artrose-hofte (LH Indholdsside)

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    <Content>
      <HtmlField Name="PageContent"><![CDATA[<h2>Diagnose</h2>
<h3>Diagnostiske kriterier</h3>
<ul>
    <li>Diagnosen stilles ud fra klinikken og st&oslash;ttet af r&oslash;ntgenfund</li>
    <li>Der er ikke altid sammenh&aelig;ng mellem klinik og r&oslash;ntgenfund, i s&aring; fald er klinikken afg&oslash;rende</li>
</ul>
<h3>Sygehistorie</h3>
<ul>
    <li>Gradvis udvikling af smerter lokaliseret i lysken fortil og nogle gange lateralt p&aring; l&aring;ret, ofte str&aring;lende ned mod kn&aelig;et. Kn&aelig;smerter kan v&aelig;re eneste tegn p&aring; artrose i hoften</li>
    <li>Smerterne er ofte relateret til aktivitet, og generne &oslash;ges ved meget aktivitet og mindskes ved mindre aktivitet</li>
    <li>Typisk er der igangss&aelig;tnings-smerter, som forsvinder efter nogen tid, men som kommer tilbage efter nogen tids belastning</li>
    <li>Hvile- og nattesmerter udvikles gradvist. Ved nattesmerter er tilstanden fremskreden</li>
    <li>Gangfunktionen p&aring;virkes med nedsat distance, behov for stok (bruges p&aring; modsat side) og halten</li>
</ul>
<h3>Kliniske fund</h3>
<ul>
    <li>Inspektion
    <ul>
        <li>Atrofi af gluteal- og l&aring;rmuskulatur ses ofte</li>
    </ul>
    </li>
    <li>Bev&aelig;geligheden
    <ul>
        <li>Er afficeret i tidlige stadier og har h&oslash;j pr&aelig;diktionsv&aelig;rdi for artrose</li>
        <li>Tidlige tegn p&aring; hofteledsartrose er smerte og indskr&aelig;nket passiv bev&aelig;gelighed&nbsp;</li>
    </ul>
    </li>
    <li>Kontrakturer
    <ul>
        <li>Kan opst&aring;, som oftest i flekteret, adduceret og udadroteret stilling</li>
        <li>Kontrakturer kan give en funktionel anisomeli med sekund&aelig;r skoliose</li>
    </ul>
    </li>
    <li>Hos 20 % er tilstanden bilateral, begge hofter b&oslash;r derfor unders&oslash;ges<a href="EditorPage.aspx?da=core&amp;id=%7B459F747F-3A1F-4339-B887-DA7BB7A3FC2F%7D&amp;ed=FIELD19201242559&amp;vs&amp;la=da&amp;fld=%7B850D32D3-55A1-49E4-9CDF-F0C88D91563C%7D&amp;so=%2Fsitecore%2Fsystem%2FSettings%2FHtml%20Editor%20Profiles%2FRich%20Text%20LHPH&amp;di=0&amp;hdl=H19201243076&amp;us=sitecore%5Canvi&amp;mo&amp;pe=0&amp;fbd=1" data-type="journal-reference" data-value="Lane NE, Osteoarthritis of the hip. N Engl J Med 2007;357: 1413-21" data-value-piped="Lane NE|Osteoarthritis of the hip|N Engl J Med|2007|357|1413-21" data-url="reference-link" title="Lane NE, Osteoarthritis of the hip. N Engl J Med 2007;357: 1413-21"><sup>1</sup></a></li>
</ul>
<h3>Supplerende unders&oslash;gelser i almen praksis</h3>
<ul>
    <li>Blodpr&oslash;ver
    <ul>
        <li>Kan evt. tages for at udelukke andre sygdomme s&aring;som infektion, men er ellers ikke indiceret</li>
    </ul>
    </li>
</ul>
<h3>Andre unders&oslash;gelser hos specialist</h3>
<ul>
    <li>R&oslash;ntgen
    <ul>
        <li>R&oslash;ntgenforandringer optr&aelig;der sent i artrosesygdommens forl&oslash;b</li>
        <li>Viser karakteristisk ledspalteforsn&aelig;vring, osteofytter, subkondral sklerose og cystedannelse&nbsp;</li>
    </ul>
    </li>
</ul>
<h3>Differentialdiagnoser</h3>
<ul>
    <li><a href="~/link.aspx?_id=33B41768A4164413B268ED5E1FB26938&amp;_z=z">Trochantertendinitis</a>&nbsp;(bursitis)</li>
    <li><a href="~/link.aspx?_id=BA77007FD5454D78BF5B5701D82C0135&amp;_z=z">Ischias</a></li>
    <li><a href="~/link.aspx?_id=B6A02B03C1E84B028FF1E4B58AB490AF&amp;_z=z">Piriformissyndrom</a></li>
    <li>Neoplasme - metastaser</li>
    <li>Inflammationer i gluteus medius eller tensor fascia lata</li>
</ul>
<h2>Behandling</h2>
<h3>Behandlingsm&aring;l</h3>
<ul>
    <li>Kontrollere smerter og andre gener</li>
    <li>Bevare og evt. forbedre funktionsniveau</li>
</ul>
<h3>Generelt om behandlingen</h3>
<ul>
    <li>En helhedsvurdering m&aring; altid foretages og valg af behandling m&aring; vurderes i forhold til patientens generelle helbredstilstand. Dette er ofte &aelig;ldre mennesker med supplerende gener</li>
    <li>Initielt behandles med svage analgetika og muskelstyrkende tr&aelig;ning af muskler omkring hoften. Endvidere v&aelig;gtreduktion ved behov</li>
    <li>Standardbehandlingen ved invaliderende artrose hos patienter over 50 &aring;r er inds&aelig;ttelse af hofteprotese</li>
</ul>
<h3>H&aring;ndtering i almen praksis</h3>
<ul>
    <li>Igangs&aelig;tning af tr&aelig;ning</li>
    <li>V&aelig;gttab ved behov</li>
    <li>Medicinsk smertebehandling med svage analgetika</li>
    <li>Henvisning til r&oslash;ntgen unders&oslash;gelse af hofteled</li>
    <li>Ved manglende effekt af initial behandling, da henvisning til ortop&aelig;dkirurgisk afdeling</li>
</ul>
<h3>R&aring;d til patienten</h3>
<ul>
    <li>V&aelig;gtreduktion<a href="EditorPage.aspx?da=core&amp;id=%7B459F747F-3A1F-4339-B887-DA7BB7A3FC2F%7D&amp;ed=FIELD19201242559&amp;vs&amp;la=da&amp;fld=%7B850D32D3-55A1-49E4-9CDF-F0C88D91563C%7D&amp;so=%2Fsitecore%2Fsystem%2FSettings%2FHtml%20Editor%20Profiles%2FRich%20Text%20LHPH&amp;di=0&amp;hdl=H19201243340&amp;us=sitecore%5Canvi&amp;mo&amp;pe=0&amp;fbd=1" data-type="journal-reference" data-value="Lievense AM, Bierma-Zeinstra SM, Verhagen PA, van Baar ME, Verhaar JS, Koes BW, Influence of obesity on the development of osteoarthritis of the hip: a systematic review. Rheumatology (Oxford) 2002;41: 1155-62" data-value-piped="Lievense AM, Bierma-Zeinstra SM, Verhagen PA, van Baar ME, Verhaar JS, Koes BW|Influence of obesity on the development of osteoarthritis of the hip: a systematic review|Rheumatology (Oxford)|2002|41|1155-62" data-url="reference-link" title="Lievense AM, Bierma-Zeinstra SM, Verhagen PA, van Baar ME, Verhaar JS, Koes BW, Influence of obesity on the development of osteoarthritis of the hip: a systematic review. Rheumatology (Oxford) 2002;41: 1155-62"><sup>2</sup></a>. Dette er ikke mindst vigtigt forud for en operation med inds&aelig;ttelse af protese</li>
    <li>Undg&aring; langvarigt og st&aring;ende arbejde, tunge og l&aelig;ngerevarende l&oslash;ft</li>
    <li>Fordel at ligge p&aring; maven eller p&aring; siden med pude mellem benene for at undg&aring; kontrakturer, n&aring;r man sover</li>
    <li>Fysisk aktivitet i form af cykling eller sv&oslash;mning<a href="EditorPage.aspx?da=core&amp;id=%7B459F747F-3A1F-4339-B887-DA7BB7A3FC2F%7D&amp;ed=FIELD19201242559&amp;vs&amp;la=da&amp;fld=%7B850D32D3-55A1-49E4-9CDF-F0C88D91563C%7D&amp;so=%2Fsitecore%2Fsystem%2FSettings%2FHtml%20Editor%20Profiles%2FRich%20Text%20LHPH&amp;di=0&amp;hdl=H19201243340&amp;us=sitecore%5Canvi&amp;mo&amp;pe=0&amp;fbd=1" data-type="journal-reference" data-value="Hinman RS, Heywood SE, Day AR, Aquatic physical therapy for hip and knee osteoarthritis: results of a single-blinded randomized controlled trial. Phys Ther 2007;87: 32-43" data-value-piped="Hinman RS, Heywood SE, Day AR|Aquatic physical therapy for hip and knee osteoarthritis: results of a single-blinded randomized controlled trial|Phys Ther|2007|87|32-43" data-url="reference-link" title="Hinman RS, Heywood SE, Day AR, Aquatic physical therapy for hip and knee osteoarthritis: results of a single-blinded randomized controlled trial. Phys Ther 2007;87: 32-43"><sup>3</sup></a>&nbsp;anbefales</li>
    <li>Benytte krykke/stok kontralateralt for den smertende hofte</li>
</ul>
<h3>Medicinsk behandling</h3>
<h4>Behandlingsstrategier</h4>
<ul>
    <li>Dosering
    <ul>
        <li>Behandling kan gives ved behov, intermitterende eller kontinuerlig</li>
        <li>Hos patienter med lette og moderate gener vil behandling ved behov v&aelig;re tilstr&aelig;kkelig. Det kan v&aelig;re aktuelt at give h&oslash;jere initialdose end de doser, som bruges ved kontinuerlig behandling&nbsp;</li>
    </ul>
    </li>
    <li>Kombinationsbehandling
    <ul>
        <li>Til smertelindring anvendes&nbsp;[DliActiveSubstance;6381;paracetamol]&nbsp;i rekommanderede doser</li>
        <li>Kombination af l&aelig;gemidler med forskellige virkningsmekanismer (fx&nbsp;[DliActiveSubstance;6381;paracetamol]&nbsp;og&nbsp;<a href="http://pro.medicin.dk/Laegemiddelgrupper/Grupper/213010">NSAID</a>) kan v&aelig;re nyttig hos nogle patienter. NSAID b&oslash;r ikke anvendes som l&aelig;ngerevarende behandling, men kan anvendes behovsrelateret</li>
        <li>Morfika b&oslash;r ikke anvendes<a href="EditorPage.aspx?da=core&amp;id=%7B459F747F-3A1F-4339-B887-DA7BB7A3FC2F%7D&amp;ed=FIELD15369374474&amp;vs&amp;la=da&amp;fld=%7B850D32D3-55A1-49E4-9CDF-F0C88D91563C%7D&amp;so=%2Fsitecore%2Fsystem%2FSettings%2FHtml%20Editor%20Profiles%2FRich%20Text%20LHPH&amp;di=0&amp;hdl=H15369374529&amp;us=sitecore%5Csoko&amp;mo&amp;pe=0&amp;fbd=1" data-type="journal-reference" data-value="da Costa BR, Nüesch E, Kasteler R, Husni E, Welch V, Rutjes AW, Jüni P, Oral or transdermal opioids for osteoarthritis of the knee or hip. Cochrane Database Syst Rev 2014;: CD003115" data-value-piped="da Costa BR, Nüesch E, Kasteler R, Husni E, Welch V, Rutjes AW, Jüni P|Oral or transdermal opioids for osteoarthritis of the knee or hip.|Cochrane Database Syst Rev|2014||CD003115|25229835" data-url="reference-link" data-pubmedid="25229835" title="da Costa BR, Nüesch E, Kasteler R, Husni E, Welch V, Rutjes AW, Jüni P, Oral or transdermal opioids for osteoarthritis of the knee or hip. Cochrane Database Syst Rev 2014;: CD003115"><sup>4</sup></a>&nbsp;</li>
    </ul>
    </li>
    <li>Nedtrapning
    <ul>
        <li>Hvis patienterne bliver smertefrie, b&oslash;r der g&oslash;res seponeringsfors&oslash;g</li>
        <li>Evt. kan man overg&aring; til behandling ved behov, eller intermitterende behandling</li>
    </ul>
    </li>
    <li>Det er vigtigt at diskutere bivirkninger med patienterne</li>
    <li>Ingen medikamentel behandling har dokumenteret effekt p&aring; selve brusk&oslash;del&aelig;ggelsen, hverken i positiv eller negativ retning</li>
</ul>
<h4>Medikamenter</h4>
<ul>
    <li>Svage analgetika
    <ul>
        <li>Anbefales som f&oslash;rstevalg i perioder med smerter</li>
        <li>Fx&nbsp;[DliActiveSubstance;6381;paracetamol]: 1 g x 4 i 1 - 4 &nbsp;uger<a href="EditorPage.aspx?da=core&amp;id=%7B459F747F-3A1F-4339-B887-DA7BB7A3FC2F%7D&amp;ed=FIELD19201242559&amp;vs&amp;la=da&amp;fld=%7B850D32D3-55A1-49E4-9CDF-F0C88D91563C%7D&amp;so=%2Fsitecore%2Fsystem%2FSettings%2FHtml%20Editor%20Profiles%2FRich%20Text%20LHPH&amp;di=0&amp;hdl=H19201243340&amp;us=sitecore%5Canvi&amp;mo&amp;pe=0&amp;fbd=1" data-type="journal-reference" data-value="Altman RD, Zinsenheim JR, Temple AR, Schweinle JE, Three-month efficacy and safety of acetominophen extended release for osteoarthritis pain of the hip or knee: a randomized, double-blind, placebo-controlled trial. Osteoarthritis Cartilage 2007;15: 454-61" data-value-piped="Altman RD, Zinsenheim JR, Temple AR, Schweinle JE|Three-month efficacy and safety of acetominophen extended release for osteoarthritis pain of the hip or knee: a randomized, double-blind, placebo-controlled trial|Osteoarthritis Cartilage|2007|15|454-61" data-url="reference-link" title="Altman RD, Zinsenheim JR, Temple AR, Schweinle JE, Three-month efficacy and safety of acetominophen extended release for osteoarthritis pain of the hip or knee: a randomized, double-blind, placebo-controlled trial. Osteoarthritis Cartilage 2007;15: 454-61"><sup>5</sup></a><sup>,</sup><a href="EditorPage.aspx?da=core&amp;id=%7B459F747F-3A1F-4339-B887-DA7BB7A3FC2F%7D&amp;ed=FIELD19201242559&amp;vs&amp;la=da&amp;fld=%7B850D32D3-55A1-49E4-9CDF-F0C88D91563C%7D&amp;so=%2Fsitecore%2Fsystem%2FSettings%2FHtml%20Editor%20Profiles%2FRich%20Text%20LHPH&amp;di=0&amp;hdl=H19201243340&amp;us=sitecore%5Canvi&amp;mo&amp;pe=0&amp;fbd=1" data-type="other-reference" data-value="Towheed TE, Maxwell L, Judd MG, Catton M, Hochberg MC, Wells G. Acetaminophen for osteoarthritis. Cochrane Database Syst Rev, issue 1, 2006." data-url="http://www.ncbi.nlm.nih.gov/pubmed/16437479" title="Towheed TE, Maxwell L, Judd MG, Catton M, Hochberg MC, Wells G. Acetaminophen for osteoarthritis. Cochrane Database Syst Rev, issue 1, 2006."><sup>6</sup></a></li>
    </ul>
    </li>
    <li><a href="http://pro.medicin.dk/Laegemiddelgrupper/Grupper/213010">NSAID</a>
    <ul>
        <li>Kan v&aelig;re nyttige som supplement i korte perioder med mange smerter<a href="EditorPage.aspx?da=core&amp;id=%7B459F747F-3A1F-4339-B887-DA7BB7A3FC2F%7D&amp;ed=FIELD19201242559&amp;vs&amp;la=da&amp;fld=%7B850D32D3-55A1-49E4-9CDF-F0C88D91563C%7D&amp;so=%2Fsitecore%2Fsystem%2FSettings%2FHtml%20Editor%20Profiles%2FRich%20Text%20LHPH&amp;di=0&amp;hdl=H19201243340&amp;us=sitecore%5Canvi&amp;mo&amp;pe=0&amp;fbd=1" data-type="other-reference" data-value="Towheed TE, Maxwell L, Judd MG, Catton M, Hochberg MC, Wells G. Acetaminophen for osteoarthritis. Cochrane Database Syst Rev, issue 1, 2006." data-url="http://www.ncbi.nlm.nih.gov/pubmed/16437479" title="Towheed TE, Maxwell L, Judd MG, Catton M, Hochberg MC, Wells G. Acetaminophen for osteoarthritis. Cochrane Database Syst Rev, issue 1, 2006."><sup>6</sup></a></li>
        <li>NSAID kan gives som tablet eller appliceres lokalt.</li>
        <li>NSAID kan for&aring;rsage maves&aring;r og mavebl&oslash;dning. For at undg&aring; dette kan NSAID behandling kombineres med protonpumpeh&aelig;mmer</li>
        <li>NSAID synes at kunne give hjerte-kar bivirkninger specielt ved patienter med hjerte- og karlidelser</li>
        <li>Behandling med NSAID b&oslash;r gives med mindst mulige dosis og i kortest mulige periode</li>
    </ul>
    </li>
    <li>Andre medikamenter:
    <ul>
        <li>Glukosamin har ingen&nbsp;effekt&nbsp;<a rel="noopener noreferrer" href="https://www.sst.dk/da/Udgivelser/2012/NKR-Knaeartrose" target="_blank">(NKR-kn&aelig;artrose 2012 Sundhedsstyrelsen)</a><a href="EditorPage.aspx?da=core&amp;id=%7B459F747F-3A1F-4339-B887-DA7BB7A3FC2F%7D&amp;ed=FIELD19201242559&amp;vs&amp;la=da&amp;fld=%7B850D32D3-55A1-49E4-9CDF-F0C88D91563C%7D&amp;so=%2Fsitecore%2Fsystem%2FSettings%2FHtml%20Editor%20Profiles%2FRich%20Text%20LHPH&amp;di=0&amp;hdl=H19201243340&amp;us=sitecore%5Canvi&amp;mo&amp;pe=0&amp;fbd=1" data-type="journal-reference" data-value="Runhaar J, Rozendaal RM, van Middelkoop M, Bijlsma HJW, Doherty M, Dziedzic KS, Lohmander LS, McAlindon T, Zhang W, Bierma Zeinstra S, Subgroup analyses of the effectiveness of oral glucosamine for knee and hip osteoarthritis: a systematic review and individual patient data meta-analysis from the OA trial bank. Ann Rheum Dis 2017;76: 1862-1869" data-value-piped="Runhaar J, Rozendaal RM, van Middelkoop M, Bijlsma HJW, Doherty M, Dziedzic KS, Lohmander LS, McAlindon T, Zhang W, Bierma Zeinstra S|Subgroup analyses of the effectiveness of oral glucosamine for knee and hip osteoarthritis: a systematic review and individual patient data meta-analysis from the OA trial bank.|Ann Rheum Dis|2017|76|1862-1869|28754801" data-url="reference-link" data-pubmedid="28754801" title="Runhaar J, Rozendaal RM, van Middelkoop M, Bijlsma HJW, Doherty M, Dziedzic KS, Lohmander LS, McAlindon T, Zhang W, Bierma Zeinstra S, Subgroup analyses of the effectiveness of oral glucosamine for knee and hip osteoarthritis: a systematic review and individual patient data meta-analysis from the OA trial bank. Ann Rheum Dis 2017;76: 1862-1869"><sup>7</sup></a></li>
        <li>Tramadol&nbsp;b&oslash;r undg&aring;s</li>
        <li>Opiater b&oslash;r undg&aring;s&nbsp;<a href="EditorPage.aspx?da=core&amp;id=%7B459F747F-3A1F-4339-B887-DA7BB7A3FC2F%7D&amp;ed=FIELD15369374474&amp;vs&amp;la=da&amp;fld=%7B850D32D3-55A1-49E4-9CDF-F0C88D91563C%7D&amp;so=%2Fsitecore%2Fsystem%2FSettings%2FHtml%20Editor%20Profiles%2FRich%20Text%20LHPH&amp;di=0&amp;hdl=H15369374529&amp;us=sitecore%5Csoko&amp;mo&amp;pe=0&amp;fbd=1" data-type="journal-reference" data-value="da Costa BR, Nüesch E, Kasteler R, Husni E, Welch V, Rutjes AW, Jüni P, Oral or transdermal opioids for osteoarthritis of the knee or hip. Cochrane Database Syst Rev 2014;: CD003115" data-value-piped="da Costa BR, Nüesch E, Kasteler R, Husni E, Welch V, Rutjes AW, Jüni P|Oral or transdermal opioids for osteoarthritis of the knee or hip.|Cochrane Database Syst Rev|2014||CD003115|25229835" data-url="reference-link" data-pubmedid="25229835" title="da Costa BR, Nüesch E, Kasteler R, Husni E, Welch V, Rutjes AW, Jüni P, Oral or transdermal opioids for osteoarthritis of the knee or hip. Cochrane Database Syst Rev 2014;: CD003115"><sup>4</sup></a></li>
    </ul>
    </li>
</ul>
<h3>Ikke kirurgisk behandling<a href="https://www.sst.dk/da/udgivelser/2021/NKR-Hofteartrose--ikke-kirurgisk-behandling-og-genoptraening-efter-THA" data-type="other-reference" data-value="NKR: Hofteartrose – ikke-kirurgisk behandling og genoptræning efter total hoftealloplastik" data-url="https://www.sst.dk/da/udgivelser/2021/NKR-Hofteartrose--ikke-kirurgisk-behandling-og-genoptraening-efter-THA" title="NKR: Hofteartrose – ikke-kirurgisk behandling og genoptræning efter total hoftealloplastik"><sup>8</sup></a><sup>,</sup><a href=" " data-type="journal-reference" data-value="Mechlenburg I, Reimer LU, Kjeldsen T, Frydendal T, Dalgas U, [Effect of training in the different stages of hip osteoarthritis]. Ugeskr Laeger 2021;183: " data-value-piped="Mechlenburg I, Reimer LU, Kjeldsen T, Frydendal T, Dalgas U|[Effect of training in the different stages of hip osteoarthritis].|Ugeskr Laeger|2021|183||34219643" data-url="reference-link" data-pubmedid="34219643" title="Mechlenburg I, Reimer LU, Kjeldsen T, Frydendal T, Dalgas U, [Effect of training in the different stages of hip osteoarthritis]. Ugeskr Laeger 2021;183: "><sup>9</sup></a></h3>
<ul>
    <li>Tr&aelig;ning anbefales som f&oslash;rste trin i behandling af hofteartrose</li>
    <li>Tr&aelig;ning har en symptomlindrende effekt hos personer med mild til moderat hofteartrose</li>
    <li>Ved sv&aelig;r hofteartrose kan tr&aelig;ning pr&aelig;operativt og kortvarigt postoperativ formentlig medvirke til forbedret smerte, funktionsevne og muskelstyrke</li>
    <li>Overvej at tilbyde patienter med hofteartrose neuromuskul&aelig;r/funktionel tr&aelig;ning i till&aelig;g til vanlig behandling
    <ul>
        <li>Neuromuskul&aelig;r tr&aelig;ning: Fokus på bev&aelig;gekvalitet og tr&aelig;ning af sensomotorisk kontrol og funktionel stabilitet</li>
        <li>Funktionel tr&aelig;ning:&nbsp;Dagligdagsfunktioner som for eksempel gang, trappegang og rejse/s&aelig;tte sig fra en stol</li>
    </ul>
    </li>
    <li>Overvej at tilbyde patienter med hofteartrose superviseret styrketr&aelig;ning i till&aelig;g til vanlig behandling
    <ul>
        <li>Superviseret styrketr&aelig;ning:&nbsp;Styrke&oslash;velser med ekstern modstand og med en belastning på mindst 60 % af maksimal belastning</li>
    </ul>
    </li>
    <li>Overvej at tilbyde patienter med hofteartrose manuel terapi i till&aelig;g til vanlig behandling</li>
    <li>Det er god praksis at tilbyde v&aelig;gttabsintervention til overv&aelig;gtige patienter med hofteartrose i till&aelig;g til vanlig behandling</li>
    <li>Overvej at tilbyde kombineret patientuddannelse og tr&aelig;ning i till&aelig;g til vanlig behandling til patienter med hofteartrose</li>
    <li>Se&nbsp;<a href="~/link.aspx?_id=2921EFECD0C4445CAF903F807C70FB52&amp;_z=z">film med &oslash;velser for hofte</a>&nbsp;&nbsp;&nbsp;</li>
</ul>
<h3>Akupunktur</h3>
<ul>
    <li>Har formentlig ingen eller meget lille effekt<a href="EditorPage.aspx?da=core&amp;id=%7B459F747F-3A1F-4339-B887-DA7BB7A3FC2F%7D&amp;ed=FIELD19201242559&amp;vs&amp;la=da&amp;fld=%7B850D32D3-55A1-49E4-9CDF-F0C88D91563C%7D&amp;so=%2Fsitecore%2Fsystem%2FSettings%2FHtml%20Editor%20Profiles%2FRich%20Text%20LHPH&amp;di=0&amp;hdl=H19201243340&amp;us=sitecore%5Canvi&amp;mo&amp;pe=0&amp;fbd=1" data-type="journal-reference" data-value="Manheimer E, Cheng K, Wieland LS, Shen X, Lao L, Guo M, Berman BM, Acupuncture for hip osteoarthritis. Cochrane Database Syst Rev 2018;5: CD013010" data-value-piped="Manheimer E, Cheng K, Wieland LS, Shen X, Lao L, Guo M, Berman BM|Acupuncture for hip osteoarthritis.|Cochrane Database Syst Rev|2018|5|CD013010|29729027" data-url="reference-link" data-pubmedid="29729027" title="Manheimer E, Cheng K, Wieland LS, Shen X, Lao L, Guo M, Berman BM, Acupuncture for hip osteoarthritis. Cochrane Database Syst Rev 2018;5: CD013010"><sup>10</sup></a></li>
</ul>
<h3>Kirurgi</h3>
<h4>Protesekirurgi</h4>
<ul>
    <li>Optimalt tidspunkt for kirurgi er ikke afklaret<a href="EditorPage.aspx?da=core&amp;id=%7B459F747F-3A1F-4339-B887-DA7BB7A3FC2F%7D&amp;ed=FIELD19201242559&amp;vs&amp;la=da&amp;fld=%7B850D32D3-55A1-49E4-9CDF-F0C88D91563C%7D&amp;so=%2Fsitecore%2Fsystem%2FSettings%2FHtml%20Editor%20Profiles%2FRich%20Text%20LHPH&amp;di=0&amp;hdl=H19201243340&amp;us=sitecore%5Canvi&amp;mo&amp;pe=0&amp;fbd=1" data-type="journal-reference" data-value="Lane NE, Osteoarthritis of the hip. N Engl J Med 2007;357: 1413-21" data-value-piped="Lane NE|Osteoarthritis of the hip|N Engl J Med|2007|357|1413-21" data-url="reference-link" title="Lane NE, Osteoarthritis of the hip. N Engl J Med 2007;357: 1413-21"><sup>1</sup></a>, effekten er muligvis bedre ved operation tidligt i forl&oslash;bet inden der tabes for meget muskelmasse og funktion<a href="EditorPage.aspx?da=core&amp;id=%7B459F747F-3A1F-4339-B887-DA7BB7A3FC2F%7D&amp;ed=FIELD19201242559&amp;vs&amp;la=da&amp;fld=%7B850D32D3-55A1-49E4-9CDF-F0C88D91563C%7D&amp;so=%2Fsitecore%2Fsystem%2FSettings%2FHtml%20Editor%20Profiles%2FRich%20Text%20LHPH&amp;di=0&amp;hdl=H19201243340&amp;us=sitecore%5Canvi&amp;mo&amp;pe=0&amp;fbd=1" data-type="journal-reference" data-value="Fortin PR, Penrod JR, Clarke AE, et al, Timing of total joint replacement affects clinical outcomes among patients with osteoarthritis of the hip or knee. Arthritis Rheum 2002;46: 3327-30" data-value-piped="Fortin PR, Penrod JR, Clarke AE, et al|Timing of total joint replacement affects clinical outcomes among patients with osteoarthritis of the hip or knee|Arthritis Rheum|2002|46|3327-30" data-url="reference-link" title="Fortin PR, Penrod JR, Clarke AE, et al, Timing of total joint replacement affects clinical outcomes among patients with osteoarthritis of the hip or knee. Arthritis Rheum 2002;46: 3327-30"><sup>11</sup></a></li>
    <li>St&oslash;rst effekt ses dog hos patienter med de sv&aelig;reste grader af artrose</li>
    <li>Stadige forbedringer
    <ul>
        <li>Bedre materialer og bedre design har f&oslash;rt til &oslash;get bev&aelig;gelighed, forst&aelig;rket stabilitet og nedsat slitage</li>
        <li>Hurtig mobilisering efter kirurgi&nbsp;</li>
    </ul>
    </li>
    <li>Andre typer kirurgi?
    <ul>
        <li>I sj&aelig;ldne tilf&aelig;lde kan andre former for kirurgi v&aelig;re aktuelle</li>
        <li>Dette kan v&aelig;re korrigerende osteotomier p&aring; b&aelig;kken eller femursiden. Disse indgreb udf&oslash;res oftest hos yngre patienter med hoftedysplasi med minimale eller ingen r&oslash;ntgenologiske tegn p&aring; artrose. Hos patienter over 45 &aring;r med symptomatisk hoftedysplasi og ingen tegn p&aring; artrose og ingen overv&aelig;gt kan overvejes osteotomi p&aring; b&aelig;kken<a href="https://www.ortopaedi.dk/wp-content/uploads/2023/11/2023-KKR-Behandling-af-hoftedysplasi-%E2%80%93-PAO-for-patienter-over-45-aar-inkl-hoeringssvar_uploaded.pdf" data-type="other-reference" data-value="Kort klinisk retningslinie fra Dansk Ortopædkirurgisk Selskab 2023 omkring Periacetabularosteomi (PAO) for patienter over 45 år med symptomatisk hoftedysplasi.  " data-url="https://www.ortopaedi.dk/wp-content/uploads/2023/11/2023-KKR-Behandling-af-hoftedysplasi-%E2%80%93-PAO-for-patienter-over-45-aar-inkl-hoeringssvar_uploaded.pdf" title="Kort klinisk retningslinie fra Dansk Ortopædkirurgisk Selskab 2023 omkring Periacetabularosteomi (PAO) for patienter over 45 år med symptomatisk hoftedysplasi.  "><sup>12</sup></a></li>
    </ul>
    </li>
</ul>
<h4>Langtidseffekt</h4>
<ul>
    <li>Positive effekter
    <ul>
        <li>Overlevelsen af hofteproteser (f&oslash;r revision til ny protese eller fjernelse fra leddet) er over 90 % efter 10 &aring;r, og cirka 80 % af patienterne er tilfredse</li>
    </ul>
    </li>
    <li>Negative effekter
    <ul>
        <li>For opererede patienter - l&oslash;sning af protese, infektion, luksation, fraktur omkring protese</li>
        <li>Ingen proteser sidder biologisk fastvokset, idet der kun opst&aring;r en mekanisk forbindelse mellem protese/cement/knogle pga. uj&aelig;vnheder</li>
    </ul>
    <ul>
        <li>Der kan derfor opst&aring; mikrobev&aelig;gelser i forbindelseszonerne ved brug af ekstremiteten. Disse bev&aelig;gelser medf&oslash;rer dog ikke smerter, og protesen betragtes som fast forankret</li>
        <li>De fleste proteser er imidlertid klinisk l&oslash;se efter 15-20 &aring;r</li>
        <li>Det er heller ikke us&aelig;dvanligt, at proteser l&oslash;sner sig tidligere</li>
        <li>Man m&aring; regne med en gennemsnitlig revisionshyppighed p&aring; 2,5 % efter fem &aring;r<a href="EditorPage.aspx?da=core&amp;id=%7B459F747F-3A1F-4339-B887-DA7BB7A3FC2F%7D&amp;ed=FIELD15369374474&amp;vs&amp;la=da&amp;fld=%7B850D32D3-55A1-49E4-9CDF-F0C88D91563C%7D&amp;so=%2Fsitecore%2Fsystem%2FSettings%2FHtml%20Editor%20Profiles%2FRich%20Text%20LHPH&amp;di=0&amp;hdl=H15369374529&amp;us=sitecore%5Csoko&amp;mo&amp;pe=0&amp;fbd=1" data-type="journal-reference" data-value="Espehaug B, Havelin LI, Engesæter LB, Vollset SE, Langeland N, Early revision among 12,179 hip prostheses: a comparison of 10 different brands reported to the Norwegian Arthroplasty Register, 1987 - 1993. Acta Orthop Scand 1995;66: 487 - 93" data-value-piped="Espehaug B, Havelin LI, Engesæter LB, Vollset SE, Langeland N|Early revision among 12,179 hip prostheses: a comparison of 10 different brands reported to the Norwegian Arthroplasty Register, 1987 - 1993|Acta Orthop Scand|1995|66|487 - 93" data-url="reference-link" title="Espehaug B, Havelin LI, Engesæter LB, Vollset SE, Langeland N, Early revision among 12,179 hip prostheses: a comparison of 10 different brands reported to the Norwegian Arthroplasty Register, 1987 - 1993. Acta Orthop Scand 1995;66: 487 - 93"><sup>13</sup></a></li>
        <li>Ved recidiverende hofteluksationer kan der inds&aelig;ttes specialprotese (constrained liner)</li>
    </ul>
    </li>
</ul>
<h4>Rehabilitering</h4>
<ul>
    <li>Patienten b&oslash;r efter operationen f&oslash;lge en rehabiliteringsplan - varigheden afh&aelig;nger af individuelle behov</li>
    <li>Genoptr&aelig;ningen bedrer patientens funktion</li>
    <li>Maksimal reduktion af smerter og bedring i funktion efter total hofteplastik kan tage op til 12 m&aring;neder</li>
    <li>Den nationale kliniske retningslinje for hofteartrose konkluderer at man<a href="https://www.sst.dk/da/udgivelser/2021/NKR-Hofteartrose--ikke-kirurgisk-behandling-og-genoptraening-efter-THA" data-type="other-reference" data-value="NKR: Hofteartrose – ikke-kirurgisk behandling og genoptræning efter total hoftealloplastik" data-url="https://www.sst.dk/da/udgivelser/2021/NKR-Hofteartrose--ikke-kirurgisk-behandling-og-genoptraening-efter-THA" title="NKR: Hofteartrose – ikke-kirurgisk behandling og genoptræning efter total hoftealloplastik"><sup>8</sup></a>:
    <ul>
        <li>Kun b&oslash;r anvende superviseret genoptr&aelig;ning efter n&oslash;je overvejelse, da den gavnlige effekt af supervision er usikker</li>
        <li>Kun b&oslash;r anvende superviseret styrketr&aelig;ning i till&aelig;g til vanlig behandling efter n&oslash;je overvejelse, da der ikke er fundet en klinisk relevant forskel imellem effekten af superviseret styrketr&aelig;ning og vanlig behandling</li>
        <li>Overveje at anbefale patienter, der er opereret, at overholde en grad af bev&aelig;gerestriktioner i en begr&aelig;nset tidsperiode postoperativt</li>
    </ul>
    </li>
</ul>
<h3>Forebyggende behandling</h3>
<ul>
    <li>Pr&aelig;operativt
    <ul>
        <li>V&aelig;gtreduktion og optr&aelig;ning af muskulatur har gunstig effekt p&aring; udfaldet</li>
        <li>Rygeoph&oslash;r reducerer hyppigheden af komplikationer<a href="EditorPage.aspx?da=core&amp;id=%7B459F747F-3A1F-4339-B887-DA7BB7A3FC2F%7D&amp;ed=FIELD19201242559&amp;vs&amp;la=da&amp;fld=%7B850D32D3-55A1-49E4-9CDF-F0C88D91563C%7D&amp;so=%2Fsitecore%2Fsystem%2FSettings%2FHtml%20Editor%20Profiles%2FRich%20Text%20LHPH&amp;di=0&amp;hdl=H19201243340&amp;us=sitecore%5Canvi&amp;mo&amp;pe=0&amp;fbd=1" data-type="journal-reference" data-value="Møller AM, Villebro N, Pedersen T, et al, Effect of preoperative smoking intervention on postoperative complications: a randomised clinical trial. Lancet 2002;359: 114-7" data-value-piped="Møller AM, Villebro N, Pedersen T, et al|Effect of preoperative smoking intervention on postoperative complications: a randomised clinical trial|Lancet|2002|359|114-7" data-url="reference-link" title="Møller AM, Villebro N, Pedersen T, et al, Effect of preoperative smoking intervention on postoperative complications: a randomised clinical trial. Lancet 2002;359: 114-7"><sup>14</sup></a></li>
    </ul>
    </li>
    <li>Tidlig postoperativ mobilisering
    <ul>
        <li>Hindrer komplikationer som fx pneumoni og dyb venetrombose</li>
    </ul>
    </li>
</ul>
<h2>Henvisning</h2>
<h3>Til ortop&aelig;d</h3>
<ul>
    <li>Ved manglende effekt af initial behandling (tr&aelig;ning, v&aelig;gtreduktion ved behov, medicinsk smertebehandling)&nbsp;</li>
    <li>Udtalte nattesmerter</li>
    <li>Kontrakturer</li>
    <li>Problemer med at fungere i dagliglivet p&aring; grund af hoftegener</li>
    <li>Artrose hos unge patienter</li>
    <li>I henvisningen angives de behandlingstiltag (svage analgetika, tr&aelig;ning), som har v&aelig;ret iv&aelig;rksat forud for henvisning til ortop&aelig;dkirurg</li>
</ul>
<h2>Opf&oslash;lgning</h2>
<h3>Plan</h3>
<ul>
    <li>Patienten f&oslash;lges op efter behov</li>
</ul>
<h2>Sygdomsforl&oslash;b, komplikationer og prognose</h2>
<h3>Sygdomsforl&oslash;b</h3>
<ul>
    <li>Normalt sker der en gradvis progression af tilstanden, men mange fungerer godt med konservative tiltag i lange perioder</li>
    <li>Artrose har ofte et fluktuerende forl&oslash;b, af og til med spontan forbedring af b&aring;de symptomer og ledstruktur&nbsp;</li>
    <li>Hos en del bliver de smertefri perioder efterh&aring;nden kortere med en tendens til, at smerterne varer ved, ogs&aring; under hvile og evt. med smerter om natten</li>
</ul>
<h3>Komplikationer</h3>
<ul>
    <li>Atrofi og immobilisering</li>
</ul>
<h3>Prognose</h3>
<ul>
    <li>Mange har tilfredsstillende effekt af konservative tiltag</li>
    <li>Hos patienter som opereres, vil de fleste blive betydeligt bedre. De bedste resultater opn&aring;s blandt dem med mest udtalte gener f&oslash;r operationen</li>
    <li>Data fra norsk nationalt register for ledproteser viser, at 10 % af proteserne bliver revideret i l&oslash;bet af 10 &aring;r pga. l&oslash;sning</li>
    <li>Baseret p&aring; data fra skandinaviske registre synes det som om, at 80 % af patienterne har smertefri og velfungerende hofte 10 &aring;r efter en prim&aelig;r operation med total protese</li>
</ul>
<h2>Baggrundsoplysninger</h2>
<h3>Definition</h3>
<ul>
    <li>Degenerative forandringer i hofteleddet </li>
    <li>Artrose er en samlebetegnelse for ledsygdomme, som karakteriseres af svigtende ledfunktion med varierende &oslash;del&aelig;ggelse af ledbrusk og p&aring;virkning af ledn&aelig;r knogle<a href=" " data-type="journal-reference" data-value="Dieppe PA, Lohmander LS, Pathogenesis and management of pain in osteoarthritis. Lancet 2005;365: 965-73" data-value-piped="Dieppe PA, Lohmander LS|Pathogenesis and management of pain in osteoarthritis|Lancet|2005|365|965-73" data-url="reference-link" title="Dieppe PA, Lohmander LS, Pathogenesis and management of pain in osteoarthritis. Lancet 2005;365: 965-73"><sup>15</sup></a><sup>,</sup><a href=" " data-type="journal-reference" data-value="Lane NE, Osteoarthritis of the hip. N Engl J Med 2007;357: 1413-21" data-value-piped="Lane NE|Osteoarthritis of the hip|N Engl J Med|2007|357|1413-21" data-url="reference-link" title="Lane NE, Osteoarthritis of the hip. N Engl J Med 2007;357: 1413-21"><sup>1</sup></a> </li>
    <li>Ved r&oslash;ntgenunders&oslash;gelse af et led med artrose ses forandringer som reduceret ledspalte, subkondral sklerose, osteofytter og cystedannelse</li>
    <li>Der er i mange tilf&aelig;lde diskrepans mellem r&oslash;ntgenfund og symptomer, specielt graden af smerte<a href=" " data-type="journal-reference" data-value="Lane NE, Osteoarthritis of the hip. N Engl J Med 2007;357: 1413-21" data-value-piped="Lane NE|Osteoarthritis of the hip|N Engl J Med|2007|357|1413-21" data-url="reference-link" title="Lane NE, Osteoarthritis of the hip. N Engl J Med 2007;357: 1413-21"><sup>1</sup></a></li>
</ul>
<h3>Forekomst</h3>
<ul>
    <li>Artrose forekommer hyppigst i hofteleddet</li>
    <li>Pr&aelig;valens
    <ul>
        <li>Symptomgivende prim&aelig;r artrose angives i den kaukasiske befolkning over 55 &aring;r at v&aelig;re ca. 1,6 %, og den stiger st&aelig;rkt med alderen</li>
        <li>90 % af patienter over 65 &aring;r, som klager over hoftesmerter, har artrose i hofteleddet</li>
    </ul>
    </li>
    <li>Hofteoperationer
    <ul>
        <li>&Aring;rlig inds&aelig;ttes der ca. 12.000 hofteproteser i Danmark<a href="https://danskhoftealloplastikregister.dk/wp-content/uploads/2016/04/DHR-%C3%A5rsrapport-2018_til-offentligg%C3%B8relse.pdf" data-type="other-reference" data-value="Årsrapport 2018: Dansk Hoftealloplastik Register" data-url="https://danskhoftealloplastikregister.dk/wp-content/uploads/2016/04/DHR-%C3%A5rsrapport-2018_til-offentligg%C3%B8relse.pdf" title="Årsrapport 2018: Dansk Hoftealloplastik Register"><sup>16</sup></a>&nbsp;(2018), og af disse er ca. 10 % re-operationer</li>
    </ul>
    </li>
</ul>
<h3>&AElig;tiologi og patogenese</h3>
<ul>
    <li>Artroseforandringer kommer som resultat af l&aelig;ngere tids slitage mod brusken i ledfladerne<a href=" " data-type="journal-reference" data-value="Lane NE, Osteoarthritis of the hip. N Engl J Med 2007;357: 1413-21" data-value-piped="Lane NE|Osteoarthritis of the hip|N Engl J Med|2007|357|1413-21" data-url="reference-link" title="Lane NE, Osteoarthritis of the hip. N Engl J Med 2007;357: 1413-21"><sup>1</sup></a> </li>
    <li>Bruskskaden efterf&oslash;lges af kondensering af den subkondrale knogle, dannelse af knogleudbygning (osteofytter) og mild til moderat synovial inflammation </li>
    <li>Det er p&aring;vist, at synovia udskiller proteintransmittere, som stimulerer kondrocytterne til produktion af et proteindegraderende enzym. Synovit-tilstande st&aring;r derfor centralt i artrose-patogenesen </li>
    <li>Arvelige faktorer kan have betydning for udvikling af sygdommen<a href=" " data-type="journal-reference" data-value="Lanyon P, Muir K, Doherty S, Doherty M, Assessment of a genetic contribution to osteoarthritis of the hip: sibling study. BMJ 2000;321: 1179-83" data-value-piped="Lanyon P, Muir K, Doherty S, Doherty M|Assessment of a genetic contribution to osteoarthritis of the hip: sibling study.|BMJ|2000|321|1179-83|11073507" data-url="reference-link" data-pubmedid="11073507" title="Lanyon P, Muir K, Doherty S, Doherty M, Assessment of a genetic contribution to osteoarthritis of the hip: sibling study. BMJ 2000;321: 1179-83"><sup>17</sup></a> </li>
    <li>Det skelnes mellem prim&aelig;r (idiopatisk) og sekund&aelig;r hofteledsartrose</li>
</ul>
<h3>Disponerende faktorer</h3>
<ul>
    <li>Alder </li>
    <li>Overv&aelig;gt </li>
    <li>Ledfladeinkongruens som f&oslash;lge af fraktur, <a href="~/link.aspx?_id=E666CD5F2753479CA957375F16C73E2D&amp;_z=z">mb. Calv&eacute;-Legg-Perthes</a>, epifysiolyse</li>
    <li>Ledinflammation fx<a href="~/link.aspx?_id=939AB6BE2EA74C2890648DEA4AF5E6C6&amp;_z=z">&nbsp;reumatoid artrit</a>, <a href="~/link.aspx?_id=E82C4BA484D14374B5625D94EFEB9925&amp;_z=z">psoriasis artrit</a>, septisk artrit,&nbsp;<a href="~/link.aspx?_id=2B3022F9A5604E188E7E032EDBB010FC&amp;_z=z">Mb Bechterew</a></li>
    <li>Deformiteter i b&oslash;rne- og ungdomsalderen herunder<a href="~/link.aspx?_id=579307F3581C4832B59CBED7D9A3999B&amp;_z=z">&nbsp;hofteledsdysplasi</a>&nbsp;og coxa vara </li>
    <li>Metaboliske lidelser for eksempel kondrokalcinose </li>
    <li><a href="~/link.aspx?_id=6D1FE04BD5C84ABB9860EA1204019A98&amp;_z=z">H&aelig;mofili </a>med ledbl&oslash;dninger </li>
    <li>Neuropati - Charcot-led </li>
    <li>Avaskul&aelig;r caput-nekrose </li>
    <li>Erhverv som er fysisk kr&aelig;vende, fx hvor der st&aring;s meget op, l&oslash;ft eller flytning af tunge genstande<a href=" " data-type="journal-reference" data-value="Lievense AM, Bierma-Zeinstra SA, Verhagen AP, Verhaar JAS, Koes BW, Influence of work on the development of osteoarthritis of the hip: a systematic review. J Rheumatol 2001;28: 2520-8" data-value-piped="Lievense AM, Bierma-Zeinstra SA, Verhagen AP, Verhaar JAS, Koes BW|Influence of work on the development of osteoarthritis of the hip: a systematic review|J Rheumatol|2001|28|2520-8" data-url="reference-link" title="Lievense AM, Bierma-Zeinstra SA, Verhagen AP, Verhaar JAS, Koes BW, Influence of work on the development of osteoarthritis of the hip: a systematic review. J Rheumatol 2001;28: 2520-8"><sup>18</sup></a> </li>
    <li>Deltagelse i v&aelig;gtb&aelig;rende idr&aelig;t (l&oslash;b p&aring; eliteniveau)<a href=" " data-type="journal-reference" data-value="Lievense AM, Bierma-Zeinstra SA, Verhagen AP, Bernsen RM, Verhaar JAS, Koes BW, Influence of sporting activities on the development of osteoarthritis of the hip: a systematic review. Arthritis Rheum 2003;49: 228-36" data-value-piped="Lievense AM, Bierma-Zeinstra SA, Verhagen AP, Bernsen RM, Verhaar JAS, Koes BW|Influence of sporting activities on the development of osteoarthritis of the hip: a systematic review|Arthritis Rheum|2003|49|228-36" data-url="reference-link" title="Lievense AM, Bierma-Zeinstra SA, Verhagen AP, Bernsen RM, Verhaar JAS, Koes BW, Influence of sporting activities on the development of osteoarthritis of the hip: a systematic review. Arthritis Rheum 2003;49: 228-36"><sup>19</sup></a></li>
</ul>
<h3>ICPC-2</h3>
<p>[ICPC]</p>
<h3>ICD-10/SKS-koder</h3>
<p>[ICD10]</p>
<h2>Patientinformation</h2>
<h3>Hvad du b&oslash;r informere patienten om</h3>
<ul>
    <li>At dette er en ufarlig tilstand, som i perioder kan give varierende grad af gener</li>
    <li>Vigtigheden af v&aelig;gtreduktion og tiltag beskrevet under egenbehandling</li>
</ul>
<h3>Hvad findes af skriftlig patientinformation</h3>
<ul>
    <li><a href="~/link.aspx?_id=17E70606FA664620A32D16A591713926&amp;_z=z">Information om hofteartrose</a></li>
    <li><a href="~/link.aspx?_id=D7B1EEBC5AEF46F28E7EDE14914A7DF1&amp;_z=z">Total hofteprotese</a></li>
    <li><a href="~/link.aspx?_id=4883B68F2D274554AA64B27B73795C0D&amp;_z=z">Om proteseinfektion</a></li>
    <li><a href="~/link.aspx?_id=7733A1DE69624B12AFCB54770113A729&amp;_z=z">R&aring;d til en lettere hverdag med leddegigt</a></li>
    <li><a href="https://hmi-basen.dk/news.asp?newsid=12913&amp;x_newstype=39">Hj&aelig;lpemiddelbasen, Gigt</a></li>
    <li>Podcast fra Gigtforeningen om slidgigt i hoften<a href="https://www.gigtforeningen.dk/viden-om-gigt/diagnoser/slidgigt/" data-type="other-reference" data-value="Podcast fra Gigtforeningen om slidgigt i hoften" data-url="https://www.gigtforeningen.dk/viden-om-gigt/diagnoser/slidgigt/ " title="Podcast fra Gigtforeningen om slidgigt i hoften"><sup>20</sup></a></li>
</ul>
<h3>Tr&aelig;ningsfilm for hoften</h3>
<ul>
    <li><a href="~/link.aspx?_id=818B397C2AB842C099A97B8062EFD8E3&amp;_z=z">&Oslash;velsesprogram, 3 &oslash;velser</a><br>
    &nbsp;<br>
    <a href="~/link.aspx?_id=2921EFECD0C4445CAF903F807C70FB52&amp;_z=z"><img alt="Video af øvelser til hoften. " src="9C5B771B780A41A19989427EB606036A-135-84" title="Klik for at se introduktionsvideoen" style="height: 84px; width: 135px;" height="84" width="135"></a><br>
    <br>
    </li>
    <li><a href="~/link.aspx?_id=AFFE794173B84353A6F24E26DBA2D429&amp;_z=z">&Oslash;velsesprogram, 3 &oslash;velser med arabisk tale -&nbsp;فيديوهات تمارين رياضية باللغة العربية</a><br>
    <br>
    <a href="~/link.aspx?_id=4B5988BBA14F4FB684F38176054DA4AF&amp;_z=z"><img alt="Video af øvelser til hoften på arabisk." src="737E9F0FEE87480FBBB49E2FF87F2196-135-84" title="Klik for at se introduktionsvideoen" style="height: 84px; width: 135px;" height="84" width="135"></a></li>
</ul>
<h3>Animationer</h3>
<ul>
    <li><a href="~/link.aspx?_id=DB5D9AA20A6F4A0187E7D87373AA2B5E&amp;_z=z">Slidgigt (artrose)</a></li>
    <li><a href="~/link.aspx?_id=00C45D64C94B4773AD296565E53BED4B&amp;_z=z">Slidgigt i hoften</a></li>
    <li><a href="~/link.aspx?_id=C274D735931F4CA880D0AFD350B1DF93&amp;_z=z">Inds&aelig;ttelse af kunstigt hofteled</a></li>
</ul>
<h2>Link til vejledninger</h2>
<ul>
    <li>Forl&oslash;bsbeskrivelser og pakkeforl&oslash;b [ICPC]</li>
</ul>
<h2>Illustrationer</h2>
<h3>Billeder</h3>
<ul>
    <li>
    <a href="~/link.aspx?_id=DFB62F87F5204AEBB14C954C3964F099&amp;_z=z">Coxartrose, rtg., alvorlig</a> </li>
    <li>
    <a href="~/link.aspx?_id=28FE9662F0AC451998A23BBF3E695A4C&amp;_z=z">Bilateral coxartrose, moderat og sv&aelig;r grad</a> </li>
    <li>
    <a href="~/link.aspx?_id=C3B4DD559BA6478997B810B97CEB1609&amp;_z=z">Totalprotese i hofte, rtg.</a> </li>
    <li>
    <a href="~/link.aspx?_id=6AF0F30758CB417FB2975C0148E34C76&amp;_z=z">Normal hofte, rtg.</a> </li>
</ul>
<h3>Plancher eller tegninger</h3>
<ul>
    <li>
    <a href="~/link.aspx?_id=D151452AD9C44077B47216B963126570&amp;_z=z">Normalt hofteled, tegning</a> </li>
    <li>
    <a href="~/link.aspx?_id=0FE1CB93DC2940C5BED7CBEB1E6BCB9D&amp;_z=z">Oversigt l&aring;r/hofte/b&aelig;kken, tegning</a></li>
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<h3>Diagnose</h3>
<ul>
    <li>Betydelige aktivitetsrelaterede hoftesmerter</li>
    <li>Nedsat bev&aelig;gelighed af hofteled</li>
    <li>Radiologiske tegn p&aring; artrose</li>
</ul>
<h3>Behandling</h3>
<ul>
    <li>Prim&aelig;rt symptomlindrende: tr&aelig;ning, v&aelig;gttab, medicinsk smertebehandling</li>
    <li>Total hofteprotese ved manglende effekt af ovenst&aring;ende</li>
</ul>
<h3>Henvisning</h3>
<ul>
    <li>N&aring;r tr&aelig;ning (og evt. v&aelig;gttab) har v&aelig;ret fors&oslash;gt uden effekt</li>
    <li>N&aring;r medicinsk smertebehandling ikke er tilstr&aelig;kkelig</li>
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