HIP-JOINT DISEASE.
Definition.—What is usually known as "hip-joint disease" is a tuberculosis of the hip-joint; but tuberculosis, by no means, includes all the diseases which may affect the hip. The hip may be affected by tuberculosis, by syphilis, by rheumatism, and by a variety of acute infectious processes subsequent to the occurrence of some acute infectious dis ease in other parts of the body, or may be the seat of a simple synovitis caused solely by trauma. A synovitis of the hip is usually associated with ostitis, but a synovitis may exist independent of ostitis and subside without the occurrence of any involvement of the bones.
The hip-joint is also the seat of arthri tis deformans and Charcot's disease, though the latter is rare; and occasion ally loose bodies are found in it. Malig nant tumors also may affect the hip.
Functional affections of the joint are usually traumatic neuroses, but may be considered here.
Symptoms.—The symptoms of inflam mation in the hip vary somewhat, accord ing to the character of the inflammation present. If the hip is the seat of an acute synovitis, pain will be felt in the hip itself, which will be intensified by movement of the joint or by pressure over the neck of the femur at a point between the great trochanter and the crest of the ilium. The position of the limb is very characteristic. The thigh is flexed upon the abdomen, abducted, the toes everted, and the entire limb rotated outward. This position allows the cap sule to contain the largest amount of fluid, and, in consequence, is the position of ease which the joint naturally assumes when overdistended. In cases of this sort, also, there is usually a distinct his tory of a traumatism immediately pre ceding the occurrence of pain. These cases are also extremely sensitive to any sort of motion. In standing the patient bears all the weight of the body upon the sound side, and in consequence of the position of the affected thigh, the gluteo femoral crease on this side is much less distinctly marked than on the well but tock. In cases where the joint is the seat of an acute infection, following measles, scarlet-fever, or the like, the same train of symptoms will be present, though the progress of the disease will be much more rapid, while, combined with the local symptoms, will be found those of general systemic infection, and under these cir cumstances disintegration of the joint may progress with remarkable activity.
In syphilis of the hip, on the contrary, the disease may have been present for months without the occurrence of pain sufficient to attract the parents' atten tion. It is only when a marked limp be comes noticeable that medical advice is sought, and in some of these cases when marked deformity is present and joint spasm is very pronounced, manipulation seems to give rise to but trifling incon venience, and the parents at times are loath to believe that serious trouble ex ists, because the child complains so very little.
In tuberculosis of the hip the pain at the outset is not apt to be marked; but, should an abscess form in the femur or the disease progress until the cartilage becomes involved, the pain becomes most exquisite, children often crying severely from the jar occasioned by a person walk ing on the floor, and so shaking the bed. • In some of these cases there is a dis tinct history of traumatism, and in others it seems impossible to find precisely when the disease began. Many of the cases which come to the surgeon with the history that the first symptoms were noted by the parents a few days previous, being evidently of very long standing. The inattention of the parents to the trifling limp which the child exhibits, and the fact that it did not at first com plain of pain sufficiently to attract their attention, being responsible for this. Quite frequently these children complain of being stiff on rising in the morning, and exhibit a decided limp, but after having been at play for some hours they run in almost a natural manner, and so little is thought of it. In some cases this limp gets better and may almost disap pear for a number of weeks, occasionally a couple of months, then reappear in a still more aggravated form, to subside once more, and again reappear. It is un usual, however, for cases to pursue this course, and the majority grow progress ively worse, and do not, unless treated, exhibit these periods of freedom from symptoms.