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Individual risk factors for hip osteoarthritis: obesity, hip injury, and physical activity.

Hip osteoarthritis is a major cause of pain and disability. The authors explored individual risk factors for hip osteoarthritis in a population-based case-control study. The study was performed in two English health districts (Portsmouth and North Staffordshire) from 1993 to 1995. A total of 611 patients (210 men and 401 women) listed for hip replacement because of osteoarthritis over an 18-month period were compared with an equal number of controls selected from the general population and individually matched for age, sex, and family practitioner. Information about suspected risk factors was obtained by a questionnaire administered at interview and a short physical examination. Obesity (odds ratio (OR) = 1.7, 95% confidence interval (CI) 1.3-2.4; highest vs. lowest third of body mass index), previous hip injury (OR = 4.3, 95% CI 2.2-8.4), and the presence of Heberden's nodes (OR = 1.6, 95% CI 1.2-2.2) were independent risk factors for hip osteoarthritis among men and women. Hip injury was more closely related to unilateral as compared with bilateral disease. There were a negative association between cigarette smoking and osteoarthritis among men and a weak positive association with prolonged regular sporting activity. Obesity and hip injury are important independent risk factors for hip osteoarthritis, which might be amenable to primary prevention. Hip osteoarthritis may also arise as part of the polyarticular involvement found in generalized osteoarthritis.

Aged↗

Hip injuries in children and adolescents.

Hip injuries in children present a wide spectrum of problems. Frequently because of the severity of the trauma involved, other injuries may take precedence and may require modification of the usual approaches to treatment. However, certain precepts are essential to the successful treatment of these injuries and should be kept in mind regardless of the milieu in which they are found. In the child with a hip dislocation, the potential presence of an acetabular, femoral head, femoral shaft, patellar or tibial plateau fracture must always be considered. Specialized x-ray views are necessary for this evaluation. Laminography and arthrography may also be required. The essential feature of successful subsequent treatment is a gentle closed reduction performed within 24 hours of injury. Treatment of displaced fractures of the femoral neck remains an unresolved issue. Accurate reduction held with adequate internal fixation would appear to offer the best chance for a successful result. The possible complications of avascular necrosis, delayed union and non-union, coxa vara, premature closure of the epiphyseal plate, and shortening should be appreciated. Early institution of appropriate treatment may mitigate the ultimate effect of these potentially devastating problems.

Acetabulum↗

The floating hip injury: patterns of injury.

OBJECTIVE: To evaluate the relationship between mechanism of injury, type of femoral fracture and type of acetabular fracture in floating hip injury. DESIGN: Historical retrospective. PATIENTS: Twenty consecutive patients who sustained a floating hip injury, i.e. simultaneous ipsilateral fracture of the acetabulum and the femur. INTERVENTION: Statistical analysis of the correlation between the mechanism of injury and fracture type. RESULTS: Two main patterns of floating hip injury were observed. The first is the posterior type, which occurs due to a longitudinal force along the femur that causes first, a posterior type fracture of the acetabulum and thereafter, a midshaft femoral fracture. The second pattern is the central type, caused by a lateral blow to the greater trochanter, which then causes a central fracture-dislocation of the acetabulum and a proximal fracture of the femur. CONCLUSIONS: This observation explains the biomechanical nature of this injury and has treatment related implications.

Accidents↗

An overview of hip injuries in running.

Running has steadily gained in worldwide popularity and is the primary exercise modality for many individuals of all ages. Its low cost, versatility, convenience and related health benefits appeal to men and women of broad cultural, ethnic and economic backgrounds. With more children and adults participating in recreational and competitive running, the incidence of injuries has steadily increased. Most running-related injuries affecting the lower extremities are due to preventable training errors, and some may necessitate medical evaluation or a significant reduction in training. Hip injuries in runners are due to interactions of intrinsic and extrinsic factors that adversely affect the complex regional anatomy. Acute or chronic hip pain presents a diagnostic and therapeutic challenge because the vague, nonspecific symptoms and signs may originate from local, regional or distant foci. Muscle strains and tendonitis are the most common aetiologies of hip pain and typically result from sudden acceleration/deceleration manoeuvres, direction changes or eccentric contractions. Apophysitis and avulsion fractures may affect younger runners and produce localised pain at muscle attachment sites. Iliotibial band syndrome is a common cause of lateral hip and knee symptoms characterised by sharp or burning pain that is exacerbated by activity. Bursitis, due to repetitive activity or acute trauma, may affect the trochanteric, ischial or iliopectineal bursae. Hip osteoarthritis may also produce persistent pain that worsens with running. Stress fractures are potentially serious conditions that affect women more frequently than men. Snapping hip syndrome is a benign condition that results from tight connective tissues' passing repeatedly over the greater trochanter, anterior hip capsule, lesser trochanter, femoral head or iliopectineal eminence. Acetabular labral tears, sports hernias and nerve entrapment syndromes are also potential causes of persistent hip pain in runners. Treatment of hip pain in running should focus not only on addressing the symptoms but also identifying the underlying conditions that precipitated the injury. Injury prevention and comprehensive rehabilitation are essential, since prior hip injuries increase the risk of subsequent ones. Coaches, trainers and medical personal who care for runners should advocate running regimens, surfaces, shoes, technique and individualised conditioning programmes that minimise the risk of initial or recurrent hip injuries.

Bursitis↗

[Traumatic hip injuries in the growth stage].

Injuries to the hip joint during growth are rare, but can nevertheless be problematic. Many of the complications described in the literature can be avoided by immediate, low-stress, but adequate therapy. With such an approach, however, fateful complications such as head necrosis cannot be avoided with absolute certainty. Therefore, management of such injuries must include correct enlightenment of the patient's parents and systematic follow-up of the patient, in order to identify complications which might have a negative influence on the prognosis and to treat them at an early stage.

Acetabulum↗

Common hip injuries in sport.

As a major weight-bearing joint, normal hip function is fundamental to successful sporting participation. Not only is it important in running-, jumping- and kicking-based activities, it also contributes to the generation and transference of forces in upper limb-dominated activities. Injuries to the hip do not account for a large proportion of the sports physician's workload, but may result in significant morbidity. The wide variety of acute, subacute and chronic injuries, affecting both the joint and surrounding soft tissues, can prove a diagnostic dilemma. The predisposition and the types of injuries around the hip vary with the age of the athlete. The young child rarely sustains a significant injury but one should be aware of orthopaedic conditions common in this age group that may manifest themselves through exercise. The immature skeleton of the adolescent is relatively injury prone and the demands of sport often exceed the capacity of the growing musculoskeletal system. In adults and older athletes, a further spectrum of injury exists, along with the effects of aging tissues and the concerns of degenerative joint disease. Rational treatment is based on a clear diagnosis developed through sound knowledge and a thorough history and examination. For the sports physician, treatments are typically early physical therapy and structured, progressive rehabilitation programmes which are individualised to the needs of the athlete. The spectrum of hip injuries is reviewed with current recommended diagnoses and management.

Adolescent↗

The assessment of athletic hip injury.

The differential diagnosis of athletic hip pain is extensive. The physical demands of sport place the athlete at increased risk to injure the hip. The basis of successful treatment of the athlete with hip pain lies in the ability of the physician to assess and diagnose the etiology accurately. A thorough understanding of the evaluation of the athlete with hip pain allows for an earlier diagnosis, earlier treatment, and ultimately an earlier return to sport.

Adult↗