Degenerative Joint Disease (DJD)
Macroscopic & Microscopic Appearance of Normal vs. Damaged Articular Hyaline Cartilage by DJD
Hip Osteoarthritis (OA) aka Osteoarthrosis
- Symptomatic and potentially disabling DJD
- Progressive damage and loss of the articular cartilage causing denudation and eburnation of articular bone
- Cystic changes, osteophytes and gradual joint destruction
- Develops d/t repeated joint loading and microtrama
- Obesity, metabolic/genetic factors
- Secondary Causes: trauma, FAI syndrome, osteonecrosis, pyrophosphate crystal depostion, previous inflammatory arthritis, Slipped Capital Femoral Epiphysis, Leg-Calves-Perthes disease in children etc.
- Hip OA, 2nd m/c after knee OA. Women>men
- 88-100 symptomatic cases per 100000
Radiography is the Modality of Choice for the Dx and Grading of DJD
- Special imaging is not required unless other complicating factors exist
- Acetabular-femoral joint is divided into superior, axial and medial compartments/spaces
- Normal joint space at the superior compartment should be 3-4-mm on the AP hip/pelvis view
- Understanding the pattern of hip joint narrowing/migration helps with the DDx of DJD vs. Inflammatory arthritis
- In DJD, m/c hip narrowing is superior-lateral (non-uniform) vs. inflammatory axial (uniform)
AP Hip Radiograph Demonstrates DJD
- With
non-uniform loss of joint space (superior migration), large subcortical cysts and subchondral sclerosis - Radiographic features:
- Like with any DJD changes: radiography will reveal L.O.S.S.
- L: loss of joint space (non-uniform or asymmetrical)
- O: osteophytes aka bony proliferation/spurs
- S: Subchondral sclerosis/thickening
- S: Subcortical aka subchondral cysts “geodes”
- Hip migration is m/c superior resulting in a “tilt deformity”
Radiographic Presentation of Hip OA May Vary Depending On Severity
- Mild OA: mild reduction of joint space often w/o marked osteophytes and cystic changes
- During further changes, collar osteophytes may affect femoral head-neck junction with more significant jint space loss and subchondral bone sclerosis (eburnation)
- Cyst formation will often occur along the acetabular and femoral head subarticular/subchondral bone “geodes” and usually filled with joint fluid and some intra-articular gas
- Subchondral cysts may be occasionally very large and DDx from neoplasms or infection or other pahtology
Coronal Reconstructed CT Slices in Bone Window
- Note moderate joint narrowing that appears non-uniform
- Sub-chondral cysts formation (geodes) are noted along the acetabular and femoral head subchondral bone
- Other features include collar osteophytes along head-neck junction
- Dx: DJD of moderate intensity
- Referral to the Orthopedic surgeon will be helpful for this patient
AP Pelvis (below first image), AP Hip Spot (below second image) CT Coronal Slice
- Note multiple subchondral cysts, sever non-uniform joint narrowing (superior-lateral) and subchondral sclerosis with osteophytes
- Advanced hip arthrosis
Severe DJD, Left Hip
- When reading radiological reports pay particular attention to grading of hip OA
- Most severe (advanced) OA cases require total hip arthroplasty (THA)
- Refer your patients to the Orthopedic surgeon for a consultation
- Most mild cases are good candidate for conservative care
Hip Arthroplasty aka Hip Replacement
- Can be total or hemiarthroplasty
- THA can be metal on metal, metal on polythelen and ceramic on ceramic
- Hybrid acetabular component with polyethelen and metal backing is also used (above right image)
- THA can be cemented (above right image) and non-cemented (above left image)
- Non-cemented arthroplasty is used on younger patients utilizing porous metallic parts allowing good fusion and bone ingrowth into the prosthesis
Failed THA May Develop
- Most develop within
first year and require revision - Femoral stem may fracture (above left)
- Postsurgical infection (above right)
- Fracture adjacent to prosthesis (stress riser)
- Particle disease
Femoroacetabular Impingement Syndrome
- (FAI): abnormality of normal morphology of the hip leading to eventual cartilage damage and premature DJD
- Clinically: hip/groin pain aggravated by sitting (e.g. hip flexed & externally rotated). Activity related pain on axial loading esp. with hip flexion (e.g. walking uphill)
Pincer type acetabulum: > in middle age women potentially many causes- CAM-type deformity: > in men in 20-50 m/c 30s
- Mixed type (pincer-CAM) is most frequent
- Up until the 90s FAI was not well-recongnised
FAI Syndrome
- CAM-type FAI syndrome
- Radiography can be a reliable Dx tool
- X-radiography findings: osseous bump on the lateral aspect of femoral head-neck junction. Pistol-grip deformity. Loss of normal head sphericity. Associated features: os
acetabule , synovial herniation pit (Pit’s pit). Evidence of DJD in advanced cases - MRI and MR arthrography (most accurate Dx of labral tear) can aid the diagnosis of labral tear and other changes of FAI
- Referral to the Orthopedic surgeon is necessary to prevent DJD progression and repair labral abnormalities. Late Dx may lead to irreversible changes of DJD
AP Pelvis: B/L CAM-type FAI syndrome
Pincer-Type FAI with Acetabula Over-Coverage
- Key radiographic signs: “Cross-over sign” and abnormal center-edge and Alfa-angle evaluation methods
Dx of FAI
- Center-edge angle (above the first image) and Alfa-angle (above the second image)
- B/L CAM-type FAI with os acetabule (above right image)
MR Arthrography
- Labral tear and CAM-type FAI syndrome on axial (above left) and coronal T2 W (above right) MR arthrography
- Note acetabula labral tear. Referral to orthopedic surgeon is required. For more information:
- https://radiopaedia.org/articles/femoroacetabular-impingment-1
Hip Pelvis Arthritis & Neoplasms
Advanced Chiropractic & Wellness Authority ⚕ Healthcare Educator • Injury, Sciatica Specialist • 915-850-0900 📞
We Welcome You 👊🏻.
Purpose & Passions: I am a Doctor of Chiropractic specializing in progressive, cutting-edge therapies and functional rehabilitation procedures focused on clinical physiology, total health, practical strength training, and complete conditioning. We focus on restoring normal body functions after neck, back, spinal and soft tissue injuries.
We use Specialized Chiropractic Protocols, Wellness Programs, Functional & Integrative Nutrition, Agility & Mobility Fitness Training and Cross-Fit Rehabilitation Systems for all ages.
As an extension to effective rehabilitation, we too offer our patients, disabled veterans, athletes, young and elder a diverse portfolio of strength equipment, high-performance exercises and advanced agility treatment options. We have teamed up with the cities premier doctors, therapist and trainers to provide high-level competitive athletes the possibilities to push themselves to their highest abilities within our facilities.
We’ve been blessed to use our methods with thousands of El Pasoans over the last three decades allowing us to restore our patients’ health and fitness while implementing researched non-surgical methods and functional wellness programs.
Our programs are natural and use the body’s ability to achieve specific measured goals, rather than introducing harmful chemicals, controversial hormone replacement, un-wanted surgeries, or addictive drugs. We want you to live a functional life that is fulfilled with more energy, a positive attitude, better sleep, and less pain. Our goal is to ultimately empower our patients to maintain the healthiest way of living.
With a bit of work, we can achieve optimal health together, no matter the age or disability.
Join us in improving your health for you and your family.
It’s all about: LIVING, LOVING & MATTERING! 🍎
Welcome & God Bless
EL PASO LOCATIONS
Central:
6440 Gateway East, Ste B
Phone: 915-850-0900
East Side:
11860 Vista Del Sol, Ste 128
Phone: 915-412-6677
Comments are closed.