Arthritis of the hip. Diagnostics & therapy

How is osteoarthritis of the hip detected and treated?

The mobility of the joint needs to be improved at a hip arthrosis again.

The mobility of the joint needs to be improved at a hip arthrosis again.

Discomfort in the legs or in the back. Pain at rest or with stress: Arthrosis of the hip joint is expressed quite differently for many people. Depending on the stage of the disease, the wear of the articular cartilage goes hand in hand with more or less severe limitations in daily life. Therefore it's even more important to narrow the cause of the complaints accurately. And to be able to find the correct diagnosis.
If arthritis of the hip was identified, the appropriate treatment can be initiated depending on the severity and stage. The therapeutic spectrum ranges from conservative measures such as physical therapy, to the replacement of the hip joint with a endoprothesis.

 

From diagnostics to treatment and rehabilitation.

Diagnostics. How a hip arthritis is detected

How is hip arthritis identified?

If hip arthritis is suspected we at Schön Klinik initially assess hip mobility by carrying out a physical examination. This will allow capsular swelling and malpositions of the joints to be felt. Pain related to movement can be detected by various hand grip and examination techniques and confirm any initial suspicions.

 

An X-ray is the most important pointer.

Whether the hip joint is damaged and how advanced wear and tear is, can easily be seen on an X-ray.

Whether the hip joint is damaged and how advanced wear and tear is, can easily be seen on an X-ray.

Imaging procedures are indispensable for diagnosing hip arthritis. An X-ray examination is the first and most important pointer. In most cases, an image of the joint from several different angles will be sufficient. Change to the bony shape of the joint can be identified without problem. It is also possible to say something from narrowed joint spaces about cartilage wear in the joint – the less cartilage in the joint, the narrower the joint space.

 

Nuclear spin tomography [MRI] and ultrasound for further clarification.

In addition to an X-ray, ultrasound examinations, magnetic resonance tomography (MRT) or computed tomography (CT) can also be used to diagnose hip arthritis.

With suspected rheumatoid arthritis or bacterial joint inflammation, a blood test may also be necessary or even a puncture of the joint.

 

Conservative treatment. Non-surgical therapy

What types of treatment are available for hip arthritis?

It does not always have to be an artificial hip straight away. If possible, we at Schön Klinik treat or patients with conservative measures initially – i.e. without an operation. Top priority is always the treatment of pain. With the help of a combination of medications to alleviate pain and inflammation, general freedom from pain and a regression in inflammatory values can be achieved in the joint.

However if the arthritis in the hip has already progressed too far so that the joint is considerably damaged or even destroyed, then an operation is recommended. Either the joint itself can be repaired or exchanged for an artifical one. Nowadays there are many individual solutions available.

 

Physiotherapy for treating malpositions and gaining strength.

Arthritis of the hip is not synonymous with a joint replacement: Also a therapy/exercise pool can reduce pain and ease restricted mobility.

Arthritis of the hip is not synonymous with a joint replacement: Also a therapy/exercise pool can reduce pain and ease restricted mobility.

Once acute pain has been relieved with medication, specific physiotherapy can support the healing process. Shortened tendons and muscles because of avoidance postures and malpositioning of the hip can be stretched and the whole musculature strengthened by specific measures. Electrotherapy, the exercise pool and also X-ray irradiation also have a positive effect on the course of arthritis. Products that stimulate cartilage formation may also ease symptoms in individual cases.

„Even without an operation many options are also available for treating arthritis of the hip",according to Prof. Dr. Pavel Dufek, Consultant Orthopaedist in the Schön Klinik Neustadt. „Through specific physiotherapy we can achieve freedom from pain or at the least alleviation of pain for many patients with arthritis in the initial stages, even after treatment with pain relievers."

 

Joint surgery. Realignment & hip replacement.

Realignment operation for arthritis of the hip.

So that the femoral head sits properly in the acetabulum again, any malpositioning must be corrected.

So that the femoral head sits properly in the acetabulum again, any malpositioning must be corrected.

For persistent pain or rapidly progressive arthritis of the hip, an operation should be given consideration. „the deciding criterion for the right point in time for surgery is always the patient's quality of life&Idquo; and Dr. Prof. Dr. Pavel Dufek knows this from numerous discussions with patients.  „If the patient's mobility is severely reduced because of wear and tear to a joint and pain is virtually intolerable and conservative measures have brought no improvement, then certainly the right point in time has arrived for an operation."

A realignment operation corrects the shape of the joint: The joint shape/position is examined and adjusted accordingly – in the same way as an out-of-round tyre is balanced. Therefore progressive arthritis can be halted by severe abrasion. Also the removal of protruding bony growths can improve arthritic symptoms and so reduce pain.

 

Joint replacement for arthritis of the hip.

If the hip joint is severely damaged, a total endoprosthesis (TEP) can be used. In this case the acetabulum and femoral head are replaced with a prosthesis.

If the hip joint is severely damaged, a total endoprosthesis (TEP) can be used. In this case the acetabulum and femoral head are replaced with a prosthesis.

If the joint is already considerably damaged because of arthritis or even destroyed, then an artificial hip joint is recommended. Physicians speak of an endoprosthesis of the hip joint/artificial hip joint replacement. Either part or all of the destroyed hip joint itself is exchanged for an artificial joint. The artificial joint attempts to duplicate the function and structure of the hip joint itself as well as possible.

Depending on the extent of the arthritis, the bone quality and in each case bone structure, we choose the best possible implant prior to the operation in consultation with our patients. This is because just as the body and bone structure of each person is individual, so are the models offered by the manufacturers equally as individual: Men and women's hips differ in size and shape. The age of our patients, their gender, bone density, weight and, last but not least, the activities of daily living also play a role in this decision.

 

Surface replacement or cap endoprostheses.

Hip implant with a surface replacement: only the damaged joint surface has been replaced.

Hip implant with a surface replacement: only the damaged joint surface has been replaced.

Here, only the damaged joint surfaces are replaced by the implant. Therefore a lot of the bone can be preserved during implantation. Any possible exchange of material after 10 to 15 years is therefore easier. In addition this prosthesis allows a greater range of movement: These joints seldom dislocate if subject to major contorsion.

  • Requirement: The preference is for surface or cap endoprostheses if the initial anatomical conditions are normal. I.e. no destruction over a large area should have taken place.
  • Disadvantage: For patients with nickel, cobalt and/or chromium allergies, these prostheses are not suitable because of the implant alloys.
 

Short shaft or femoral neck endoprostheses.

This type of prosthesis can also be implanted to save the bone with the femoral head preserved. It is also particularly well suited for what are known as minimally invasive interventions, i.e. interventions which cause less damage to the tissue.

  • Advantage: When using this prosthesis cutaneous incisions can be kept particularly small and only very few muscle attachments have to be released or dissected. This facilitates mobility after an operation and reduces wound pain.
  • What is also advantageous: The implants are made from titanium alloys and can therefore also be used for patients with a metal allergy.
 

Standard shaft hip endoprotheses.

This hip implant is also implanted using surgical techniques that preserve the tissue. The rough titanium surface grows together well with the body's own bone and is therefore stable in the longer term.

  • Advantage: The bearing surfaces of the femoral head and acetabulum can be composed from different optinal combinations to the advantage of our patient (plastic-metal, plastic-ceramic, ceramic-ceramic, metal-ceramic).
  • What is also advantageous: Titanium alloys are very well tolerated by the surrounding tissue, promote bone growth and are safe to use in most cases, even in patients with allergies to metal.
 

Modular cement-free femoral shaft prosthesis.

This prosthesis also permits secure, primarily cement-free fixation in the bone. This is because its modular principle guarantees optimum adaptation to the individual anatomical conditions of our patients – as if tailor-made,

  • Advantage: We recommend this hip prosthesis in particular to our patients with severe congenital or inherited malpositions of the hip itself.
 

Special modular prostheses.

In special cases where there are very severe bone defects and damage to the joint for instance after several exchange operations or if there is a tumour, special prostheses can also be made. A total replacement of the thigh bone itself is possible nowadays.

 

Rehabilitation.

Rehab - learn to walk properly again.

During medical training therapy, a part of the musculature is targeted for training. Depending on the patient's condition training levels are increased.

During medical training therapy, a part of the musculature is targeted for training. Depending on the patient's condition training levels are increased.

New hip – new feeling of movement. For many of our patients a new episode in their lives begins after a hip operation or implantation of an artificial hip joint. Now it is step by step up hill not down hill.

Nevertheless there is still a long way to go. Wounds have to heal and the muscles, tendons and ligaments that are shortened from years of avoidance and abnormal postures, have to be built up and strengthened. Therefore following a hip operation, intensive and professionally-led rehabilitation is recommended. Only in this way can the new joint regain its full function and weight bearing ability. Rehab can be on an inpatient or outpatient basis – all depending on what the individual patient's state of health allows.

 

Individual therapy concept for every patient.

Our challenge here at Schön Klinik is to develop an individual treatment concept made up from different components for each one of our patients – according to the specifications of the surgeon. During ward rounds, ward doctors therefore discuss in detail with the patient their the treatment measures. Depending on progress the plans are adapted several times.

Even the day after the operation the first steps are attempted: Getting out of bed, walking alone through a room – a little walking training and work outs to improve circulation.

 

All for one - Cooperation between all departments.

In order to be able to implement our patients' individual therapy plans, different therapy departments work in cooperation: The Department for Physical Therapy, Physiotherapy and Ergotherapy and the Department for Medical Training Therapy.

  • Heat treatment, massages, lymphatic drainage, medicinal baths, jet spray massages, inhalations, and electrotherapy are carried out in the Physical Therapy department.
  • The Physiotherapists improve the mobility of the joints, and teach strengthening and coordination exercises. They correct poor posture in order to redevelop ergonomic mobility. Besides individual therapies there are group therapies specially adapted for hip patients that take place at different levels of difficulty.
  • During medical training therapy parts of the musculature are targeted for training. Through incremental, all-inclusive and specifically adapted training, our patients can develop their endurance, coordination and strength in all the important muscle groups. Daily training sessions on medical training equipment but also in group rooms, in the exercise pool or outdoors are important components for successful rehabilitation following hip arthritis.
 

Train for daily life.

Upright walking is practised at the mobility training centre. Many years of avoidance postures can be set aside step by step.

Upright walking is practised at the mobility training centre. Many years of avoidance postures can be set aside step by step.

So that you can manage at home on your own,  our  physiotherapists train you for everyday living even during the rehab. stage. Once mobility has improved therefore  and also accompanied by therapists, you can walk in the grounds and the immediate vicinity. The ergotherapists provide any medical aids that might be needed.

Also our Clinic Social Services support the patient to make the start at home as uncomplicated as possible: Healthcare support and occupational reintegration, as far as self-help groups at a local level for exchanging information with counterparts.

 

Hip arthritis.

If cartilage tissue is damaged the femoral head and acetabulum (hip socket) rub against each other. Arthritis develops.

Hip arthritis.

 

Endoprothesis: Everyday life

An artificial hip is ALMOST like your own. It is precisely because of this that some types of sport and exercise are out of the question.

Everyday life. Advice & Tips

Specialised clinics

From non-invasive therapy to joint surgery. Our specialized clinics for the treatment and rehabilitation of hip arthritis at a glance.

Specialised clinics