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Hip Arthrosis

Hip Arthrosis


Arthrosis is a disease affecting joints, often in terms of their mechanical functioning, and which gradually destroys the joints. Also known as osteoarthritis, it is one of the most incapacitating and most common diseases in the world. It affects seven million people in Spain alone and there is great demand for treatment which leads to high healthcare spending.

With arthrosis, first the cartilage is destroyed and then there appear gradual changes to the sub-chondral bone which is left exposed. It also affects the other tissue inside the joint capsule such as the synovial membrane, ligaments, periarticular muscles and tendons. Joint degeneration may evolve rapidly or slowly and may depend on different mitigating circumstances and even on the activities the patient performs.


It is a degenerative process unlike the standard ageing process; it "progresses" gradually and is accompanied by pain and difficulties in moving which increase over time.

Hip arthrosis or coxarthrosis may be primary (idiopathy) or secondary. In the latter case, it may be due to a certain pathology or prior mitigating circumstance such as femoroacetabular impingement, hip dysplasia, childhood hip pathologies, joint infections or prior trauma injury.


Arthrosis may lead to pain, loss of mobility and deformity of the affected areas.

It is commonly characteristic that the patient complains of pain, generally in the groin and/or in the lower part of the muscle. This pain is highly localised. It tends to be related to activity and occasionally spreads towards the buttocks or towards the distal area of the thigh. The pain increases as the cartilage or periarticular structure degeneration process advances. Finally, the patient may complain of pain when resting and even when sleeping.

In the early stages of arthrosis patients tend to complaint of limited mobility concerning internal rotation and flexion and as a result it is a common complaint that it has become difficult to cut toenails or to put socks or shoes on. As the disease evolves, restricted mobility even makes it difficult to open one’s legs.

In the case of the hip, as this is a deep joint enclosed by muscle, the deformity is not apparent externally as is the case with hands or knees. However, this will show up in a simple hip X-ray.


The symptoms reported by the patient and physical examination are crucial in suspecting the presence of coxarthrosis. With a simple pelvis X-ray, the presence of arthrosis can be confirmed and it may even be possible to evaluate the severity.

In exceptional cases, other tests such as a CT scan or an MRI scan may be required.


When the arthrosis is not advanced, conservative treatment may be followed involving for example physical activity (with no impact or brusque movements), stretching exercises, rehabilitation programmes, weight control, pharmaceutical therapy (non-steroidal inflammatory medication, chondroprotective medication) or biological therapies.

The Arthroscopic Surgery Unit is a pioneer in the application of  PGRF®-Endoret® for hip arthrosis. Furthermore, its effectiveness has been proved in a number of medical studies.

In cases where the patient is unable to control the symptoms and has to continuously take medication, total hip arthroplasty is recommended (total hip replacement or THR) where the joint areas are replaced with artificial implants.

There are different types and models of prostheses. One important prosthesis is the Surface Prosthesis which comprises a large metal head, inserted over the femoral head to avoid bone wear, and a socket part, which is inserted into the socket using pressure. A prosthesis which uses less bone for when it is subsequently replaced can be used in young patients.

There are also conventional full prostheses made up of an acetubular and another femoral implant, known as a rod, which is inserted into the femoral canal once it has been prepared. Both implants can be cemented in (using biological polymethylmethacrylate cement) or non-cemented. Screws may be used to fasten the implants.

In recent years, small or short-rod prostheses have often been inserted. These implants bring together a concept of anchoring similar to that of conventional femoral rods (nails) yet in a closer area (nearer to the neck) in an aim to save femoral bone for an eventual later change.