Arthrosis of the hip joint (coxarthrosis) is a degenerative disease of the cartilage of the hip joint, which leads to permanent joint dysfunction and disability of the patient. More often, osteoarthritis of the hip joint can be found in older patients, and men are more likely to be ill than women.
Classification of osteoarthritis of the hip joints
There are two main types of the disease:
- primary - the onset of the disease against the background of complete well-being;
- secondary - develops against the background of an inflammatory joint disease, after a previous injury, as well as in the presence of congenital disorders of the hip joint, dysplasia.
Causes of coxarthrosis
There are the following types of causes of osteoarthritis of the hip joint:
- idiopathic - coxarthrosis that develops without a specific cause;
- mixed - osteoarthritis associated with age-related changes that are natural for the body, manifests itself in old age;
- dysplastic (congenital) - osteoarthritis that develops in the joint against the background of congenital anomalies of development;
- post-infection - arthrosis that develops in the joints affected by rheumatoid arthritis and some other infections;
- post-traumatic - osteoarthritis that develops as a result of traumatic damage to the joint;
- dyshormonal - coxarthrosis, which develops against the background of metabolic diseases due to diseases of the endocrine system or hormonal therapy;
- vascular - the disease develops as a result of circulatory disorders in the joint;
- hereditary - develops as a result of hereditary features of the development of cartilage tissue (often combined with deformed osteoarthritis of other joints).
In addition, osteoarthritis of the hip joint can result in a violation of the body's biomechanics of movement, curvature of the spine, intervertebral hernias, or defects in the skeletal bone of the lower extremities (e. g. , shortening of one of them). Weakness or poor posture causes excessive stress on the hip joint, which can trigger coxarthrosis. Another common cause of coxarthrosis is inactivity, but excessive physical activity (sports or work) can also lead to joint pathology.
How does osteoarthritis of the hip joint manifest itself?
First of all, coxarthrosis patients complain of pain in the hip joint. This is accompanied by lameness, atrophy of the thigh and gluteal muscles over time. Movement in the joint is accompanied by a characteristic crisis; the mobility of the joint decreases over time. The intensity of symptoms directly depends on the degree of the disease.
Coxarthrosis 1 degree
The initial stage of the disease manifests itself in the morning or after a small amount of pain in the joint, which can be uncomfortable after the application of severe physical force. Meteorological sensitivity of the affected joint can also be noted, which manifests itself in pain when the weather changes. The patient may feel stiffness in the joint in the morning, disappears after exercise, a slight warming.
Radiological changes are minimal - there may be a slight narrowing of the joint space, thinning of the cartilage surrounding the head of the femur.
Grade 2 coxarthrosis
At this stage of the disease, the intensity of pain increases slightly, and the pain spreads to the groin and knees. There are often misdiagnosis of coxarthrosis associated with pain that spreads to the knee and popliteal ligaments. Pain begins to worry not only after physical exertion, but also at rest. During the movement of the limb, extraneous sounds from the joint are visible (clicks, squeaks). The range of motion in the joint is significantly reduced, especially in rotation (circular), the biomechanics of movement in the joint is impaired and therefore the functionality is reduced. Pain and decreased mobility in the joint cause the appearance of a slight lameness, which leads to moderate atrophy of the gluteal muscles by the affected joint.
The radiograph shows a narrowing of the joint space by one-third of its normal width, a significant thinning of the cartilage until it is absent in some places, the appearance of osteophytes on the joint surfaces, deformation of the femoral head and its upper displacement.
Coxarthrosis grade 3
At this stage of the disease, the pain is persistent, including at night, and it is difficult to eliminate painkillers. The range of motion in the joint is minimized, and the biomechanics of the joint are significantly impaired. The slightest movement is accompanied by crepitus, lameness manifests itself, there is a significant distortion in the pelvis and shortening of the joint by the affected joint. The gluteal and femoral muscles on the affected side atrophy. Due to significant lameness, patients are often unable to move independently without a cane or support.
X-ray examination shows an open deformation of the femoral head, thickening of the femoral neck. The joint surfaces are covered with bone growths, the joint space is so narrow that it is practically absent.
Diagnosis of osteoarthritis of the hip joint
Diagnostic measures begin with an interview and examination of the patient, a series of laboratory tests, followed by the use of special instrumental methods to confirm the diagnosis. The following methods are considered the most informative today:
- X-ray examination -allows you to see the contours of the articular surfaces, the presence or absence of bone growth, the presence of deformities of the femoral head and the width of the joint space;
- Joint ultrasoundallows not only to examine the joint surfaces, but also to identify dystrophic changes in the joint joints;
- computed tomography (CT)- X-ray type, but allows you to get clearer and more voluminous images;
- magnetic resonance imaging (MRI) -allows you to study the condition of joint structures, joint surfaces, bones and ligaments with a high degree of vision. It is currently considered the most advanced diagnostic method.
Treatment of coxarthrosis
The most effective is a complex treatment of osteoarthritis of the hip joint, taking into account the stage of the disease. It is important to remember that the earlier treatment is started, the more likely it is to avoid the development of the disease, the patient's immobility and loss of ability to work. Therefore, even with the slightest discomfort in the joint, visible pain, stiffness, meteosensitivity of the joint, you should consult an orthopedic doctor who will examine, confirm the diagnosis and prescribe treatment. Cartilage tissue does not recover, so it is best not to wait for the moment when the damage is significant, and to start treatment during the feeding phase of cartilage until irreversible changes occur.
The area of treatment depends on the stage of the disease. Thus, with first-degree coxarthrosis, non-narcotic analgesics and NSAIDs are used - to eliminate the pain syndrome, as well as to eliminate inflammation in the joint tissues, without further damage to the tissues. There is no need for long-term use of such drugs, as the pain syndrome and inflammation are not strong at this stage. As a rule, it is enough to do with local means - ointments, gels with NSAIDs. At this stage, it is more important to ensure the normalization of metabolic processes in cartilage tissue, to minimize degeneration using drugs from the group of chondroprotectors. Their task is to restore metabolism in the cells of cartilage tissue, which improves the trophism of the joint and reduces the intensity of inflammation. For example, in the treatment of coxarthrosis, a chondroprotective drug, the active ingredient of which is a source of natural components of healthy cartilage tissue, has proven itself well. Stimulates the production of the most important structural component in cartilage - proteoglycans and prevents the destruction of cartilage tissue.
Complete treatment of secondary and tertiary coxarthrosis is already more difficult: the cartilage is already significantly damaged, the joint surfaces are exposed, and a large number of osteophytes form, which impede the normal movement of the joints. Only symptomatic treatment is possible at this stage, which allows to reduce joint pain and slow down the process of cartilage destruction. At this stage of the disease, the pain is intense, analgesics and NSAIDs are used to relieve them, and the best solution would be a combination of the use of topical agents (ointments, creams) and dosage forms of systemic action (tablets, injections). .
During the exacerbation of the disease, regardless of the stage, the load on the joint should be minimized to avoid further damage to the cartilage. In addition to taking chondroprotectors to normalize metabolic processes in cartilage tissue during remission, exercise therapy, massage and kinesitherapy are recommended. Provides a reasonable load on the joint, prevents immobilization and deposition of mineral salts in the joint tissues and joints, and stimulates microcirculation. Sports therapy is also important for the general condition of the body: during exercise, it produces biologically active substances that increase mood and overall well-being - endorphins and serotonin.
Proper nutrition plays an important role in the complex treatment of osteoarthritis of the hip joint. The patient's diet should be complete, rich in animal and plant proteins, fiber and vitamins. Proper nutrition is important not only to stimulate joint regeneration, but also to keep the patient's body weight at a normal level. Excess weight is an additional burden on the patient's joint and a factor in the development of the disease.
In remission, physiotherapy methods have proven to be good - electrophoresis, mud therapy, ultrasound and magnetotherapy. In addition, the effectiveness of biological and mechanical methods in the treatment of coxarthrosis is noted. The most popular biological method is hirudotherapy (leech therapy), which provides blood thinning and stimulation of capillary microcirculation in both the joint and surrounding muscles, which prevents atrophic processes in them. Mechanical methods include joint traction to reduce excessive stress on the affected joint and acupuncture. However, we must not forget that physiotherapeutic, mechanical and biological methods of treatment of coxarthrosis can be used only in remission. With the exacerbation of the disease, its use is fraught with the development of inflammation and destruction of cartilage tissue.
If conservative methods do not work in the treatment of coxarthrosis, the patient may be offered surgical treatment - arthroplasty and joint replacement. The first option involves the restoration of mobility in the joint due to the plastics of their own tissues, and the second - the replacement of joint surfaces with an endoprosthesis - a mechanical joint. Surgery allows to restore joint mobility and the patient's ability to work.
Prevention of osteoarthritis of the hip joint
Preventive measures, especially for those who exercise or do strenuous physical activity, include chondroprotectors, proper nutrition, and reasonable stress on the joints.
Coxarthrosis is a serious disease that can deprive a patient of the ability to move independently. From the first stage of the pathology, disability can be prevented by receiving immediate medical attention during the first joint discomfort, subject to complex treatment.