Osteoarthritis of the hip joint (coxarthrosis) is a chronic pathology accompanied by gradual destruction of the cartilage tissue of the affected area, followed by the involvement of adjacent structures in the process. The disease requires long-term treatment, and in severe cases the only way to regain mobility is to replace the joints.
Main information
Coxarthrosis belongs to the group of degenerative diseases. It begins gradually with microscopic changes in the structure of cartilage. Increased stress, inflammatory diseases, disorders of blood supply lead to structural transformations and thinning of cartilage tissue, and they in turn deform the contours of the joint area. As a result, the distribution of the load on the contact surfaces of the bones changes and the areas with maximum pressure begin to wear faster. This causes a whole cascade of pathological reactions:
- the appearance of microcracks and areas of compaction in the cartilage tissue;
- reducing the smoothness of joint surfaces;
- cartilage overgrowth at the site of thinning and its replacement by bone tissue;
- the appearance of osteophytes (bone growths) at the edges of the joint area;
- thickening and reduced elasticity of the joint capsule;
- hardening and reduced bond strength;
- changes in the composition of synovial fluid (natural lubrication inside the joint);
- narrowing of the joint space;
- fusion of all elements of the joint (ankylosis).
Without treatment, coxarthrosis inevitably causes immobilization and injury.
Reasons
Depending on the causes of the disease, primary and secondary coxarthrosis are distinguished. In the first case it appears on its own, for example against the background of hereditary predisposition, in the second it is provoked by other diseases or injuries. In most cases, the process of cartilage degeneration occurs due to a combination of several factors. The reason may be:
- congenital dislocation of the hip joint;
- flat feet, scoliosis and other orthopedic problems;
- Legg-Calve-Perthes disease;
- inflammation of the joints (arthritis), regardless of origin;
- injuries and microtraumas of the hip joint against the background of overweight, professional sports, etc. ;
- hip dysplasia;
- metabolic disorders;
- endocrine diseases (especially diabetes mellitus);
- disorders of the blood supply to the lower extremities;
- frequent stress;
- heredity (coxarthrosis in parents or other close relatives significantly increases the risks of its development in a child);
- congenital pathologies and autoimmune diseases of the connective tissue (hypermobility of the joints, rheumatoid arthritis, systemic lupus erythematosus, etc. );
- underwent joint operations.
Age is an important predisposing factor. According to statistics, after 45 years the probability of developing coxarthrosis increases significantly.
Symptoms
The main symptoms of coxarthrosis of the hip joint do not depend on the cause of development. Most patients report:
- restriction of movement: one of the earliest symptoms due to thinning of the cartilage layer and increased friction of the articular surfaces of the bones; in the future the appearance of cartilage growths further exacerbates the problem;
- pain: friction of bones devoid of cartilage layer against each other, the gradual inclusion of all elements of the joint in the degenerative process, reduced blood supply to tissues cause pain, which increases with the progression of the disease; the pain is shooting in nature and often worsens towards the end of the day;
- muscle spasm, which leads to increased symptoms of pain and limited range of motion in the joint;
- reduction in leg length: this symptom occurs in the later stages of the disease due to narrowing of the joint space and gradual grinding of the bone heads due to constant rubbing; the difference between the legs can be up to 2 cm;
- lameness: associated with severe pain and restriction of movement, as well as shortening of the legs; is an unfavorable sign indicating serious damage to the joint apparatus.
Stages
In the process of development, coxarthrosis goes through several stages, which depend on the degree of tissue damage.
- 1 degree. At this time, the patient notices mild joint pain that occurs after intense or prolonged physical activity and passes quickly after rest. As a rule, the discomfort appears exactly in the area of the hip joint, but in some cases it extends to the hip joint or the knee. The gait does not change, the movements of the legs are completely preserved. Specific changes are noted on the radiograph: subchondral sclerosis.
- 2nd degree. The pain becomes stronger, occurs after exercise, spreads throughout the thigh and groin. Slight lameness may occur after exercise. Difficulties in abducting the legs are found. Radiography shows a significant reduction in the distance between the bones (by 50% or more), deformity of the femoral head and pronounced bone growths.
- 3 degrees. The pain becomes constant, walking without a cane becomes impossible. When moving, the patient noticeably bends 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. X-ray examination revealed significant deformation of the joint, a change in the contour of the head of the femur 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. X-rays show complete destruction of the articular cartilage, as well as signs of fusion of bones (ankylosis). To deal with the disease at this stage is possible only through surgery.
Diagnosis
The orthopedic traumatologist is responsible for identifying the symptoms and choosing the treatment. To diagnose and determine the extent of the disease, he uses:
- survey: hearing the patient's complaints, identifying risk factors (trauma, illness, heredity, etc. );
- examination: assessment of limb mobility, identification of areas with the greatest pain;
- X-ray: the X-ray image makes it possible to assess the condition of the bones and cartilage, the size of the joint space, the presence and location of bone growths; in order to see in more detail the necessary details, the examination is supplemented by CT (computed tomography);
- laboratory diagnosis: a general blood test allows you to identify signs of an inflammatory process, biochemical - to note some risk factors, such as uric acid levels;
- MRI (magnetic resonance imaging): allows you to assess the condition not only of bones and cartilage, but also of soft tissues: bones, ligaments, muscles, joint capsule and others. ;
- puncture of the joint.
If it is necessary to make a differential diagnosis with other diseases, as well as to assess concomitant pathologies, additional tests, instrumental examinations and consultations of close specialists are prescribed.
Treatment of coxarthrosis
The treatment of coxarthrosis of the hip joint depends on its stage and the severity of the symptoms. Pathology requires an integrated approach using different methods:
- Medication treatment;
- non-drug treatment (physiotherapy, exercise);
- surgery;
- lifestyle and diet adjustment.
Medication treatment
Medicines prescribed for osteoarthritis of the hip are aimed at:
- elimination of the pain syndrome;
- restoration or at least delay the destruction of cartilage tissue;
- improving the blood supply and nutrition of the affected area;
- treatment of concomitant pathologies.
Pain relievers are used in the form of tablets, intramuscular and intraarticular injections and topical agents: creams, ointments, patches. Nonsteroidal anti-inflammatory drugs are sufficient for most patients in the early stages of the disease. In severe pain syndrome, hormonal agents are used. The introduction of analgesics 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 analgesics.
The use of painkillers should be limited in time and dose so as not to cause additional damage to cartilage tissue and other side effects (especially the development of gastritis and gastric ulcers).
Chondroprotectors are drugs that help restore cartilage tissue. They are effective only with prolonged regular use, which is combined with other methods of treatment, lifestyle and dietary adjustments. Drugs to improve blood microcirculation help to enhance their effect. Warming ointments are prescribed for such a purpose. Only a doctor is involved in the choice of dose and regimen.
Treatment without drugs
This category includes various physiotherapy and manual techniques, as well as physiotherapy exercises. They help to improve microcirculation and restore movement in the damaged joint. Depending on the situation, the doctor prescribes:
- shock wave therapy;
- magnetic therapy;
- electromyostimulation;
- various types of electrophoresis and phonophoresis (accompanied by the use of anesthetics);
- mechanotherapy;
- massage and exercise therapy.
Surgery
If the disease has reached 3-4 stages of development, medication and physiotherapy will only alleviate the patient's condition, but will not restore his ability to move fully. In this case, arthroplasty is indicated, ie complete 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.
Prevention
Lifestyle can significantly reduce the risk of developing coxarthrosis, as well as the rate 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 an amateur level without a race for records helps to improve blood supply and inhibits the processes of joint degeneration;
- normalization of body weight to reduce the load on the legs;
- elimination of injuries, hypothermia and occupational risk factors (vibration, weight lifting, standing work);
- timely treatment of all diseases, including those that are not directly related to the musculoskeletal system;
- correct posture disorders in a timely manner, wear comfortable shoes.
Diet
With the help of nutritional correction, the patient can not only reduce body weight, but also reduce inflammatory reactions, tissue salt deposits and metabolic disorders. It is advisable to stick to a balanced menu with enough but not excessive amounts of carbohydrates, proteins and fats, as well as vitamins and minerals. Particular attention should be paid to unsaturated fats (olive and flaxseed oil), omega-3 acids (found in excess in fish), collagen (jelly, aspic). It is recommended to minimize fast carbohydrates, alcohol, strong coffee, products with artificial flavors, preservatives and flavor enhancers.
Consequences and complications
Coxarthrosis is one of the common causes of disability in the elderly. Without proper treatment, the pathology inevitably leads to complete disability, especially in bilateral lesions. Pain and limited mobility do not allow you to work and take care of yourself, so it is important to be treated on time.