Hip joint disease

Hip joint disease is a common disease. According to the clinical incidence rate, approximately 30-50% of people suffer from this disease. This disease often occurs in some areas with backward medical technology. It is very different from femoral head necrosis. Judging from the patient's symptoms, there will be adverse phenomena such as pain. If it is not treated in time, it will cause lesions, and eventually the patient will lose the ability to walk freely and can only be bedridden.

1. “Hip joint disease” easily leads to “femoral head necrosis”?

In fact, hip joint disease does not mean femoral head necrosis. However, the two are quite similar in terms of film images and clinical manifestations. Therefore, many doctors, especially orthopedic doctors, tend to mistake "late-stage hip joint disease" for "femoral head necrosis" and confuse the two.

"Femoral head necrosis" is mostly caused by long-term excessive use of hormones, drinking, trauma, etc. The main pathology is "ischemia and necrosis of the bone." However, in addition to "synovial inflammation destroying the bones of the joints", hip joint diseases also affect the surrounding muscles, ligaments, etc., leading to muscle atrophy and contracture. Distinguishing the difference between the two is of great significance for treatment.

2. How high is the incidence of hip joint disease?

Answer: About 30-50% of patients will eventually develop hip joint lesions to varying degrees. There are large regional differences, and the incidence of AS in the Chinese population is significantly higher than that in other countries. According to a survey conducted by the author's unit, approximately 9% of AS patients in southern China have hip joint lesions as their first symptom. About one-third of patients with hip joint diseases suffer from hip ankylosis, and this proportion is even higher in rural, mountainous and backward areas.

3. Who is prone to hip joint disease?

Answer: A. Those who are younger (e.g. <22 years old) when the disease occurs. B. The father, mother or close relative also suffers from AS. C. People with early onset of peripheral arthritis of the knee, ankle, etc. D. The incidence of hip joint disease in women is slightly higher than that in men, and the condition is also slightly more serious. E. Those whose inflammatory indicators are significantly abnormal for a long time.

4. Is there a "dangerous period" for the occurrence of hip joint disease?

Answer: According to incomplete statistics, about 90% of hip joint diseases occur within 5 years of onset, and most of them occur within 10 years of onset. Therefore, if you survive the 5- or even 10-year "danger period", the chances of developing hip joint disease are very small. Therefore, chronic patients don’t have to worry too much.

5. What symptoms and hazards may occur with hip joint disease?

Early symptoms include severe pain in the hips, groin, inner thighs, and buttocks. Subsequently, the hip joint movement is restricted, the joint muscles atrophy, and finally ankylosis (which may be accompanied by severe osteoporosis) occurs, making daily life difficult, which is the main cause of disability caused by AS.

Many patients eventually undergo a hip replacement to restore some function. In addition to the physical pain and financial burden, patients who need "joint replacement" at a young age will inevitably need "renovation" in the long run. “A rope saws through wood, and water drips wear away a stone”; no matter how strong an artificial prosthesis is, it will inevitably wear out day after day. The muscles and ligaments around the hip joint atrophy and contract due to inflammation, which also limits the function and service life of the joint after replacement.

In addition, for patients whose disease progresses rapidly and who need joint replacement prematurely, their studies, employment, marriage, and fertility will be affected to a certain extent.

6. How should hip joint disease be treated?

Answer: Early and active treatment is particularly important. The rate of hip joint destruction should be slowed down as much as possible to avoid or delay hip replacement surgery. If the muscles around the joint are also well protected, the surgical effect will be relatively good even if the joint needs to be replaced in the future. From our practice, with active treatment within 1 to 2 years, most patients can achieve satisfactory control; some female patients can even stop taking medication and get married and have children.

Specific medication: Non-steroidal anti-inflammatory drugs (anti-inflammatory analgesics) are far from sufficient to control the disease. Hormones can be injected into the joint cavity and can temporarily improve symptoms, but oral or intravenous use is not recommended. Disease-modifying antirheumatic drugs (DMARDs), such as sulfasalazine, methotrexate, and thalidomide, have low to moderate efficacy and can mitigate joint destruction. Biological agents are effective but expensive. Because there are many types of biological agents and each has its own pharmacological characteristics, they should be selected according to one's own needs. Some Chinese patent medicines have auxiliary therapeutic effects, but their overall efficacy is limited and attention should also be paid to their side effects.