Coxarthrose

Coxarthrosis: General

In the case of coxarthrosis (coxarthrosis), the hip joint wears off. This consists of two parts:

• Hip joint socket (formed by the pelvic bone)
• Hip joint head (formed by the femur)

Coxarthrosis is a common disease in Germany, whose risk increases with age. In certain pre-existing conditions, however, arthrosis in the hip can occur even in very younger people.

Watch out: Even if the X-ray shows a hip joint arthrosis, the affected person does not necessarily have complaints. Then there is a purely radiological (ie X-ray) visible hip osteoarthritis.

The situation is different with a clinically defined hip osteoarthritis. It shows clear signs of wear in imaging and causes pain to those affected.

Coxarthrosis: causes

Hip and hip joint can be damaged by various diseases. In some cases, a hip osteoarthritis then develops. These possible triggers of coxarthrosis include bone fracture, inflammation and inflammatory joint disease and metabolic diseases.

Coxarthrosis often develops even with a deformed hip. The femoral head is not located correctly in the acetabulum. This is the case, for example, with hip dysplasia (malformation of the hip joint), Morbus Perthes and Epiphyseolysis capitis femoris. These diseases already exist at birth or occur in childhood or adolescence. But they often lead to a hip joint arthrosis only many years later.

Coxarthrosis: examinations

If a coxarthrosis is suspected, the doctor will first ask for the medical history (anamnesis). For this he talks extensively with the patient and asks, for example, the following questions:

• How many meters can you walk without pain?
• Can you bend down to the ground?
• Do you have problems climbing stairs?
• Is it difficult for you to put on stockings or shoes?
• Do you have pain while sitting or lying down?
• Do you or did you have previous illnesses or injuries in the hip area?

This is followed by a physical examination. The doctor examines the gait pattern of the patient and checks the mobility in the hip joint. Imaging procedures such as X-rays show signs of wear in the hip joint in Coxarthrose.

If you want to know more about how a coxarthrosis or other forms of arthrosis are detected, read the article Osteoarthritis.

Coxarthrosis: therapy

Doctors recommend some general measures for coxarthrosis as well as other types of osteoarthritis. This includes, for example, relieving the affected joint. In the case of an arthrosis hip, for example, this means reducing existing overweight. Then there is less weight on the hip joint.

It is also important to move the Coxarthrosis hip regularly without any load. Swimming is especially suitable for this.

Physiotherapy and medications also help reduce the symptoms of coxarthrosis.

More about general measures and conservative therapies for coxarthrosis and other forms of osteoarthritis can be found in the article Osteoarthritis.

Artificial hip joint in Coxarthrosis

Sometimes the symptoms of pronounced osteoarthritis in the hip joint can not be improved with conservative measures. Then it may be useful to use an artificial hip joint. You can either replace only the femoral head, only the hip socket or both against a prosthesis.

The available hip prostheses differ in several ways: shape, material and type of anchorage in healthy bone. Which prosthesis is most suitable in a particular case depends on various factors. For example, the age of the patient, the bone structure, the stage of the disease and possible allergies to certain prosthetic materials play a role.

Artificial hip joint: anchoring

For younger people, preference is given to using cementless prostheses. In older patients, however, artificial hip joints are cemented more frequently.

Cementless prostheses have the advantage of being easier to replace. This is especially important for younger people. Because an artificial hip joint is not indefinitely durable and must then be replaced. To anchor the prosthesis, a solid bone structure is necessary, which is usually given in younger people. Older patients, on the other hand, are more likely to suffer from osteoporosis. Therefore, a cementless prosthesis often can not be adequately fixed with them.

There are also combined prostheses (hybrid prostheses) for patients with an arthrosis hip. These consist for example of a cemented prosthesis socket and a cement-free socket.

Artificial hip joint: materials

A hip prosthesis can consist of different materials. The type of material influences the durability and resilience of the artificial hip joint.

The small sliding washer between the femoral head and the socket usually consists of the plastic polyethylene or ceramic. The other parts of the prosthesis may be made of different metals (such as titanium, chromium, cobalt) or ceramics. The combination of materials is called sliding pairing. A hip prosthesis in Coxarthrose very often has the sliding metal-polyethylene. The metal condyle slides in the polyethylene-lined pan.

Polyethylene is a very soft material that can be worn faster in active people. For such coxarthrosis patients, therefore, a metal-metal sliding pair can be selected. In this case, however, more metal can enter the body. For patients with metal allergies they are therefore not suitable. In addition, click sounds may occur.

A ceramic bearing does not cause metal allergies and is rarely worn out. However, it breaks faster. It is therefore used only in selected cases of coxarthrosis.

Artificial hip joint: aftertreatment

As a rule, a hip operation is followed by rehabilitation. There, the hip joint is loaded and moved to exact specifications, the muscles are trained specifically. How fast and how much the hip may be loaded depends, among other things, on the operation chosen. A targeted rehabilitation should prevent possible complications. This allows the coxarthrosis patient to resume his usual activities as quickly as possible.

Artificial hip joint: complications

The fitting of a hip prosthesis in coxarthrosis patients can lead to complications:

• Immediately after surgery, a blood clot can easily form. This can clog a vessel (thrombosis, embolism). This can usually be prevented by using suitable blood-thinning medications.
• Some coxarthrosis patients injure a nerve during the procedure. This can change the feeling on the leg.
• Often the legs are not the same length after the operation. Many hip osteoarthritis patients will need to wear shoes with balancing soles after surgery.
• In some operated coxarthrosis patients ossified the hip joint. It can then move only limited.
• In some patients, the artificial joint replacement loosens and must be replaced.
• The femoral head can slip out of the pan. Doctors call this a dislocation. In addition, the bone may break around the prosthesis (periprosthetic fracture).

A hip operation at Coxarthrose So there are many risks and should therefore be well considered.

Additional information

Book recommendation:

• The Tübingen hip concept (for arthrosis): From science to practice, Arnd Rüskamp et al., 2014, Hellblau-Verlag; Edition: 1