Coxarthrosis of the hip joint (HJ) is a degenerative-dystrophic disease that affects cartilage and bone tissue. In medical articles, it can be called differently: coxarthrosis deformity, DOA of the hip joint, osteoarthritis. All of these terms mean the same pathology - arthrosis, but "coxarthrosis" is a narrower concept that characterizes the defeat of the hip joint.
Cartilage is the first to undergo arthrosis, then the bones and surrounding structures - ligaments and muscles - are involved in the pathological process. If there are changes in the bone, the prefix "osteo" is added to the word "arthrosis". In advanced cases, the joint is deformed, and they are already talking about deformed arthrosis (osteoarthritis).
common characteristics
Deformed osteoarthritis of the hip joint is the second most common after knee gonarthrosis. Due to the deep location of the hip joint, bone defects can go unnoticed for a long time, and only X-ray images taken at a later stage will show changes.
The development of the disease is influenced by a variety of factors, including an inactive lifestyle, trauma and metabolic disorders. It is because of the specifics of modern life, where there is often no room for physical education, arthrosis affects an increasing number of people. Moreover, the peak incidence falls in the middle age group - from 40 to 60 years.
References:coxarthrosis more often affects women than men.
Development mechanism
The thigh joint is formed by two bones: the femur and the iliac (pelvis). The head of the femur enters the pelvic acetabulum, which remains immobile during movement - walking, running. At the same time, the articular surface of the femur can move in several directions, providing flexion, extension, abduction, adduction and rotation (rotation) of the thigh.
During physical activity, the femur bone moves freely in the acetabulum due to the cartilage tissue that covers the articulatory surface. The hyaline cartilage is distinguished by its strength, firmness and elasticity; it acts as a shock absorber and participates in load distribution during human movement.
Inside the joint there is synovial fluid - the synovium - which is important for lubricating and nourishing cartilage. The entire joint is enclosed in a dense, thin capsule surrounded by strong muscles in the thighs and buttocks. These muscles, also act as shock absorbers, serve to prevent injury to the hip joint.
The development of coxarthrosis begins with changes in the joint fluid, which becomes more viscous and thicker. Due to lack of moisture, the cartilage does not receive adequate nutrition and begins to dry out, loses its smoothness, and cracks appear on it.
The bones can no longer move freely as before, and rub against each other, causing micro damage in the cartilage. The pressure between the bones increases, the cartilaginous layer becomes thinner. Under the influence of increasing stress, bones gradually change shape, local metabolic processes are disrupted. In the final stage, there is significant atrophy of the leg muscles.
cause
Deformation of arthrosis of the hip joint can be primary and secondary. It is not always possible to determine the cause of primary arthrosis. Secondary arthritis appears against a background of pre -existing disease, namely:
- congenital hip dislocation or hip dysplasia;
- Perthes disease (aseptic necrosis of the femoral head);
- coxarthritis of the hip joint, which has an infectious, rheumatic or other cause;
- pelvic bone injury - dislocation, fracture.
Hip dysplasia is a congenital defect that is sometimes not clinically evident for a long time and in the future (at the age of 25-55 years) can lead to the development of dysplastic coxarthrosis.
Coxo arthrosis can be left -sided, right -sided and symmetrical. In primary arthrosis, concomitant diseases of the musculoskeletal system are often observed - in particular, osteochondrosis and gonarthrosis.
There are also risk factors that contribute to the onset of the disease:
- overweight and excessive load that burdens the joints;
- violations of blood circulation and metabolism;
- hormonal changes;
- curvature of spine, feet flat;
- old age;
- hypodynamics;
- descent.
It should be noted that coxarthrosis itself is not inherited. However, certain features of metabolism or connective tissue structure may create prerequisites for the development of arthrosis in children in the future.
Symptoms of coxarthrosis
The main symptom of arthrosis of the hip joint is pain in the hip and groin area, which has varying intensity. Stiffness and stiffness during movement, a decrease in muscle volume, shortening of the affected limb, and changes in gait due to lameness were also observed.
Coxarthrosis most often develops slowly, causing discomfort at first and mild pain after exercising. However, over time, the pain increases and appears during rest.
A typical manifestation of pathology is difficulty in hip abduction, when a person can not sit "crouched" on a chair. The presence and severity of symptoms of coxarthrosis depends on its stage, but pain syndrome is always present.
There are three degrees or types of hip joint arthrosis, varying in the severity of the injury and the accompanying symptoms:
- 1 degree. The thighs are not painful all the time, but periodically, especially after walking or standing for a long time. The pain syndrome is localized in the joint area, but sometimes it can spread to the feet to the knees. Muscles with stage 1 coxarthrosis do not decrease in size, gait does not change, motor ability is fully maintained;
- 2nd degree. The sensation of increasing pain, arises not only after running or walking, but also during rest. The pain is more often concentrated in the thigh area, but can spread to the knee. In moments of heavy load, it is painful to step on an injured limb, so the patient begins to save the leg and limp. The range of motion in the joint is reduced, it is very difficult to move the leg to the side or rotate the hip;
- 3 degrees. The pain becomes permanent and does not subside even at night. Walking style is significantly affected, free movement is very complicated, and the patient leans on a cane. The range of motion is very limited, the muscles of the back and the whole leg, including the lower leg, atrophy.
- Due to muscle weakness, the pelvis is tilted forward, the affected leg is shortened. To compensate for the difference in limb length, the patient tilts the body to the affected part when walking. This leads to a shift of the center of gravity and an increase in pressure on the affected joint.
Osteoarthritis or Osteoarthritis?
Arthritis is an inflammation of the joints, which can be disease independent or develop against a background of systemic pathology (e. g. , rheumatism). In addition to the inflammatory response, symptoms of osteoarthritis (especially in advanced stages) include limited mobility and changes in joint shape.
At the heart of degenerative-dystrophic changes in arthrosis is the defeat of cartilage tissue, which often leads to the appearance of inflammation. That is why arthrosis is sometimes called arthrosis-arthritis. And because arthrosis is almost always associated with joint deformity, the term "osteoarthritis" can be applied to it.
References:according to the international classification of diseases (ICD-10), osteoarthritis and osteoarthritis are the same type of pathology.
Diagnosis of coxarthrosis
The diagnosis of "coxarthrosis of the hip joint" is made based on examination, patient complaints and examination results. The most informative method is X-ray: in the picture you can see the degree of damage to the joints and the cause of the disease.
For example, in hip dysplasia, the acetabulum is flatter and inclined, and the cervical-diaphyseal angle (inclination of the femoral neck in the vertical plane) is larger than normal. Defects of the femur located around the joint are characteristic of Perthes disease.
Stage 3 coxarthrosis is characterized by narrowing of the joint space, expansion of the femoral head and some bone growth (osteophytes).
If the patient has a fracture or dislocation, signs of trauma will also be visible on the x-ray. If a detailed assessment of the condition of the bones and soft tissues is required, magnetic resonance imaging or computed tomography may be prescribed.
Differential diagnosis is made with the following diseases:
- gonarthrosis;
- osteochondrosis and radicular syndrome arising on its background;
- trochanteritis (inflammation of the trochanter bone of the thigh);
- ankylosing spondylitis;
- reactive arthritis.
The decrease in muscle volume that accompanies 2nd and 3rd degrees of coxarthrosis can cause pain in the knee area. Moreover, the knee often hurts more than the hip joint itself. To confirm the diagnosis and rule out gonarthrosis, X-rays are usually sufficient.
With spinal diseases - osteochondrosis and pinched nerve roots - the pain is very similar to coxarthrosis. However, it happens unexpectedly, after unsuccessful movements, sharp turns of the body or weight lifting. The sensation of pain starts in the gluteal area and spreads to the back of the foot.
Radicular syndrome is characterized by severe pain when lifting a straight limb from a supine position. However, there are no difficulties during lateral leg abduction, such as coxarthrosis. Keep in mind that osteochondrosis and arthrosis of the hip joint are often diagnosed simultaneously, so a comprehensive examination is required.
Trochanteritis, or trochanteric bursitis, develops rapidly, in contrast to arthrosis, which can slowly develop over years and even decades. The pain syndrome forms within a week or two, while it is quite intense. The cause of trochanteritis is trauma or excessive exercise. Unlimited movement and legs are not shortened.
Ankylosing spondylitis and reactive arthritis can also be accompanied by symptoms that mimic coxarthrosis. A special feature of the disease is the appearance of pain especially at night. The hips may hurt quite badly, but when walking and moving, the pain subsides. In the morning, the patient worries about stiffness, which disappears after a few hours.
Treatment of arthrosis of the hip joint
Coxarthrosis can be cured conservatively or surgically. The choice of treatment method depends on the stage and nature of the course of the pathological process. If diagnosed with 1 or 2 degrees of the disease, it is treated with medication and physiotherapy. After relieving acute symptoms, therapeutic exercises and massages are added to them. If necessary, a special diet is prescribed.
The sooner coxarthrosis is detected and treated, the better the prognosis. With the help of drugs and therapeutic measures, you can significantly slow down the pathological process and improve the quality of life.
Nonsteroidal anti-inflammatory drugs (NSAIDs) are used to relieve pain and inflammation. It should be noted that anesthesia is carried out in the shortest possible period, because NSAID class drugs can negatively affect the gastrointestinal tract and slow down the regeneration process in cartilage tissue.
It is possible to accelerate cartilage recovery with the help of chondroprotectors. However, these funds are effective only in the early stages of the disease, when the hyaline cartilage is not completely destroyed. Chondroprotectors are prescribed in the form of tablets or intra-articular injections.
To increase the blood supply to the joints, vasodilators are used. For muscle cramps, muscle relaxants are advised.
In cases of persistent pain syndrome, which is difficult to eliminate with pills, injections are made into the hip joint. Corticosteroids relieve inflammation and pain well.
Drug therapy can also be supplemented with topical agents - ointments and gels. They have no obvious effect, but they help relieve muscle cramps and reduce pain.
Physiotherapy helps improve blood circulation and cartilage nutrition. For coxarthrosis, procedures such as shock wave therapy (SWT), magnetotherapy, infrared laser, ultrasound and hydrogen sulfide baths have proven themselves very good.
Operation
Treatment of stage 3 osteoarthritis can only be through surgery, because the joint is almost completely destroyed. To restore hip joint function, partial or total arthroplasty is performed.
Surgical treatment is used in advanced cases of arthrosis, when conservative therapy is not powerful.
In partial prosthetics, only the head of the femur is replaced with an artificial prosthesis. Total prosthetics are meant to replace both the femoral head and the acetabulum. Surgery is performed under general anesthesia, and in most cases (about 95%), hip joint function is fully restored.
During the recovery period, patients are given antibiotics to prevent infectious complications. Sutures were removed on days 10–12 and exercise therapy was initiated. The treating physician helps the patient learn to walk and distributes the load properly on the operated limb. Exercise is an important step to increase muscle strength, endurance, and elasticity.
Work capacity is restored on average 2-3 months after surgery, but for older people this period can be up to six months. Upon completion of rehabilitation, the patient can move fully, work and even play sports. The service life of the prosthesis is at least 15 years. To replace the worn prosthesis, a second surgery is performed.
Effect
Without timely and adequate treatment, coxarthrosis can not only worsen quality of life, but also lead to disability and disability. Already in the second stage of arthrosis, patients are assigned the 3rd deformity group.
When shortening the affected limb by 7 cm or more, when a person moves only with the help of improvised means, a second group is assigned. The first group of defects is received by patients with stage 3 coxarthrosis, accompanied by complete loss of motor ability.
Indications for medical and social examination (MSK) are:
- a long course of arthrosis, more than three years, with frequent exacerbations. The frequency of exacerbations is at least three times every 12 months;
- undergo endoprosthetic surgery;
- severe disorders of limb musculoskeletal function.
Prophylaxis
The main measures to prevent coxarthrosis are diet (if you are overweight) and regular, but moderate physical activity. It is very important to avoid injuries to the pelvic area and hypothermia.
With the presence of risk factors for the development of arthrosis, as well as all patients with the diagnosed disease, swimming is beneficial. Sports such as running, jumping, football and tennis are not encouraged.