Hip arthritis in India affects young and medium people in contrast to the west, where primary osteoarthritis of the hip joint is prevalent, affecting older people. Surgery in this group of relatively young patients requires new methods and implants. This article sheds light on the disease and existing treatments.
Types of hip joint
Hip arthritis is classified as primary and secondary osteoarthritis. Primary osteoarthritis is age-related arthritis. This is a rare occurrence in India. Secondary osteoarthritis occurs at a young age and is more common. Rheumatoid arthritis, avascular necrosis, traumatic arthritis and other disorders of the connective tissue, such as SLE, psoriasis, etc., Lead to secondary osteoarthritis.
Rheumatoid arthritis is an autoimmune disorder that affects all joints, especially small joints, but also does not spare the thigh and knee.
Vascular necrosis is a condition that reduces the blood supply to the end of the bone. This affects patients with excessive alcohol intake by consuming steroids, connective tissue disorders, such as SLE. Systemic lupus erythematosus (SLE) is a disease of the connective tissue that affects predominantly young women. An important feature is a photosensitive rash on the cheeks, renal involvement and arthritis. Vascular necrosis affects the proportion of patients with SLE.
Gaucher disease is a genetic disorder. Post traumatic arthritis occurs after a severe hip injury. Fractures of the ball (upper thigh) or nest (acetabulum) can lead to inadequate treatment of arthritis.
Hip arthritis is very incapable, as it is a small articulated joint, unlike the knee joint, which is large. With a common disease until recently, orthopedic surgeons recommended a complete replacement of the hip joint. Advances in orthopedic surgery now meet the specific requirements of these young patients.
Surgical Solutions
They are the basis of treatment, since conservative measures are not associated with pain. Total hip replacement (THR) is a time-tested operation and a success rate of 93% of those who survive 10 years.
It may be necessary to replace the hip joint with an artificial joint, when it is irreversibly damaged and cannot be saved by alternating surgery. The patient complains of pain and restricted movement. Pain can often be attributed to the knee or sensation in the knee and without symptoms of the hip joint. Apparently, the pain may be felt more in the area of the buttocks, and not before the groin.
Who needs a hip replacement?
In India, many young patients with ankylosing spondyloarthritis, avascular necrosis, post-septic arthritis, post-traumatic injury suffer from hip arthritis, and they are offered a hip replacement for pain. Thus, many hip replacement surgeries are performed in young patients. The operation must meet the increased requirements for artificial connection of younger and more active patients. Naturally, the operation intended for Western elderly patients is not suitable for young patients.
What is a total hip replacement?
In this operation, the spherical upper end of the thigh (femur) and the socket (acetabulum) are replaced. The ball is replaced by a long metal rod, which is attached to the upper end if the bone is white. Its upper spherical end is pivotally connected to a cup-shaped polyethylene socket, which is cemented into the pelvis.
Normal hip replacements bring most of the normal bone, since the head, neck, and upper portion of the poor bone are removed to implant the prosthesis. In addition, wear debris from a polyester liner leads to osteolysis and bone loss. When this first hip needs to be changed or changed after its lifespan, more bone loss occurs. Normal hips have a small ball to reduce friction and wear, but the poor effect of this is an increased risk of dislocation. Reported average dislocation speed of 3-4%. These implants did not last more than 20 years, and it was reported that the renewal rate was 50% for 20 years. Survival rates are less satisfactory for patients with reliable breasts. Thus, complete hip replacement is not an ideal implant for young patients less than fifty years old who require a new hip.
Problems with common hip replacement:
o Excessive sacrifice and bone loss
o Increased dislocation risk
o Patients cannot squat or sit with crossed legs on the floor without risk of dislocation.
o Motion range less
o Patients cannot play sports
o Poor survival in young and active patients requires an earlier revision.
o Revision of operation difficult
o The hip feels like an ordinary thigh.
o A cup wears with time, and the plastic from it harms the bones
o Change in leg length after surgery, resulting in inconsistencies in leg length
Why remove a normal bone when only the surface of the ball is bad?
This is the logic of the recovery of the hip joint. This bone, which preserves the hip joint transfusion, includes the replacement of only the affected bone surfaces of the femoral head and the acetabulum. This includes sculpting the femoral head and covering it with a metal lid and fixing the loose socket in the acetabulum to receive the head.
Hip Resurfacing - the bone supporting the hip replacement!
Bone preservation and protection from stress facilitate the revision of this hip, if necessary. The large head size provides a very stable joint and recreates the feeling of a normal hip joint. After this operation, patients returned to the game of judo and squash. Successes of metallurgy make metal on metal articulation likely to survive longer in a young and active patient. With less metal inside the bone and less intrusion into the medullary cavity of the femur, the risk of infection is reduced. Rehabilitation is faster and better.
Advantages of the hip joint:
o Allows the patient to squat and sit cross-legged on the floor, safely
o Allows normal range of motion
o Donates only the affected bone and maintains normal bone.
o Improves a more normal feeling.
o The joint will probably last longer even in young and active patients.
o Early and fast rehabilitation
o Less dislocation risk
o Easier to revise if necessary
o Leg length mismatch
Proxima backrest replacement - ideal hip replacement?
This is the latest addition to the arsenal of a hip surgeon in India. This is a bone supporting hip replacement. In this operation, the entire diseased head of the femur is removed. The lining of the hip joint is opened with a metal cup. At the upper end of the femur or femur, there is a tiny, deflected hip with a short stem called the hip Proxime.
The size of the implant is natural, and therefore the risk of dislocation is almost eliminated. It is recommended when bone destruction is advanced and due to unsuitability for grinding, and a complete replacement of the hip joint will be unnecessary.
The advantages of Proxima are:
o suitable for minimally invasive surgery
o No pain in the hips
o Metal on metal - ensures durability
o Compliance with the normal size eliminates the risk of dislocation
o The ability to correct biomechanical disorders makes it excellent for ascent
o Improves a more normal feeling.
o Allows normal range of movement and normal activity
