Arthrosis of the hip joint (coxarthrosis) is a degenerative disease of the cartilage of the hip joint, which leads to persistent joint dysfunction and patient disability. More often, arthrosis of the hip joint can be found in elderly patients, and men get sick more often than women.
Classification of arthrosis of the hip joints
There are two main types of the disease:
- IM - the onset of illness in the context of complete well-being;
- secondary - develops in the context of an inflammatory disease of the joint, after a previous injury, as well as in the presence of congenital developmental disorders of the hip joint, its dysplasia.
Causes of coxarthrosis
Based on the reasons for the development of arthrosis of the hip joint, the following types are distinguished:
- idiopathic - coxarthrosis, which develops for no specific reason;
- involutive - arthrosis associated with age-related natural changes in the body, manifests itself in old age;
- dysplastic (congenital) - arthrosis that develops in the joint in the context of congenital developmental anomalies;
- post-infectious - arthrosis that develops in joints affected by rheumatoid arthritis, as well as due to some other infections;
- post-traumatic - arthrosis, which develops as a result of traumatic injury to the joint;
- dishormonal - coxarthrosis, which develops in the context of metabolic disorders due to endocrine system disorders or hormonal therapy;
- vascular - the disease develops as a result of circulatory disturbances in the joint;
- hereditary - develops as a result of hereditary characteristics of cartilage tissue development (often combined with deforming osteoarthritis of other joints).
In addition, hip joint osteoarthritis can be a consequence of a violation of the biomechanics of body movement, which often accompanies spinal curvature, intervertebral hernias, or defects in the bony skeleton of the lower extremities (eg, shortening of one of them ). Lameness or inappropriate posture puts excessive pressure on the hip joint, which can trigger coxarthrosis. Another common cause of coxarthrosis is inactivity, however, excessive physical activity (sports or work) can also cause joint pathology.
How does hip joint osteoarthritis manifest?
First, patients with coxarthrosis complain of pain in the hip joint. It is accompanied by lameness, with time, atrophy of the thigh and gluteal muscles appears. Movement in the joint is accompanied by characteristic compression; over time, joint mobility decreases. The intensity of symptoms directly depends on the degree of the disease.
Coxarthrosis 1 degree
The early stage of the disease is manifested by mild pain, which can be uncomfortable in the morning or after significant physical exertion on the joint. Meteorosensitivity of the affected joint can also be seen, which manifests as pain when the weather changes. The patient may notice morning stiffness in the joint, which disappears after movement, a little warming up.
Radiological changes are minimal - there may be a slight narrowing of the joint space, thinning of the cartilage that covers the head of the femur.
2nd degree coxarthrosis
The intensity of pain at this stage of the disease increases slightly, while the pain radiates to the groin, knee. Misdiagnosis of coxarthrosis associated with pain radiating to the knee and popliteal ligaments is frequent. The pain starts to bother not only after physical exertion, but also at rest. During limb movement, strange sounds appear emanating from the joint (clicks, pops). The range of motion in the joint is significantly reduced, especially rotational (circular), the biomechanics of joint movement is impaired and, consequently, its functionality is reduced. Pain and decreased mobility in the joint lead to mild lameness, which in turn leads to moderate atrophy of the gluteal muscles on the side of the affected joint.
On radiography, it is possible to observe the narrowing of the joint space by one third of its normal width, significant thinning of the cartilage until its absence in some areas, the appearance of osteophytes on the joint surfaces, deformation of the femoral head and its upward displacement.
Grade 3 coxarthrosis
At this stage of the disease, pain becomes constant, even at night, as analgesics are difficult to relieve. The range of motion of the joint is reduced to a minimum, the biomechanics of the joint is significantly impaired. Minor movements are accompanied by crackling, lameness becomes pronounced, there is significant distortion of the pelvis and shortening of the limb on the side of the affected joint. The gluteal and femoral muscles on the affected side are atrophied. Due to significant lameness, patients are often unable to move independently without the use of a cane or support.
X-ray examination reveals a pronounced deformation of the femoral head, thickening of the femoral neck. The joint surfaces are covered with bony protuberances, the joint space is so narrow that it is practically absent.
Diagnosis of arthrosis of the hip joint
Diagnostic measures begin with interviewing and examining the patient, performing a series of laboratory tests, after which special instrumental techniques are used to confirm the diagnosis. The following methods are considered the most informative today:
X-ray exam - allows you to see the contours of the joint surfaces, the presence or absence of bone growth on them, to determine the presence of deformities of the femoral head and the width of the joint space;Joint ultrasound allows not only to examine the articular surfaces, but also to identify dystrophic alterations in the articular ligaments;computed tomography (CT) - allows you to obtain layer-by-layer images of the radiological type, but sharper and more voluminous;magnetic resonance imaging (MRI) - allows you to study the state of joint structures, joint surfaces, bones and ligaments with a high degree of visualization. It is currently considered the most advanced diagnostic method.
Coxarthrosis Treatment
The most effective is the complex treatment of arthrosis of the hip joint, taking into account the stage of the disease. It is worth remembering: the sooner treatment is started, the more likely it is to prevent disease progression, patient immobilization and loss of work ability. Therefore, even with the slightest discomfort of the joint, apparently insignificant pain, stiffness, and meteosensitivity of the joint, it is necessary to consult an orthopedist who will carry out an examination, clarify the diagnosis and prescribe the treatment. Cartilaginous tissue is not restored, so it is better not to wait for the moment when its damage is significant, but to start treatment in the cartilage malnutrition phase, until irreversible changes develop in it.
The scope of treatment depends on the stage of the disease. Thus, in first-degree coxarthrosis, non-narcotic analgesics and NSAIDs are used - they allow eliminating the painful syndrome, in addition to eliminating inflammation in the tissues of the joint, preventing further damage to its tissues. Because at this stage the pain syndrome and inflammation are not intense, there is no need for prolonged use of these drugs. As a rule, just do it with local means - ointments, gels containing NSAIDs. It is much more important at this stage to guarantee the normalization of metabolic processes in the cartilaginous tissue, to minimize its degeneration, for which drugs from the chondroprotective group are used. Its task is to restore metabolism in cartilage tissue cells, as a result of which joint trophism improves and inflammation intensity decreases. For example, in the treatment of coxarthrosis, a chondroprotective drug has shown itself well, whose active substance is a source of natural components of healthy cartilage tissue. It stimulates the production of the most important structural components of cartilage - proteoglycans and prevents the processes of cartilage tissue destruction.
A complete treatment of second- and third-degree coxarthrosis is already much more difficult: the cartilage is already significantly damaged, the joint surfaces are exposed, osteophytes are formed in them in large numbers, which impede the normal movement of the joint. At this stage, only symptomatic treatment is possible, which reduces joint pain and slows down the processes of cartilage destruction. Pain at this stage of the disease is intense, analgesics and NSAIDs are used to relieve it, and the best solution would be a combination of local agents (ointments, creams) and pharmaceutical forms of systemic action (tablets, injections) .
During disease exacerbations, regardless of its stage, the load on the joint must be minimized to avoid further damage to the cartilage. During remission, in addition to the course of chondroprotectors to normalize the metabolic processes in the cartilage tissue, exercise therapy, massage and kinesiotherapy are recommended. They provide a reasonable load on the joint, prevent its immobilization and the deposition of mineral salts in the joint tissues and ligaments, and stimulate microcirculation. Exercise therapy is also of great importance for the general state of the body: when you move, biologically active substances are produced that increase mood and general well-being - endorphins and serotonin.
Adequate nutrition plays an important role in the complex treatment of arthrosis of the hip joint. The patient's diet must be complete, rich in animal and vegetable proteins, fiber, vitamins. Proper nutrition is important not only to stimulate joint regeneration, but also to keep the patient's body weight within normal limits. Overweight is an additional burden on the diseased joint and a factor in disease progression.
In the remission phase, physical therapy methods have proven to be successful - electrophoresis, mud therapy, ultrasound and magnetotherapy. In addition, the effectiveness of biological and mechanical methods for the treatment of coxarthrosis is observed. Among the biological methods, the most popular is hirudotherapy (leech therapy), which provides blood thinning and stimulation of capillary microcirculation both in the joint and in the muscles around it, preventing atrophic processes in them. Mechanical methods include joint traction to relieve excess stress on the affected joint and acupuncture. However, it should be remembered: physiotherapeutic, mechanical and biological methods of treating coxarthrosis can only be used during the period of remission. With the exacerbation of the disease, its use is fraught with the progression of inflammation and the destruction of cartilage tissue.
If conservative methods for the treatment of coxarthrosis do not work, the patient can receive surgical treatment - arthroplasty and joint replacement. The first variant of the operation involves the restoration of mobility in the joint due to the plastic of the tissues themselves, the second - the replacement of the joint surfaces by an endoprosthesis - a mechanical joint. Surgical intervention restores the mobility of the joint and the patient's ability to work.
Prevention of arthrosis of the hip joint
Preventive measures are reduced to taking chondroprotectors, proper nutrition and reasonable stress on the joints, especially for those who engage in sports or heavy physical work.
coxarthrosis is a serious condition that can deprive the patient of the ability to move independently. Disability can be avoided by promptly seeking medical help at the first joint discomfort, subject to a complex and competent treatment of the pathology from its first stage.