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: deforming coxarthrosis, DOA of the hip joint, osteoarthritis. All these terms mean the same pathology - arthrosis, but "coxarthrosis" is a narrower term that characterizes the defeat of the hip joint.
Cartilage is the first to suffer from osteoarthritis, then the bones and surrounding structures - ligaments and muscles - are involved in the pathological process. If there are changes in the bones, the word "osteoarthritis" is added to the word "osteoarthritis". In advanced cases, the joint is deformed and there is already talk of deforming arthrosis (osteoarthritis).
Main characteristics
Deforming osteoarthritis of the hip joint is the second most common after gonarthrosis of the knee joint. Due to the deep location of the hip joint, the deformation of the bones may go unnoticed for a long time and only X-rays taken in the later stages will show changes.
The development of this disease is influenced by various factors, including an inactive lifestyle, trauma and metabolic disorders. Precisely because of the specifics of modern life, in which there is often no place for physical education, osteoarthritis affects an increasing number of people. In addition, the peak incidence falls on the middle age group - from 40 to 60 years.
reference:coxarthrosis affects women more often than men.
Development mechanism
The femur is formed by two bones: the femur and the iliac (pelvic). The head of the femur enters the acetabulum of the pelvis, which remains immobile when moving - walking, running. At the same time, the articular surface of the femur can move in several directions, providing flexion, extension, abduction, adduction, and rotation of the thigh.
During physical activity, the femur moves freely in the acetabulum due to the cartilage tissue covering the articulating surfaces. Hyaline cartilage is distinguished by its strength, hardness and elasticity; it acts as a shock absorber and participates in the distribution of load in human movements.
Inside the joint is the synovial fluid - synovium - which is essential for lubricating and nourishing cartilage. The entire joint is enclosed in a dense, thin capsule surrounded by powerful muscles in the thighs and buttocks. These muscles, also acting 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 enough nutrition and begins to dry out, loses its smoothness and cracks appear on it.
The bones can no longer move as freely as before and rub against each other, causing microdamages in the cartilage. The pressure between the bones increases, the cartilage layer becomes thinner. Under the influence of increasing pressure, the bones gradually deform, the local metabolic processes are disrupted. In the later stages there is a pronounced atrophy of the leg muscles.
Reasons
Deforming osteoarthritis of the hip can be primary or secondary. It is not always possible to determine the cause of primary osteoarthritis. Secondary osteoarthritis occurs against the background of existing diseases, namely:
- congenital dislocation of the hip joint or hip dysplasia;
- Perthes' disease (aseptic necrosis of the femoral head);
- coxarthritis of the hip joint, which has an infectious, rheumatic or other origin;
- pelvic injuries - sprains, fractures.
Hip dysplasia is a congenital malformation that sometimes does not manifest itself clinically for a long time and in the future (aged 25-55 years) can lead to the development of dysplastic coxarthrosis.
Coxarthrosis can be left, right 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 loads that overload the joints;
- circulatory and metabolic disorders;
- hormonal changes;
- curvature of the spine, flat feet;
- adulthood;
- hypodynamia;
- heredity.
It should be noted that coxarthrosis itself is not inherited. However, some features of the metabolism or the structure of the connective tissue may create preconditions for the development of osteoarthritis in a child in the future.
Symptoms of coxarthrosis
The leading symptom of osteoarthritis of the hip joint is pain in the thigh and groin, which has varying intensity. Stiffness and stiffness during movement, decrease in muscle volume, shortening of the affected limb and change in gait due to lameness are also noted.
Coxarthrosis usually progresses slowly, causing discomfort at the beginning and mild pain after exercise. However, over time, the pain increases and appears at rest.
A typical manifestation of the pathology is difficulty in abducting the hip joint, when a person can not sit "riding" on a chair. The presence and severity of the signs of coxarthrosis depend on its degree, but the pain syndrome is always present.
There are three degrees or types of osteoarthritis of the hip, which differ in the severity of the injury and the accompanying symptoms:
- 1 degree. The thigh does not hurt all the time, but periodically, mainly after walking or prolonged standing. The pain syndrome is localized in the joint area, but can sometimes spread from the leg to the knee. Muscles with 1st degree coxarthrosis do not decrease in size, gait does not change, motor ability is fully preserved;
- 2nd degree. The sensations of pain intensify, occur not only after running or walking, but also at rest. The pain is more often concentrated in the thighs, but can spread down to the knee. In times of heavy exertion, it is painful to step on the injured limb, so the patient begins to spare the leg and lameness. The range of motion in the joint decreases, it is especially difficult to move the legs to the side or rotate the thigh;
- 3rd degree. The pain becomes permanent and does not subside even at night. The gait is noticeably impaired, independent movement is significantly impaired, and the patient rests on a cane. The range of motion is sharply limited, the muscles of the buttocks and the whole leg, including the lower leg, atrophy.
- Due to muscle weakness, the pelvis bends forward, the affected leg shortens. To compensate for the difference in limb length, the patient tilts the body to the affected side when walking. This leads to a shift in the center of gravity and increased stress on the affected joint.
Osteoarthritis or osteoarthritis?
Arthritis is an inflammation of the joint, which can be a disease in its own right or develop against the background of systemic pathologies (eg rheumatism). In addition to the inflammatory response, the symptoms of osteoarthritis (especially in the advanced stages) include limited mobility and changes in the shape of the joint.
At the heart of degenerative-dystrophic changes in osteoarthritis is the damage to cartilage tissue, which often leads to inflammation. This is why osteoarthritis is sometimes called osteoarthritis-arthritis. And because osteoarthritis is almost always associated with joint deformity, the term "osteoarthritis" is applicable to it.
reference:according to the International Classification of Diseases (ICD-10), osteoarthritis and osteoarthritis are variants of the same pathology.
Diagnosis of coxarthrosis
The diagnosis of "coxarthrosis of the hip joint" is made on the basis of examination, patient complaints and examination results. The most informative method is an X-ray: in the photos you can see both the degree of damage to the joint and the cause of the disease.
For example, in hip dysplasia, the acetabulum is flatter and sloping, and the cervical-diaphyseal angle (slope of the femoral neck in the vertical plane) is larger than normal. The deformity of the part of the femur located next to the joint is characteristic of Perthes' disease.
Grade 3 coxarthrosis is characterized by narrowing of the joint space, enlargement of the femoral head, and numerous bone growths (osteophytes).
If the patient has had a fracture or sprain, signs of trauma will also be visible on X-rays. If a detailed assessment of the condition of the bones and soft tissues is required, magnetic resonance imaging or computed tomography may be prescribed.
The differential diagnosis is made with the following diseases:
- gonarthrosis;
- osteochondrosis and radicular syndrome arising against its background;
- trochanteritis (inflammation of the trochanteric bone of the thigh);
- ankylosing spondylitis;
- reactive arthritis.
The decrease in muscle volume that accompanies grade 2 and 3 coxarthrosis can cause pain in the knee area. In addition, the knee often hurts even more than the hip joint itself. An X-ray is usually sufficient to confirm the diagnosis and rule out gonarthrosis.
In diseases of the spine - osteochondrosis and pinched nerve roots - the pain is very similar to coxarthrosis. However, this happens unexpectedly, after a failed movement, a sharp turn in the body or lifting weights. The sensations of pain begin in the gluteal area and spread to the back of the leg.
Radicular syndrome is characterized by severe pain when lifting a straight limb from a lying position. However, there are no difficulties during the abduction of the legs, as in coxarthrosis. It is worth noting that osteochondrosis and osteoarthritis of the hip are often diagnosed at the same time, so a comprehensive examination is needed.
Trochanteritis or trochanteric bursitis develops rapidly, unlike osteoarthritis, which can progress slowly over years and even decades. The pain syndrome accumulates within a week or two and is quite intense. The cause of trochanteritis is trauma or excessive exercise. The movement is not restricted and the leg is not shortened.
Ankylosing spondylitis and reactive arthritis may also be accompanied by symptoms that mimic coxarthrosis. The hallmark of such diseases is the appearance of pain mainly at night. The hip joint can hurt quite badly, but when walking and moving the pain subsides. In the morning, patients worry about stiffness, which disappears after a few hours.
Treatment of osteoarthritis of the hip
Coxarthrosis can be treated conservatively or surgically. The choice of treatment method depends on the stage and nature of the pathological process. If grade 1 or 2 disease is diagnosed, it is treated with medication and physiotherapy. After relieving the acute symptoms, therapeutic exercises and massage are added to them. If necessary, a special diet is prescribed.
The earlier 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.
Non-steroidal anti-inflammatory drugs (NSAIDs) are used to relieve pain and inflammation. It should be noted that anesthesia is performed in the shortest possible course, as drugs from the class of NSAIDs can adversely affect the digestive tract and slow down the processes of regeneration in cartilage tissue.
It is possible to accelerate the recovery of cartilage with the help of chondroprotectors. However, these remedies are effective only in the early stages of the disease, when its hyaline cartilage is not completely destroyed. Chondroprotectors are prescribed in the form of tablets or intra-articular injections.
Vasodilators are used to improve the blood supply to the joint. In case of muscle spasms, muscle relaxants are recommended.
In case 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 be supplemented with topical agents - ointments and gels. They have no pronounced effect, but help to cope with muscle spasms and reduce pain.
Physiotherapy helps to improve blood circulation and cartilage nutrition. In coxarthrosis, procedures such as shock wave therapy (SWT), magnetic therapy, infrared laser, ultrasound and hydrogen sulfide baths have proven to be excellent.
Operation
Treatment of stage 3 osteoarthritis can only be surgical, as the joint is almost completely destroyed. Partial or total arthroplasty is performed to restore the function of the hip joint.
Surgical treatment is resorted to in advanced cases of osteoarthritis, when conservative therapy is powerless.
In partial prosthetics, only the head of the femur is replaced with an artificial prosthesis. Total prosthesis means replacement of both the head of the femur and the acetabulum. The operation is performed under general anesthesia, and in the majority of cases (about 95%) the function of the hip joint is completely restored.
During the rehabilitation period, the patient is prescribed antibiotics to prevent infectious complications. The sutures are removed every 10-12 days and training therapy is started. The attending physician helps the patient to learn to walk and to properly distribute the load on the operated limb. Exercise is an important step in increasing muscle strength, endurance and elasticity.
Working capacity is restored on average 2-3 months after surgery, but in the elderly this period can be up to six months. After completing the rehabilitation, patients can fully move, work and even play sports. The service life of the prosthesis is at least 15 years. A second operation is performed to replace a worn prosthesis.
Effects
Without timely and adequate treatment, coxarthrosis can not only significantly impair quality of life, but also lead to disability and disability. At the second stage of osteoarthritis the patient is given the 3rd group of disability.
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 appointed. Group 1 disability occurs in patients with coxarthrosis grade 3, accompanied by complete loss of mobility.
Indications for medical and social examination (MSC) are:
- long course of osteoarthritis, more than three years, with regular exacerbations. The frequency of exacerbations is at least three times every 12 months;
- endoprosthetics;
- severe disorders of musculoskeletal function of the limb.
Prevention
The main measures to prevent coxarthrosis are diet (if you are overweight) and regular but moderate physical activity. It is very important to avoid pelvic injuries and hypothermia.
In the presence of risk factors for the development of osteoarthritis, as well as in all patients diagnosed with the disease, swimming is beneficial. Sports such as running, jumping, football and tennis are not recommended.