OVERVIEW

The Hellenic Foundation of Rheumatology describes it as a chronic rheumatic condition, located in peripheral joints (upper and lower extremities), as well as in vertebral column joints. One of the most common degenerative arthritides is that of the hip, one of the largest and most burdened joints of the body.
The degeneration of the articular cartilage, the tissue that acts as a cushion between the bones and distributes the loads, means that the acetabulum (part of the large pelvic bone and the “socket” of the femoral head) “rubs” against the femoral head, the upper ball-shaped end of the femur. At the same time, a hardening of the surfaces is observed, while cysts and osteophytes are formed.
On the other hand, rheumatoid arthritis (an autoimmune disease with an inflammation of the synovial membrane) causes early cartilage degeneration at younger ages. The result of a severe joint injury, such as an intra-articular fracture, is called post-traumatic arthritis.

HIGH RISK GROUPS
Epidemiological data speak for themselves: Osteoarthritis is one of ten conditions that cause disability in developed countries, and according to the World Health Organization (2016), 10% of men and 18% of women around the world, aged over 60, present some form of hip arthritis.
The most important risk factor besides gender is age, although studies have shown that obesity, sedentary life, smoking and alcohol are also responsible, while old injuries but also activities related to joint strain (sports such as dancing or karate are considered “guilty”). Those with a similar family history are also considered vulnerable.

WHICH ARE THE SYMPTOMS?
The most common symptom is pain around the joint. Over time, patients experience pain in the groin and thigh that radiates in the buttocks, and even in the knee. Heavy activity “triggers” pain, while the joint becomes stiff, especially in the morning or after a rest period. The difficulty in walking and bending are just as typical, as is the “locking” and “blocking” of the joint, but also the characteristic “cracking” sound.

WHICH IS THE BEST TREATMENT?
At the initial stage, the doctor shall recommend the restricting of the activities that aggravate the condition, and weight loss, in order to unburden the joint. The American Academy of Orthopedic Surgeons, in a list of guidelines issued in April 2017 for the first time, recommends the injection of corticosteroids, physiotherapy, and non-steroidal anti-inflammatory drugs, before resorting to surgery.
However, if the symptoms do not subside and the hip remains non-functional, thus significantly affecting the patient’s quality of life, the replacement of the worn joint with an artificial one, is recommended. According to the OECD data for its member countries, total hip replacements increased by 35% over the period 2000-2013. The highest rates were recorded in Switzerland, Germany and Austria.
Over the last five years, the minimally invasive hip replacement procedure (SuperPathTM) is applied worldwide, allowing the surgeon to perform a total arthroplasty without cutting or injuring a muscle. This procedure was first performed in Greece at the Metropolitan Hospital, in December 2016, by the medical team of Mr. Anastasios Tokis. This surgery reduces the chances of a dislocation, which is one of the most serious complications. Usually, this procedure is applied in younger patients. After total arthroplasty, physiotherapy is required for around 4 weeks, in order for functionality to be restored.

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