Distinct types of hip disorder in Mseleni joint disease

Painful arthropathy of the hips is common in the black population around Mseleni in northern Kwazulu. Despite considerable variability in clinical and radiographic appearance, the disorder has always been regarded as a single entity. This study addressed the possibility that 'Mseleni joint disease' embraces more than one condition. In a survey of 1659 people in the Manguzi Health Ward, 60 km north of Mseleni, 126 were reported to have hip pain and/or impaired walking ability; 92 of these subjects were examined radiographically. Osteo-arthritis (OA) of the hips was found in 33 cases, the prevalence increasing with age to over 16% in those aged over 60 years. In most cases the OA was associated with two distinct abnormalities: protrusio acetabuli, which affects mainly females and increases in frequency with age, and hip dysplasia, which has a constant frequency with age. The protrusio disorder is fairly common among women of other black populations and is attributed to environmental factors. The hip dysplasia is unique to the population around Manguzi; it is part of a generalized condition indistinguishable from multiple epiphyseal dysplasia, which is a known genetic disorder.