Arthrosis of the hip joint (coxarthrosis) is a chronic pathology that is accompanied by the gradual destruction of the cartilage tissue of the affected area, followed by the involvement of neighboring structures. The disease requires long-term treatment, and in severe cases the only way to restore mobility is with joint replacement.
general information
Coxarthrosis belongs to the group of degenerative diseases. It gradually begins with microscopic changes in the structure of the cartilage. Increased stress, inflammatory diseases, circulatory disorders lead to structural changes and thinning of the cartilage tissue and in turn deform the contours of the joint area. This changes the load distribution on the contact surfaces of the bones and the zones with the maximum pressure wear out more quickly. This triggers a whole cascade of pathological reactions:
- the appearance of microcracks and areas of compression in the cartilage tissue;
- Decrease in the smoothness of the articular surfaces;
- Overgrowth of cartilage at the point of thinning and replacement with bone tissue;
- the appearance of osteophytes (bone growth) along the edges of the joint site;
- Thickening and decreased elasticity of the joint capsule;
- Hardening and decreased strength of the ligaments;
- Changes in the composition of the synovial fluid (natural lubrication in the joint);
- Narrowing of the joint space;
- Fusion of all elements of the joint (ankylosis).
Without treatment, coxarthrosis inevitably becomes the cause of immobility and disability.
causes
Depending on the causes of the development of the disease, a distinction is made between primary and secondary coxarthrosis. In the first case, it occurs alone, for example, against the background of a hereditary predisposition, in the second, it is provoked by other diseases or injuries. In most cases, the process of degeneration of cartilage tissue occurs due to a combination of several factors. The reason can be:
- congenital hip dislocation;
- Flat feet, scoliosis, and other orthopedic problems;
- Legg-Calve-Perthes disease;
- Joint inflammation (arthritis), regardless of the origin;
- injuries and microtraumas of the hip joint against the background of obesity, professional sports, etc. ;
- dysplasia of the hip joint;
- Metabolic disorders;
- endocrine diseases (especially diabetes mellitus);
- violations of the blood supply to the lower extremities;
- frequent stress;
- Heredity (coxarthrosis in parents or other close relatives significantly increases the risk of developing it in a child);
- congenital pathologies and autoimmune diseases of connective tissue (joint hypermobility, rheumatoid arthritis, systemic lupus erythematosus, etc. );
- subjected to joint operations.
Age is an important predisposing factor. According to statistics, the probability of developing coxarthrosis increases significantly after 45 years.
Symptoms
The main symptoms of coxarthrosis of the hip joint do not depend on the cause of the development. Most patients notice:
- Restriction of movement: one of the earliest symptoms due to thinning of the cartilage layer and increased friction of the articular surfaces of the bones; in the future, the appearance of cartilage overgrowths further aggravates the problem;
- pain: friction of bones from which a layer of cartilage has been deprived, the gradual involvement of all elements of the joint in the degenerative process, a decrease in the blood supply to the tissues cause pain sensations that increase as the disease progresses; the pains shoot out into nature and often worsen towards the end of the day;
- Muscle spasms, which lead to increased symptoms of pain and reduced mobility in the joint;
- Decrease in leg length: this symptom appears 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 mobility as well as shortening of the leg; is an unfavorable sign of severe damage to the joint apparatus.
Stages
In the development process, coxarthrosis goes through several stages, which depend on the degree of tissue damage.
- 1 degree. At this point, the patient notices mild aching joint pain that occurs after intense or prolonged physical activity and quickly passes after rest. As a rule, complaints occur in the area of the hip joint, but in some cases they extend to the hip or knee. The gait does not change, the leg movements are completely retained. Specific changes are noted on the X-ray: subchondral sclerosis.
- 2 degrees. The pain becomes stronger, occurs after exertion, spreads to the entire thigh and groin. Slight lameness may occur after exertion. Difficulty abducting the leg is noted. The x-ray shows a significant decrease in bone spacing (by 50% or more), deformation of the femoral head, and pronounced bone growth.
- 3 degrees. The pain becomes permanent, walking without a stick becomes impossible. When moving, the patient leans noticeably to the painful side, which further increases the stress on the joint. The range of motion is restricted, the leg and gluteal muscles atrophy. The affected extremity is shortened. The x-ray shows a significant deformity of the joint, a change in the contour of the femoral head and a large number of osteophytes.
- 4 degrees. The pain becomes stronger and does not stop for a minute, the patient loses the ability to move independently. The x-ray shows complete destruction of the articular cartilage and signs of bone fusion (ankylosis). Coping with the disease at this stage is only possible through surgery.
diagnosis
An orthopedic traumatologist is responsible for identifying symptoms and choosing treatment. To diagnose and determine the extent of the disease, he uses:
- Survey: listen to patient complaints, identify risk factors (trauma, illness, heredity, etc. );
- Examination: Assessment of the mobility of the limbs, determination of the greatest pain areas;
- X-ray: an X-ray makes it possible to assess the condition of bones and cartilage, the size of the joint space, the presence and location of bone growth; in order to see the necessary details more precisely, the study is supplemented by CT (computed tomography);
- laboratory diagnostics: a general blood test allows you to identify signs of an inflammatory process, biochemical - to pay attention to some risk factors, for example, the level of uric acid;
- MRI (magnetic resonance imaging): allows you to assess the condition not only of bones and cartilage, but also of soft tissues: bones, ligaments, muscles, joint capsule, etc. ;
- Puncture of the joint.
If there is a need for differential diagnosis in other diseases, as well as the assessment of concomitant diseases, additional tests, instrumental examinations and consultations from close specialists are prescribed.
Coxarthrosis treatment
Treatment for coxarthrosis of the hip joint depends on the stage and severity of the symptoms. Pathology requires an integrated approach using different methods:
- medication;
- non-drug treatment (physiotherapy, exercise therapy);
- Surgery;
- Lifestyle correction and nutrition.
Medication
The drugs prescribed for osteoarthritis of the hip joint are aimed at:
- Removal of pain syndrome;
- Restoring or at least slowing down the destruction of cartilage tissue;
- Improving the blood supply and nutrition of the affected area;
- Treatment of comorbidities.
Painkillers are used in the form of tablets, intramuscular and intra-articular injections, and topical agents: creams, ointments, plasters. In the early stages of disease development, nonsteroidal anti-inflammatory drugs are sufficient for most patients. In severe pain syndrome, hormonal agents are used. Introducing analgesics directly into the joint capsule has a good effect.
If the course of the disease is accompanied by muscle spasms, muscle relaxants are used. They are used in combination with other analgesics.
The use of painkillers should be limited in time and dose so as not to cause 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 only effective with long-term regular use combined with other treatments, lifestyle and dietary adjustments. Drugs to improve microcirculation in the blood help to increase their effects. For a similar purpose, warming ointments are prescribed. Only a doctor is involved in the selection of the dosage and regimen.
Drug-free treatment
This category includes various physical therapy and manual techniques, as well as physical therapy exercises. They help improve microcirculation and restore movement in the damaged joint. Depending on the situation, the doctor will prescribe:
- Shock wave therapy;
- Magnetic therapy;
- Electromyostimulation;
- various types of electrophoresis and phonophoresis (accompanied by the administration of anesthetics);
- Mechanotherapy;
- Massage and exercise therapy.
surgery
When the disease has reached the 3-4 stage of development, medication and physical therapy will only relieve the patient's condition, but will not restore full mobility to him. In this case, endoprosthetics are indicated, i. H. complete or partial replacement of the damaged joint with a titanium prosthesis.
In the case of indications, a lighter variant of the procedure is carried out: grinding the contact surfaces of the bones and covering them with special smooth implants that facilitate sliding.
prevention
Lifestyle can significantly reduce the risk of developing coxarthrosis and the rate at which it progresses. It is important to strictly adhere to the rules:
- lead an active lifestyle: swimming in the pool, hiking, cycling - amateur level physical activity without record racing improves blood supply and inhibits the processes of joint degeneration;
- normalize body weight to reduce the load on the legs;
- Eliminate injuries, hypothermia and occupational risk factors (vibration, lifting weights, standing work);
- treat all diseases in a timely manner, including those that are not directly related to the musculoskeletal system;
- Correct posture disorders in good time, wear comfortable shoes.
diet
With the help of nutritional correction, the patient can not only reduce body weight, but also reduce inflammatory reactions, salt deposits in the tissues and metabolic disorders. A balanced diet with sufficient but not too high amounts of carbohydrates, proteins and fats as well as vitamins and minerals is recommended. Particular attention should be paid to unsaturated fats (olive and linseed oil), omega-3 acids (present in excess in fish), collagen (jellied meat, aspic). It is recommended to minimize quick carbs, 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 adequate treatment, the pathology inevitably leads to complete disability, especially with bilateral lesions. Pain and reduced mobility do not allow you to work and take care of yourself, which is why it is important to receive treatment on time.