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: coxarthrosis deformans, AOD of the hip joint, osteoarthritis. All of these terms refer to 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, and 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 "arthritis". In advanced cases, the joint is deformed and there is already talk of deforming osteoarthritis (osteoarthritis).
Main Features
Hip osteoarthritis is the second most common after knee osteoarthritis. Due to the deep location of the hip joint, bone deformity may go unnoticed for a long time, and only x-ray images taken in later stages will show changes.
The development of this disease is influenced by various factors, including an inactive lifestyle, trauma and metabolic disorders. It is because of the specifics of modern life, in which there is often no place for physical education, that osteoarthritis affects more and more people. In addition, the maximum incidence falls on the middle age group - from 40 to 60 years.
Reference:coxarthrosis affects women more often 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 stationary during movement - walking, running. At the same time, the articular surface of the femur can move in several 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 covering the joint surfaces. Hyaline cartilage is distinguished by its strength, firmness and elasticity; it acts as a shock absorber and participates in the distribution of the load during human movements.
Inside the joint is the synovial fluid - the synovium - 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, 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 a lack of moisture, the cartilage does not receive enough nutrition and begins to dry out, loses its softness, and cracks appear on it.
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 cartilage layer thins. Under the influence of increasing pressure, the bones gradually deform, local metabolic processes are disturbed. In the later stages there is a pronounced atrophy of the muscles of the legs.
Causes
Osteoarthritis deformans 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 dislocation of the hip 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 lesions - dislocations, fractures.
Hip joint dysplasia is a congenital malformation that sometimes does not manifest clinically for a long time and in the future (at the age of 25-55 years) can lead to the development of dysplastic coxarthrosis.
Coxo's osteoarthritis can be left side, right side, 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;
- advanced age;
- hypodynamia;
- heredity.
It should be noted that coxarthrosis itself is not hereditary. However, certain features of the metabolism or connective tissue structure 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 varies in intensity. There is also stiffness and stiffness during movement, a decrease in muscle volume, shortening of the affected limb and a change in gait due to lameness.
Coxarthrosis most often progresses slowly, causing discomfort at first and slight pain after exercise. However, over time the pain increases and appears when at rest.
A typical manifestation of the pathology is the difficulty of hip abduction, when a person cannot sit "astride" on a chair. The presence and severity of signs of coxarthrosis depend on its degree, but the pain syndrome is still present.
There are three degrees or types of osteoarthritis of the hip joint, which differ in the severity of the injury and the symptoms that accompany it:
- 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 in the area of the joint, but it can sometimes extend from the leg to the knee. The muscles with coxarthrosis of the 1st degree do not decrease in size, the gait does not change, the motor capacity is fully preserved;
- 2nd degree. Pain sensations intensify, occur 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 heavy load, it is painful to step on the injured limb, so the patient begins to spare the leg and lameness. The range of motion of the joint decreases, it is especially difficult to move the leg to the side or rotate the hip;
- 3 degree. The pain becomes permanent and does not go away even at night. The gait is noticeably impaired, the independent movements are considerably complicated and the patient leans on a cane. The range of motion is severely limited, the muscles of the buttocks and the entire leg, including the lower leg, wither away.
- Due to muscle weakness, the pelvis leans forward, the affected leg is shortened. To compensate for the difference in limb length, the patient tilts the body to the affected side when walking. This causes a shift in the center of gravity and increased stress on the affected joint.
Osteoarthritis or arthritis?
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 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 arthritis-arthritis. And since 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 varieties of the same pathology.
Diagnosis of coxarthrosis
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 x-ray: 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 inclined, and the neck and 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 hip osteoarthritis is characterized by narrowing of the joint space, expansion of the femoral head and multiple bony growths (osteophytes).
If the patient has had a fracture or dislocation, signs of trauma will also be visible on the 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 ordered.
Differential diagnosis is carried out with the following diseases:
- gonarthrosis;
- osteochondrosis and radicular syndrome appearing on its background;
- trochanteritis (inflammation of the trochanter bone of the thigh);
- ankylosing spondylitis;
- reactive arthritis.
The decrease in muscle volume accompanying the 2 and 3 degrees of coxarthrosis can cause pain in the knee. Additionally, the knee often hurts even more than the hip joint itself. To confirm the diagnosis and rule out 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 of weights. Pain sensations start in the buttock area and spread to the back of the leg.
Radicular syndrome is characterized by severe pain when raising a right limb from a supine position. However, there are no difficulties when abducting the leg to the side, as with hip osteoarthritis. It should be noted that osteochondrosis and osteoarthritis of the hip joint are often diagnosed simultaneously, so a full examination is required.
Trochanteritis, or trochanteric bursitis, develops rapidly, unlike osteoarthritis, which can progress slowly over years or even decades. The pain syndrome accumulates in a week or two, when 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 mimicking hip osteoarthritis. The hallmark of these diseases is the appearance of pain mainly at night. The hip can hurt a lot, but as you walk and move the pain subsides. In the morning, patients worry about the 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 diagnosed with 1 or 2 degree of the disease, it is treated with drugs and physiotherapy. After the relief of acute symptoms, therapeutic exercises and massage are added to it. 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.
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 time, since drugs of the class of NSAIDs can negatively affect the digestive tract and slow down 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 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 remove with pills, injections are made into the hip joint. Corticosteroids provide good relief for inflammation and pain.
Drug treatment 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 the nutrition of cartilage. For hip osteoarthritis, procedures such as shock wave therapy (SWT), magnetotherapy, infrared laser, ultrasound, and hydrogen sulfide baths have proven to be excellent.
Surgery
The treatment of stage 3 osteoarthritis can only be surgical, the joint being almost completely destroyed. To restore the function of the hip joint, partial or total arthroplasty is performed.
Surgical treatment is used in advanced cases of osteoarthritis, when conservative treatment is powerless.
In partial prosthesis, only the head of the femur is replaced by an artificial prosthesis. The total prosthesis consists of replacing both the femoral head and the acetabulum. The operation is performed under general anesthesia and in the overwhelming 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 exercise therapy is started. The attending physician helps the patient to learn to walk and to distribute the load correctly on the operated limb. Exercise is an important step in increasing muscle strength, endurance, and elasticity.
The ability to work is restored on average 2-3 months after the operation, but for older people this period can be up to six months. At the end of the rehabilitation, patients can move fully, work and even play sports. The service life of the prosthesis is at least 15 years. To replace a worn prosthesis, a second surgical procedure 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 at the second stage of osteoarthritis, the patient receives 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 assigned. The 1st group of disability is received by patients with the 3rd degree of coxarthrosis, accompanied by a complete loss of motor capacity.
The indications for the medical-social examination (MSK) are:
- long-lasting osteoarthritis, greater than three years, with regular exacerbations. The frequency of exacerbations is at least three times every 12 months;
- had endoprosthetic surgery;
- serious disorders of the musculoskeletal function of the limb.
Prophylaxis
The main preventative measures for coxarthrosis are diet (if you are overweight) and regular but moderate physical activity. It is very important to avoid injury to the pelvic area 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.