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 more limited concept that characterizes the defeat of the hip joint.
Cartilage is the first to suffer osteoarthritis, then 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 there is already talk of deforming osteoarthritis (osteoarthritis).
general characteristics
Deforming osteoarthritis of the hip joint is the second most common after knee osteoarthritis. Due to the deep location of the hip joint, the bone deformity can go unnoticed for a long time and only the X-ray images taken in the later stages will show changes.
The development of this disease is influenced by several factors, including an inactive lifestyle, trauma, and metabolic disorders. Due to the peculiarities of modern life, in which there is often no place for physical education, osteoarthritis affects an increasing number of people. In addition, the highest incidence falls in the middle-aged group, 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 immobile during movement - walking, running. At the same time, the articular surface of the femur can move in various directions, providing flexion, extension, abduction, adduction, and rotation (rotation) of the thigh.
During physical activity, the femur moves freely in the acetabulum due to the cartilaginous tissue that covers the articulated surfaces. Hyaline cartilage is distinguished by its strength, firmness and elasticity; it acts as a shock absorber and participates in the distribution of load during human movements.
Within the joint is the synovial fluid, the synovial membrane, which is essential for lubricating and nourishing the cartilage. The entire joint is enclosed in a dense, thin capsule surrounded by powerful muscles in the thighs and buttocks. These muscles, which also act as shock absorbers, serve to prevent injuries to the hip joint.
The development of coxarthrosis begins with changes in the joint fluid, which becomes more viscous and thick. Due to the lack of moisture, the cartilage does not receive enough nutrition and begins to dry out, loses its softness, and cracks appear.
The bones can no longer move as freely as before and rub against each other, causing micro-damage to the cartilage. The pressure between the bones increases, the cartilaginous layer becomes thinner. Under the influence of increased pressure, the bones gradually deform, and 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 osteoarthritis 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 to 55 years) can lead to the development of dysplastic coxarthrosis.
Coxal 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 appearance of the disease:
- excess weight and excessive loads that strain the joints;
- violation of blood circulation and metabolism;
- hormonal changes;
- curvature of the spine, flat feet;
- advanced age;
- hypodynamics;
- inheritance.
It should be noted that coxarthrosis itself is not inherited. However, certain features of the metabolism or the structure of connective tissues can create prerequisites for the development of osteoarthritis in a child in the future.
Symptoms of coxarthrosis.
The main symptom of osteoarthritis of the hip joint is pain in the hip and groin area, which has a variable intensity. Stiffness and stiffness are also noted during movement, a decrease in muscle volume, shortening of the affected limb, and a change in gait due to lameness.
Coxarthrosis usually progresses slowly, causing discomfort at first and mild pain after exertion. However, over time, the pain increases and appears at rest.
A typical manifestation of the pathology is difficulty in hip abduction, when a person cannot "straddle" a chair. The presence and severity of the signs of coxarthrosis depend on their degree, but the pain syndrome is always present.
There are three degrees or types of osteoarthritis of the hip joint, differing 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 standing for a long time. The pain syndrome is localized to the joint area, but can sometimes spread from the leg to the knee. Muscles with first degree coxarthrosis do not decrease in size, gait does not change, motor capacity is fully preserved;
- 2nd grade. 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 extend to the knee. At times of great load, it is painful to step on the injured limb, so the patient begins to leave 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 go away even at night. Gait is markedly impaired, independent movement is significantly complicated, and the patient is leaning on a cane. The range of motion is severely limited, the muscles in the buttocks and the entire leg, including the lower leg, atrophy.
- Due to muscle weakness, the pelvis leans forward, the affected leg shortens. To compensate for the difference in limb length, the patient leans the body toward 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 an independent disease or develop against the background of systemic pathologies (for example, 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 defeat of cartilage tissue, which often leads to the appearance of inflammation. That is why osteoarthritis is sometimes called osteoarthritis-arthritis. And since osteoarthritis is almost always associated with joint deformity, the term "osteoarthritis" is applied to it.
Reference:According to the international classification of diseases (ICD-10), osteoarthritis and osteoarthritis are varieties of the same pathology.
Diagnosis of coxarthrosis
The diagnosis of "coxarthrosis of the hip joint" is made on the basis of the examination, the patient's complaints, and the results of the examination. The most informative method is X-rays - on 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.
Third-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 evaluation of the condition of the bones and soft tissues is required, an MRI or CT scan may be prescribed.
Differential diagnosis is made with the following diseases:
- gonarthrosis;
- osteochondrosis and root syndrome arising in its context;
- trochanteritis (inflammation of the trochanteric bone of the thigh);
- ankylosing spondyloarthritis;
- reactive arthritis
The decrease in muscle volume that accompanies 2 and 3 degrees of coxarthrosis can cause pain in the knee area. Also, the knee often hurts even more than the hip joint itself. To confirm the diagnosis and exclude knee osteoarthritis, an X-ray is usually sufficient.
With diseases of the spine (osteochondrosis and pinched nerve roots) the pain is very similar to coxarthrosis. However, it happens unexpectedly, after an unsuccessful movement, a sharp turn of the body or lifting a weight. Pain sensations start in the gluteal region and spread down the back of the leg.
Root syndrome is characterized by severe pain when lifting a straight limb from a supine position. However, there are no difficulties during lateral leg abduction, as with coxarthrosis. It is worth noting that osteochondrosis and osteoarthritis of the hip joint are often diagnosed simultaneously, therefore a full examination is necessary.
Trochanteritis or trochanteric bursitis develops rapidly, in contrast to osteoarthritis, which can progress slowly over years and even decades. The pain syndrome builds up in a week or two, although it is quite severe. The cause of trochanteritis is trauma or excessive exercise. 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 a lot, but when you walk and move, the pain goes away. In the morning, patients are concerned about stiffness, which disappears after a few hours.
Treatment of osteoarthritis of the hip joint.
Coxarthrosis can be cured conservatively or surgically. The choice of the method of treatment depends on the stage and nature of the course of the pathological process. If you are diagnosed with 1 or 2 degrees of the disease, it is treated with medication and physical therapy. After the relief of acute symptoms, therapeutic exercises and massages are added to them. If necessary, a special diet is prescribed.
The earlier 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.
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 course, since drugs of the NSAID class can adversely affect the digestive tract and slow down the regeneration processes in cartilage tissue.
It is possible to accelerate the restoration of cartilage with the help of chondroprotectors. However, these funds are effective only in the early stages of the disease, when your 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 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 do not have a pronounced effect, but they help to cope with muscle spasms and reduce pain.
Physical therapy 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 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 resorted to in advanced cases of osteoarthritis, when conservative therapy is impotent.
In partial dentures, 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 (about 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 between the 10th and 12th day and exercise therapy is started. The treating physician helps the patient learn to walk and correctly distribute the load on the operated limb. Exercise is an important step in increasing muscle strength, endurance, and elasticity.
The working capacity is restored on average 2-3 months after the operation, but for the elderly this period can be up to six months. After rehabilitation is complete, patients can move, work, and even play sports fully. The useful life of the prosthesis is at least 15 years. To replace a worn prosthesis, a second surgery is performed.
Effects edit
Without timely and proper treatment, coxarthrosis can not only significantly worsen quality of life, but can also lead to disability and disability. Already in the second stage of osteoarthritis, the patient receives the third group of disability.
By 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 disability is received by patients with the third degree of coxarthrosis, accompanied by a complete loss of motor ability.
The indications for the medical and social examination (MSK) are:
- prolonged course of osteoarthritis, more than three years, with regular exacerbations. The frequency of exacerbations is at least three times every 12 months;
- underwent endoprosthesis surgery;
- severe disorders of 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 injuries in 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.