Osteoarthritis of the hip joint (coxarthrosis) is a chronic pathology, accompanied by the gradual destruction of the cartilage tissue of the affected area, followed by the participation of adjacent structures in the process. The disease requires long-term treatment and, in severe cases, the only way to regain mobility is joint replacement.
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, in turn, deform the contours of the joint area. As a result, the load distribution on the contact surfaces of the bones changes and the areas with the maximum pressure begin to wear out more quickly. This triggers a whole cascade of pathological reactions:
- the appearance of microcracks and areas of compaction in cartilage tissue;
- decreased smoothness of joint surfaces;
- excessive cartilage growth at the site of thinning and replacement with bone tissue;
- the appearance of osteophytes (bony growths) along the edges of the joint 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 within the joint);
- joint space narrowing;
- 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 are 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 degeneration process 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 its origin;
- injuries and microtraumas of the hip joint in the context of overweight, professional sports, etc. ;
- hip joint dysplasia;
- 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 connective tissue diseases (joint hypermobility, rheumatoid arthritis, systemic lupus erythematosus, etc. );
- they underwent joint operations.
Age is an important predisposing factor. According to statistics, after 45 years, the probability of developing coxarthrosis increases significantly.
The main symptoms of coxarthrosis of the hip joint do not depend on the cause of development. Most patients notice:
- restriction of movement - one of the first 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 aggravates the problem;
- pain - the friction of the bones deprived of a cartilaginous layer with each other, the gradual participation 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 you progress the illness; the pain is stabbing in nature and is often worse towards the end of the day;
- muscle spasm, leading to increased pain symptoms and limited range of motion in the joint;
- decrease in leg length - this symptom appears in the later stages of the disease due to narrowing of the joint space and 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; It is an unfavorable sign that indicates serious damage to the joint apparatus.
In the development process, coxarthrosis goes through several stages, which depend on the degree of tissue damage.
- 1 degree. At this time, the patient notices mild pains in the joint that appear after intense or prolonged physical activity and that pass quickly after rest. As a general rule, the 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 movements of the legs are preserved in their entirety. On radiography, specific changes are noted: subchondral sclerosis.
- 2nd grade. The pain becomes more severe, arises after exertion, spreads to the entire thigh and groin. After exertion, a slight limp may appear. Difficulties are found to abduct the leg. The radiograph shows a significant decrease in the distance between the bones (by 50% or more), deformation of the femoral head, and pronounced bone growths.
- 3 degrees. The pains become permanent, walking without a cane becomes impossible. When moving, the patient noticeably leans to the painful side, which further increases the load on the joint. The range of motion is reduced, the muscles of the legs and buttocks atrophy. There is a shortening of the affected limb. Radiography reveals a significant deformity of the joint, a change in the contour of the femoral head, and a large number of osteophytes.
- 4 degrees. 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). Coping with the disease at this stage is possible only through surgery.
An orthopedic traumatologist is responsible for identifying symptoms and selecting treatment. To diagnose and determine the extent of the disease, use:
- survey: listen to patient complaints, identify risk factors (trauma, disease, heredity, etc. );
- examination: evaluation of the mobility of the limbs, determination of the areas of greatest pain;
- X-rays: an X-ray image allows evaluating the state of the bones and cartilage, the size of the joint space, the presence and location of bone growths; to see the necessary details further, the study is supplemented with CT (computed tomography);
- laboratory diagnosis - a general blood test allows you to identify signs of an inflammatory, biochemical process, to look at some risk factors, for example, the level of uric acid;
- MRI (magnetic resonance imaging) - allows you to assess the state 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 diagnoses with other diseases, as well as to assess concomitant pathologies, additional tests, instrumental examinations and limited specialist consultations are prescribed.
Treatment of coxarthrosis of the hip joint depends on the stage and severity of the symptoms. Pathology requires an integrated approach using several methods:
- drug treatment;
- non-drug treatment (physical therapy, exercise therapy);
- lifestyle and diet correction.
Prescription medications for osteoarthritis of the hip joint aim to:
- elimination of pain syndrome;
- restoring or at least slowing down the destruction of cartilage tissue;
- improve blood supply and nutrition of the affected area;
- treatment of concomitant pathologies.
Pain relievers are used in the form of tablets, intramuscular and intra-articular 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. Introducing painkillers 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 pain relievers.
The taking of 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 regular long-term use, which is combined with other methods of treatment, lifestyle, and dietary adjustments. Drugs to improve blood microcirculation help to enhance its effect. For a similar purpose, warming ointments are prescribed. Only a doctor is involved in the selection of the dose and regimen.
Drug free treatment
This category includes various manual and physical therapy techniques, as well as physical therapy exercises. They help 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 therapy and exercises.
If the disease has reached the 3-4 stage of development, drugs and physiotherapy will only alleviate the patient's condition, but will not return the ability to fully move. In this case, arthroplasty is indicated, that is, total or partial replacement of the damaged joint with a titanium prosthesis.
If there are indications, a lighter version of the intervention is performed: grinding the contact 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 speed 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 the amateur level without competing for records helps improve blood supply and inhibits joint degeneration processes;
- normalize body weight to reduce the load on the legs;
- eliminate injuries, hypothermia and occupational risk factors (vibrations, weight lifting, standing work);
- timely treat all diseases, including those that are 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. Special attention should be paid to unsaturated fats (olive and flaxseed oil), omega-3 acids (found in excess in fish), collagen (jellied meat, aspic). Minimize fast carbohydrates, alcohol, strong coffee, artificially flavored products, preservatives, and flavor enhancers.
Consequences and complications
Coxarthrosis is one of the common causes of disability in older people. Without proper treatment, the pathology inevitably leads to complete disability, especially in bilateral injuries. Pain and limited mobility keep you from working and taking care of yourself, so it's important to get treatment on time.