Arthrosis of the hip joint (coxarthrosis) is a chronic pathology, accompanied by the gradual destruction of cartilaginous tissue in the affected area, followed by the involvement of adjacent structures in the process. The disease requires long-term treatment, and in severe cases, the only way to regain mobility is joint replacement.
General information
Coxarthrosis belongs to the group of degenerative diseases. It begins gradually with microscopic changes in the structure of the cartilage. Increased stress, inflammatory diseases, disruption of blood supply cause structural transformation and thinning of cartilage tissue, and in turn, they change the shape of the articular area. As a result, the load distribution on the surface of the bone in contact changes, and the zone with maximum pressure begins to rapidly deplete. This triggers an overall pathological reaction:
- the appearance of microcracks and areas of compaction on cartilage tissue;
- decreased smoothness of the articular surface;
- excessive cartilage growth at the site of thinning and replacing it with bone tissue;
- the appearance of osteophytes (bone growths) along the edges of the articular site;
- thickening and decreased elasticity of the joint capsule;
- hardening and reduction of ligament strength;
- changes in the composition of synovial fluid (natural lubrication in the joints);
- narrowing of the joint space;
- fusion of all joint elements (ankylosis).
Without treatment, coxarthrosis is bound to be the cause of disability and disability.
Cause
Depending on the cause of the development of the disease, primary and secondary coxarthrosis are distinguished. In the first case, it occurs spontaneously, for example, against a background of hereditary predisposition, in the second, it is caused by another disease or injury. In most cases, the process of cartilage tissue degeneration occurs due to a combination of several factors. The reason may be:
- congenital hip dislocation;
- flat feet, scoliosis and other orthopedic problems;
- Legg-Calve-Perthes disease;
- inflammation of the joints (arthritis), regardless of origin;
- injuries and microtraumas of the hip joint with a background of overweight, professional sports, etc . ;
- dysplasia of the hip joint;
- metabolic disorders;
- endocrine diseases (especially diabetes mellitus);
- violation of blood supply to the lower limbs;
- frequent stress;
- heredity (coxarthrosis in parents or other close relatives significantly increases the risk of developing it in children);
- congenital pathology and autoimmune diseases of connective tissue (joint hypermobility, rheumatoid arthritis, systemic lupus erythematosus, etc. );
- undergo joint surgery.
Age is an important predisposing factor. According to statistics, after 45 years, the likelihood of developing coxarthrosis increases significantly.
Symptoms
The main symptoms of coxarthrosis of the hip joint do not depend on the cause of its development. A large number of patients stated:
- restriction of movement: one of the early symptoms due to thinning of the cartilage layer and increased friction of the articular surface of the bone; in the future, the appearance of cartilage growth exacerbates the problem;
- pain: friction of bones deprived of the cartilage layers of each other, gradual involvement of all elements of the joints in the degenerative process, decreased blood supply to tissues causes an increased sensation of pain as the disease progresses; the pain peaks and often worsens at the end of the day;
- muscle spasms, which lead to increased symptoms of pain and limited movement in the joints;
- decrease in leg length: these symptoms appear in the later stages of the disease due to narrowing of the joint space and gradual grinding of the bone head due to constant friction; the difference between the legs can be up to 2 cm;
- lameness: associated with severe pain and limitation of movement, as well as shortening of the legs; is a bad sign indicating serious damage to the articular apparatus.
Level
In the process of development, coxarthrosis goes through several stages, which depend on the degree of tissue damage.
- 1 degree. At this time, patients noted little pain in the joints that appeared after vigorous or prolonged physical activity and quickly passed after rest. As a rule, discomfort occurs right in the hip joint area, but in some cases extends to the hip or knee. The way of walking does not change, the movement of the legs is fully preserved. On the roentgenogram, specific changes were observed: subchondral sclerosis.
- Grade 2. The pain becomes worse, arises after exercise, spreads throughout the thighs and groin. After exercising, slight lameness may appear. The difficulty of abducting a leg was found. X-rays showed a significant decrease in the distance between the bones (by 50% or more), deformation of the femoral head and significant bone growth.
- 3 degrees. The pain became permanent, walking without a cane became impossible. While moving, the patient appears to be tilted toward the painful side, which increases the load on the joint. Reduced range of motion, leg muscles and back atrophy. There is a shortening of the affected limb. X-rays revealed significant joint deformities, changes 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 freely. X-rays show complete destruction of articular cartilage, as well as signs of bone fusion with each other (ankylosis). To overcome the disease at this stage is possible only with surgery.
Diagnostics
An orthopedic traumatologist is responsible for identifying symptoms and selecting treatment. To diagnose and determine the extent of the disease, he uses:
- survey: listen to patient complaints, identify risk factors (trauma, disease, heredity, etc. );
- examination: assessment of limb movements, determination of the greatest pain area;
- X-ray: X-ray images make it possible to assess the condition of bone and cartilage, the size of the joint space, the presence and location of bone growth; to see the required details in more detail, the study was equipped with CT (computed tomography);
- laboratory diagnostics: general blood tests allow you to identify signs of inflammatory processes, biochemistry - to find out some risk factors, for example, the level of uric acid;
- MRI (magnetic resonance imaging): allows you to assess the condition of not only bones and cartilage, but also soft tissues: bones, ligaments, muscles, joint capsules, etc . ;
- joint puncture.
If it is necessary to perform differential diagnostics with other diseases, as well as to assess the corresponding pathology, additional tests, instrumental examinations, and narrow specialist consultation are prescribed.
Treatment of coxarthrosis
Treatment of coxarthrosis of the hip joint depends on the degree and severity of symptoms. Pathology requires an integrated approach using a variety of methods:
- drug treatment;
- non -drug treatment (physiotherapy, exercise therapy);
- surgery;
- lifestyle and dietary corrections.
Drug treatment
Medications prescribed for hip arthrosis are intended to:
- elimination of pain syndrome;
- recovery or at least slowing down the destruction of cartilage tissue;
- increase blood supply and nutrition to the affected area;
- equivalent pathological treatment.
Painkillers are used in the form of tablets, intramuscular and intraarticular injections and topical agents: creams, ointments, patches. In the early stages of the development of the disease, non-steroidal anti-inflammatory drugs are sufficient for most patients. With severe pain syndrome, hormonal agents are used. The introduction of analgesics directly into the joint capsule has a good effect.
If the disease is accompanied by muscle spasms, muscle relaxation is used. They are used in combination with other analgesics.
Taking painkillers should be limited in time and dose, so as not to cause further damage to cartilage tissue and other side effects (in particular, the development of gastritis and stomach ulcers).
Chondroprotectors are drugs that help restore cartilage tissue. It is effective only with long -term use, combined with other treatment methods, lifestyle and dietary adaptation. Medicines to improve blood circulation help increase its effects. For a similar purpose, a warming ointment is prescribed. Only physicians are involved in the selection of doses and regimens.
Drug -free treatment
This category includes a variety of physiotherapy and manual techniques, as well as physiotherapy training. They help improve microcirculation and restore movement in damaged joints. Depending on the situation, the doctor prescribes:
- shock wave therapy;
- magnetotherapy;
- electromyostimulation.
- various types of electrophoresis and phonophoresis (accompanied by the administration of anesthetic drugs);
- mechanotherapy;
- massage therapy and exercise.
Surgery
If the disease has reached developmental stage 3-4, medications and physiotherapy will only alleviate the patient’s condition, but will not give him the ability to move fully. In this case, arthroplasty is indicated, which is the complete or partial replacement of the damaged joint with a titanium prosthesis.
If there are signs, a milder version of the intervention is performed: grind the part of the bone in contact and cover it with a special fine implant that facilitates sliding.
prevention
Lifestyle can reduce the risk of coxarthrosis, as well as the rate of its development. It is important to follow the rules strictly:
- lead an active lifestyle: swimming in the pool, walking, cycling - physical activity at the amateur level without racing helps increase blood supply and prevents the process of joint degeneration;
- normalize weight to reduce the load on the legs;
- eliminates injuries, hypothermia and occupational risk factors (vibration, weight lifting, standing work);
- treat all diseases in a timely manner, including those not directly related to the musculoskeletal system;
- correct posture disorders in a timely manner, wear comfortable shoes.
Diet
With the help of dietary correction, patients are not only able to lose weight, but also able to reduce inflammatory reactions, salt deposits in tissues and metabolic disorders. It is best that you follow a balanced menu with adequate, but not excessive, amounts of carbohydrates, proteins and fats, as well as vitamins and minerals. Particular attention should be paid to unsaturated fats (olive oil and flaxseed), omega-3 acids (there is an excess in fish), collagen (jelly meat, aspic). It is best to cut down on 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 will inevitably result in complete disability, especially on bilateral wounds. Pain and limited movement do not allow you to work and take care of yourself, which is why it is important to get treatment on time.