Osteoarthritis of the hip joint (coxarthrosis) is a degenerative disease of the cartilage of the hip joint, which leads to persistent joint dysfunction and disability of the patient. Most often, hip arthrosis can be found in elderly patients, and men get sick more often than women.
Classification of hip arthrosis
There are two main types of disease:
- primary - the onset of the disease against the background of complete well-being;
- secondary - develops against the background of a joint inflammatory disease, after a previous injury, as well as in the presence of congenital disorders of joint development of the hip, its dysplasia.
Causes of coxarthrosis
Based on the reasons for the development of osteoarthritis of the hip joint, the following types are distinguished:
- idiopathic - coxarthrosis, which develops without any specific reason;
- inclusive - osteoarthritis associated with natural age-related changes to the body, manifested in old age;
- dysplastic (congenital) - arthrosis that develops in the joint against the background of congenital anomalies of its development;
- post-infectious - osteoarthritis that develops in the joints affected by rheumatoid arthritis, as well as due to some other infections;
- post-traumatic - osteoarthritis, which develops as a result of traumatic joint damage;
- dyshormonal - coxarthrosis, which develops against the background of metabolic disorders due to diseases of the endocrine system or hormone therapy;
- vascular - the disease develops as a result of circulatory disorders in the joints;
- hereditary - develops as a result of hereditary features of cartilage tissue development (often combined with deforming osteoarthritis of other joints).
In addition, osteoarthritis of the hip joints may be the result of a violation of the biomechanics of body movement, which often accompanies spinal curvature, intervertebral hernias, or defects in the skeletal bone of the lower extremities (for example, shortening of one of thethose). Laziness or poor posture puts excessive stress on the hip joint, which can cause coxarthrosis. Another common cause of coxarthrosis is inactivity, however, excessive physical activity (sport or work) can also cause joint pathology.
How is osteoarthritis manifested in the hip joint?
First of all, patients with coxarthrosis complain of pain in the hip joint. Accompanied by lameness, over time atrophy of the thigh and gluteal muscles appears. Movement in the joints is accompanied by a characteristic seizure; over time, joint mobility decreases. The intensity of the symptoms depends directly on the degree of the disease.
Coxarthrosis 1 degree
The initial stage of the disease is manifested by mild pain, which can bother in the morning or after a considerable physical exertion on the joints. Sensitivity of meteosensitivity can also be observed, which is manifested by pain when the weather changes. The patient may notice morning stiffness in the joints, which disappears after movement, little warmth.
Radiological changes are minimal - there may be a slight narrowing of the joint space, thinning of the cartilage covering the femoral head.
2nd degree coxarthrosis
The intensity of pain at this stage of the disease increases slightly, while the pain radiates to the groin, knee. There are frequent cases of misdiagnosis of coxarthrosis associated with radiating pain in the knee and popliteal ligaments. The pain starts to bother not only after physical exertion but also at rest. During limb movement, external sounds appear emanating from the joint (clicks, chewing). The range of motion in the joint is significantly reduced, especially rotational (circular), the biomechanics of movement in the joint is impaired and, accordingly, its functioning is reduced. Pain and reduced joint movement provoke the appearance of a slight lameness, which leads to moderate atrophy of the gluteal muscle on the part of the affected joint.
On roentgenogram, one can see narrowing of the joint space by one third of normal width, considerable thinning of the cartilage to its absence in some areas, the appearance of osteophytes on the surfaces of the joint, deformation of the femoral head and its displacement upwards.
Coxarthrosis degree 3
At this stage of the disease, the pain becomes constant, including at night, the pain relievers are difficult to relieve. The range of motion in the joint is reduced to a minimum, the biomechanics of the joint is significantly impaired. Smaller movements are accompanied by crepitus, lameness becomes pronounced, there is a significant distortion of the pelvis, and shortening of the limb by the affected joint. The gluteal and femoral muscles on the affected side are atrophied. Due to considerable lameness, patients often cannot move independently without the use of a cane or support.
X-ray examination reveals a pronounced deformity of the femoral head, thickening of the femoral neck. The articular surfaces are covered with bony growth, the joint space is narrowed so much that it is practically absent.
Diagnosis of hip arthrosis
Diagnostic measures begin with interviewing the patient and examining him, taking a number 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 examination -allows you to see the contours of articular surfaces, the presence or absence of bone growths on them, to determine the presence of deformities of the femoral head and the width of the joint space;
- Joint ultrasoundallows not only to examine articular surfaces, but also to identify dystrophic changes in articular ligaments;
- computed tomography (CT)- makes it possible to take images from the layer in the type of X-rays, but clearer and more voluminous;
- magnetic resonance imaging (MRI) -allows you to study the condition of joint structures, articular surfaces, bones and ligaments with a high degree of visualization. At present, it is considered the most advanced diagnostic method.
Treatment of coxarthrosis
The most effective is the complex treatment of osteoarthritis of the hip joint, taking into account the stage of the disease. It should be remembered: the earlier treatment is started, the more likely it is to avoid disease progression, immobilization of the patient, and loss of his ability to work. Therefore, even with the slightest discomfort from the joint, seemingly insignificant pain, stiffness, sensitivity to meteosis, you should consult an orthopedic doctor who will perform an examination, clarify the diagnosis and prescribe treatment. Cartilage 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 stage of cartilage malnutrition, until irreversible changes develop in it.
Fieldof treatment depends on the stage of the disease. So with first degree coxarthrosis, non-narcotic analgesics and NSAIDs are used - they allow you to eliminate the pain syndrome as well as eliminate the inflammation in the joint tissues, preventing further damage to its tissues. Due to the fact that at this stage the pain syndrome and inflammation are not intense, there is no need for long-term use of such drugs. As a rule, it is enough to do it with local means - oils, gels containing NSAIDs. Much more important at this stage is to ensure the normalization of metabolic processes in cartilage tissue, to minimize its degeneration, for which drugs from the group of chondroprotectors are used. Their task is to recover the metabolism in the cartilage tissue cells, as a result of which the trophism of the joint is improved and the intensity of inflammation is reduced. For example, in the treatment of coxarthrosis, a chondroprotective drug has proven itself well, the active substance of which is a source of natural constituents of healthy cartilage tissue. Stimulates the production of the most important structural components in cartilage - proteoglycans and prevents the processes of destruction of cartilage tissue.
A complete treatment of second- and third-degree coxarthrosis is already much more difficult: the cartilage is already significantly damaged, the articular surfaces are exposed, osteophytes form on them in large numbers, which impede the normal movement of the joint. At this stage, only symptomatic treatment is possible, which makes it possible to reduce joint pain and slow down the processes of cartilage destruction. The pain at this stage of the disease is intense, analgesics and NSAIDs are used to relieve them, and the best solution would be a combination of the use of topical agents (oils, creams) and dosage forms of systemic action (tablets, injections).
During exacerbations of the disease, regardless of its stage, the load on the joints should be minimized to avoid further cartilage damage. During remission, in addition to the course of taking chondroprotectors for the normalization of metabolic processes in cartilage tissues, exercise therapy, massage and kinesitherapy are recommended. They provide a reasonable load on the joint, prevent its immobilization and deposition of mineral salts in joint tissues and ligaments, and stimulate microcirculation. Exercise therapy is also of great importance for the general condition of the body: when it moves, it produces biologically active substances that enhance mood and general 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, 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, physiotherapy methods have proven themselves well - electrophoresis, mud therapy, ultrasound and magnetotherapy. In addition, the effectiveness of biological and mechanical methods of treating coxarthrosis is observed. Among the biological methods, the most popular is hirudotherapy (caterpillar therapy), which provides blood thinning and stimulation of capillary microcirculation both in the joints and in the surrounding muscles, which prevents atrophic processes in them. Mechanical methods include pulling the joints to relieve excessive 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 remission period. With an exacerbation of the disease, their use is fraught with the progression of inflammation and the destruction of cartilage tissue.
If conservative methods of treating coxarthrosis have not worked, the patient may be offered surgical treatment - arthroplasty and joint replacement. The first variant of the operation involves the restoration of mobility in the joints due to the plasticity of its own tissue, the second - the replacement of articular surfaces with an endoprosthesis - a mechanical joint. Surgical intervention allows you to restore joint movement and the patient's ability to work.
Prevention of osteoarthritis of the hip joint
Preventive measures are reduced in taking chondroprotectors, proper nutrition and reasonable stress on the joints, especially for those who play sports or hard physical work.
Coxarthrosis is a serious disease that can deprive the patient of the ability to move independently. Disability can be avoided by immediately seeking medical help at the first discomfort in the joint, which undergoes complex competent treatment of the pathology from its first stage.