The hip joint is the largest joint in our body.It has a hinge configuration that allows movement in different planes.At the same time, the joint is surrounded by strong ligaments and muscles.The hip joints bear the main load when walking, running or carrying heavy loads.Coxarthrosis (another name for osteoarthritis of the hip) is quite common in old and young people.Once it begins, it can go undiagnosed for a long time, because visible limitation of hip movement does not occur immediately.
Often, patients, without being examined by a doctor or presenting all their complaints, begin to treat lumbosacral osteochondrosis or osteoarthritis of the knee joints without any visible effect.During this time, the untreated disease progresses and results in lameness, constant pain, shortening of the leg, and an inability to bend and extend.And treatment at this stage is possible only surgically, that is, the joint must be replaced with prostheses.
Causes of coxarthrosis
Primary osteoarthritis of the hip develops more often in people over 40 years old.Its causes have not yet been studied.The hyaline cartilage that covers joint surfaces and provides gliding begins to thin and collapse.Due to increased friction and pressure on the bones, bone spurs appear on them.The joint is deformed, movements are limited.In primary coxarthrosis, the knee joints and the spine are often affected.
Secondary osteoarthritis develops against the background of various diseases:
- Hip dysplasia.This term refers to the congenital underdevelopment of the components of this joint in a child.As a result, the femoral head is not centered as it should be in the acetabulum.There are three types of dysplasia: preluxation, subluxation and dislocation of the hip.In congenital dislocation, the femoral head lies outside the socket and, if appropriate treatment is not carried out, osteoarthritis subsequently develops.
- Aseptic necrosis.The bone tissue of the femoral head begins to dissolve due to impaired blood supply.The bone tissue is focally resorbed, the head of the joint is deformed.Osteoarthritis develops secondarily.
- Legg-Calvé-Perthes disease.It is an osteochondropathy of the femoral head, occurring in children aged 3 to 14 years, mainly in boys.Usually occurs as a result of complications following infectious processes, as well as injuries, physical overload and metabolic diseases.The cartilaginous area of the head is not well supplied with blood, which leads to necrosis of this area and deformation of the joint.
- Inflammations, infections.If hip arthritis develops, the synovial fluid loses its lubricating properties, the joint mucosa thickens, the hyaline cartilage is subjected to mechanical stress, and at the same time metabolic disorders occur in the joint.
- Injuries: contusions, fractures of the femur, acetabulum, hip dislocations, chronic trauma, i.e. microtrauma received systematically.
- Overload of the hip joint associated with sports and professional activities.For example, long walking without rest, the effects of vibration, constant jumping and carrying heavy loads are undesirable for the joint.The muscular corset of a child or adolescent cannot always compensate for such loads.
- Increased body weight, especially at a young age, when the cartilage is not yet able to withstand significant axial loads.In addition, these patients generally present with metabolic problems.
- Coxarthrosis itself is not hereditary, but genetically relatives may have a certain structure of cartilage tissue, metabolic disorders leading to the development of osteoarthritis.Therefore, it is worth considering whether parents or more distant relatives suffer from joint diseases.
- Osteoporosis.The area vulnerable to this disease is the femoral neck.Its structure becomes rarefied, pathological fractures are possible.All this secondary leads to osteoarthritis.
- Diabetes mellitus.In this case, osteoarthritis develops due to vascular disorders.
- Polyneuropathy with altered sensation in the legs.
- Diseases of other parts of the musculoskeletal system.These include: scoliosis, osteoarthritis and knee injuries, flat feet.The load distribution on the hip joints changes, shock-absorbing properties decrease and, as a result, the cartilaginous covering suffers.
Symptoms of coxarthrosis
To prevent the disease and its early diagnosis, it is important to know the signs of emerging osteoarthritis of the hip joint (stage 1 coxarthrosis):
- Pain that occurs periodically after physical activity.Specific painful sensations may be located in the groin, side, hip or knee.After the rest, they go away, so we don't give them any importance.In the meantime, this is an alarming sign.
- Slight limitation of hip rotation (inwards and outwards).This can be easily checked by lying on your back, rotating the entire leg clockwise and counterclockwise.
- An x-ray may reveal a slight, irregular narrowing of the joint space.
With osteoarthritis of the 2nd stage, the signs are more pronounced:
- The pain occurs at the level of the joint projection, most often in the inguinal fold, and is also observed at rest.
- Restrictions appear not only when rotating the leg, but also when abducting the hip to the side.Movements of the joint are somewhat painful, especially in extreme positions (with maximum hip abduction, flexion of the leg toward the stomach).
- On an x-ray, you can see moderate narrowing of the joint space and isolated bony growths at the edges of the acetabulum.Cysts can also form in the bony structure of the femoral head.
3rd stage hip osteoarthritis is easily diagnosed, its symptoms are severe:
- Pain in the joint during exercise, at night.
- Lameness, patients often use a cane.
- Marked limitation of joint movement, making it difficult for a person to put on socks or shoes.
- The leg becomes thinner due to hypotrophy of the thigh and lower leg muscles.The muscles of the gluteal region also weaken.
- It is possible to shorten the leg due to incomplete extension and deformity of the femoral head.As a result, scoliosis of the lumbar region (lateral curvature) forms and pain appears in the lumbosacral region.
- Signs of the 3rd stage, revealed by x-rays, are a pronounced narrowing of the joint space up to its complete absence, bone growths, deformation of the head and neck of the hip joint.
Diagnosis
When making a diagnosis, it is of great importance to clarify subjective complaints, collect anamnesis, assess symptoms, and also clarify the stage - x-ray, CT and MRI.Computed tomography allows you to study in detail the bone structure of the hip joint, and the magnetic resonance method visualizes soft tissues, the state of the joint capsule and the presence of synovitis.
Treatment
Treatment of coxarthrosis depends on the stage of the process and in most cases includes a whole range of procedures.Of course, the earlier treatment is started, the greater its effectiveness.
- Conservative treatment
- Drug therapy.To relieve pain, nonsteroidal anti-inflammatory drugs are used in the form of tablets, suppositories or intramuscular injections.Dosage forms such as ointments, gels and creams are not effective enough due to the surrounding of the hip joint by large muscles and subcutaneous tissue.Prolonged courses of nonsteroidal anti-inflammatory drugs are not recommended due to side effects on the cardiovascular system and gastrointestinal tract.To help them, the doctor may prescribe medications that relieve muscle spasms - a muscle relaxant.In cases of severe inflammation, intra-articular glucocorticoids may be necessary.Chondroprotectors are one of the main groups of drugs intended for the treatment of coxarthrosis.They are administered intramuscularly and intra-articularly;in milder cases, tablets may be taken.These drugs are aimed at improving the processes of restoration of cartilage tissue and slowing down its degeneration.The doctor may also prescribe vascular medications to improve local blood circulation.
- Physiotherapy.Its procedures improve blood circulation in the joint area and relax the muscles.These are UHF, magnetotherapy, laser treatment, diadynamic currents, electrophoresis.Purpose - according to individual indications.
- Therapeutic massage.An indispensable method of treating coxarthrosis: relieves muscle spasms, has a beneficial effect on blood circulation and, when carried out systematically, strengthens the muscles.
- Therapeutic gymnastics.Improves blood circulation and strengthens the muscular corset of the joint.Recommended exercises in case of hip osteoarthritis (performed on a solid support):
- “cycling” while lying down;
- lying on your back, grab your knee with your hand and pull it towards your stomach, and do the same with the other leg;
- while lying on your back, bend your knees, press your plants on the ground and raise your pelvis, maintain in this position;
- lying on your back, move your thigh as far to the side as possible;
- sitting on a chair, squeeze the ball between your thighs;
- lying on your back, turn your legs in and out;
- Standing with your right foot on a slight elevation and holding the support with your hands, swing your left leg back and forth and left to right, then do the same, switching legs.
- Surgical treatment.Endoprostheses, that is, the replacement of a joint with an artificial one, are performed at the 3rd stage of coxarthrosis in the presence of shortening of the limb, constant pain and severe contracture.Endoprostheses can be cemented (in the presence of osteoporosis) or cementless.The prosthesis itself can be unipolar (replacement of the head only) and total (replacement of both components).Already the day after the operation, some elements of exercise therapy are carried out in a supine position, the patient can get up, but for now without supporting his leg, and a few days later - on crutches.After 2-3 months, crutches will no longer be necessary and full support on the leg will be allowed.Patients who have undergone stents are recommended to undergo rehabilitation including physical therapy, massage and physical therapy.In most cases, limb function is restored.The lifespan of the prosthesis is 10 to 20 years, then it is replaced with a new one.
Prevention of coxarthrosis
Prevention measures are very important, especially if you have a history of hip dysplasia, fractures, severe bruises or purulent processes in this area.
- Avoid lifting heavy objects and jumping (especially from heights).Try not to stand for long periods of time.
- Body weight control (reduce the consumption of flour products, table salt, sweet and strong tea and coffee in the diet).Being overweight increases the risk of hip osteoarthritis.
- Dosed physical exercises aimed at strengthening the muscles of the thighs and buttocks (cycling or exercise bike, swimming, therapeutic exercises).
- If there are diseases related to metabolism (diabetes mellitus, atherosclerosis), they must be compensated.
Compliance with preventive measures, early detection of coxarthrosis and its adequate treatment are the key to a positive prognosis of this disease.
Which doctor should I contact?
If you experience pain in your leg or hip joint, you should consult a doctor.He will prescribe primary diagnostic measures, including x-rays of the hip joint.Once the stage of the disease has been established, the patient will be referred to a rheumatologist or orthopedist.A nutritionist and endocrinologist can provide additional help in losing weight and slowing the progression of the disease.It would be helpful for women to consult a gynecologist to prescribe hormone replacement therapy to prevent osteoporosis.