Leg Pain

The Hip Joint, Osteoarthritis, Bursitis Syndrome

The hip joint is a complex joint with movement in three directions Flexion/Extension, Abduction/Adduction, Horizontal Flexion/Extension. The ball of the head of the femur articulates with the concave surface of the acetabulum of the Ischium, one of the 3 bones that make up the pelvis. It is the best example of the Ball and socket Joint in the body. The joint is held together by ligaments surrounding the joint. Some ligaments are thicker and stronger than others. The joint is a synovial joint with articular cartilage lining both sides of the joint.

Dislocations of the hip can cause tears in the ligaments. There is a vital ligament that connects from the top of the femur to the acetabulum, the ligamentum Teres. Nerves, veins and the major artery to the head of the femur passes through this ligament. This artery supplies the top of the femur, from the femoral neck upwards. Disruption of the blood flow by dislocation or disease can lead to avascular necrosis or the death of the bone. This most often happens when the Neck of Femur is fractured in a fall in the elderly. The blood flow is compromised and the result is a Total Hip Replacement.

Because the hip is a weight bearing joint it is one of the stoutest joints in the body. It is surrounded by thick, strong muscles that Flex , Extend, ABduct (out to the side) (the Gluteal muscles) or ADduct (bring the leg to midline),(Adductor Magnus). Some of the muscles are classified as two joint muscles. The Quadriceps group of four muscles passes from the pelvis to the tibia in the front of the thigh and flex the hip as well as extend the knee. The Hamstring group of muscles pass from the pelvis to the tibia at the back of the thigh and extend the hip or flex the knee. There are thin wiry or small muscles as well that rotate the hip or control movements like crossing the legs.

Osteo and Rheumatoid Arthritis

These are the main diseases that affect the hip joint. The joint wears out from over use or a systemic disease process develops in the synovial linings and articular cartilage of the joint. These diseases are best managed with physiotherapy, exercises and medication, however when pain becomes too extreme a Total Hip Replacement THR is the best treatment option. This can involve the whole hip being replaced or just the articular surface. Modern advances in THR technology allows the hip to be inserted for over 20 years as the wear on the bone-metal interfaces are greatly reduced, thus extending the time that it takes for the prosthesis to breakdown.

Physiotherapy is recommended post surgery to help guide the patient on their rehabilitation and strengthen the joint. The muscles will not function correctly if they have been dealing with an arthritic joint for some time and need to be re-educated to control the new hip joint.