Osteoarthritis of the hip joint (coxarthrosis) is a degenerative disease of the cartilage of the hip joint, which results in persistent dysfunction of the joint and disability of the patient. Most often, osteoarthritis of the hip joint can be observed 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 against the background of full well-being;
- secondary - develops against the background of inflammatory joint disease, 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
Based on the reasons for the development of osteoarthritis of the hip joint, the following types are distinguished:
- idiopathic - coxarthrosis, which develops for no special reason;
- involutive - osteoarthritis associated with age-related natural changes in the body, manifests itself 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 joints affected by rheumatoid arthritis, as well as due to other infections;
- post-traumatic - arthritis, 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 hormone therapy;
- vascular - the disease develops as a result of circulatory disorders in the joint;
- hereditary - developing as a result of hereditary features of the development of cartilage tissue (often associated with deforming osteoarthritis of other joints).
In addition, osteoarthritis of the hip joint can be the consequence of a violation of the biomechanics of body movements, which often accompanies a curvature of the spine, intervertebral hernias or bone skeletal defects of the limbs. lower (for example, shortening one of them). Lameness or poor posture puts undue stress on the hip joint, which can trigger coxarthrosis. Another common cause of hip osteoarthritis is inactivity, however, excessive physical activity (sport or work) can also cause joint pathology.
How does osteoarthritis of the hip joint manifest itself?
First of all, patients with coxarthrosis complain of pain in the hip joint. It is accompanied by lameness, over time, atrophy of the thigh and gluteal muscles appears. Movement in the joint is accompanied by a characteristic crunch; over time, the mobility of the joint decreases. The intensity of 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 uncomfortable in the morning or after heavy physical exertion on the joint. A meteorology of the affected joint may also be noted, 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 covering 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. There are frequent cases of misdiagnosis of hip osteoarthritis associated with pain radiating to the knee and popliteal ligaments. Pain begins to bother not only after physical exertion, but also at rest. During the movement of the limb, parasitic sounds appear emanating from the joint (clicks, crackles). The range of motion in the joint is significantly reduced, especially in rotation (circular), the biomechanics of movements in the joint are impaired and, as a result, its functionality is reduced. Pain and decreased mobility in the joint causes the appearance of mild lameness, which in turn leads to moderate atrophy of the gluteal muscles on the side of the affected joint.
On the roentgenogram, we can see the narrowing of the joint space of a third of the normal width, a significant thinning of the cartilage until its absence in certain places, the appearance of osteophytes on the joint surfaces, a deformationof the femoral head, and its upward displacement.
Coxarthrosis grade 3
At this stage of the disease, the pain becomes constant, including at night, pain relievers are difficult to relieve. The range of motion in the joint is reduced to a minimum, the biomechanics of the joint are significantly impaired. The slightest movements are accompanied by crepitations, the lameness becomes pronounced, there is a significant distortion of the pelvis and a shortening of the limb on the side of the affected joint. The gluteal and femoral muscles on the affected side are atrophied. Due to severe lameness, patients often cannot move around independently without the use of a cane or stand.
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 is so narrowed that it is practically absent.
Diagnosis of osteoarthritis of the hip joint
Diagnostic measures begin with questioning and examining the patient, performing 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 the joint surfaces, the presence or absence of bone growth on them, determine the presence of deformities of the femoral head and the width of the joint space;
- Joint ultrasoundallows not only to examine joint surfaces, but also to identify dystrophic changes in joint ligaments;
- computed tomography (CT)- makes it possible to obtain images layer by layer of the radiography type, but sharper and more voluminous;
- Magnetic Resonance Imaging (MRI) -allows you to study the condition of joint structures, joint surfaces, bones and ligaments with a high degree of visualization. Currently, 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 the treatment is started, the more likely it is to avoid the progression of the disease, the immobilization of the patient and the loss of his capacity for work. Therefore, even with the slightest discomfort in the joint, seemingly insignificant pain, stiffness, meteorology of the joint, you need to see 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 until the moment when its damage is significant, but to begin treatment at the stage of cartilage malnutrition, until irreversible changes have developed.
The extent of treatment depends on the stage of the disease. So, with coxarthrosis of the first degree, non-narcotic pain relievers and NSAIDs are used - they allow you to eliminate the pain syndrome, as well as remove inflammation in the tissues of the joint, thereby preventing damagemore its fabrics. Since 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 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, in order to minimize its degeneration, for which drugs from the group of chondroprotectors are used. Their task is to restore the metabolism in the cells of cartilage tissue, which improves the trophism of the joint and decreases the intensity of inflammation. For example, in the treatment of coxarthrosis, a proven chondroprotective drug, 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.
Full 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 in them in large numbers, which impedes the normal movement ofthe joint. At this stage, only symptomatic treatment is possible, which reduces joint pain and slows down the processes of cartilage destruction. The pain at this stage of the disease is severe, 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 dosage forms of systemic action(tablets, injections).
During exacerbations of the disease, regardless of its stage, the load on the joint should be minimized to avoid further damage to the cartilage. During remission, in addition to taking chondroprotectors to normalize metabolic processes in cartilage tissue, exercise therapy, massage and physical therapy are recommended. They ensure a reasonable load on the joint, prevent its immobilization and the 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: during movement, biologically active substances are produced in it that increase mood and general well-being - endorphins and serotonin.
Good 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, fibers, vitamins. Good 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.
At the stage of remission, physiotherapy methods have proven to be successful - electrophoresis, mud therapy, ultrasound and magnetotherapy. In addition, the effectiveness of biological and mechanical methods of treatment of hip osteoarthritis is noted. Among the biological methods, the most popular is hirudotherapy (leech therapy), which helps to thin the blood and stimulate capillary microcirculation both in the joint and in the muscles around it, which preventsatrophic processes. Mechanical methods include joint traction to relieve excess stress on the affected joint and acupuncture. However, it should be remembered that physiotherapeutic, mechanical and biological methods of treating coxarthrosis can be used only during the period of remission. With an exacerbation of the disease, their use is fraught with the progression of inflammation and the destruction of cartilage tissue.
In the event that 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 the mobility of the joint thanks to the plastic of its own tissues, the second - the replacement of the articular surfaces with a stent - a mechanical joint. The surgical intervention allows to restore the mobility of the joint and the working capacity of the patient.
Prevention of osteoarthritis of the hip
Preventive measures are reduced to taking chondroprotectors, good nutrition and reasonable stress on the joints, especially for those who practice sports or intense physical work.
Coxarthrosis is a serious disease that can deprive the patient of the ability to move around independently. Disability can be avoided by promptly seeking medical help at the first discomfort in the joint, subject to complex and competent treatment of the pathology from its very first stage.