A study led by Jonathan Vigdorchik, MD, assistant professor of orthopedic surgery at NYU Langone Health, suggests that a new risk prediction model and treatment algorithm can help identify patients More thanhip replacements are performed in the United States each year, and an estimated 2. In a hip replacement, an artificial joint comprising a ball and socket is implanted to replace the natural ball and socket in the pelvis, enabling movement that is typical of the hip joint.
Find articles by J. Abstract Examination of a painful hip is fairly concise and reliable at detecting the presence of a hip joint problem. Hip joint disorders often go undetected, leading to the development of secondary disorders. Using a thoughtful approach and methodical examination techniques, most hip joint problems can be detected and a proper treatment strategy can then be implemented based on an accurate diagnosis.
The purpose of this clinical commentary is to present a systematic examination process that outlines important components in each of the evaluation areas of history and physical examination including inspection, measurements, symptom localization, muscle strength, and special tests.
Examination of a painful hip is fairly succinct. For example, hip joint disease may co-exist with lumbar spine disease. Considerable attention may be necessary in order to distinguish which is the major factor. Among athletes, a significant incidence of hip pathology and concomitant athletic pubalgia can occur.
The symptoms can be difficult to distinguish, especially when they co-exist. Hip joint disorders often remain undetected for protracted periods of time. In the course of compensating for their symptoms, patients often develop secondary dysfunction.
This dysfunction may lead to symptoms of trochanteric bursitis or chronic gluteal discomfort. The examination findings for the secondary disorders may be more evident and mask the underlying problem with the hip.
Coincidental findings unrelated to disorders of the hip may exist.
Snapping of the iliopsoas tendon and iliotibial band are usually incidental findings without clinical significance. However, this snapping can become a source of symptoms or may exist coincidentally with hip joint pathology.
Once again the clinical assessment can become challenging to distinguish the features of each. A myriad of structures may create similar or overlapping symptoms.
In addition to the joint, the clinician must be cognizant of bone problems, surrounding musculotendinous and bursal structures, neurological disorders including numerous small sensory nerves, and even visceral disorders that can refer symptoms to the hip area.
HISTORY As there are various disorders that can result in a painful hip, the history may be equally varied as far as onset, duration, and severity of symptoms. For example, acute labral tears associated with an injury have gone undiagnosed for decades, presenting as a chronic disorder.
Conversely, patients with a degenerative labral tear may describe the acute onset of symptoms associated with a relatively innocuous episode and gradual progression of symptoms. In general, a history of a significant traumatic event is a good prognostic indicator of a potentially correctable problem.
Patients may recount a minor precipitating episode such as a twisting injury; however, even under these circumstances, be wary that underlying susceptibility of the joint to damage may exist and, again, a less certain prognosis.
With any hip joint problem, the clinician must look closely for predisposing factors. For example, femoro-acetabular impingement is a recognized cause of joint breakdown in young adults.
The management strategy may have to be multi-faceted, as well. Perhaps not all factors can be identified or corrected, but the evaluation must be thorough. Mechanical symptoms such as locking, catching, popping, or sharp stabbing in nature are better prognostic indicators of a correctable problem.
This finding may indicate an unstable lesion inside the joint, but many painful intra-articular problems never demonstrate this finding, and popping and clicking can occur due to many extra-articular causes, most of which are normal. There are characteristic features of the history that often indicate a mechanical hip problem Table 1.
As expected, the pain is worse with activities, although the degree is variable. Straight plane activities such as straight ahead walking or even running are often well tolerated, while twisting maneuvers such as simply turning to change direction may produce sharp pain, especially turning towards the symptomatic side which places the hip in internal rotation.
Sitting may be uncomfortable, especially if the hip is placed in excessive flexion. Rising from the seated position is especially painful and the patient may experience an accompanying catch or sharp stabbing sensation. Symptoms are worse with ascending or descending stairs or other inclines.
Entering and exiting an automobile is often difficult with accompanying pain, because the hip is in a flexed position along with twisting maneuvers.Rationale: Prevents dislocation of hip prosthesis and prolonged skin or tissue pressure, reducing risk of tissue ischemia and/or breakdown.
Demonstrate and assist with transfer techniques and use of mobility aids, e.g., trapeze, walker. Radiography is the primary imaging method for the evaluation of Total Hip Arthroplasty. A lucency at the metal-cement interface along the proximal lateral aspect of the femoral stem may be seen on the initial postoperative radiograph as a The risk of intraoperative infection is less than 1% due to the use of antimicrobial prophylaxis.
Risk factors for prosthetic hip and knee infections according to arthroplasty site. Multivariate conditional logistic regression techniques were used in assessment of risk factors by adding, there was an associated 10% increase in . 3 days ago · A novel risk assessment tool helps identify which patients undergoing total hip replacement may be at higher risk for an implant dislocation after surgery, according to a new study from researchers at NYU Langone Health and described at the American Academy of Orthopaedic Surgeons (AAOS) Annual Meeting in New Orleans.
Hip and Knee Risk Assessment. How’s the state of your knee or hip? Find out. This free assessment walks you through a series of questions based on internationally accepted research to give you an evaluation of your joint. While nothing can replace speaking with a physician, this is a great place to start learning more about your joint health.
Hip replacement surgery is a procedure in which a doctor surgically removes a painful hip joint with arthritis and replaces it with an artificial joint .