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: osteoarthritis, but "coxarthrosis" is a narrower concept that characterizes the defeat of the hip joint.
Cartilage is the first to suffer from osteoarthritis, so the bones and surrounding structures - ligaments and muscles - are involved in the pathological process. If there are changes in the bones, the prefix "osteo" is added to the word "osteoarthritis". In advanced cases, the joint is deformed and already there is talk of deformation of arthrosis (arthrosis).
general features
Deforming osteoarthritis of the hip joint is the second most common after knee osteoarthritis. Due to the deep position of the hip joint, the bone deformity can go unnoticed for a long time, and only X-ray images 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 disturbances. It is because of the specificities of modern life, in which there is often no room for physical education, that osteoarthritis affects an increasing number of people. Furthermore, the peak of incidence falls on the middle age group, from 40 to 60 years.
Reference:coxarthrosis often affects women than men.
Development mechanism
The thigh joint is made up of two bones: the femur and the iliac (pelvic). The head of the femur enters the acetabulum of the pelvis, which remains motionless during movement - walking, running. At the same time, the articular surface of the femur can move in multiple directions, providing flexion, extension, abduction, adduction and rotation (rotation) of the thigh.
During physical activity, the femoral bone moves freely in the acetabulum thanks to the cartilage tissue that covers the joint surfaces. Hyaline cartilage stands out for its strength, compactness and elasticity; acts as a shock absorber and participates in the distribution of the load during human movements.
Inside the joint is synovial fluid - the synovium - which is essential for lubricating and nourishing the cartilage. The entire joint is encased 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 dense. Due to a lack of moisture, the cartilage does not receive enough nutrition and begins to dry out, it loses its smoothness, and cracks appear on it.
The bones can no longer move as freely as before and rub against each other, causing microdamage in the cartilage. The pressure between the bones increases, the cartilage layer becomes thinner. Under the influence of increased pressure, the bones gradually deform, local metabolic processes are disrupted. In the later stages, there is a pronounced atrophy of the leg muscles.
causes
Deforming osteoarthritis of the hip joint can be primary and secondary. It is not always possible to establish the cause of primary osteoarthritis. Secondary arthrosis appears against the background of existing diseases, 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 origin;
- pelvic bone injuries - dislocations, fractures.
Dysplasia of the hip joint is a congenital malformation that sometimes does not manifest itself clinically for a long time and in the future (at the age of 25-55) can lead to the development of dysplastic coxarthrosis.
Coxo's osteoarthritis can be left-sided, right-sided, and symmetrical. In primary osteoarthritis, 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:
- excess weight and excessive loads that overload the joints;
- violation of blood circulation and metabolism;
- hormonal changes;
- curvature of the spine, flat feet;
- old age;
- hypodynamia;
- inheritance.
It should be noted that coxarthrosis itself is not inherited. However, some features of the metabolism or the structure of connective tissues can create prerequisites for the development of osteoarthritis in a child in the future.
Coxarthrosis Symptoms
The main symptom of hip joint osteoarthritis is pain in the hip and groin area, which varies in intensity. Stiffness and stiffness during movement, a decrease in muscle volume, a shortening of the affected limb, and a change in gait due to lameness are also noted.
Coxarthrosis most often progresses slowly, causing discomfort in the beginning and mild pain after exertion. However, over time, the pain increases and appears at rest.
A typical manifestation of the condition is difficulty in hip abduction, when a person cannot sit "astride" 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 hip joint osteoarthritis, which differ in the severity of the injury and associated symptoms:
- 1 degree. The thigh does not always hurt, but periodically, mainly after walking or standing for a long time. 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 capacity is maintained in full;
- 2nd degree. Pain sensations intensify, arise not only after running or walking, but also at rest. The pain is most often concentrated in the thigh area, but can spread to the knee. In moments of heavy load, it is painful to step on the injured limb, so the patient begins to spare the leg and limps. The range of motion in the joint decreases, it is especially 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. Gait is noticeably impaired, independent movement is noticeably complicated, and the patient leans on a cane. The range of motion is markedly limited, the gluteal muscles and the entire 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 while walking. This leads to a shift in the center of gravity and increased stress on the affected joint.
Osteoarthritis or arthrosis?
Arthritis is inflammation of the joint, which can be an independent disease or develop against the background of systemic pathologies (for example, rheumatism). In addition to the inflammatory response, 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 defeat of cartilage tissue, which often leads to the appearance of inflammation. This is why osteoarthritis is sometimes called osteoarthritis-arthritis. And since osteoarthritis is almost always associated with joint deformation, the term "osteoarthritis" applies to it.
Reference:according to the international classification of diseases (ICD-10), osteoarthritis and osteoarthritis are varieties of the same pathology.
Coxarthrosis Diagnosis
The diagnosis of "coxarthrosis of the hip joint" is made on the basis of the examination, patient complaints and the results of the examination. The most informative method is radiography - in the pictures 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 more inclined and the cervico-shaft angle (inclination of the femoral neck in the vertical plane) is greater than normal. The deformity of the part of the femur located in the immediate vicinity of the joint is characteristic of Perthes disease.
3rd degree coxarthrosis is characterized by a narrowing of the joint space, expansion of the femoral head, and multiple bone growths (osteophytes).
If the patient has had a fracture or dislocation, 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, MRI or computed tomography may be prescribed.
Differential diagnosis is carried out with the following diseases:
- gonarthrosis;
- osteochondrosis and radicular syndrome occurring in the background;
- trochanteritis (inflammation of the trochanter bone in the thigh);
- ankylosing spondylitis;
- reactive arthritis.
The decrease in muscle volume that accompanies 2 and 3 degrees of coxarthrosis can cause pain in the knee area. Additionally, the knee often hurts even more than the hip joint itself. To confirm the diagnosis and rule out gonarthrosis, an x-ray is usually sufficient.
With diseases of the spine - osteochondrosis and pinched nerve roots - pain is very similar to coxarthrosis. However, it occurs unexpectedly, after an unsuccessful movement, a sharp turn of the body, or the lifting of a weight. Pain sensations begin in the gluteal region and spread along the back of the leg.
Radicular syndrome is characterized by severe pain when lifting a straight limb from a supine position. However, there are no difficulties during abduction of the leg to the side, as with coxarthrosis. It is worth noting that osteochondrosis and osteoarthritis of the hip joint are often diagnosed at the same time, so a comprehensive examination is required.
Trochanteritis, or trochanteric bursitis, develops rapidly, unlike osteoarthritis, which can progress slowly over years and even decades. The pain syndrome builds up within a week or two, while it is quite intense. The cause of trochanteritis is trauma or excessive exercise. The movement is not limited and the leg is not shortened.
Ankylosing spondylitis and reactive arthritis can also be accompanied by symptoms that mimic coxarthrosis. The hallmark of such diseases is the appearance of pain mainly at night. The hip can hurt quite badly, but when walking and moving, the pain subsides. In the morning, patients are concerned about stiffness, which disappears after a few hours.
Treatment of osteoarthritis of the hip joint
Coxarthrosis can be treated conservatively or surgically. The choice of the method of treatment depends on the stage and nature of the course of the pathological process. If diagnosed with 1 or 2 degree of the disease, it is treated with medication and physiotherapy. After the relief of acute symptoms, therapeutic exercises and massage are added. If necessary, a special diet is prescribed.
The earlier the coxarthrosis is detected and treated, the more favorable 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 carried out in the shortest possible course, since drugs of the class of NSAIDs can adversely affect the digestive tract and slow down the regeneration processes in the cartilage tissue.
It is possible to accelerate the restoration of cartilage with the help of chondroprotector. However, these funds 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.
To improve the blood supply to the joint, vasodilators are used. For muscle spasms, muscle relaxants are recommended.
In the case of persistent pain syndrome, which is difficult to get rid of 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 do not have a pronounced effect, but they help to cope with muscle spasms and reduce pain.
Physiotherapy helps improve blood circulation and nutrition of the cartilage. For coxarthrosis, procedures such as shock wave therapy (SWT), magnetotherapy, 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. To restore the function of the hip joint, a partial or total arthroplasty is performed.
Surgical treatment is used in advanced cases of osteoarthritis, when conservative therapy is powerless.
In partial prostheses, only the head of the femur is replaced with an artificial prosthesis. Total prosthesis means replacing both the femoral head and the acetabulum. The operation is performed under general anesthesia, and in the vast majority of cases (approximately 95%), the function of the hip joint is fully restored.
During the rehabilitation period, the patient is prescribed antibiotics to prevent infectious complications. The stitches are removed on day 10-12 and physical therapy is started. The attending physician helps the patient to learn to walk and to correctly 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 the operation, but for older people this period can be up to six months. After rehabilitation is complete, patients can move, work and even play sports completely. The duration of the prosthesis is at least 15 years. To replace a worn prosthesis, a second surgery is performed.
Effects
Without timely and adequate treatment, coxarthrosis can not only significantly worsen the quality of life, but also lead to disability and disability. Already in the second stage of arthrosis, the patient is assigned the 3rd group of disabilities.
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 1st disability group is received by patients with 3rd degree coxarthrosis, accompanied by a complete loss of motor ability.
The indications for the medical and social examination (MSK) are:
- long course of arthrosis, more than three years, with regular exacerbations. The frequency of exacerbations is at least three times every 12 months;
- underwent endoprosthetic surgery;
- severe disorders of the musculoskeletal function of the limb.
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 injury to the pelvic region and hypothermia.
In the presence of risk factors for the development of osteoarthritis, as well as in all patients with a diagnosed disease, swimming is beneficial. Sports such as running, jumping, soccer and tennis are not recommended.