Illnesses
hip impingement
Abnormal contact between the femur and pelvis
Femoroacetabular impingement (FAI) results from abnormal, early contact between the femoral neck and the acetabular rim. During O movement of bending of hips are two structures should not touch.
Due to the impact, early contact, the patient will complain of pain in the groin and the doctor, when examining him, will notice that there is a limitation of in some movements of the hip joint.
Femoroacetabular impingement results from changes in shape of the femur or acetabulum. When the femoral neck shows alterations in its anatomy, which is wider, we may be facing a "cam" type impact. The change in the acetabulum is called a pincer and results from the increase in coverage of the femoral head by the acetabulum, which advances its edge.
Patients with FAI complain of hip pain when sitting and always look for a different position to accommodate in the seat trying to avoid pain. The patient feels better walking than sitting.
As a consequence of the impact, injury to the acetabular labrum and acetabular cartilage occurs, these are initial degenerative injuries of the hip that can lead the patient to coxarthrosis with disabling pain, if correction is not made.
In the treatment of impact, the doctor will perform osteoplasty, bone remodeling, aiming at the correction of the anatomy of the femoral neck and/or the acetabulum, since patients can often exhibit both deformities and the impact is called the mixed type.
The results of surgical impact treatment will depend on the extent and severity of the injury. The more severe the injury, the more limited the results will be.
Osteoarthritis of the hip (coxarthrosis)
pain and disability
Osteoarthritis of the hip or coxarthrosis results from the degradation of articular cartilage. The cartilages lining the femoral head and acetabulum allow painless gliding of the joint.
Patients with osteoarthritis will mainly complain of pain and difficulty performing daily activities. In the most severe cases, there may be a complaint of pain. even the patient is at rest.
The causes of hip arthrosis can be diverse, such as previous fractures, infections, inflammatory diseases, genetic causes and bone deformities.
The treatment of hip arthrosis starts conservatively (non-surgical) with the aim of relieving pain and preserving the femoral head. The use of medication, canes, physical therapy and muscle strengthening are the most common forms of non-surgical treatment.
If conservative measures do not relieve the patient's symptoms, surgical treatment is considered, with hip arthroplasty (prosthesis) being the most commonly indicated surgery.
hip bursitis
side hip pain
Trochanteric bursitis is inflammation of the bursa on the side of the hip. Bursae are fibrofatty tissues that serve as a mattress preventing friction between tendons and bones.
About 10 to 20% of the population will develop lateral hip pain and assessment of this pain is not easy due to the large number of potential causes. In fact, the trochanteric bursa is not the only cause of lateral hip pain. The complex anatomy of the region with the various trochanteric bursae, myotendinous and fascial structures, in addition to the frequent sites that radiate pain to the region (spine, pelvis) make it difficult to interpret the pain condition.
Misinterpretations of lateral hip pain often lead to treatments that only achieve partial and temporary relief. The vast majority of patients respond to conservative treatment with medications and physical therapy. Some more resistant cases may require infiltrations and even surgery.
Osteonecrosis of the femoral head
Early treatment is ideal
Osteonecrosis of the femoral head (ONCF) is a progressive disease caused by reduced blood flow to critical levels that can lead to cell death. In addition to the circulatory disturbance, functional changes may also occur in the cells that are responsible for maintaining the structure of the femoral head.
Clinically, ONFC is manifested by pain and decreased function of the affected hip in young or middle-aged patients (20-50 years). The use of corticosteroids or consumption of alcoholic beverages, some types of anemia and genetic diseases are some of the factors associated with osteonecrosis.
In the course of osteonecrosis, the structurally compromised femoral head may fracture its surface and deform (collapse) leading to hip arthrosis. After the collapse of the femoral head, the most appropriate treatment for patients with disabling pain is surgical treatment with total hip arthroplasty.
However, our objective in the management of ONCF is the early diagnosis, before the femoral head deformity. In this situation, we will try to use therapeutic resources that preserve and even recover the diseased femoral head, avoiding hip arthroplasty. For early diagnosis, MRI is the best exam.
Recently, with regenerative medicine techniques, we can stimulate revascularization and cellular repopulation of necrotic areas of the femoral head with minimally invasive procedures.