(Osteo = bone) ( arthrosis = degeneration of the joint) this condition rises when the cartilage covering the surfaces of the Femur (head) and Acetabulum (socket) of the hip joint degenerates. This process could be primary degeneration as a result of wear and tear process related to aging. It could also be secondary to a trauma, occupational overuse or biomechanical alterations (i.e. leg length discrepancy.
Aging related osteoarthrosis is a process that builds up with time. Symptoms including pain and limitation of movement start to appear gradually. The appearance of symptoms in the early stage of the disease isn’t necessary to be associated with findings x-ray.
Osteoarthrosis can be divided into 3 stages:
Early Stage: at this stage patient starts complaining of pain of gradual onset which is felt with weight bearing activities. Pain is often felt in the buttock or groin area.
Middle Stage: this stage is characterized by progression of pain and limitation of movement. Pain might be present at rest and is aggravated with weight bearing activities.
Late Stage: at this stage pain is unbearable and extreme limitation of range of motion is present and as a result functional disability takes place. This category of patients is indicated for surgery and conservative therapy won’t give promising results.
Physiotherapy intervention for the early and middle stages will be decided upon the presentation of the patient and it will be tailored to meet patients needs. Therapy may include but not limited to:
- Heat application which will help to improve the blood circulation and helps the muscles to relax.
- Mobilization techniques and Range of motion exercises both passively ( applied by the therapist) and actively (applied by the patient) that would create more room for the surfaces to move and to stretch the capsule of the joint.
- Stretching muscles surrounding the hip joint.
- Strengthening exercises of the weak muscles.
- Balance exercises.
- Gait training exercises.
- Patients education about the disease and home based program exercises to maintain the improvement gained from the session.
As mentioned above late stage is indicator for surgery. The surgeon will decide if he is going to replace one surface of the joint ( hemi-arthroplasty) or both surfaces (Total Hip Arthroplasty) depending on age of the patient and on the damaged surface(s).
After the operation patients will need to do physiotherapy to help them regain strength of muscles, range of motion of the joint and balance. Patients will be reeducated to walk again using walker at the beginning, then using a cane on the sound side before they regain optimal balance needed to walk unaided. Artificial joints have a limited life span so the patient must be educated on how to maintain them. Also the stability of the artificial joints (hip joint compared to knee joint) is of great importance since the joint motion has to be limited in certain directions and exceeding these limits might result in a dislocated hip.
Patients have to be educated on how to maintain their artificial joint(s) and how to avoid maneuvers that compromises their integrity.