The hip joint is the largest joint in our body.It has a hinged 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 arthrosis of the hip joint) is quite common among the elderly and the young.Once it starts, it can go undiagnosed for a long time because visible limitation of hip movements does not occur immediately.
Patients often begin to treat lumbosacral osteochondrosis or arthrosis of the knee joints without making a medical examination or presenting their complaints, without having a visible effect.Meanwhile, the untreated disease progresses and leads to lameness, constant pain, shortening of the leg, and inability to bend and extend.At this stage, treatment is only possible surgically, i.e. the joint must be replaced with a prosthesis.
Causes of coxarthrosis
Primary arthrosis of the hip joint develops more often in people over 40 years of age.The reasons for this have not yet been investigated.The hyaline cartilage that covers the joint surfaces and ensures gliding begins to thin and collapse.Due to the 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 arthrosis develops against the background of various diseases:
- Hip dysplasia.This term refers to congenital underdevelopment of the components of the 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 the case of congenital dislocation, the femoral head is located outside the socket, and if proper treatment is not carried out, arthrosis develops later.
- Aseptic necrosis.The bone tissue of the femoral head begins to dissolve due to damage to the blood supply.The bone tissue is focally absorbed, the head of the joint is deformed.Arthrosis develops secondarily.
- Legg-Calvé-Perthes disease.This is osteochondropathy of the femoral head, which occurs in children aged 3-14 years, mainly boys.It usually occurs as a result of complications after 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 arthritis of the hip joint has developed, the synovial fluid loses its lubrication, the lining of the joint thickens, the hyaline cartilage is exposed to mechanical stress, and metabolic disturbances occur in the joint.
- Injuries: bruises, femur fractures, acetabulum, hip joint dislocations, chronic trauma, i.e. systematically received microtraumas.
- Overloading of the hip joint with sports and professional activities.For example, long walks without rest, vibration effects, constant jumping and carrying heavy loads are undesirable for the joint.The muscular corset of a child or teenager is not always able to compensate for such loads.
- Increased body weight, especially at a young age, when the cartilage is not yet able to withstand high axial loads.In addition, such patients usually have metabolic problems.
- Coxarthrosis itself is not inherited, but genetically, relatives may have a certain cartilage tissue structure, metabolic disorders that lead to the development of arthrosis.It is therefore worth considering whether the parents or distant relatives have joint diseases.
- Osteoporosis.The vulnerable area of this disease is the femoral neck.Its structure is rarefied, pathological fractures are possible.All this leads to secondary arthrosis.
- Diabetes mellitus.In this case, arthrosis develops due to disorders of the vascular system.
- Polyneuropathy with sensory disturbances in the legs.
- Diseases of other parts of the locomotor system.These include: scoliosis, arthrosis and knee injuries, flat feet.The distribution of the load on the hip joints changes, the shock-absorbing properties decrease, and the cartilage coating suffers as a result.
Symptoms of coxarthrosis
In order to prevent the disease and diagnose it early, it is important to know the signs of incipient hip joint arthrosis (stage 1 coxarthrosis):
- Pain that occurs intermittently after physical activity.Special pain sensations can be localized in the groin area, side, hip or knee.They leave after resting, so they do not attach importance.Meanwhile, this is a warning sign.
- Slight restriction of hip rotation (inward and outward).You can easily check this by lying on your back and rotating your entire leg clockwise and counterclockwise.
- An X-ray may reveal a slight uneven narrowing of the joint space.
With stage 2 arthrosis, the signs are more pronounced:
- The pain occurs in the projection of the joint, most often in the inguinal fold, and can also be observed at rest.
- Restrictions occur not only when turning the leg, but also when pulling the hip to the side.Movements in the joint are somewhat painful, especially in extreme situations (maximum abduction of the hip, bending of the leg towards the stomach).
- A moderate narrowing of the joint space and isolated bone growths on the edges of the acetabulum can be seen on the X-ray.Cysts can also form in the bone structure of the femoral head.
Stage 3 hip arthrosis is easy to diagnose, and its symptoms are severe:
- Pain in the joint during exercise, at night.
- Lameness, patients often use a cane.
- Significant limitation of movement in the joint, as a result of which the person has difficulty putting on socks or shoes.
- The leg becomes thinner due to hypotrophy of the muscles of the thigh and lower leg.The muscles of the gluteal region also weaken.
- It is possible to shorten the leg due to its incomplete extension and deformation of the femoral head.As a result, scoliosis of the lumbar region (lateral curvature) develops and pain occurs in the lumbosacral region.
- The signs of the 3rd stage, which are shown on X-rays, are a pronounced narrowing of the joint space to its complete absence, bone growth, deformation of the head and neck of the hip joint.
Diagnostics
Clarifying subjective complaints, collecting anamnesis, evaluating symptoms, and clarifying the stage - X-ray, CT and MRI are of great importance in diagnostics.Computed tomography enables a detailed study of the bone structure of the hip joint, and the magnetic resonance method shows the soft tissues, the condition of the joint capsule and the presence of synovitis.
Treatment
The therapy of coxarthrosis depends on the stage of the process and in most cases includes a whole series of procedures.Of course, the earlier the treatment starts, the greater its effectiveness.
- Conservative treatment
- Drug therapy.Non-steroidal anti-inflammatory drugs in tablets, suppositories or intramuscular injections are used to relieve pain.Dosage forms such as ointments, gels, creams are not effective enough, since the hip joint is surrounded by large muscles and subcutaneous tissue.Long courses of NSAIDs are not recommended due to cardiovascular and gastrointestinal side effects.To help them, the doctor can prescribe medicines that relieve muscle spasm - muscle relaxants.In case of severe inflammation, intra-articular glucocorticoids may be necessary.Chondroprotectors are one of the main groups of drugs for the treatment of coxarthrosis.It is administered both intramuscularly and intra-articularly;in milder cases, it can also be taken in tablet form.These drugs are aimed at improving cartilage tissue repair processes and slowing down its degeneration.The doctor may also prescribe vascular drugs to improve local blood circulation.
- Physiotherapy.Its procedures improve blood flow in the joint area and relax the muscles.These are UHF, magnetic therapy, laser treatment, diadynamic currents, electrophoresis.Purpose - according to individual indications.
- Therapeutic massage.An indispensable treatment method for coxarthrosis: it relieves muscle spasms, has a beneficial effect on blood circulation, and systematically strengthens the muscles.
- Therapeutic gymnastics.It improves blood flow and strengthens the ligaments of the joint.Recommended exercises for coxarthrosis (performed on solid support):
- "bicycle" in a recumbent position;
- lying on your back, grab your knee with your hand and pull it towards your stomach, and do the same with the other leg;
- lying on your back, bend your knees, press the soles of your feet to the floor and lift your pelvis, keep it in this position;
- lying on your back, move your thighs to the side as far as possible;
- sit on a chair and squeeze the ball between your thighs;
- lying on your back, turn your legs in and out;
- standing with your right leg slightly elevated and holding the support with your hand, swing your left leg forward and backward and left and right, then do the same with the other leg.
- Surgical treatment.Endoprosthetics, i.e. replacement of the joint with an artificial one, is performed in 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 only the head) or complete (replacement of both parts).On the day after the operation, some elements of the movement therapy are performed while lying in bed, the patient can stand up, but for the time being without leg support, and a few days later with crutches.After 2-3 months, crutches are no longer needed and full weight bearing is allowed.Rehabilitation of patients who have undergone endoprosthesis consists of physical therapy, massage and physical therapy.In most cases, the function of the limb is restored.The lifespan of the prosthesis is 10-20 years, and then it is replaced with a new one.
Prevention of coxarthrosis
Preventive measures are very important, especially if you have a history of hip dysplasia, fractures, severe bruising or purulent processes in this area.
- Avoid heavy lifting and jumping (especially from heights).Try not to stand on your feet for long periods of time.
- Weight control (reduce the consumption of flour products, table salt, sweet, strong tea and coffee in your diet).Being overweight increases the risk of hip arthrosis.
- Dosed physical exercises aimed at strengthening the muscles of the thighs and buttocks (cycling or exercise bike, swimming, physical therapy).
- If there are diseases related to metabolism (diabetes mellitus, arteriosclerosis), they must be compensated.
Adherence to preventive measures, early detection and appropriate treatment of coxarthrosis are the keys to a positive prognosis of the disease.
Which doctor should I see?
If you feel pain in your leg or hip joint, see a doctor.Prescribes primary diagnostic measures, especially X-ray of the hip joint.After determining the stage of the disease, the patient is referred to a rheumatologist or orthopedist.A nutritionist and an endocrinologist can provide additional help in losing weight and slowing the progression of the disease.It would be helpful for women to see a gynecologist so that they can prescribe hormone replacement therapy to prevent osteoporosis.