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DrAlisonGrimaldi Blog_DrWeinrauch Interview_Surgical Options for Hip OA

Surgical Management of Hip Osteoarthritis – Types of Prostheses and Approaches

Includes videocast, podcast, infographic & video/podcast notes. When the time does come for surgery for advanced hip osteoarthritis, it’s not one size fits all in terms of surgical and prosthetic options. There are choices around conventional Total Hip Replacement or Resurfacing, cemented or uncemented prostheses, bearing surfaces and surgical approaches to the hip. This interview presented in both videocast and podcast format, explores the options available and the relative indications, advantages and disadvantages, limitations or risks. It is important for non-surgical health professionals to be aware of these options as there are implications for post-operative management and advice provided to patients undergoing or who have undergone various surgical procedures for advanced hip osteoarthritis.

Watch the interview here:

or if you prefer, listen to the interview here (Podcast only):

About Associate Professor Patrick Weinrauch :

Associate Professor Patrick Weinrauch is an Orthopaedic Surgeon, founder of Brisbane Hip Clinic in Queensland, Australia. The name of his clinic says it all. He focuses exclusively on the management of hip joint disorders, with a high level of experience and expertise in a full range of surgical procedures for the hip, including hip joint arthroscopy, hip joint preservation surgery, hip resurfacing and hip replacement procedures. Dr Weinrauch is a Fellow of the Royal Australasian College of Surgeons and a Fellow of the Australian Orthopaedic Association, and not only has a busy clinical practice but contributes to education programs for other surgeons and health professionals and to scientific research in this field. Dr Weinrauch has published over 50 peer-reviewed scientific papers and is the Deputy Editor for the International Journal of Advanced Joint Reconstruction. He is currently appointed as an Associate Professor at the Griffith University School of Medicine and has been awarded a Doctorate of Philosophy and Master of Engineering for his research relating to the surgical management of adult hip joint disorders. We are very grateful to Patrick for sharing his valuable time and wisdom.

Video/Podcast Notes

The decision about going to surgery and which implant are blended.
So the first question is, ‘Do I need a joint replacement?’ based on function, pain, response to other therapies, degree of osteoarthritic wear.
If the answer to the first question is ‘Yes’, then the next question is ‘Which implant is the suitable one for me?’

Surgical Options

The two main surgical options:
1. Conventional Total Hip Replacement
• Most common procedure – 98-99% of procedures for hip osteoarthritis
2. Hip Resurfacing
• For select scenarios
For appropriately selected patients who meet the criteria for those implants, the expectation is for a consistently good long-term outcome, with complete or near complete pain relief.

Prostheses for Total Hip Replacement

‘Anatomy’ of a Prosthesis

Anatomy of a Hip Prosthesis

• Femoral side – consists of a stem and a head component
• Acetabular side – socket with a bearing inside – the liner

Two main categories
1. Cemented
• Uses some form of grout to bond the implant to the bone
2. Uncemented
• No grout used, bone will grow directly onto the implant
The femoral stem of an uncemented prosthesis
• Generally made of titanium
• The stem is coated with a spray, either of titanium or a calcium spray called hydroxyapatite, to stimulate bone to grow directly onto the stem – this creates a very firm bond of the prosthesis within the femur
• Titanium is a well-tolerated metal, which is not associated with allergy and bonds very well with bone.
• While titanium is excellent as stem material, it is a relatively soft metal and is therefore not good as a bearing surface, so other materials are used for the bearing surfaces of the ball and socket

Bearing surface options

Prosthetic Bearing Options for Resurfacing and THR

The femoral component
Polyethylene
i. A plastic-like material
ii. Has changed a lot over the last 20 years – now highly-linked polyethylene is used, where all the fibres are linked together and the molecular structure is very long
iii. Current day polyethylene is therefore extremely wear-resistant
iv. Vast majority of protheses now have some polyethylene component
Ceramic
i. May be used alone as the bearing surface of the femoral head, or in combination with a second bearing surface
ii. Advantages of ceramic surface is that they are very smooth, and when they are wet by the synovial fluid, they are extremely slippery, so the wear rate is very low.
Combination – The Dual Mobility Implant
i. Ceramic inner ball
ii. Combined with an outer ball – a second bearing surface over the top made of polyethylene, which rotates freely over the inner ball

The acetabular component
• Socket implant is often made of 2 parts
i. Titanium shell that the bone can grow onto it
ii. Bearing surface that lines the shell and communicates with the femoral head
• Types of bearing surface
i. Ceramic bearing surface, so that a Ceramic-on-Ceramic implant refers to an implant where the bearing surface of both the ball and the socket are both made of ceramic
ii. Polyethylene
iii. Cobalt Alloy – wear resistant metal. This is used in the Dual Mobility Implant, so that the polyethylene outer ball sits over the ceramic ball and articulates with the Cobalt Alloy bearing surface of the socket.

Hip Resurfacing

• Is a bone preserving alternative to conventional hip replacement – the bone is preserved and only the damaged cartilage is replaced
• Is still a prosthetic joint replacement with the same recovery and rehabilitation periods and requirements.
• Is not a lesser operation, just a different implant
Process
• Instead of removing the head and placing a stem down the femur, the procedure involves shaving around the outside of the ball and placing a hollow metal cap over the ball
• The socket is also shaved out and lined with a metal liner

Criteria for suitability
• Are very stringent
• Generally used for larger-framed, male patients
• Particularly younger patients, due to the fact that if the prosthesis fails over their lifetime, it is then relatively easy to convert then to a full total hip replacement by removing the whole ball and adding a conventional femoral implant. This facilitates an easier revision if it should be required in the future.

Surgical Options for Hip OA

Prosthetic Failure

Two main causes:
1. Aseptic loosening

  • the most common form of failure of an implant
  • related to wearing of the bearing surface – usually the polyethylene component, and impact of the debri on the bond between the implant and the bone
  • rates of loosening are likely to reduce over time due to the use of far more wear-resistant bearings of modern implants
  • can have loosening of either femoral or acetabular component
  • revision surgery may involve replacement of either the ball or socket or both components, depending on the situation

2. Instability associated with dislocation

  • 2nd most likely cause of revision in Australia
  • A revision is not always necessary following dislocation, but recurrent dislocation is an indication for revision surgery
  • May develop over longer periods of time related to changes in posture, pelvic position and relative loads across the joint that may change with ageing – this situation may only require a reorientation of the socket component.
  • Revision of modern modular implants
    • Modern implants are modular, comprised of a number of connecting components. This gives the surgeon lots of options to choose components that are most suited to the individual’s requirements and morphology
    • This also means that if one component fails, the whole implant does not necessarily need to be replaced. For example, if the femoral head fails, it can be removed easily from the stem and replaced with another ball, without needing to replace the stem component
    • If a well fixed stem does need to be replaced, this involves a larger surgical procedure, usually with a longer rehabilitation time post-operatively.

Selection of Prosthesis

Joint replacement technologies and implants are not a one-size-fits all scenario.
Determined by:
1. Surgeon Preference
• Associated with experience, reading of the literature, familiarity with different implant designs
• Implants that have a good track record with the particular application
2. Patient Criteria
• Bone density
• Bone shape
• Leg length
• Muscle length-tension relationships
• Age
• Anticipated activity requirements – nature and volume of activities

Considerations for a younger patient:
• May be a candidate for a bone preserving surgery such as resurfacing
• A stem with a shorter length or reducing area of porous coating may be selected, so that the stem is easier to remove in the future, if revision is required

Considerations for patients who would like to return to repetitive impact activities:
• Would choose implant designs that are more wear resistant and impact resistance
• Also, non-modular implants may be more appropriate, as each junction may be a source of failure under repetitive load situations
• Metal on metal implants such as resurfacing are very wear resistant
• Previously there have been concerns regarding ceramic bearing surfaces in repetitive impact loading tasks and the potential risk of cracking or chipping of the implant. However, ceramics have undergone much development and the modern ceramic bearing surfaces are very impact and wear resistant. The fracture rate is now extremely low, approximately 1 in 10 000, so most surgeons are happy for patients with the newer ceramic prostheses to return to casual running and fitness activities.
• Some of the older style ceramics had a fracture rate more like 1-2% and therefore health professionals need to be careful with recommendations for running or impact activities in those that have had a ceramic implant in situ for some time.
• For the more extreme athlete, competing in ultramarathons and ironman events, there will be a risk analysis – the higher the exposure to repetitive impact, the greater the risk of potential failure of the implant. In such cases, a non-modular prosthesis or a resurfacing will provide least risk of failure under such conditions.
• Advantages of resurfacing for the extreme athlete:
i. Resurfacing implants are non-modular
ii. have extreme wear resistance and
iii. if failure does occur, there is the option to convert to a conventional prosthesis.

Considerations for patients who would like to return to large ROM activities, such as yoga:
• Would choose implant designs that are more appropriate for extremes of range of motion, with high dislocation resistance
i. The Dual Mobility Implant – large femoral head size and the dual bearing bearing surface of the femoral head, provide high levels of dislocation resistance
ii. Resurfacing implants are also very stable, with risk of dislocation from a posterior approach about 0.5%
iii. For those with extreme risk of dislocation or recurrent dislocations of current prosthesis, there is an option of ‘Constraint’ where the liner of the socket grips onto the femoral head

Surgical Approaches for Total Hip Replacement

The approaches are named relative to the approach to the femur, for example a surgical approach from the back of the femur is called a Posterior Approach and from the front of the femur is called an Anterior Approach. There are also some other variations such as an anterolateral approach or a transfemoral approach, which includes a trochanteric osteotomy. The two most common current approaches are Posterior and Anterior.
1. Posterior Approach
• Still most common approach in Australia, representing about 80% of joint replacements
• Advantages
i. Very reproducible operation with many different patient anatomical presentations
ii. Provides good access to the whole of the joint – important for more difficult situations with unusual bone shape or complex revisions
• Higher rates of dislocation than anterior approach, although comparable with a resurfacing procedure which is done through a posterior approach.
2. Anterior Approach
• Represents most of the remaining 20% of joint replacements
• More recently adopted in Australia in larger volumes, although the approach has been around for quite some time
• Advantages
i. More stable prosthesis with lower dislocation rate of 0.5% or less, compared with 3-4% with posterior approach. Risk of revision due to instability is substantially reduced with an anterior approach.
ii. Smaller incision with less dissection of muscles around the hip joint, so rehabilitation in the early phases might be a little better with less patient discomfort.
With modern physiotherapy and rehabilitation, both approaches do well with good outcomes in the longer term.

 

That concludes our interview series on non-surgical and surgical options for those with hip osteoarthritis, thanks to Dr Patrick Weinrauch, orthopaedic surgeon. His insights will have been valuable to you all, I’m sure. If you are not signed up to the www.dralisongrimaldi.com mailing list, sign up today to receive alerts for my monthly blogpost. Don’t forget to explore the dralisongrimaldi.com site where you’ll find a wealth of clinically applicable information on all things hip.

Learn more about
CONTEMPORARY DIAGNOSTIC & MANAGEMENT STRATEGIES FOR ANTERIOR HIP & GROIN PAIN, here

Non-surgical options for management of hip osteoarthritis: An orthopaedic perspective

Includes podcast, infographic & podcast notes. Hip Osteoarthritis can be well managed through a blended approach of activity and load modification, exercise therapy and strength and conditioning, manual therapy and a polypharmacy approach of short acting, usually oral pharmaceuticals and long acting, usually injectable pharmaceuticals. Prior to being considered as a candidate for total hip replacement or resurfacing, most patients with hip osteoarthritis will have undertaken a reasonable trial of non-surgical care. This is because there are many options for non-surgical care that can be blended for successful outcomes for a large proportion of patients until late stage pathology. This podcast will provide a better understanding of a blended approach to non-surgical management of hip OA and the relative indications, risks and benefits of the available pharmaceuticals and injectables.

Listen to the interview here:

About Associate Professor Patrick Weinrauch :

Associate Professor Patrick Weinrauch is an Orthopaedic Surgeon, founder of Brisbane Hip Clinic in Queensland, Australia. The name of his clinic says it all. He focuses exclusively on the management of hip joint disorders, with a high level of experience and expertise in a full range of surgical procedures for the hip, including hip joint arthroscopy, hip joint preservation surgery, hip resurfacing and hip replacement procedures. Dr Weinrauch is a Fellow of the Royal Australasian College of Surgeons and a Fellow of the Australian Orthopaedic Association, and not only has a busy clinical practice but contributes to education programs for other surgeons and health professionals and to scientific research in this field. Dr Weinrauch has published over 50 peer-reviewed scientific papers and is the Deputy Editor for the International Journal of Advanced Joint Reconstruction. He is currently appointed as an Associate Professor at the Griffith University School of Medicine and has been awarded a Doctorate of Philosophy and Master of Engineering for his research relating to the surgical management of adult hip joint disorders. We are very grateful to Patrick for sharing his valuable time and wisdom.

Podcast Notes

Key Point:

Non-surgical treatment very consistently works. There is a high expectation that with a coordinated program of non-surgical management that patients will often receive worthwhile benefit.

The degree of benefit may be variable, determined by:
1. limitations on what we can provide to patients due to their particular circumstances, for example their tolerance/suitability for certain medications
2. degree of wear & dysfunction – with more severe presentations, symptoms may be reduced but the outcomes may still not achieve adequate patient satisfaction

A blended approach to non-surgical management of Hip OA is usually most successful, involving the use of a number of strategies, in combination.
1. Activity modification
2. Exercise prescription/strength & conditioning
3. Other Physiotherapy modalities e.g. manual therapy
4. Long acting therapy – usually injectable
5. Short acting therapy for intermittent flares of symptoms – pharmaceutical tablets

Injectables

The role of injectable therapies is to reduce the overall symptoms – patients will still have symptoms and intermittent flares but the overall severity of symptoms will be reduced.

Types of injections:
1. Intra-articular corticosteroid injection

• Provides quite a consistent positive response but should be used sparingly
• Has limitations
i. Relatively short-lasting effect – 2-3 months
ii. Repeated CSI’s are not recommended as a longer-term strategy
• Best used for
i. Acute exacerbations e.g. for a patient who has been managing well for a long time then presents with an acute, severe flare-up and symptoms need to be settled quickly.
ii. Differential diagnosis e.g. for patients with both lumbar and hip pathology, an intraarticular hip CSI may help clarify the relative contribution of the hip to current symptoms. In this situation the steroid would usually be mixed with a local anaesthetic, for a combined diagnostic and therapeutic effect
• Risks/Contraindications
i. There is concern that corticosteroid may be detrimental to chondral health and may accelerate the degree of degenerative change
ii. Also risk of introducing infection into the joint, with any intra-articular injection. These risks are low but with higher frequency of injection comes higher risks.

2. Viscosupplementation

• Provides a longer lasting effect – variable but usually 6-18 months
• Modest effect on symptoms – commonly 30-40% reduction
• Types of pharmaceutical – Durolane, Euflexxa, Synvisc
• Procedure performed in clinic, under ultrasound guidance
• Absorbed by the synovial lining of the hip joint, which produces the lubricant (synovial fluid) for the hip joint. The pharmaceutical stimulates the synovial cells to produce thicker lubricant, increasing viscosity of the synovial fluid within the joint.
• Effect is limited to the joint that is injected
• Lag time in effect while the biological response develops
i. 50% of effect by 6 weeks
ii. Maximal effect by 3 months
• Frequency of repeat injections: Shortest timeframe for repeat injection would usually be 6 months. If symptoms are not improved for at least 6 months, persisting with repeat viscosupplementation injections is unlikely to be successful.
• Risks/Contraindications
i. Allergy – some products contain avian proteins – not suitable for those with allergy to chicken or egg. There are pharmaceuticals available without avian proteins, so selection of the particular pharmaceutical will avoid problems.

3. Platelet Rich Plasma

• Role in management of hip OA unclear at present
• Scientific evidence inadequate
• Not been shown to be more effective than viscosupplementation

4. Radiofrequency ablation/neurotomy (injection-like therapy)

• Relatively new procedure around the hip
• Involves placing needle with electrified tip close to hip joint at specific locations, to ablate small sensory nerves that serve the hip joint
• Not possible to access all sensory nerves that serve the hip joint, so the procedure will reduce but not remove all sensation from the hip joint
• When used together with viscosupplementation, see longer lasting effects in terms of symptom reduction
• Best done in a hospital under a general anaesthetic, so therefore more considerations regarding general applicability or ease of this treatment
• Therefore, tends to be used sparingly in specific scenarios, e.g. where a patient has very severe pathology and symptoms but is medically unfit for joint replacement surgery and is not responding to other non-surgical interventions

Oral Pharmaceuticals

The role of oral pharmaceuticals is to provide short acting relief for intermittent symptoms. They allow treatment of the symptoms on the day. If the patient is requiring high doses of oral pharmaceuticals regularly, management of overall symptoms is not optimal and should be reviewed.

1. Non Steroidal Anti-inflammatory Drugs (NSAIDs)

• Best used
i. short term for acute flare ups
ii. to provide a ‘pharmaceutical holiday’ from symptoms, e.g. to get through an important activity or short holiday. May take medications for a couple of days – a couple of weeks.
• Risks – regular ongoing use poses health risks
i. Gastrointestinal upset
ii. Worsening of asthma symptoms in those with asthma
iii. Risk profile increase with dose and duration of therapy
• FALSE – that a patient needs to continue take the medication continuously to get an effect. Instead, dose should be titrated depending on symptoms.
• Types of NSAIDs
i. Over the counter – Voltaren, Nurofen
ii. Prescription NSAID’s (Celebrex, Mobic) do have advantages
1. Longer acting therapies – sustained release, providing an effect over a 24 hour period, as opposed to a 6-8 hour effect from over the counter medications
2. Compliance with dosing is better as the patient only needs to take the medication once/day
3. More ‘stomach-friendly’, less gastrointestinal irritation

2. Paracetamol

• Often used together with NSAIDs in a ‘polypharmacy’ approach
• Very well tolerated for the vast majority of people & very low side effect profile
• Not strong enough to control severe symptoms, but within a blended approach with other non-surgical management strategies, paracetamol use may have some merit, even if only providing a 5-10% reduction in symptoms
• Need to take it quite frequently as most preparations are short acting, but longer-acting paracetamol preparations are now available – Panadol Osteo

Supplements

• Generally safe with a low side-effect profile. Many people have tried at least 1-2 supplements before seeing an orthopaedic specialist
• Most commonly used natural adjuncts are Glucosamine and Fish Oil
• Evidence is weak with any effect likely to be small

That it’s for Part 2 of this interview series. If you are not signed up to the www.dralisongrimaldi.com mailing list, sign up today to ensure you don’t miss the last of this great series, which will be a video interview that explores the different prostheses, surgical approaches and their indications. Don’t forget to explore the dralisongrimaldi.com site where you’ll find a wealth of clinically applicable information on all things hip.

Learn more about
CONTEMPORARY DIAGNOSTIC & MANAGEMENT STRATEGIES FOR ANTERIOR HIP & GROIN PAIN, here

Total Hip Replacement – Is it time yet?

Guidelines from Dr Patrick Weinrauch, Orthopaedic Surgeon. Includes podcast, infographic & podcast notes. Making the decision to undergo Total Hip Replacement (Total Hip Arthroplasty) is something that patients with hip osteoarthritis (OA) may agonise over – understandably so. Although this is generally a remarkably successful procedure with the potential to substantially improve function and quality of life, it is a big operation with substantial inherent risks and costs. I regularly see patients with hip OA who come to see me with a very specific question in mind – ‘Is it time yet? Is it time to get my hip replaced?’ There are many considerations that determine when ‘the right time’ might be for each individual. In this blog, we have been fortunate to receive some words of wisdom from Dr Patrick Weinrauch, Orthopaedic Surgeon, who generously shared his time and insights during an interview at Brisbane Hip Clinic, in Queensland, Australia. This information will be useful to guide your response when you next see a patient with advanced hip OA.

Listen to the interview here:

About Associate Professor Patrick Weinrauch :

Associate Professor Patrick Weinrauch is an Orthopaedic Surgeon, founder of Brisbane Hip Clinic in Queensland, Australia. The name of his clinic says it all. He focuses exclusively on the management of hip joint disorders, with a high level of experience and expertise in a full range of surgical procedures for the hip, including hip joint arthroscopy, hip joint preservation surgery, hip resurfacing and hip replacement procedures. Dr Weinrauch is a Fellow of the Royal Australasian College of Surgeons and a Fellow of the Australian Orthopaedic Association, and not only has a busy clinical practice but contributes to education programs for other surgeons and health professionals and to scientific research in this field. Dr Weinrauch has published over 50 peer-reviewed scientific papers and is the Deputy Editor for the International Journal of Advanced Joint Reconstruction. He is currently appointed as an Associate Professor at the Griffith University School of Medicine and has been awarded a Doctorate of Philosophy and Master of Engineering for his research relating to the surgical management of adult hip joint disorders. We are very grateful to Patrick for sharing his valuable time and wisdom.


Podcast Notes

The focus of our discussion was on hip osteoarthritis, a condition suffered by many all around the world. Hip Osteoarthritis is often managed very successfully for a long time with non-surgical care such as that supplied by physiotherapists, but for some, there comes a time when their symptoms and function begin to deteriorate despite their best efforts to look after their hip. Physiotherapists and general practitioners caring for these patients often get asked then, ‘Is it time yet? Is it time for surgery?’

Here, Dr Weinrauch discusses what factors he uses to guide his decision-making process around eligibility for hip replacement surgery

Key Points:

• The decision is very personal one, influenced strongly by how it is affecting the individual’s quality of life
• There is a considerable mismatch between changes on imaging and symptoms, some experiencing only mild symptoms with good function despite advanced
osteoarthritis and cartilage loss while others with more focal damage joint may experience quite severe symptoms.

Patient Interview includes:

  • Extensive clinical history
  • Pain – nature, location, severity
  • Function – What can’t you do? What have you had to give up? What would you like to achieve that you can’t because of your hip? If your hip was completely painfree, with no restriction from your hip, how would that change the quality of your life? How would it affect your sporting and recreational pursuits and your family life?

Key criteria for eligibility:

  • Severity that is impacting on function
  • Persistent pain over a longer duration of time
  • Not adequately responsive to non-surgical therapies
  • Good trial of non-operative therapies appropriate for their condition
  • Established wear on imaging modalities

Adequate previous trial of non-surgical management would typically include:

  • Education on hip care and conditioning
  • An exercise program for hip specific conditioning
  • Injectable therapies
  • Oral pharmaceuticals
  • Clear indications of patient commitment and compliance to a non-surgical management approach as an initial management strategy

Non-surgical management for osteoarthritic hips works! But there may be limitations with very advanced disease or particular presentations. It must be an appropriate, coordinated program with adequate commitment from patient.

Length of time to persist with non-surgical therapies depends on presentation.

There are two main presentations with hip osteoarthritis:

1. Slowly progressive

  • Mild symptoms for many years
  • Not particularly intrusive on function initially
  • Small modifications in activities over time – “creeps up”
  • Use oral medications and therapies intermittently
  • Slowly progressive until start to have more meaningful impact on function and quality of life
  • A longer trial of non-surgical intervention is appropriate, as they may just be having a flare which will settle again with good management

2. Rapidly progressive

  • Subclinical or non-symptomatic advanced osteoarthritis – not aware of having had an underlying hip problem
  • At some point develop very severe symptoms, very quickly
  • Often a trigger (increase/change activity, slip/fall, heavy impact e.g. missed bottom step), but not always
  • In retrospect may recall having some hip stiffness &/or an occasional ‘groin strain
  • This group would still have a trial of non-surgical care, but if problems persist, are likely to go to surgery more quickly

Pain location and behaviour associated with hip osteoarthritis

  • Most common location is mid-inguinal groin region
  • Worse with impact and deep hip flexion
  • Labral tears & focal/early chondral lesions more commonly present with localised mid-inguinal or c-sign pain
  • Features of advancing osteoarthritis
    • Patient begins to experience referred pain to anterior thigh and knee and also anterolateral shin pain is very common, occasionally in the buttock
    • Rest pain that is waking the patient. Note, be aware that gluteal tendinopathy may also commonly be associated with night pain, but the region of pain is over the greater trochanter, rather than the mid-inguinal/groin region.

Is hip replacement only recommended for older individuals?

This space has changed considerably

  • Prosthetic materials have become more refined
  • Bearing surfaces have become much more durable, with high wear-resistance
    Therefore, hip replacement has become a more viable option for younger people with severe persistent symptoms and advanced early hip osteoarthritis, after a good trial of non-surgical therapies. This is still a consideration however, for longer life expectancy and therefore greater chances of failure over life span.

 

 

Imaging Features: 

Radiographic changes (XRay)

  • Joint space narrowing
  • Subchondral sclerosis
  • Osteophyte formation
  • Geode formation (subchondral bone cysts)
    • Geodes appear on the acetabular side first
    • Presence of geodes in the femoral head indicates later stage pathology & reduced likelihood of a good outcome with non-surgical management

Magnetic Resonance Imaging

  • Early pathology
    • evident first on the acetabular side, in most people
    • anterior-superior acetabular rim most common initial region of change
  • As pathology advances
    • acetabular pathology progresses to encompass a larger area
    • then changes develop on the femoral side
  • Features that may influence potential effectiveness of joint preserving treatments:
    • Degree of hyaline cartilage wear will have a major influence
    • Labral pathology relatively less influence on outcome
  • DEGEMRIC scans
    • Not useful in advanced pathology with cartilage loss
    • Most useful in earlier stages of pathology to determine the quality of the cartilage, where thickness of the cartilage is relatively normal
    • Provides better ability to grade degree of cartilage change than standard MRI, where this can be very difficult
    • Not necessary if the patient is a candidate for hip arthroscopy, as arthroscopy provides an opportunity for direct visualisation and palpation of the cartilage surfaces to assess the degree of chondral pathology

 

That it’s for Part 1 of this interview series. If you are not signed up to the www.dralisongrimaldi.com mailing list, sign up today to ensure you don’t miss the rest of this great series where we’ll be talking about non-surgical options for management of hip OA and a video interview that explores the different prostheses, surgical approaches and their indications. Don’t forget to explore the dralisongrimaldi.com site which contains a wealth of clinically applicable information on all things hip.

Learn more about

CONTEMPORARY DIAGNOSTIC & MANAGEMENT STRATEGIES FOR ANTERIOR HIP & GROIN PAIN, here