Chapter 39 The Hip

The hip is a ball-and-socket joint formed by the head of the femur and the cup-shaped acetabulum. The joint allows a considerable range of movement in different planes and is still inherently stable because of its bony anatomy and the static and dynamic stabilisers. Avascular necrosis (AVN), or osteonecrosis of the femoral head, occurs because of an interruption in the blood supply to the femoral head, leading to bone death. AVN usually affects men aged 35–45 and is bilateral in over 50% of patients. A weight-bearing anteroposterior radiograph of the pelvis along with a lateral radiograph will show the classical features of AVN, including increased sclerosis in the early stages and the crescent sign indicating subchondral bone resorption. Femoroacetabular impingement has recently been recognised as a cause of hip pain in the young adult and may lead to secondary hip osteoarthritis. Hip dysplasia is a condition in which there is under-coverage of the femoral head, secondary to a shallow acetabulum.

Multiple Choice Questions
Weblinks

Journal articles

https://www.researchgate.net/publication/282699397_Femoroacetabular_impingement_A_cause_for_osteoarthritis_of_the_hip/ (free)

Femoroacetabular impingement was proposed by Ganz et al. in 2003 as a cause for the development of osteoarthritis.

https://link.springer.com/article/10.1007%2Fs00264-017-3431-4/ (free)

Extra-articular hip impingement can be a source of hip pain that has to be differentiated from intra-articular causes. This article details current concepts in the diagnosis and management of extra-articular hip impingement syndromes.

https://link.springer.com/article/10.1007%2Fs00167-020-06354-1/ (free)

Lateral hip pain can be a debilitating condition affecting 1.8 patients per 1000 per year. This article provides an evidence-based update of the relevant literature focusing only on the pathoanatomy, clinical assessment and diagnosis of pathology in the peritrochanteric space.

https://www.sciencedirect.com/science/article/pii/S0883540318302262?via%3Dihub/ (free)

Periprosthetic joint infections (PJIs) pose a challenge to the treating surgeon. This article provides an update on the management of PJIs.

Databases

https://www.njrcentre.org.uk/

Registries are useful for monitoring long-term outcomes of procedures. The National Joint Registry is one such registry in the UK that contains data on all joint replacement performed in the UK.

https://www.nahr.co.uk/

The Non-Arthroplasty Hip Registry has a database of all non-arthroplasty hip surgery performed in the UK. This helps to monitor long-term outcomes in this cohort of patients.

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