Osteoarthritis of the hip joint (coxarthrosis) is a chronic pathology, followed by gradual destruction of the cartilaginous 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 joint.
General information
Coxarthrosis belongs to the group of degenerative diseases. It begins with gradual microscopic changes in the structure of the 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 load distribution on the contact surfaces of the bones changes, and the zones with maximum pressure begin to wear out faster. This triggers a whole cascade of pathological reactions:
- the appearance of microcracks and areas of compaction in the cartilage tissue;
- reduction of smoothness of joint surfaces;
- cartilage overgrowth at the site of thinning and replacement by bone tissue;
- the appearance of osteophytes (growths on the bones) along the edges of the joint;
- thickening and reduced elasticity of the joint capsule;
- firming and reduced ligament strength;
- changes in synovial fluid composition (natural lubrication within the joint);
- narrowing of the joint space;
- fusion of all joint elements (ankylosis).
Without treatment, coxarthrosis inevitably becomes a cause of immobility and disability.
Causes
Depending on the causes of the development of the disease, primary and secondary coxarthrosis are distinguished. In the first case it occurs independently, for example, in the background of hereditary predisposition, in the second they cause other diseases or injuries. In most cases, the process of degeneration of cartilage tissue occurs due to a combination of several factors. The reason may be:
- congenital hip dislocations;
- 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 in the background of overweight, professional sports, etc. ;
- hip joint dysplasia;
- metabolic disorders;
- endocrine diseases (especially diabetes mellitus);
- violations of the blood supply to the lower extremities;
- frequent stress;
- heredity (coxarthrosis in parents or other close relatives significantly increases the risk of development in the child);
- congenital pathologies and autoimmune connective tissue diseases (joint hypermobility, rheumatoid arthritis, systemic lupus erythematosus, etc. );
- undergo 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 note:
- 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 cartilaginous growths further exacerbates the problem;
- pain: friction of bones deprived of the cartilaginous layer against each other, the gradual involvement of all elements of the joint in the degenerative process, reduced blood flow to the tissues cause painful sensations that increase as the disease progresses; the pain is shooting in nature and often intensifies towards the end of the day;
- muscle spasm, leading to increased pain symptoms 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 friction; the difference between the legs can be up to 2 cm;
- lameness: associated with severe pain and restricted movement, as well as shortening of the leg; is an unfavorable sign that indicates serious damage to the joint apparatus.
Phases
In the process of developing coxarthrosis, it goes through several phases, which depend on the degree of tissue damage.
- 1 degree. At this time, the patient notices mild aching pains in the joint that appear after intense or prolonged physical activity and pass quickly after rest. As a rule, the discomfort occurs in the area of the hip joint, but in some cases it extends to the hip or knee. The gait does not change, the movements of the legs are preserved in full. Specific changes were noted on the radiograph: subchondral sclerosis.
- 2nd degree. The pain becomes stronger, occurs after exertion, spreads to the entire thigh and groin. Slight lameness may occur after exertion. Difficulties in abducting the leg were found. X-rays show a significant reduction in the distance between the bones (by 50% or more), deformation of the femoral head and pronounced bone growth.
- 3 degrees. The pain becomes permanent, walking without a cane becomes impossible. When moving, the patient noticeably leans towards the painful side, which further increases the load on the joint. The range of motion decreases, the muscles of the legs and buttocks atrophy. There was a shortening of the affected limb. X-rays reveal significant joint deformation, changes in the contour of the femoral head 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 mutual fusion of bones (ankylosis). Coping with the disease at this stage is only possible with surgery.
Diagnosis
An orthopedic traumatologist is responsible for recognizing symptoms and selecting treatment. To diagnose and determine the extent of the disease uses:
- research: hearing patient complaints, identifying risk factors (trauma, illness, heredity, etc. );
- examination: assessment of limb mobility, determination of the area of greatest pain;
- X-ray: X-ray image allows to assess the condition of bones and cartilage, the size of the joint space, the presence and location of bone growths; in order to see the necessary details in more detail, the study was supplemented by CT (computed tomography);
- laboratory diagnosis: a general blood test allows you to recognize the signs of the inflammatory process, biochemically - to identify some risk factors, for example, uric acid levels;
- MRI (magnetic resonance imaging): allows you to assess the condition of not only bones and cartilage, but also soft tissues: bones, ligaments, muscles, joint capsules, etc. ;
- joint puncture.
If it is necessary to conduct a differential diagnosis with other diseases, as well as to assess the accompanying pathologies, additional tests, instrumental examinations and consultations with narrow specialists are prescribed.
Treatment of coxarthrosis
Treatment of hip coxarthrosis depends on the stage and severity of the symptoms. Pathology requires an integrated approach using different methods:
- drug treatment;
- drug-free treatment (physiotherapy, exercise therapy);
- surgery;
- lifestyle and diet correction.
Drug treatment
Medications prescribed for osteoarthritis of the hip joint are aimed at:
- elimination of pain syndrome;
- restoring or at least slowing down 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 intra-articular injections and topical agents: creams, ointments, patches. In the early stages of disease development, nonsteroidal anti-inflammatory drugs are sufficient for most patients. 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 spasms, muscle relaxants are used. They are used in combination with other analgesics.
Taking painkillers should be limited in time and dose to avoid further damage to the cartilage tissue and other side effects (especially the development of gastritis and stomach ulcers).
Chondroprotectors are drugs that help regenerate cartilage tissue. They are effective only with long-term regular use that is combined with other methods of treatment, lifestyle and dietary adjustments. Drugs to improve blood microcirculation help enhance their effect. Warming fats are prescribed for a similar purpose. Only a doctor is involved in choosing the dose and regimen.
Drug-free treatment
This category includes various physiotherapy and manual techniques, as well as physiotherapy exercises. They help improve microcirculation and restore movement in the damaged joint. Depending on the situation, the doctor prescribes:
- shock wave therapy;
- magnetotherapy;
- electromyostimulation;
- various types of electrophoresis and phonophoresis (accompanied by the administration of anesthetic drugs);
- 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 slipping.
Prevention
Lifestyle can significantly reduce the risk of developing coxarthrosis, as well as the speed of its progression. It is important to strictly follow the rules:
- lead an active lifestyle: swimming in the pool, walking, cycling - physical activity on an amateur level without racing for records helps to improve the blood supply and inhibits the processes of joint degeneration;
- normalize body weight to reduce the load on the legs;
- remove injuries, hypothermia and risk factors at work (vibration, weight lifting, standing work);
- timely treatment of all diseases, including those not directly related to the musculoskeletal system;
- correct posture disorders in time, wear comfortable shoes.
Diet
With the help of dietary correction, the patient can not only reduce body weight, but also reduce inflammatory reactions, tissue salt deposits and metabolic disorders. It is recommended that you adhere to a balanced diet with sufficient but not excessive amounts of carbohydrates, proteins and fats, as well as vitamins and minerals. Special attention should be paid to unsaturated fats (olive and flaxseed oil), omega-3 acids (excessive amounts are found in fish), collagen (jelly meat, aspic). It is recommended to reduce fast carbohydrates, alcohol, strong coffee, products with artificial aromas, 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, which is why it is important to treat yourself on time.