The Aetiology of Primary Osteoarthritis of the Hip

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Abstract
Osteoarthritis of the hip was divided into those arising in the presence of normal or abnormal anatomy. The variations in the latter group included imperfect acetabular development- acetabular dysplasia-and an abnormal relationship of the femoral head to the femoral neck, comparable to the residual adult deformity of epiphysiolysis in adolescence. Osteoarthritis in the presence of normal anatomy (described as idiopathic) was found in 35% with a female to male preponderance of approximately 4.1. The average age of onset of symptoms was 57.7 years. Osteoarthritis in the presence of abnormal anatomy accounted for the remaining 65%. That associated with acetabular dysplasia represented 25.5% of the whole series and also showed a female to male preponderance of approximately 4:1 with a rather earlier average age of onset of symptoms[long dash]50.8 years. This type is probably a forme-fruste of congenital dislocation of the hip. The tilt deformity was found in 39.5% with a marked variation in sex incidence, approximately 6 males being affected for every female. The age of onset of symptoms in this group was 51.5 years. This anatomical variation may result from minor and unrecognized trauma in adolescence. These minor anatomical variations indicate joint incongruity and potential osteoarthritic change. A normal adult pelvic radiography makes the subsequent development of osteoarthritis of the hip much less likely. Earlier recognition of degenerative change may permit earlier treatment by osteotomy and arrest of the process of deterioration.

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