The Hip: Preservation, Replacement and Revision

Osteoarthritis

- Discussion:
   - OA is defined as a chronic irreversible degenerative disease of articular cartilage
   - predisposing conditions 
   - pathology and histology
   - clinical features
   - laboratory aspects 

- Osteoarthritis of the Knee


 - Hip Osteoarthritis:
    - clinical features:
          - pain on wt-bearing felt in the groin, buttock, or medial thigh;
          - trendelenburg gait will decrease mechanical stress on joint and thereby lessen pain (see forces acting on hip joint); 
          - pain during sleep results from loss of protective function of muscular splinting; 
          - in some cases, a patient w/ OA of the hip will experience acute hip pain which often correlates w/
                   rupture of subcondral cyst into the joint;
          - ref: A Heritable Predisposition to Osteoarthritis of the Hip
    - treatment options:
          - arthrodesis
          - total hip replacement
          - valgus extension osteotomy:
                 - may be indicated in younger patients with DJD w/ flattened or mushroom shaped head, an osteophyte on the medial side
                          of femoral head, and an osteophyte partially covering the true acetabular floor;
                 - technique is less useful for patients with primary hip disease or reduced range of motion;
                 - technique considerations:
                          - abductor lever arm is maintained by elevation of greater trochanter through the insertion of a portion of wedge taken
                                  from osteotomy, as a graft under the greater trochanter;
                          - osteotomy shifts the center of the stress medially which improves joint mechanics;
                          - extension of the femoral head, recenters the head, and prevents anterior subluxation; 
                          - anterior capsule is opened using the lateral approach;
                          - guide wires are inserted to help determine the proper bone cuts;
                          - proximal osteotomy is made 2 cm distal to the entry side for the blade plate;
                 - ref: Proximal femoral osteotomy as the primary operation for young adults who have osteoarthrosis of the hip.  

- Ankle:
    - ref: The Comparative Morphology of Idiopathic Ankle Osteoarthritis

- Shoulder:
    - arthrodesis
    - shoulder arthroplasty

- Fingers and Hand: (see CMC arthritis)
    - occurs most often in fifth or sixth decade of life;
    - gradual onset of pain in the distal interphalangeal (DIP) joints;
    - aggravating nocturnal fingertip pain and paresthesias may develop;
    - Heberden's nodes: 
          - cystic swellings containing gelatinous hyaluronic acid appear on the dorsolateral aspects of DIP joints (see mucous cyst);
    - metacarpophalangeal (MCP) joints are typically spared







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An Aggrecanase and Osteoarthritis.

Osteoarthritis Slide Show

Neurovascular invasion at the osteochondral junction and in osteophytes in osteoarthritis

Migratory Chondrogenic Progenitor Cells from Repair Tissue during the Later Stages of Human Osteoarthritis

Stem cell therapy for cartilage regeneration in osteoarthritis

Moose Offer Trail of Clues on Arthritis




Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Monday, November 9, 2015 7:45 am