Kelgren and Lawrence have produced a useful, and relatively straight forward grading system for X-rays of the arthritic hip. It considers the following criteria:
"Doubtful narrowing of joint space and possible osteophytic lipping."
Note in the above X-ray:
"Definite osteophytes, definite narrowing of joint space."
Notice again the presence of a "Pincer" deformity. Earlier this was simply categorised as early osteoarthritis. Now we know it's simply a feature of Femero Acetabular Impingement Syndrome, a condition that in it's early phase responds extremely well to Chiropractic management of the hip, and even in it's more advanced phase, responds moderately well.
Prevention, it is better than a cure.
Neglected it progresses unerringly as in this Kellgren Lawrence grade II case.
"Moderate multiple osteophytes, definite narrowing of joints space, some sclerosis and possible deformity of bone contour."
This is a letter received recently:
"I am 52-years old with serious arthritis of the hip. Medical treatment to date has not helped and they recommend surgery.
I saw a chiropractor because I had a marked limp and a lot of pain. After only a few treatments the pain and limp are virtually gone.
Thank you for your website."
These are the X-rays that J sent me. I suggested she send her chiropractor a bottle of excellent red wine. Maybe a case! Notice the multiple osteophytes, the loss of joint space and the deformity of bone contour of the femoral head. This is verging on Grade 4. Well done, doc.
Notice too the CAM deformity: Femoral Acetabular Impingement Syndrome FAIS, in my opinion should be part of the routine chiropractic examination of each and every patient, especially the young patient.
It takes only 60 seconds to do range of motion tests of the hips after all. Detected at 25, with the correct chiropractic management, I believe this progression to the pain and disability of an arthritic hip, and likely total hip replacement could be prevented.
"Large osteophytes, marked narrowing of joint space, severe sclerosis and definite deformity of bone contour."
The next two views are not from a Chiropractic clinic. Frankly I think it unlikely that Chiropractic can help a Kellgran Lawrence Grade 4. Time to find a good orthopaedic surgeon.
If you have a short leg, ask him if s/he can compensate for it. If your pelvis is level, plead with him to make sure that are still level after the surgery!
LEG LENGTH INEQUALITY explains the significance of a short leg.
Typical features of how developmental hip dysplasia if not carefully managed leads unerringly to hip arthritis. Notice the shallow socket, the sloping acetabulum and the unroofed femoral head.
Clinical note: every young person complaining of groin pain needs a thorough hip examination, including X-ray. If the range of motion is increased a clear distinction needs to be made: is this hypermobility of the hip OR hip dysplasia. The former can lead a relatively normal life, but in a case like the one above, the young patient with hip dysplasia must accept that some limitation of certain activities is vital if they are to escape disability, pain and total hip replacement.
In both these two X-rays we see the typical features of a Kellgren Lawrence Grade 4: This large osteophytes, the dramatic sclerosis, the complete loss of joint space superiorally, altered bony contour and cysts within both the acetabulum and ball.
And in the first the presence of Developmental Hip Dysplasia, and the second a CAM deformity in Femoro Acetabular Impingement Syndrome.
In the examination of the hip, DDH has a pronounced INCREASED range of motion, whereas in FAIS the ROM is DECREASED. In the young adult, a decreased Hip ROM should immediately raise suspicion of FAIS. Treated promptly with chiropractic... a stitch in time...
Sometimes it may be tragic if FAIS or DDH is detected in a young sportsman or woman, but in my opinion they should be immediately advised to live a normal active life, but extreme sports are strictly contraindicated.
The child with DDH is often hypermobile and will excel at gymnastics, but later in life....
I have taken an active interest in treating the arthritic hip for more than five years now. I have no figures or research to back me up, but in my experience the obese patient is not likely to respond to the chiropractic management of the arthritic hip. Nor any other treatment, apart from surgery of course.
Unless they are ready to commit to a weight loss programme, I will no longer accept them as a patient. It's a waste of their money, and our time. Sometimes you have to be cruel to be kind...FREE WEIGHT LOSS PROGRAMS ...
For the hyaline cartilage to regenerate, which research in the Netherlands proves it can, it needs to be "unloaded" (= weight-loss), the joint needs to be set in movement (= Chiropractic) and the synovial fluid must contain the right ingredients. A rich soup, fully oxygenated (I have no figures, but I'm fairly sure smokers are less likely to respond well to the chiropratic management of hip arthritis) and rich in glucosamine and chondroitin sulphate.
Unfortunately research shows that patients with hip arthritis do
not respond any better with glucosamine chondroitin suplphate in tablet
form, than patients on a placebo.
GLUCOSAMINE CHONDROITIN sulphate ...
So my nutritional programme for patients with hip arthritis is:
Kellgren Lawrence grading scale measures how bad your arthritis is?