in the groin and in the buttock area. In addition, pain may radiate to the knee.

Sometimes knee pain is the first symptom of osteoarthritis in the hip joints.

The most characteristic feature of this pain is the so-called starting pain. The greatest intensity of symptoms occurs during the first movements after a period of immobility, and they gradually decrease with subsequent movements.

As the disease progresses, pain arises not only during physical activity, but also during rest and sleep. Patients complain of limited mobility in the joint and serious difficulties in moving.

  • Risk factors and predispositions

Osteoarthritis of the hip joints develops not only in the elderly, but also in patients with congenital defects of the hip joints (dysplasia) or after fractures.

Arthritis can also be a consequence of overweight, obesity and metabolic diseases. An important role in the development of the disease is played by genetic predisposition and the occurrence of osteoarthritis among members of the closest family.

  • Recognition

The diagnosis of osteoarthritis of the hip joints is made by an orthopedic surgeon on the basis of the patient's physical examination and radiological imaging examinations. A characteristic feature is limited mobility of the joint and the occurrence of pain during internal rotation of the thigh and abduction or flexion of the affected joint.

The diagnosis is confirmed on the basis of a radiological examination of the pelvis and jointiliac, in which the narrowing of the joint space and the presence of cysts, osteophytes or sclerosis of the subchondral bone layer are described.

  • Treatment

Treatment of osteoarthritis is based on relieving the joint and using non-steroidal anti-inflammatory and analgesic drugs. It must be remembered that they reduce pain, but do not affect the process of cartilage destruction.

The goal of therapy is both to relieve symptoms and reduce the risk of disease progression. It is worth using the help of physiotherapists and physical rehabilitation, as well as not forgetting about the positive effect of weight loss on the articular surfaces and the cartilage covering them.

If conservative treatment does not bring the expected results, it may be necessary to undergo surgery and implantation of a hip replacement.

  • Prevention

Osteoarthritis of the hip usually occurs in the elderly, as a result of the physiological loss of flexibility and strength of the cartilage covering the articular surfaces.

The tendency to wear out articular cartilage faster is genetically determined, however, it has been proven that some factors, such as overweight and obesity, overload both the hip and knee joints, which significantly accelerates the process of destroying the articular cartilage and causes that the first symptoms of the disease occur in much younger people.

Introducing a he althy lifestyle, a properly balanced diet and proper physical exercises that relieve the joints (swimming and cycling are especially recommended) can significantly reduce the risk of osteoarthritis in these patients in the future.

DISCLOSURE OF THE HIP JOINT

Dislocation of the hip joint in adults is most often caused by communication and sports injuries. There are posterior, anterior and central dislocations:

  • rear dislocations, which result from the application of a traumatic force in the front, e.g. during a knee impact against a car dashboard (the most common dislocations).
  • front dislocations, which occur, among others, as a result of a fall from a height or a traumatic force from the rear, e.g. as a result of a pedestrian hitting the rear by a car.
  • central dislocations, which result from the direct action of a traumatic force on the greater trochanter of the femur (lateral impact)
  • Diagnostics

The diagnosis of hip dislocation is made by an orthopedic surgeon on the basis of a physical examination and a radiological image of the hip jointand pelvis in at least two AP and oblique projections.

  • Treatment

Treatment of a dislocated hip joint can be both conservative and surgical. Nonsurgical treatment consists in setting the dislocation under deep anesthesia and making the patient relaxed.

It is important to remember to check the dorsal, posterior tibial and popliteal pulses both before and after setting the dislocation to avoid damaging the blood vessels.

In a situation where conservative treatment does not bring satisfactory results or it is impossible to carry it out (e.g. as a result of damage to the acetabulum), the orthopedic surgeon should decide to perform the surgery.

  • Complications

The most common complications of hip dislocation include osteoarthritis, periarticular calcification and ossification, joint instability, and aseptic necrosis of the femoral head.

SNAP HIP

Trochanteric syndrome, also known as a snapping hip, is characterized by a shooting or crackling sensation in the hip joint. It results from the movement of the tense tendons of the hip muscles over the trochanter of the femur.

Symptoms most often occur when walking and performing exercises consisting in rotating the straightened lower limb in the supine position (the patient is lying on his he althy side).

Usually, the feeling of crackling is not accompanied by pain. Imaging examinations of patients with a slamming hip show no lesions.

They are ordered by doctors in order to exclude other bone pathologies or diseases of the hip joint. Snapping hip treatment is based on the use of properly selected exercises with a physiotherapist that will help stretch the tense muscles and increase the elasticity of soft tissues.

Diseases of the hip joint in children

DEVELOPMENTAL DISPLAYSIS OF THE HIP JOINT

Developmental hip dysplasia found in children includes dislocation of the hip joint at birth, subluxations and permanent, rigid dislocations of the hip joint, which are a consequence of congenital malformations of the osteoarticular system (e.g. arthropryposis), and hip dysplasia developing in early childhood.

The disease consists in the unfavorable shape of the acetabulum, which does not provide adequate support to the proximal femoral epiphyses. This leads to a gradual protrusion of the femoral head from the acetabulumhip and subluxation or dislocation.

  • Occurrence

They are much more common in girls than in boys (in a 4: 1 ratio), and also in children born during pelvic (more specifically gluteal) labor.

Developmental dysplasia of the hip occurs in some children along with other birth defects, such as torticollis, clubfoot and squamous foot.

It is considered that hip dysplasia is one of the most common defects among the population, it occurs on average in 1-2 children per 1000 live births.

  • Reasons

The cause of developmental hip dysplasia has not yet been known. It is assumed that the developmental disturbance of the hip joint may be a congenital defect, as well as a defect that arose during fetal life.

The abnormal development of the hip joint in newborn babies may be influenced, among others, by the generalized laxity of the newborn, resulting from the action of the mother's hormones on the child's body.

Estrogens and relaxin cause relaxation of ligaments and joint capsule and muscle weakness, which results in increased susceptibility of the hip joint to dislocation. It is believed that the abnormalities in the development of the hip joint are also caused by the tightness of the fetus in the uterine cavity caused by a small amount of amniotic fluid.

It causes improper positioning of the lower limbs in the uterine cavity and disrupts their proper development. In addition, instability in the hip joint may also appear during labor (especially after buttock births) and after delivery (as a result of improper care and care of the newborn).

  • Diagnostics and diagnosis

Joint development disorders in the form of a too shallow acetabulum are most often found right after the baby is born, because every newborn baby should undergo routine screening tests in the form of the Barlow test and the Ortolani test before discharge from the hospital.

These tests allow for the early detection of disorders in the development of the hip joint, the use of appropriate therapy, and also reduce the risk of serious complications in the form of movement disorders and disability.

The BARLE TEST, otherwise known as a balance or dislocation test, assesses the instability of the hip joint. The doctor examines whether there is a displacement of the femoral head beyond the acetabulum of the newborn. A positive Barlow symptom indicates instability of the dysplastic hip joint and is an indication for the extension of diagnostics to hip ultrasound.

ORTOLAN'S MANEUVER, otherwise known asan attempt to adjust or a symptom of skipping, consists in an attempt to introduce a dislocated head of the femur into the acetabulum of the hip joint. The doctor examines whether the previously displaced femoral neck, which has emerged from the hip socket, jumps back into it during the abduction movement. The examination consists in gentle abduction and adduction of the newborn's thigh with the hip joints bent at right angles.

Ultrasound of the HIP JOINTS should be performed after the first month of a child's life (preferably between 6 and 8 weeks of age). It enables an accurate assessment of the tissues that make up the joint and their boundaries, as well as the angular analysis of the bone formation of the acetabular top and the cartilage covering of the femoral head.

Ultrasound examination is safe, harmless to the child and can be repeated many times. Moreover, it is a good tool for monitoring the treatment progress of dysplastic hip joints. However, it is important that they are performed on the right, modern equipment and that the results are interpreted by an experienced doctor.

  • Symptoms

In older children, a unilateral hip dislocation is manifested by shortening of the lower limb on the side of the dislocation, asymmetry of skin folds around the hip joints, limited limb abduction movement, and movement disorders, limping and abnormal gait.

The shortening of the limb is clearly visible in the patient lying on his back with the limbs flexed at the knee joints - the knee on the side of the dislocation is positioned lower.

Moreover, in order to eliminate the shortening of a limb, the child walks on the toes of the sick leg. Bilateral hip dislocation is less common and much more difficult to recognize as both lower limbs are symmetrically shortened.

  • Prevention

Prevention of hip dysplasia consists in keeping the lower limbs of a newborn bent and abducted. Do not dress the baby in restrictive movements of clothes or cover it with heavy quilts.

  • Treatment

Treatment for developmental hip dysplasia, especially hip dislocation, should be started as soon as possible after diagnosis. Early diagnosed and treated developmental dysplasia of the hip most often responds to conservative treatment, and delaying the introduction of appropriate therapy may lead to the inability to remove the dislocated hip, movement disorders, severe pain and permanent disability.

In the first days and months of life, treatment consists of keeping the lower limbs flexed and abducting the hips. To holdthe correct position is used by special pillows (Frejka's pillow), cameras and harnesses.

Treatment of a hip dislocation is based on bringing the femoral head back into the acetabulum and preventing it from being dislocated again until the hip is stabilized.

In some cases, it is required to wear the Pavlik harness, a specialized positioning rail that stabilizes and holds both of the child's thighs in the bent and abduction position. It is put on for a period of 2-3 months, during which time it enables the proper development of the acetabulum and prevents it from being dislocated again.

If conservative treatment is not successful, surgery may be required.

  • Complications

The complications of hip dysplasia include aseptic necrosis of the femoral head and the development of degenerative changes within the joint.

LEGG-CALVEGO-PERTHES DISEASE

Perthes disease is a rare childhood disease with a typical feature of spontaneous aseptic necrosis of the femoral head. It is four times more common in boys than girls, especially between the ages of 4 and 8.

Necrosis of the femoral head occurs unilaterally in most cases. The causes of Perthes disease have not been known so far, it is assumed that its development is influenced by abnormal work of blood vessels supplying the femoral head and hip joint, or by endocrine diseases.

  • Symptoms

Common symptoms of Perthes disease include progressive gait disturbance and reduced mobility in the hip joint. The disease develops secretly, children usually do not report pain from the affected hip joint, but with time they begin to limp while walking.

  • Diagnostics

The main diagnostic tool in the case of necrosis of the femoral head is the X-ray of the pelvis in two projections (AP and lateral).

Pathological changes in the early stages of the disease are visible only in the epiphysis, later flattening of the femoral head is visible.

In doubtful cases, a specialist physician may decide to perform a pelvic magnetic resonance imaging (MRI) to confirm the diagnosis.

  • Differentiation

The differential diagnosis of Legg-Calve-Perthes disease includes juvenile arthritis and other hip joint inflammations.

  • Treatment

Treatment of Perthes' disease is difficult and lengthy. It resists the absorption of necrotic changes andreplacing them with he althy bone tissue and maintaining the physiological shape of the femoral head.

To avoid bone deformation during healing, your doctor may decide to put on a plaster or use a specialized extract to immobilize the affected hip.

JUNIOR EXTRUSION OF THE FEMAL HEAD

Juvenile exfoliation of the epiphysis of the femoral head is a disease that occurs mainly in children during the period of intensive adolescent growth, that is around the time of puberty around 12-13. age. It involves the displacement of the epiphyseal cartilages between the head and the neck of the femur, while the bone head remains in the acetabulum.

Exfoliation of the femoral head may be acute (lasting less than 1 month) or chronic (up to 6 months).

The causes of juvenile desquamation of the femoral head are not yet known, and most cases are idiopathic.

  • Occurrence

Children most exposed to this disease are not only obese children, but also those actively practicing sports. The male gender is also among the predisposing factors. It is worth mentioning that the desquamation of the femoral head is often accompanied by endocrine disorders such as hypothyroidism and growth hormone (GH) deficiency.

  • Symptoms

The main symptoms patients report during their doctor's appointment include dull, dull pain in the upper thigh and groin, which appears and worsens with physical activity, and over time radiates to the knee or front of the thigh. In addition, there is often a restriction of the range of motion in the hip joint and limb weakness.

  • Recognition

Diagnosis of flaking of the femoral head can be made by an experienced orthopedic surgeon on the basis of a thorough clinical examination. A characteristic feature of this condition is loss of internal rotation in the flexed hip joint.

During the examination, discrete shortening of the affected limb is often diagnosed as well as limitation of abduction and straightening of the affected hip. Confirmation of the initial diagnosis is possible after taking an X-ray of the pelvis in two projections (AP and lateral).

In the initial stage of the disease, the widening of the femoral epiphysis is described, while with the passage of time, the radiologist describes visible shedding of the femoral head.

  • Differentiation

Exfoliation of the femoral headshould be differentiated from muscle overload, as well as avulsion fractures (they arise as a result of pulling a bone fragment by the attached tendon and its detachment), Legg-Calve-Perthes disease and neoplastic diseases.

  • Treatment

Treatment of exfoliation of the femoral head consists in preventing further displacement of the femoral head and accelerating the closure of the epiphyseal cartilage. The goal is to relieve pain and restore full range of motion in the affected hip joint.

In some cases, it is required to put on a hip plaster and use an orthopedic lift, and even the use of surgery and stabilization of the femoral head with a special screw.

LOCAL PROXIMAL FAULTY DEVELOPMENT OF THE FEMAL BONE

Local underdevelopment of the proximal femur is a congenital disorder.

It occurs very rarely and is usually accompanied by other congenital defects of the lower limbs, such as hip dysplasia or lack of fibula.

The disease is an abnormal development of the femur during human fetal life, which results in its significant shortening.

Category:

Anatomy