Arthrosis of the hip joint (coxarthrosis) is a chronic pathology, accompanied by the gradual destruction of the cartilaginous tissue of 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 arthroplasty.
Coxarthrosis belongs to the group of degenerative diseases. It begins gradually with microscopic changes in the structure of the cartilage. Increased stress, inflammatory diseases, blood supply disturbances lead to structural transformations and thinning of the cartilage tissue, and they, in turn, deform the contours of the articular site. As a result, the distribution of the load on the contacting surfaces of the bones changes, and the zones with the maximum pressure begin to wear out faster. This triggers a whole cascade of pathological reactions:
- the appearance of microcracks and areas of compaction in the cartilaginous tissue;
- decrease in the smoothness of the articular surfaces;
- overgrowth of cartilage 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 reduced strength of the ligaments;
- changes in the composition of the synovial fluid (natural lubrication inside the joint);
- narrowing of the joint space;
- fusion of all elements of the joint (ankylosis).
Without treatment, coxarthrosis inevitably becomes the cause of immobility and disability.
Depending on the causes of the development of the disease, primary and secondary coxarthrosis is distinguished. In the first case, it occurs on its own, for example, against the background of a hereditary predisposition, in the second, it is provoked by other diseases or injuries. In most cases, the process of degeneration of cartilage tissue occurs due to a combination of several factors. The reason may be:
- congenital dislocation of the hip;
- flat feet, scoliosis and other orthopedic problems;
- Legg-Calve-Perthes disease;
- joint inflammation (arthritis), regardless of origin;
- injuries and microtraumas of the hip joint against the background of overweight, professional sports, etc . ;
- dysplasia of the hip joint;
- metabolic disorders;
- endocrine diseases (especially diabetes mellitus);
- violations of the blood supply to the lower extremities;
- frequent stress;
- heredity (coxarthrosis in parents or other close relatives significantly increases the risks of developing it in a child);
- congenital pathologies and autoimmune diseases of the connective tissue (joint hypermobility, rheumatoid arthritis, systemic lupus erythematosus, etc. );
- undergone joint operations.
Age is an important predisposing factor. According to statistics, after 45 years, the likelihood of developing coxarthrosis increases significantly.
The main symptoms of coxarthrosis of the hip joint do not depend on the cause of development. Most patients note:
- restriction of movement: one of the earliest symptoms due to thinning of the cartilage layer and increased friction of the articular surfaces of the bones; in the future, the appearance of cartilaginous growths further exacerbates the problem;
- pain: friction of bones deprived of a cartilaginous layer against each other, the gradual involvement of all elements of the joint in the degenerative process, a decrease in the blood supply to the tissues cause pain sensations that increase as the disease progresses; the pain is shooting in nature and often worsens towards the end of the day;
- muscle spasm, which leads to an increase in the pain symptom and limitation of the range of motion in the joint;
- decrease in leg length: this symptom appears in the later stages of the disease due to the narrowing of the joint space and the gradual grinding of the heads of the bones 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 leg; is an unfavorable sign indicating serious damage to the articular apparatus.
In the process of development, coxarthrosis goes through several stages, which depend on the degree of tissue damage.
- 1 degree. At this time, the patient notes slight aching pains in the joint that appear after intense or prolonged physical activity and quickly pass after rest. As a rule, discomfort occurs precisely in the area of the hip joint, but in some cases it extends to the hip or knee. The gait does not change, the leg movements are preserved in full. On the roentgenogram, specific changes are noted: subchondral sclerosis.
- 2nd degree. The pain becomes more severe, arises after exertion, extends to the entire thigh and groin. After exertion, slight lameness may appear. Difficulties in abducting the leg are found. X-ray shows a significant decrease in the distance between the bones (by 50% or more), deformation of the femoral head and pronounced bone growths.
- 3 degree. The pains become permanent, walking without a cane becomes impossible. When moving, the patient noticeably leans towards the painful side, which further increases the load on the joint. The range of motion is reduced, the muscles of the leg and buttocks atrophy. There is a shortening of the affected limb. X-ray reveals a significant deformity of the joint, a change in the contour of the femoral head, and a large number of osteophytes.
- 4 degree. The pain becomes stronger and does not stop for a minute, the patient loses the ability to move independently. The X-ray shows complete destruction of the articular cartilage, as well as signs of bone fusion with each other (ankylosis). To cope with the disease at this stage is possible only by surgery.
An orthopedic traumatologist is involved in the identification of symptoms and the selection of treatment. To diagnose and determine the extent of the disease, he uses:
- survey: listening to patient complaints, identifying risk factors (trauma, disease, heredity, etc. );
- examination: assessment of limb mobility, determination of areas of greatest pain;
- X-ray: an X-ray image makes it possible to assess the condition of bones and cartilage, the size of the joint space, the presence and location of bone growths; in order to see the necessary details more thoroughly, the study is supplemented by CT (computed tomography);
- laboratory diagnostics: a general blood test allows you to identify signs of an inflammatory process, biochemical - to note 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 capsule, etc. ;
- puncture of the joint.
If it is necessary to carry out differential diagnostics with other diseases, as well as to assess concomitant pathologies, additional tests, instrumental examinations, and consultations of narrow specialists are prescribed.
Treatment of coxarthrosis of the hip joint depends on its stage and severity of symptoms. Pathology requires an integrated approach using various methods:
- drug treatment;
- non-drug treatment (physiotherapy, physiotherapy exercises);
- lifestyle correction and diet.
The drugs prescribed for arthrosis of the hip joint are aimed at:
- removal of pain syndrome;
- restoration or at least slowing down the destruction of cartilage tissue;
- improving blood supply and nutrition to the affected area;
- treatment of concomitant pathologies.
Anesthetic drugs 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 course of the disease is accompanied by muscle spasm, muscle relaxants are 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 the cartilage tissue and other side effects (in particular, the development of gastritis and stomach ulcers).
Chondroprotectors are drugs that help restore cartilage tissue. They are effective only with long-term regular use, which is combined with other treatment methods, lifestyle and dietary adjustments. Drugs to improve blood microcirculation help to enhance their effect. For a similar purpose, warming ointments are prescribed. Only a doctor is involved in the selection of the dosage and regimen.
This category includes various physiotherapy and manual techniques, as well as physiotherapy exercises. They help to improve microcirculation and restore movement in the damaged joint. Depending on the situation, the doctor prescribes:
- shock wave therapy;
- various types of electrophoresis and phonophoresis (accompanied by the administration of anesthetic drugs);
- massage and exercise therapy.
If the disease has reached the 3-4 stage of development, medications and physiotherapy will only alleviate the patient's condition, but will not return him the ability to fully move. In this case, arthroplasty is indicated, i. e. complete or partial replacement of the damaged joint with a titanium prosthesis.
If there are indications, a lightweight intervention is performed: grinding of the contacting areas of the bones and covering them with special smooth implants that facilitate sliding.
Lifestyle can significantly reduce the risk of developing coxarthrosis, as well as the rate of its progression. It is important to strictly adhere to the rules:
- lead an active lifestyle: swimming in the pool, walking, cycling - physical activity at an amateur level without racing for records helps to improve blood supply and inhibits the processes of joint degeneration;
- normalize body weight to reduce the load on the legs;
- eliminate injuries, hypothermia and occupational risk factors (vibration, weight lifting, standing work);
- timely treat all diseases, including those not directly related to the musculoskeletal system;
- correct posture disorders in time, wear comfortable shoes.
With the help of nutritional correction, the patient can not only reduce body weight, but also reduce inflammatory reactions, salt deposits in tissues and metabolic disorders. It is recommended that you stick to a balanced menu with sufficient, but not excessive amounts of carbohydrates, proteins and fats, as well as vitamins and minerals. Particular attention should be paid to unsaturated fats (olive and flaxseed oil), omega-3 acids (found in excess in fish), collagen (jellied meat, aspic). It is recommended to minimize fast carbohydrates, alcohol, strong coffee, products with artificial flavors, preservatives and flavor enhancers.
Consequences and complications
Coxarthrosis is one of the common causes of disability in older people. Without proper treatment, pathology inevitably leads to complete disability, especially in bilateral lesions. Pain and limited mobility do not allow you to work and take care of yourself, which is why it is important to get treatment on time.