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 of these terms mean the same pathology - osteoarthritis, but "coxarthrosis" is a narrower term that characterizes the defeat of the hip joint.
Cartilage is the first to suffer from osteoarthritis, then bones and surrounding structures - ligaments and muscles - are involved in the pathological process. In the case of bone changes, the word "osteoarthritis" is preceded by the prefix "osteo". In advanced cases, the joint is deformed and one speaks of deforming osteoarthritis (osteoarthritis).
General properties
Deforming osteoarthritis of the hip joint is the second most common after gonarthrosis of the knee joint. Due to the low position of the hip joint, a bone deformity can go unnoticed for a long time, and x-rays only taken in later stages show changes.
Various factors affect the development of this disease, including an inactive lifestyle, trauma, and metabolic disorders. Due to the peculiarities of modern life, in which there is often no space for physical education, more and more people are affected by osteoarthritis. In addition, the peak incidence falls on the middle age group - from 40 to 60 years.
Reference:Coxarthrosis more often affects women than men.
Development mechanism
The thigh joint is made up of two bones: the thigh bone and the iliac bone (pelvis). The femoral head penetrates the hip socket 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, allowing flexion, extension, abduction, adduction, and rotation (rotation) of the thigh.
During physical activity, the femur bone moves freely in the acetabulum because the cartilage tissue covers the joint surfaces. Hyaline cartilage is characterized by its strength, strength and elasticity; it acts as a shock absorber and takes part in the distribution of the load during human movements.
In the joint is the synovial fluid - the synovium - which is essential for the lubrication and nutrition of the cartilage. The entire joint is surrounded by a dense, thin capsule that is surrounded by powerful muscles on the thighs and buttocks. These muscles, which also act as shock absorbers, serve to prevent injury to the hip joint.
The development of coxarthrosis begins with changes in the synovial fluid, which becomes thicker and more viscous. Due to the lack of moisture, the cartilage does not receive enough nutrients and begins to dry out, lose its smoothness and cracks appear.
Bones can no longer move as freely as before and rub against each other, which leads to micro-damage in the cartilage. The pressure between the bones increases, the cartilage layer becomes thinner. Under the influence of increasing pressure, bones are gradually deformed, local metabolic processes are disturbed. In the later stages there is pronounced atrophy of the leg muscles.
causes
Deforming osteoarthritis of the hip joint can be primary and secondary. It is not always possible to determine the cause of primary osteoarthritis. Secondary osteoarthritis occurs 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 is of infectious, rheumatic, or other origin;
- Pelvic bone injuries - dislocations, fractures.
Hip dysplasia is a congenital malformation that sometimes does not manifest itself clinically for a long time and can lead to the development of dysplastic coxarthrosis in the future (between the ages of 25 and 55).
Coxo osteoarthritis can be left-sided, right-sided, and symmetrical. Concomitant diseases of the musculoskeletal system are often observed in primary osteoarthritis - in particular osteochondrosis and gonarthrosis.
There are also risk factors that contribute to the onset of the disease:
- obesity and excessive loads that overload the joints;
- violation of blood circulation and metabolism;
- hormonal changes;
- Curvature of the spine, flat feet;
- older age;
- Hypodynamia;
- Inheritance.
It should be noted that coxarthrosis itself is not inherited. However, certain features of the metabolism or the structure of connective tissue can create conditions for the future development of osteoarthritis in a child.
Symptoms of coxarthrosis
The main symptom of hip osteoarthritis is pain in the hip and groin area, which differ in severity. Stiffness and stiffness during movement, a decrease in muscle volume, a shortening of the affected limb, and a change in gait due to limping are also noted.
Coxarthrosis usually progresses slowly and initially causes discomfort and, after exertion, slight pain. 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 sit "astride" a chair. The presence and severity of signs of coxarthrosis depend on its degree, but pain syndrome is always present.
There are three degrees or types of osteoarthritis of the hip joint, which differ in the severity of the injury and the accompanying symptoms:
- 1 degree. The thigh hurts not constantly, but regularly, mainly after long walking or standing. The pain syndrome is localized in the area of the joint, but sometimes it can spread to the leg up to the knee. Muscles with coxarthrosis of the 1st degree do not decrease, the gait does not change, the motor skills are fully preserved;
- 2 degrees. Pain sensations intensify and occur not only after running or walking, but also when you are at rest. The pain is more often concentrated in the thigh area but can spread to the knee. In moments of high stress, stepping on the injured limb is painful, so the patient begins to rest the leg and limp. 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. Pain becomes permanent and does not subside even at night. The gait is noticeably impaired, independent movement is considerably more difficult and the patient leans on a walking stick. The range of motion is severely restricted, the muscles of the buttocks and the entire leg including the lower leg are stunted.
- Muscle weakness causes the pelvis to tilt forward and the affected leg is shortened. To compensate for the difference in length of the limbs, 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 inflammation of the joint, which can be a disease on its own or develop against a background of systemic pathologies (for example, rheumatism). The symptoms of osteoarthritis (especially in the advanced stage) include the inflammatory reaction, limited mobility and changes in the shape of the joint.
The focus of degenerative-dystrophic changes in osteoarthritis is the destruction of the cartilage tissue, which often leads to inflammation. This is why osteoarthritis is sometimes referred to as osteoarthritis arthritis. And since osteoarthritis is almost always associated with joint deformations, the term "osteoarthritis" applies.
Reference:According to the International Classification of Diseases (ICD-10), osteoarthritis and osteoarthritis are variants of the same pathology.
Diagnosis of coxarthrosis
The diagnosis "coxarthrosis of the hip joint" is made on the basis of examination, patient complaints and examination results. The most revealing method is X-ray: in the pictures you can see both the degree of joint damage and the cause of the disease.
In the case of hip dysplasia, for example, the acetabulum is flatter and inclined and the cervico-diaphyseal angle (inclination of the femoral neck in the vertical plane) is larger than normal. The deformation of the part of the femur that is in the immediate vicinity of the joint is characteristic of Perthes disease.
3rd degree coxarthrosis is characterized by a narrowing of the joint space, an expansion of the femoral head and multiple bone growths (osteophytes).
If the patient has suffered a fracture or dislocation, signs of trauma will also be visible on the X-rays. If a detailed assessment of the condition of bones and soft tissues is required, magnetic resonance imaging or computed tomography may be prescribed.
Differential diagnosis is carried out in the following diseases:
- Gonarthrosis;
- osteochondrosis and radicular syndrome that appear on their background;
- Trochanteritis (inflammation of the trochanter bone of the thigh);
- Ankylosing spondylitis;
- reactive arthritis.
The decrease in muscle volume that accompanies the 2nd and 3rd coxarthrosis can cause pain in the knee area. In addition, the knee often hurts more than the hip joint itself. An x-ray is usually sufficient to confirm the diagnosis and rule out osteoarthritis of the knee.
In diseases of the spine - osteochondrosis and pinched nerve roots - the pain is very similar to coxarthrosis. However, it occurs unexpectedly after an unsuccessful exercise, sharp body twist, or weight lifting. Pain sensations start in the buttock area and spread to the back of the leg.
Radicular syndrome is characterized by severe pain when lifting a straight limb from the supine position. However, there are no difficulties with abduction of the leg to the side, as in 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, in contrast to 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. Trochanteritis is caused by trauma or excessive exercise. Movement is not restricted and the leg is not shortened.
Ankylosing spondylitis and reactive arthritis can also be accompanied by symptoms that are similar to coxarthrosis. The hallmark of such diseases is the appearance of pain mainly at night. The hip can be quite painful, but the pain subsides as you walk and move around. In the morning, patients worry about stiffness, which will go away after a few hours.
Treatment of osteoarthritis of the hip joint
Coxarthrosis can be cured conservatively or surgically. The choice of treatment method depends on the stage and nature of the course of the pathological process. When diagnosed with 1 or 2 degrees of the disease, it is treated with medication and physical therapy. After relieving acute symptoms, therapeutic exercises and massages are added. If necessary, a special diet is prescribed.
The earlier coxarthrosis is recognized 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 the anesthesia is carried out in the shortest possible time, since drugs of the NSAID class have a negative effect on the digestive tract and can slow down the regeneration processes in the cartilage tissue.
With the help of chondroprotectors it is possible to accelerate the restoration of the cartilage. However, these funds are effective only in the early stages of the disease, when the hyaline cartilage is not completely destroyed. Chondroprotectors are prescribed in the form of tablets or intra-articular injections.
Vasodilators are used to improve blood flow to the joint. Muscle relaxants are advisable for muscle cramps.
In the case of persistent pain syndrome, which is difficult to get rid of with pills, injections are made into the hip joint. Corticosteroids are good at relieving inflammation and pain.
Drug therapy can also be supplemented with topical agents - ointments and gels. They don't have a pronounced effect, but they help manage muscle spasms and reduce muscle soreness.
Physiotherapy helps improve blood circulation and cartilage nutrition. For coxarthrosis, procedures such as shock wave therapy (SWT), magnetic field therapy, infrared laser, ultrasound and hydrogen sulfide baths have proven to be excellent.
operation
The treatment of arthrosis in stage 3 can only be done surgically, as the joint is almost completely destroyed. Partial or total arthroplasty is performed to restore the function of the hip joint.
In advanced osteoarthritis, when conservative therapy has passed out, surgical treatment is resorted to.
With partial prosthetics, only the femoral head is replaced by an artificial prosthesis. Full dentures mean replacing both the femoral head and the acetabulum. The operation is performed under general anesthesia and in the vast majority of cases (approx. 95%) the function of the hip joint is fully restored.
During the rehabilitation period, the patient is prescribed antibiotics to prevent infectious complications. On the 10th-12thOn the 2nd day the stitches are removed and exercise therapy is started. The attending physician helps the patient learn to walk and correctly distribute the load on the operated extremity. 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 in the elderly this period can be up to six months. After the rehabilitation is complete, patients can fully exercise, 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 worsen the quality of life, but also lead to disability and disability. In the second stage of osteoarthritis, the patient receives the 3rd group of disabilities.
With a shortening of 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 the disability is obtained by patients with 3rd degree coxarthrosis, which is accompanied by a complete loss of motor skills.
Indications for the medical and social examination (MSK) are:
- long course of osteoarthritis, more than three years, with regular exacerbations. The frequency of exacerbations is at least three times every 12 months;
- had an endoprosthetic operation;
- severe dysfunction of the musculoskeletal system of the extremities.
prophylaxis
The most important 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.
Swimming is advisable if there are risk factors for the development of osteoarthritis and in all patients with a diagnosed disease. Sports such as running, jumping, soccer, and tennis are not recommended.