Coxarthrosis of the hip joint is a degenerative-dystrophic process that occurs in the articular joint of the femoral head and the acetabulum of the pelvis. The disease is more typical of middle-aged and elderly people, although it can also occur in young people, including children. Most often, its development is preceded by injuries, as well as a number of pathologies of an inflammatory and non-inflammatory nature, and pain and stiffness of movements become the main signs of a degenerative-dystrophic process in the hip joint. In its development, the disease goes through several stages, and if in the early stages it can be treated conservatively, then in the last stages, the treatment of coxarthrosis of the hip joints is effective only with surgery. Otherwise, the pathology will lead to severe disorders or even complete immobilization.
What is coxarthrosis of the hip joint and the mechanism of its development
Coxarthrosis, also called osteoarthritis and deforming arthrosis, is a complex disease of the hip joint (HJ), accompanied by progressive cartilage destruction. Over time, this leads to the deformation of adjacent bone surfaces, as well as the formation of bone growths on them, called osteophytes.
The two hip joints are the largest joints in the body. Each of them is formed by the femur bone and the acetabulum of the pelvis. The head of the femur is located in the cup-shaped cut of the pelvic bone and moves freely in different directions. This joint structure enables flexion and abduction, adduction and abduction, and rotation of the hip.
To prevent movement from causing discomfort, the surfaces of the bones that touch each other are covered with an elastic layer called hyaline cartilage. It is what allows the femoral head to slide easily into the acetabulum. Also, hyaline cartilage provides stabilization and cushioning of the hip joint during movements.
The entire joint is encased in a kind of casing called the joint capsule. It contains the synovial membrane that synthesizes the synovial fluid. It is what lubricates the surface of the cartilage, ensures the flow of water and nutrients in it, d. m. th. , is responsible for maintaining the normal structure of cartilage tissue.
Above the joint capsule is a group of femoral and pelvic muscles, with the help of which the joint is set in motion. The hip joint is also surrounded by a group of ligaments that ensure the stability of its position within physiological limits.
Since the hip joint is subjected to heavy loads every day, it is prone to wear and tear and rapid injury. The risk of such changes significantly increases the effect of a number of unfavorable factors that are practically unavoidable in the modern world, but they will be discussed below. This explains the high prevalence of coxarthrosis.
As a result of the influence of negative factors, there is a violation of the production of synovial fluid. Gradually, its quantity decreases and its qualitative composition also changes: it becomes viscous, thick and is no longer able to fully nourish the cartilage. This leads to acute nutritional deficiencies and progressive dehydration of the hyaline cartilage. As a result of such changes, the strength and elasticity of cartilage tissue decreases, it exfoliates, cracks and decreases in volume. All this prevents the smooth sliding of the femoral head in the acetabulum of the pelvis, which leads to the appearance of signs of hip coxarthrosis.
Gradually, the inter-articular gap narrows, the friction between the surfaces of the articulating bones increases, and the pressure of the bones on the hyaline cartilage increases. This leads to even greater wear and tear, which cannot but affect the biomechanics of the hip joint and a person's well-being.
As the pathological changes progress, the hyaline layer gradually disappears completely, which leads to the exposure of the bone surfaces and a critical increase in the load on the bone joint. During movements, the head of the femur is no longer covered by anything and rubs directly against the surface of the acetabulum of the pelvis. In addition to the fact that it seriously limits mobility and causes unbearable pain, the bones are pressed against each other, flattening at the same time.
As the bones of the joint deform, bone growths (osteophytes) form on their surface. They can have sharp edges and severely injure the surrounding muscles. This provokes the appearance of severe pain in the hips, legs and buttocks. Therefore, the patient unconsciously tries to spare the affected hip joint and avoid movements in it. The lack of adequate load on the muscles leads to their gradual atrophy, which further aggravates mobility problems. This results in lameness.
Reasons for development
Coxarthrosis of the hip joint can be primary or secondary. In the first case, the reasons for its development cannot be found, d. m. th. , the disease develops on its own without any apparent reason. Secondary coxarthrosis is the result of a number of changes in the state of the musculoskeletal system or lifestyle features, in particular:
- injuries of the hip joint, including bone fractures, dislocations, bruises, sprains or ruptures of the surrounding ligaments, chronic microdamages, etc. ;
- strenuous physical work;
- sedentary lifestyle;
- obesity;
- chronic infectious processes in the body;
- rheumatoid arthritis, gout, tendonitis, bursitis;
- endocrine diseases, metabolic and hormonal disorders, including diabetes mellitus;
- congenital malformations of the hip joint (displacement, dysplasia);
- aseptic necrosis of the femoral head;
- pathologies of different types of the spine;
- genetic predisposition;
- smoking addiction.
In the vast majority of cases, the development of coxarthrosis of the hip joint is due to inevitable age-related changes, and the presence of other factors from the above only increases the risk of its occurrence and increases the rate of progression.
Symptoms and degrees
During coxarthrosis, 4 degrees of development are distinguished, of which 1 is the easiest. Initially, the disease may be asymptomatic or manifest as mild pain. Most often they occur after a strong physical strain, a long walk or at the end of a busy day. In the early stages of the disease, discomfort is usually attributed to fatigue and is considered the norm. Therefore, extremely rarely, coxarthrosis of the hip joint is diagnosed in the first stage of development.
Visible signs of coxarthrosis begin to appear in the second stage of its progression, when the joint space narrows almost by half, and the femoral head is displaced and deformed. With the transition to the 3rd stage, the pains become unbearable and can bother a person even at night, they tend to radiate to the hips, legs, hips and buttocks. Since the joint space is practically absent, and numerous osteophytes form on the bone surfaces, independent movement in such situations is impossible. Therefore, patients are forced to use a cane or crutches.
So, the main symptoms of coxarthrosis of the hip joint are:
- Limitations of mobility - initially patients may notice the appearance of difficulties in performing rotational movements of the leg, but over time, morning stiffness and swelling of the HJ merge. Because of them, a person needs a few minutes to warm up and, so to speak, walk around in order to restore a normal range of motion. Gradually, the patient becomes more and more difficult to perform leg movements.
- A characteristic crack - occurs during walking, as well as flexion or extension of the hip joint. It is the result of bone surfaces rubbing against each other and with coxarthrosis it is accompanied by sharp or dull pain.
- Pain syndrome - initially pains appear after physical exertion and decrease after a long rest. An acute attack can be provoked by weight lifting or hypothermia, since coxarthrosis is often complicated by increased inflammation of the synovial membrane. As the disease progresses, the pain becomes more frequent, lasts longer, and worsens.
- Spasm of the thigh muscles - it is the result of tightening of the nerves and weakening of the ligamentous apparatus, so the muscles spasm compensatory to keep the head of the femur in the acetabulum. Also, muscle spasm can be provoked by the increase of synovitis.
- Lameness - appears in the last stages of the development of the disease, as the deformation of the bone surfaces provokes the appearance of contracture of the flexor muscles. Therefore, a person cannot fully straighten the leg and hold it in this position. Also, the patient may limp involuntarily to transfer the weight to the healthy half of the body, as this helps to reduce the intensity of the pain.
- Shortening of the leg - observed with coxarthrosis of the 3rd degree. The leg on the side of the affected hip joint may be shortened by 1 cm or more as a result of narrowing of the joint space, decreased muscle tone, and flattening of the femoral head.
At the same time, degenerative-dystrophic changes can be observed in one hip joint or both. Therefore, the characteristic symptoms will be observed either on one side or on both at the same time, but in the latter case, their severity on the left and on the right may vary.
Diagnosing
The doctor may suspect the presence of coxarthrosis of the hip joint based on the patient's complaints, external examination and the results of functional tests. Be sure to measure the length of the legs during a visual inspection. For this, the patient is asked to stand up and straighten the legs as much as possible. The measurement is taken between the front axis of the pelvic bones and any bony structures of the knee, ankle or heel. But if both hip joints are simultaneously affected by coxarthrosis, the data obtained will be uninformative.
But since the typical symptoms of coxarthrosis can accompany a number of other inflammatory and non-inflammatory diseases, instrumental examination methods are mandatory for the patient to accurately diagnose the pathology. It can be:
- CT or X-ray of the hip joint - images show destructive changes in it, narrowing of the joint space, formation of osteophytes and deformation of bone surfaces;
- MRI is the most informative examination method that allows you to accurately assess the nature of changes in cartilage structures, ligaments and the nature of blood circulation in the hip area.
Patients are also assigned laboratory tests to assess their general health and detect diseases that may cause coxarthrosis. She:
- UAC and OAM;
- blood chemistry;
- rheumatic tests;
- hip joint puncture with a biochemical study.
The task of diagnosis is the differentiation of coxarthrosis of the hip with gonarthrosis (knee joint damage), as well as radicular syndrome that occurs with osteochondrosis, as well as protrusions and herniations of the intervertebral discs. Also, the symptoms of coxarthrosis may resemble the manifestations of trochanteric bursitis and an atypical course of ankylosing spondylitis, which requires a thorough examination to reveal the true causes of pain and mobility limitations.
Conservative treatment
Conservative treatment of coxarthrosis of the hip is effective only in the initial stages of the disease. It is selected for each patient individually and may include a whole range of different methods, each of which will complement the others. Therefore, as part of the treatment of coxarthrosis of the hip joint, patients can be prescribed:
- drug therapy;
- exercise therapy;
- physiotherapy;
- plasmolifting.
In order for conservative treatment to be effective, patients must eliminate the effect of a number of factors that contribute to the development of hip coxarthrosis. If you are overweight, it is very important to reduce it as much as possible. This will reduce the load on the affected joint and the risk of progression of the degenerative-dystrophic process.
You should also give up smoking and normalize the way of physical activity, avoid overloads, but don't sit all the time. To prevent further destruction of the hip joint, it is recommended to wear bandages and special orthoses. They ensure a secure fixation of the joint and support it during movement.
Medical treatment
The nature of drug therapy is chosen strictly individually. In most cases, patients are prescribed:
- NSAIDs - drugs that simultaneously have analgesic and anti-inflammatory effects (available in the form of tablets, injections and topical agents);
- corticosteroids - drugs with a strong anti-inflammatory effect, which are prescribed if NSAIDs do not give a pronounced effect;
- chondroprotectors - contribute to the activation of cartilage tissue regeneration processes, but their effectiveness has not been proven;
- muscle relaxants - drugs that reduce muscle tone and eliminate spasms, which is necessary when spasm of muscles or certain groups against the background of severe pain;
- preparations for improving blood circulation - are used more often in the form of injection solutions and help to improve the trophism of the tissues surrounding the joint;
- group B vitamins - have been shown to normalize the transmission of nerve impulses, which is especially important when nerves are compressed by deformed bone structures.
For acute pain that cannot be eliminated with the help of tablets, intra-articular or peri-articular blockades can be performed on patients. They are performed exclusively by qualified health workers in a medical institution and involve the introduction of corticosteroid anesthetic solutions into the joint cavity or directly into the area around it.
exercise therapy
Therapeutic exercise is an effective method to deal with decreased muscle tone and limited mobility. Thanks to a set of properly selected exercises, it is possible to increase the range of motion and reduce the severity of pain. They also prevent muscle atrophy and help eliminate spasms if coxarthrosis is accompanied by compression of nerve fibers, which reflexively leads to individual muscle spasms.
Exercise therapy classes can improve blood circulation in the area of the degenerative-dystrophic process. Due to this, the quality of trophism of the diseased joint increases and the course of regenerative processes is accelerated.
For each patient, a set of exercises should be developed individually by a specialist. At the same time, not only the degree of destruction of the hip joint is taken into account, but also the level of physical development of the patient.
Physiotherapy
Physiotherapy procedures and massage have an anti-inflammatory, analgesic, tonic, anti-edematous effect. In addition, they help maintain the normal tone of the leg muscles, preventing their atony and atrophy.
With coxarthrosis of the hip joint, courses of 10-15 procedures are prescribed:
- ultrasound therapy;
- magnetic therapy;
- laser therapy;
- electrophoresis;
- ultraphonophoresis;
- UHF;
- paraffin treatment.
Also, many patients are offered mud therapy. Such procedures have a positive effect only in the first stage of the development of coxarthrosis of the hip joint or during rehabilitation after surgical treatment. Thanks to the therapeutic mud, it is possible to achieve an improvement in the quality of blood circulation and accelerate the restoration of the motor skills of the affected joint.
Plasmolifting
Plasmolifting or PRP therapy is a procedure that involves the introduction of platelet-rich plasma of the patient's own blood into the cavity of the hip joint. This allows you to activate the restoration processes of hyaline cartilage.
But, according to some scientists, such a procedure can cause the formation of malignant tumors. This point of view is based on the fact that plasmolifting promotes the formation of a large number of stem cells, the effect of which on the body has not yet been fully studied.
Surgical treatment of coxarthrosis of the hip joint
Despite the considerable discomfort in the hip joint, many seek medical help too late, when pathological changes in the joint reach 3 or even 4 degrees of severity and functionality is irreversible.
With advanced pathology, surgery is a necessary measure. Only a timely surgical intervention will help to restore normal mobility and save the patient from excruciating pain, that is, to achieve a significant improvement in the quality of human life. No medicine, physiotherapeutic procedure, can restore severely destroyed cartilage. At best, painful intra-articular injections and medication can reduce the pain. But this will be a temporary phenomenon, after which the pain will return again with the same force or even more.
Indications for hip surgery are:
- disappearance of the interarticular space;
- persistent pain in the hip joint, not suitable for relief;
- critical mobility disorders;
- hip fracture.
Depending on the severity of joint destruction and bone deformation, patients can be offered different types of surgical treatment, namely:
- arthrodesis;
- endoprosthesis;
- osteotomy.
Arthrodesis
Arthrodesis is an affordable operation that involves a firm fixation of the articular bones with metal plates. The result is complete immobilization of the joint. Therefore, with the help of arthrodesis, it is possible to correct only the supporting function of the leg, eliminate pain, but it is not necessary to talk about the restoration of mobility or a significant improvement in the quality of life.
Endoprosthetics
Endoprosthetics with arthroplasty is the only way to fundamentally solve the problem of coxarthrosis of the hip joint by restoring all its functions and motor skills. This is a high-tech method for solving the problem of coxarthrosis, which allows you to completely forget about it for 15-30 years, as well as pain and mobility restrictions. Thanks to the use of modern endoprostheses, it is possible to achieve complete restoration of motor support functions and provide the patient with a normal life.
The operation involves removing the head of the femur and part of its neck. Surgical preparation of the acetabular bed is also performed, which includes removal of osteophytes, stretching of its surface and removal of tissue that has undergone necrosis. Endoprosthetics can also be used to treat elderly patients with hip coxarthrosis.
The operation is performed under general anesthesia and lasts about an hour. Depending on the severity of the degenerative-dystrophic process, the operation can be performed using one of the following methods:
- superficial - involves grinding the head of the acetabulum and femur with further dressing with smooth implants that replace the destroyed hyaline cartilage (the method is rarely used due to the possibility of inflammation in the periarticular tissues);
- unipolar - removing the femoral head and replacing it with an endoprosthesis (used when the cartilage is preserved on the surface of the acetabulum and only the femoral head is destroyed);
- bipolar - similar to the previous technique, differing only in the design of the endoprosthesis used, which has a lower coefficient of friction and provides smoother movements in the joint bed;
- total is the most effective and safest method for solving the problem of coxarthrosis of the hip joints, which includes a complete resection of the femoral head with the capture of part of its neck, as well as the acetabular fossa and their replacement witha complete artificiality. articular articulation.
Thus, installation of different types of endoprostheses can be recommended to patients. Most hip replacements are manufactured in the USA and the UK. Chemically and biologically inert metals are used for their production: cobalt, chromium, titanium alloys. Ceramics are also often used. In most modern models, polymer pads are also used, which make it possible to ensure the natural absorbing, stabilizing and sliding properties of artificial TBS.
After the operation, antibiotics are prescribed to prevent the development of infectious complications, and the stitches are removed after 10 days. The size of the scar after the operation is approximately 8 cm. At the same time, the patient leaves the clinic. Rehabilitation after endoprosthetics is simple, but still requires physiotherapy, massage and exercise therapy.
osteotomy
Osteotomy is a surgical intervention that is a temporary measure before a cardinal replacement of the hip joint with an artificial endoprosthesis. The essence of the operation is the alignment of the shaft of the femur due to its intentional fracture. The resulting fragments are placed in the most suitable position, thereby slightly unloading the diseased joint. As a result, it is possible to temporarily reduce the severity of pain and improve mobility.
Thus, coxarthrosis of the hip is a rather scary disease that can completely deprive a person of the opportunity to move independently. It progresses for a long time and its symptoms, especially in the early stages, are often perceived by patients as a normal condition after physical exertion. But precisely in this lies the secret of the disease, because only in the initial stage of its development can it be treated non-surgically. But if the degenerative-dystrophic process has already completely destroyed the hyaline cartilage and led to the exposure of the bone surfaces, and even more so to their flattening, only surgery can help the patient. Fortunately, the modern level of medicine and surgery, in particular, makes it possible to achieve a complete restoration of the normal state of the hip joint and its functions.