PHYSIOTHERAPY MANAGMENT OF HIP OSTEOARTHRITIS

Osteoartritis (OA) je najčešća zglobna bolest, te je glavni uzrok kronične mišićnokoštane boli i fizičke onesposobljenosti u starijoj populaciji. Najčešće lokalizacije u kojima se bolest pojavljuje su šake (interfalangealni zglobovi i trapezometakarpalni zglob), kukovi, koljena, prvi metatarzofalangealni zglob, te zglobovi kralješnice (prvenstveno vratnog i slabinskog dijela). Javlja se podjednako u oba spola, češće unilateralno. Etiologija bolnog kuka vezana je za promjene intraartikularnih struktura (hrskavica, sinovijalna membrana, zglobna tijela), periartikularnih struktura zgloba kao i anatomskih struktura izvan područja kuka s projekcijom boli u to područje. Dob je dobro utvrđen faktor rizika za osteoartritis kuka kao i poremećaji u razvoju. Osnovni simptom osteoartritisa kuka je bol koja je prisutna u svim fazama bolesti. U ranim stadijima ona se javlja pri povećanom opterećenju i obično nestaje nakon odmora, dok je u razvijenim stadijima bolesti prisutna i u mirovanju te noću. Zbog bola i oštećenja funkcije zgloba otežan je hod i može doći do različitog stupnja invalidnosti, te i ograničenja u obavljanju profesionalne aktivnosti i svakodnevne životne aktivnosti, a što značajno smanjuje kvalitetu života ovih bolesnika. Dijagnoza osteoartritisa kuka postavlja se na temelju anamneze, inspekcije, palpacije, te ispitivanja pokretljivosti. Dva najčešće korištena standardizirana upitnika za procjenu funkcijskog stanja bolesnika s osteoartritisom su WOMAC i Lequesneov upitnik. Odabir liječenja spada u četiri glavne kategorije: nefarmakološko, farmakološko, komplemetntarno i alternativno, te kirurško liječenje. Fizioterapijska procjena provodi se u obliku SOAP modela, koji se sastoji od subjektivnog pregleda, objektivnog pregleda, mjerenja i testova te plana terapije. Fizioterapija osteoartritisa obično ima multimodalni pristup, koji uključuje vježbanje, manualnu terapiju, fizikalnu terapiju, edukaciju i savjetovanje te propisivanje pomagala za hod, ukoliko je potrebno.Osteoarthritis (OA) is the most common joint disease and is a major cause of chronic musculoskeletal pain and physical disability in the elderly population. The most common localizations in which the disease occurs are the hands (interphalangeal joints and trapezometacarpal joint), hips, knees, the first metatarsophalangeal joint, and the spine joints (primarily the cervical and lumbar joints). Disease occurs equally in both sexes, more often unilaterally. The etiology of a painful hip is related to changes in intrarticular structures (cartilage, synovial membrane, joints), periarticular structures of the joint, as well as anatomical structures outside the hip area with projection of pain into the area. Age is a well established risk factor for hip osteoarthritis as well as developmental disorders. The basic symptom of hip osteoarthritis is pain that is present in all stages of the disease. In the early stages, it occurs with increased workload and usually disappears after rest, while in the advanced stages of the disease it is present at rest and at night. Due to pain and damage to the function of the joint, walking is difficult and can lead to varying degrees of disability, as well as limitations in performing professional activities and daily life activities, which significantly reduces the quality od life of these patients. The diagnosis of hip osteoarthritis is made on the basis of history of desease, inspection, palpation and mobility tests. The two commonly used standardized questionnaires to evaluate the functional status of patients with osteoarthitis are the WOMAC and the Lequesne Questionnaire. The choice of treatment falls into four main categories: non-pharmacological, pharmacological, complementary and alternative and surgical treatment. Physiotherapy assessment is performed in the form of a SOAP method, consisting of subjective examination, objective examination, measurements and tests, and a treatment plan. Osteoarthritis physiotherapy usually has a multimodal approach, which includes exercises, manual therapy, physical therapy, education and counselling and prescribing walking aids, if necessary