Osteoarthritis of the hip joint (coxarthrosis) is a chronic pathology accompanied by the gradual destruction of the cartilage tissue of the affected area, followed by the involvement of surrounding structures in the process. The disease requires long-term treatment and in severe cases, the only way to restore mobility is to replace the joints.
General Information
Coxarthrosis belongs to the group of degenerative diseases. It begins gradually with microscopic changes in the cartilage structure. Increased stress, inflammatory diseases, disruption of the blood supply lead to structural transformations and thinning of cartilage tissue, and they, in turn, deform the contours of the joint zone. As a result, the load distribution on the contact surfaces of the bones changes and the zones with the maximum pressure begin to wear faster. This causes a whole cascade of abnormal reactions:
- The appearance of microcracks and compaction areas in the cartilage tissue;
- Reducing the smoothness of joint surfaces;
- Excessive growth of cartilage at the site of thinning and its replacement by bone tissue;
- The appearance of osteophytes (bone formations) along the edges of the joint site;
- Thickening of the joint capsule and reduction of elasticity;
- Ligament hardening and reduced strength;
- Changes in the composition of synovial fluid (natural lubrication inside the joint);
- Narrowing of the joint space;
- Merge all elements of the joint (ankylosis).
Without treatment, coxarthrosis causes immobility and disability.
ᲛReasons
Due to the reasons for the development of the disease, primary and secondary coxarthrosis are distinguished. In the first case, it occurs by itself, for example, against the background of hereditary predisposition, in the second, it is provoked by other diseases or injuries. In most cases, the process of cartilage degeneration occurs due to a combination of several factors. The reason may be:
- Congenital dislocation of the thigh;
- Flat feet, scoliosis and other orthopedic problems;
- Leg-Calve-Perthes disease;
- Inflammation of the joints (arthritis), regardless of origin;
- Hip joint injuries and microtraumas from overweight, professional sports, etc. Sh.
- Hip dysplasia;
- Metabolic disorders;
- Endocrine diseases (especially diabetes mellitus);
- Disorders of the blood supply to the lower extremities;
- Frequent stress;
- Heredity (coxarthrosis in parents or other close relatives significantly increases the risk of developing a child);
- Congenital pathologies and autoimmune diseases of connective tissue (joint hypermobility, rheumatoid arthritis, systemic lupus erythematosus, etc. );
- Underwent joint operations.
Age is an important predisposing factor. According to statistics, after 45 years, the probability of developing coxarthrosis increases significantly.
Symptoms
The main symptoms of coxarthrosis of the hip joint do not depend on the cause of development. Most patients report:
- Restriction of movement: One of the earliest symptoms due to thinning of the cartilage layer and increased friction on the joint surfaces of the bones; In the future, the detection of cartilage growths will exacerbate the problem;
- Pain: Friction of bones deprived of cartilage, gradual involvement of all elements of the joint in the degenerative process, reduction of blood supply to tissues causes pain sensations, which increases with disease progression; The pain throws up in nature and often intensifies at the end of the day;
- Muscle spasm leading to increased pain symptoms and limited movement in the joint;
- Decreased leg length: This symptom is manifested in the later stages of the disease due to the narrowing of the joint space and the gradual grinding of the bone heads due to constant friction; The difference between the legs can be up to 2 cm;
- Lameness: Associated with severe pain and restricted movement, as well as leg shortening; Is an unfavorable sign indicating serious damage to the joint apparatus.
Scenes
In the developmental process, coxarthrosis goes through several stages, depending on the degree of tissue damage.
- At 1 degree, the patient notices slight excruciating pain in the joint that occurs after intense or prolonged physical exertion and passes quickly after rest. Usually the discomfort occurs exactly in the area of the hip joint, but in some cases it extends to the hip or knee. The gait does not change, the foot movements are fully protected. The radiograph shows specific changes: subchondral sclerosis.
- 2nd degree. The pain becomes more intense, arising after exercise, extends to the entire thigh and groin. Slight lameness may appear after exercise. Difficulties in foot abduction found. X-ray shows a significant reduction in the distance between the bones (by 50% or more), deformity of the femoral head, and pronounced bone growths.
- 3 degrees. The pain becomes constant, it becomes impossible to walk without a cane. When moving, the patient noticeably leans towards the painful side, which further increases the load on the joint. The range of motion decreases, the muscles of the legs and buttocks atrophy. There is a reduction in the affected limb. X-ray reveals significant deformation of the joint, change in the contour of the femoral head, and a large number of osteophytes.
- 4 The degree of pain intensifies and does not stop for a minute, the patient loses the ability to move independently. X-ray shows complete destruction of the articular cartilage, as well as signs of bone fusion with each other (ankylosis). At this stage the disease can be resolved only with surgical intervention.
Diagnosis
An orthopedic traumatologist is responsible for identifying symptoms and selecting treatment. To diagnose and determine the extent of the disease, it uses:
- Survey: listening to patient complaints, identifying risk factors (trauma, disease, heredity, etc. );
- Examination: assessment of limb mobility, identification of areas of greatest pain;
- X-ray: X-ray image allows to assess the condition of bones and cartilage, the size of the joint space, the presence and location of bone formations; In order to see the necessary details more thoroughly, the study is completed by CT (computed tomography);
- Laboratory diagnosis: General blood test allows you to determine the signs of the inflammatory process, biochemical - to note some risk factors, for example, uric acid levels;
- MRI (magnetic resonance imaging): allows you to assess the condition not only of bones and cartilage, but also of soft tissues: bones, joints, muscles, joint capsules, etc.
- Joint puncture.
If it is necessary to make a differential diagnosis with other diseases, as well as to assess the accompanying pathologies, additional tests, instrumental examinations and narrow specialist consultations are prescribed.
Treatment of coxarthrosis
Treatment of coxarthrosis of the hip joint depends on its stage and the severity of the symptoms. Pathology requires an integrated approach using a variety of methods:
- Medical treatment;
- Non-medical treatment (physiotherapy, exercise therapy);
- Surgery;
- Lifestyle correction and diet.
Medication treatment
Medications prescribed for hip joint arthrosis are aimed at:
- Removal of pain syndrome;
- Restore or at least slow down the destruction of cartilage tissue;
- Improving the blood supply and nutrition of the affected area;
- Treatment of concomitant pathologies.
Analgesics are used in the form of tablets, intramuscular and intra-articular injections and topical remedies: creams, ointments, patches. For most patients in the early stages of the disease, nonsteroidal anti-inflammatory drugs are sufficient. In acute pain syndrome, hormonal agents are used. Injecting painkillers directly into the joint capsule has a good effect.
If the disease is accompanied by muscle spasm, muscle relaxants are used. They are used in combination with other analgesics.
The use of analgesics should be limited in time and dose to prevent further damage to the cartilage tissue and other side effects (in particular, the development of gastritis and gastric ulcers).
Chondroprotectors are drugs that help restore cartilage tissue. They are effective only with long-term regular use, combined with other methods of treatment, lifestyle and dietary changes. Medications to improve blood microcirculation help to enhance their effects. For a similar purpose, warming ointments are prescribed. Only a doctor is involved in the selection of dose and regimen.
Drug-free treatment
This category includes various physiotherapy and mechanical techniques as well as physiotherapeutic exercises. They help to improve microcirculation and restore movement in the damaged joint. Depending on the situation, the doctor will determine:
- Shock wave therapy;
- Magnetotherapy;
- Electromyostimulation;
- Various types of electrophoresis and phonophoresis (accompanied by the introduction of anesthetic drugs);
- Mechanotherapy;
- Massage and exercise therapy.
Surgery
If the disease has reached 3-4 stages of development, medications and physiotherapy will only alleviate the patient’s condition but will not fully restore his ability to move. In this case arthroplasty is indicated, e. g. ი. Complete or partial replacement of the damaged joint with a titanium prosthesis.
In the presence of instructions, a lighter version of the intervention is performed: grinding the contact areas of the bones and covering them with special smooth implants, which facilitates sliding.
Prevention
Lifestyle can significantly reduce the risk of developing coxarthrosis as well as its rate of progression. It is important to strictly follow the rules:
- Live an active lifestyle: swimming in the pool, walking, cycling - physical activity on an amateur level, without racing, promotes blood supply and prevents the degeneration of joints;
- Normalize body weight to reduce strain on the legs;
- Eliminate injuries, hypothermia and occupational risk factors (vibration, weight gain, standing);
- Timely treatment of all diseases, including those not directly related to the musculoskeletal system;
- Correct posture disorders in a timely manner, wear comfortable shoes.
Diet
With the help of nutritional correction, the patient can not only reduce body weight, but also reduce inflammatory reactions, tissue salt deposits and metabolic disorders. It is advisable to follow a balanced menu with sufficient but not excessive amounts of carbohydrates, proteins and fats, as well as vitamins and minerals. Particular attention should be paid to unsaturated fats (olive and flaxseed oil), omega-3 acids (in excess in fish), collagen (jelly meat, aspic). It is recommended to reduce fast carbohydrates, alcohol, strong coffee, products with artificial flavors, preservatives and flavor enhancers.
Consequences and complications
Coxarthrosis is one of the most common causes of disability in the elderly. Without proper treatment the pathology inevitably leads to complete disability, especially in bilateral injuries. Pain and limited mobility do not allow you to work and take care of yourself, which is why it is important to get treatment on time.