Clinical Cases Hip Replacement

Clinical Case
Ms. White, a 68-year-old female, presents to your office with a 10-year history of pain in her hip joints. Her vital signs are: Temp 98.7, BP 123/84, HR 70, RR 17. She has been a long-distance runner her whole life, until quitting about 10 years ago. She notices the pain more at the end of the day, and is usually worse in her right hip. She reports no other painful joints, except for her knees if she tries to walk too far.

1. What is the most likely diagnosis?

   Osteoarthritis (OA)- Characteristic symptoms of this disorder are pain in the large joints of the body that gets worse with use. Risk factors: history of "wear-and-tear," old age, obesity, and trauma to the joints

2. Which of the following would you expect to find on radiographic imaging?

   Osteophytes and narrow joint space. Osteophytes are the result of absent cartilage, causing 2 bones to rub against each other, creating a rugged joint surface. Joint space narrowing results from absent cartilage, causing a bone-on-bone articulation.

3. Which of the following is the best treatment option for Ms. Ruth?

   Hip replacement - Hip replacements typically do not last more than 10-15 years. Given the patient's age of 68 years, a hip replacement is the preferred treatment. Until surgery, OTC anti-inflammatory medications can be taken. For a younger patient, micro-fracture technique may be considered in cases of joint trauma.

4. How can you differentiate these symptoms from the presentation of rheumatoid arthritis (RA)?

   RA is an autoimmune disease, rather than a wear-and-tear syndrome like OA. RA typically presents with morning stiffness lasting longer than 1 hour with symmetric joint involvement. Systemic symptoms are also often present (fever, fatigue, etc.). RA patients often have inflammatory synovial fluid, "swan-neck" appearance of the digits, and characteristic involvement of MCP, PIP, and wrist joints (as opposed to DIP or the first CMC, as seen in OA).