Orthopaedics

The disease (anatomy, frequency)

Wear and tear of the hip cartilage

Like a buffer, the cartilage tissue between the femur and pelvis prevents our bones from rubbing against each other without protection. However, this crumple zone can gradually recede, especially with increasing age.

Such signs of wear and tear can also be favored by hereditary predisposition and congenital malformations of the hip such as hip dysplasia or malpositions such as bowlegs or knock-knees. Diseases such as rheumatism, gout or metabolic disorders can also play a role, as can heavy physical strain at work or during sport, obesity or accidents.

Osteoarthritis affects many people – around one in two adults after the age of 60. One of the most commonly affected joints is the hip joint. However, not all coxarthrosis causes symptoms.

Complaints

If the joint disease is only mild, it usually does not affect the quality of life. However, if the cartilage wear progresses unhindered, the hip often hurts even at rest and at night. Sometimes the pain radiates from the groin to the knee. People with advanced coxarthrosis often have limited mobility and suffer from stiffness of the hip joint and thighs. Everyday things like tying shoes or climbing stairs are becoming increasingly difficult. The severe cartilage abrasion also frequently leads to inflammation in the hip joint. A joint effusion forms, the joint is overheated and reacts sensitively to touch.

Diagnostics

If pain and restricted mobility lead you to the doctor, he or she will ask you in detail about your symptoms and movement habits. During the subsequent physical examination, the doctor will check your posture and gait as well as the mobility and function of your hip joint and whether there are any visible or palpable changes.

An X-ray is usually sufficient to confirm the diagnosis of osteoarthritis of the hip joint. In unclear cases, further examinations such as magnetic resonance imaging (MRI) may be useful.

Treatment

What can those affected do themselves?

Get moving

As the cartilage itself has no blood vessels, it is supplied with nutrients from the synovial fluid. Every movement of the joint promotes the distribution of synovial fluid and thus improves the nutrition of the cartilage. Regular, moderate exercise can thus help to maintain the mobility of the joint. It also strengthens the surrounding muscles. Ask your doctor for advice on suitable types of sport. Swimming, cycling or Nordic walking, for example, are considered to be particularly easy on the joints.

Reduce excessive weight

Every pound too much puts additional and unnecessary strain on the joints. If you lose any excess weight, you will relieve the strain on your hip joint.

Conservative treatment options

Pain therapy: Painkillers and anti-inflammatory medication can relieve pain in the short term.

Physical measures: For example, heat or cold applications and electrotherapy can alleviate the symptoms.
Orthopaedic aids: Insoles, special shoes or crutches can, if necessary, correct misalignments and thus relieve the hip joint.

Physiotherapy: Regular physiotherapy can have a positive influence on the course of the joint disease. Gait training and coordination training, for example, ensure that the joint is relieved and becomes more flexible again. Patients can also do appropriate exercises at home.

Surgical treatment options

Surgical intervention is usually considered in cases of advanced hip joint arthrosis with severe symptoms. However, all non-surgical measures should be exhausted before considering this option. Doctors differentiate between joint-preserving and joint-replacing surgery. The insertion of a so-called total endoprosthesis – TEP for short – is the most common surgical technique. Both joint surfaces, the acetabulum of the pelvis and the femoral head of the thigh bone, are replaced with artificial implants. As an artificial joint has an average lifespan of around 15 to 20 years, this option should only be chosen if conservative measures no longer help with the symptoms.

Rehab and AHB (requirements, benefits)

After a hip operation, a 3-week rehabilitation period (follow-up treatment) is the rule, i.e. rehabilitation immediately or a maximum of two weeks after hospitalization.
The hospital stay for arthroplasty surgery is five to ten days.

Typical rehabilitation goals

• Improvement when climbing stairs in alternating step / in readjustment step
• Improvement of the gait pattern (symmetry, rhythm)
• Increase mobility of the hip joint
• Removal of aids e.g. crutches
• Knowledge on dealing with the hip TEP in everyday life
• Information on fall prevention
• Improvement of wound healing
• Pain reduction

Therapy at the GZO

• Diagnostics
  Joint measurement, specialist visits, wound assessment, fall risk assessment, blood count, ECG, X-ray check if necessary (off-site)
• Optimization of pharmacotherapy (in particular drug-based thrombosis prophylaxis)
• Physical training
  • Individual physiotherapy (incl. gait training, use of crutches, instructions for climbing stairs),
  • Group gymnastics with coordination, balance and everyday life training
  • Medical training therapy
  • Exercise pool
• Manual and mechanical lymphatic drainage, massages, mud packs
• Knowledge transfer about the disease (presentation on total hip replacement)
• Wound care and thread pulling
• Nutritional advice
  Being overweight is a risk factor that puts pressure on the joints. A healthy diet helps to keep the new hip TEP healthy; if required, nutritional advice is available in the form of individual counseling, group counseling and healthy cooking.
• Social care and prescription of medical aids
• Psychological counseling and therapy
  Learning relaxation methods PMR, imagination, Qi Gong; individual and group discussions if required.

What happens at home?

• Outpatient physiotherapy (advanced gait training and muscle building)
• Rehabilitation sport https://bvs-bayern.com/rehasport/rehasport-naehe/
• Until 16 weeks after the day of surgery Reintegration into everyday life, society and possibly work*
• From the 4th month of sporting ability for low impact sports*
• From 6 months of age, fit for high impact sports*

*lt. Post-treatment recommendation 2019 of the German Society for Orthopaedics and Trauma Surgery