Osteoarthritis of the hip joint (coxarthrosis) is a degenerative disease of the cartilage of the hip joint, leading to persistent joint dysfunction and disability of the patient. More often, osteoarthritis of the hip joint can be found in elderly patients, and men get sick more often than women.
Classification of osteoarthritis of the hip joints.
There are two main types of disease:
- primary - the onset of the disease in the context of complete well-being;
- secondary - develops against the background of an inflammatory disease of the joints, after a previous injury, as well as in the presence of congenital disorders of the development of the hip joint, its dysplasia.
Causes of coxarthrosis
According to the reasons for the development of arthrosis of the hip joint, the following types are distinguished:
- idiopathic - coxarthrosis, which develops without a specific reason;
- involutive - osteoarthritis associated with natural age-related changes of the body, manifested in old age;
- dysplastic (congenital) - arthrosis that develops in the joint against the background of congenital abnormalities of its development;
- postinfectious - arthrosis that develops in the joints affected by rheumatoid arthritis, as well as due to some other infections;
- post-traumatic - arthrosis, which develops as a result of traumatic damage to the joint;
- dyshormonal - coxarthrosis, which develops against the background of metabolic disorders 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 deforming osteoarthritis of other joints).
Also, osteoarthritis of the hip joint can be a consequence of a violation of the biomechanics of body movement, which often accompanies curvature of the spine, intervertebral hernias or defects in the skeletal skeleton of the lower extremities (for example , shortening of one of them). Lameness or poor posture puts undue stress on the hip joint, which can lead to coxarthrosis. Another common cause of coxarthrosis is inactivity, however, excessive physical activity (sport or work) can also cause joint pathology.
How does osteoarthritis of the hip joint manifest?
First of all, patients with coxarthrosis complain of pain in the hip joint. It is accompanied by lameness, with time, atrophy of the thigh and buttock muscles appears. Movement in the joint is accompanied by a characteristic crunch; Over time, the mobility of the joint decreases. The intensity of the symptoms directly depends on the degree of the disease.
Coxarthrosis 1 degree
The initial stage of the disease is manifested by slight pain, which can be bothersome in the morning or after significant physical exertion on the joint. Meteosensitivity of the affected joint can also be noted, manifested by pain when the weather changes. The patient may notice morning stiffness in the joint, which disappears after movement, a little warming up.
The 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.
Second degree coxarthrosis
The intensity of pain at this stage of the disease increases slightly, while the pain radiates to the groin and knee. Cases of misdiagnosis of coxarthrosis associated with pain radiating to the knee and popliteal ligaments are frequent. Pain begins to bother not only after physical exertion, but also at rest. During the movement of the limb, strange sounds appear emanating from the joint (clicks, crackles). The range of motion in the joint is significantly reduced, especially rotational (circular), the biomechanics of the movements in the joint are affected and consequently its functionality is reduced. Pain and decreased mobility in the joint lead to slight lameness, which in turn leads to moderate atrophy of the gluteal muscles on the side of the affected joint.
On radiography, the narrowing of the joint space can be seen by a third of the normal width, a significant thinning of the cartilage until its absence in some areas, the appearance of osteophytes on the joint surfaces, the deformation of the femoral head and its displacement towards above.
Grade 3 coxarthrosis
At this stage of the disease, the pain becomes constant, even at night, pain relievers are difficult to relieve. The range of motion in the joint is minimized, the biomechanics of the joint are significantly affected. The mildest movements are accompanied by crepitus, the limp becomes pronounced, there is a significant distortion of the pelvis and a shortening of the limb from 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 articular surfaces are covered with bony growths, the joint space narrows so much that it is practically non-existent.
Diagnosis of osteoarthritis 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 examination -allows you to see the contours of the 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 the articular surfaces, but also to identify dystrophic changes in the articular ligaments;
- computed tomography (CT)- allows to obtain layer by layer images of the X-ray type, but clearer and more voluminous;
- magnetic resonance imaging (MRI) -allows to study the state of joint structures, joint surfaces, bones and ligaments with a high degree of visualization. At the moment, it is 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 should be remembered: the earlier treatment is started, the more likely it is to prevent disease progression, immobilization of the patient, and loss of ability to work. Therefore, even with the slightest discomfort of the joint, seemingly insignificant pain, stiffness, meteosensitivity of the joint, you should consult an orthopedic doctor who will conduct 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 at the stage of cartilage malnutrition, until irreversible changes have developed in it.
The extent of treatment depends on the stage of the disease. So, with coxarthrosis of the first degree, non-narcotic analgesics and NSAIDs are used, which allow you to eliminate the pain syndrome and eliminate inflammation in the tissues of the joint, avoiding further damage to its tissues. Due to the fact that at this stage the pain syndrome and inflammation are not intense, long-term use of such drugs is not necessary. As a rule, it is enough to do it with local means: ointments, gels containing NSAIDs. It is much more important at this stage to ensure the normalization of metabolic processes in cartilage tissue, to minimize its degeneration, for which drugs from the group of chondroprotectors are used. Its task is to restore the metabolism in the cells of cartilage tissue, as a result of which the trophism of the joint improves and the intensity of inflammation decreases. For example, in the treatment of coxarthrosis, a chondroprotective drug has proven its effectiveness, the active substance of which 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 destruction of cartilage tissue.
A complete treatment of coxarthrosis of the second and third degree is already much more difficult: the cartilage is already significantly damaged, the joint surfaces are exposed, osteophytes are formed on them in large numbers, which prevents the normal movement of the joint. At this stage, only symptomatic treatment is possible, which makes it possible to reduce pain in the joint and slow down the processes of destruction of cartilage. The pain in 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 local agents (ointments, creams) and pharmaceutical forms of systemic action (tablets, injections). .
During exacerbations of the disease, 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 taking chondroprotectors to normalize metabolic processes in cartilage tissue, exercise therapy, massage and kinesitherapy are recommended. They provide a reasonable load on the joint, prevent its immobilization and the deposit 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 moving, biologically active substances are produced that increase 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 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. Being overweight is an additional burden on the diseased joint and a factor in the progression of the disease.
In the remission stage, physiotherapy methods have proven to be good: electrophoresis, mud therapy, ultrasound, and magnetotherapy. In addition, the effectiveness of biological and mechanical methods to treat 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 surrounding muscles, 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 treatment of coxarthrosis can be used only during the period of remission. With an exacerbation of the disease, its use is fraught with the progression of inflammation and destruction of cartilage tissue.
In the event that conservative methods of treating coxarthrosis have not worked, the patient can be offered surgical treatment - arthroplasty and joint replacement. The first variant of the operation involves the restoration of mobility in the joint due to the plastics of its own tissues, the second - the replacement of the articular surfaces with an endoprosthesis - a mechanical joint. Surgical intervention allows you to restore the mobility of the joint and the patient's ability to work.
Prevention of osteoarthritis of the hip joint.
Preventive measures are reduced to taking chondroprotectants, proper nutrition and reasonable stress on the joints, especially for those who play sports or perform intense physical work.
Coxarthrosis is a serious disease that can deprive the patient of the ability to move independently. Disability can be avoided by seeking medical help immediately at the first discomfort in the joint, subject to complex and competent treatment of the pathology from its first stage.