COXARTHROSIS OF THE HIP AND THE KNEE

CLINIC AND RADIOLOGY

General symptoms of coxarthrosis:

• Pain

• Pain is the main reason persons with osteoarthritis (OA) seek medical attention.

• Initially, symptomatic patients incur pain during activity, which can be relieved by rest and may respond to simple analgesics.

• Morning joint stiffness usually lasts for less than 30 minutes.

• Stiffness during rest (gelling) may develop.

• Joints may become unstable as the osteoarthritis progresses; therefore, the pain may become more prominent (even during rest) and may not respond to medications.

Physical

• Physical examination findings are mostly limited to the affected joints.

• Malalignment with a bony enlargement (depending on the disease severity) may occur.

• Most cases of osteoarthritis do not involve erythema or warmth over the affected joint(s); however, an effusion may be present.

• Limitation of joint motion or muscle atrophy around a more severely affected joint may occur.

• Sources of pain in osteoarthritis include the following:

• Joint effusion and stretching of the joint capsule

• Increased vascular pressure in subchondral bone

• Torn menisci

• Inflammation of periarticular bursae

• Periarticular muscle spasm

• Psychological factors

• Crepitus (a rough or crunchy sensation) may be palpated during motion of an involved joint.

Hip osteoarthritis is a common type of osteoarthritis (OA). Since the hip is a weightbearing joint, osteoarthritis can cause significant problems. About 1 in 4 Americans can expect to develop osteoarthritis of the hip during their lifetime, according to research presented at the 2006 American College of Rheumatology annual meeting.

Hip osteoarthritis is caused by deterioration of articular cartilage and wear-and-tear of the hip joint. There are several reasons this can develop:

• previous hip injury

• previous fracture, which changes hip alignment

• genetics

• congenital and developmental hip disease

• subchondral bone that is too soft or too hard

• avascular necrosis

Symptoms of Femoroacetabular Impingement

• intermittent groin or hip pain

• pain that spreads to the thigh, buttock or lower back

• pain that typically develops gradually (can be sudden if it follows an injury)

• pain that intensifies with specific movements

• sharp, catching or locking hip pain

• giving way or buckling of the hip

Imaging Studies

• Radiography

• Conduct imaging studies of the affected joint.

• The presence of osteophytes (ie, spurs at the joint margins) is the most characteristic findings.

• Other findings in osteoarthritis include asymmetric joint-space narrowing, subchondral sclerosis, and subchondral cyst formation.

• Roentgenographic findings are often poor predictors of the degree of symptomatology in a particular patient.

X-ray:

Knee osteoarthritis is the most common type of osteoarthritis. More than 10 million Americans have knee osteoarthritis. It is also the most common cause of disability in the United States. Early diagnosis and treatment help manage knee osteoarthritis symptoms. An overview of knee osteoarthritis will help you understand symptoms, diagnosis, and treatment options.

Causes of Knee Osteoarthritis

Deterioration of articular cartilage is the main problem associated with knee osteoarthritis. The condition can be caused by:

• previous knee injury

• repetitive strain on the knee

• fractures, ligament tear, and meniscal injury which can affect alignment and promote wear and tear

• genetics which make some people more likely to develop knee osteoarthritis

• obesity

• problems with subchondral bone (the bone layer underneath cartilage)

Symptoms of Knee Osteoarthritis

Knee osteoarthritis typically develops gradually over a period of years. The primary symptoms associated with knee osteoarthritis include:

• pain (mild, moderate, or severe)

• stiffness

• limited range of motion in the knee

• localized swelling

Knee osteoarthritis pain is usually worse following activity, especially overuse of the affected knee. Stiffness can worsen after sitting for prolonged periods of time. As knee osteoarthritis progresses, symptoms generally become more severe. Pain can become continuous rather than only when weight-bearing.

Diagnosis of Knee Osteoarthritis

Medical history, physical examination, and x-rays are used to diagnose knee osteoarthritis. X-rays are very helpful, allowing the doctor to see evidence of joint space narrowing and rule out other causes of knee pain. If more detailed imaging is needed, an MRI may be ordered. Arthroscopic knee surgery is another way to view the condition of the knee.

Radiographically, the erosions are centrally located , in contrast to the marginal erosions in rheumatoid arthritis. Osteophytes are present; consequently, interphalangeal joints may assume a gull-wing configuration, with central erosions flanked by raised lips of bone. Periarticular soft-tissue swelling is evident. Osseous fusion, which severely limits joint motion, may occur

X- ray

Standing anteroposterior (AP) radiograph of the knees reveals bilateral medial femorotibial compartment narrowing and sharpening of the tibial spines; this finding is typical of osteoarthritis

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