Arthrosis of the hip joint (coxarthrosis) is a degenerative disease of the cartilage of the hip joint, leading to persistent dysfunction of the joint and disability of the patient. More often, arthrosis of the hip joint can be found in elderly patients, and men get sick more often than women.
Classification of arthrosis of the hip joints
There are two main types of the disease:
- primary - the onset of the disease against the background of complete well-being;
- secondary - develops against the background of an 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 arthrosis of the hip joint, the following types are distinguished:
- idiopathic - coxarthrosis, which develops without a specific reason;
- involutive - arthrosis associated with age-related changes natural for 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 - 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 - developing as a result of hereditary features of the development of cartilage tissue (often combined with deforming osteoarthritis of other joints).
In addition, 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 bone skeleton of the lower extremities (for example, shortening of one of them). Lameness or poor posture puts excessive stress on the hip joint, which can cause coxarthrosis. Another common cause of coxarthrosis is inactivity, however, excessive physical activity (sports 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, 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 bother in the morning or after significant physical exertion on the joint. Meteosensitivity of the affected joint may also be noted, which is manifested by pain when the weather changes. The patient may notice morning stiffness in the joint, which disappears after movement, a little warm-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.
Coxarthrosis 2 degree
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 erroneous diagnosis of coxarthrosis associated with pain radiating to the knee and popliteal ligaments. The pain begins to bother not only after physical exertion, but also at rest. During the movement of the limb, extraneous sounds appear emanating from the joint (clicks, crunch). The range of motion in the joint is significantly reduced, especially rotational (circular), the biomechanics of movements in the joint is impaired and, accordingly, its functionality is reduced. Pain and decreased mobility in the joint provokes the appearance of slight lameness, which in turn leads to moderate atrophy of the gluteal muscles from the side of the affected joint.
On the roentgenogram, one can see the narrowing of the joint space by a third of the normal width, significant thinning of the cartilage up to its absence in some areas, the appearance of osteophytes on the articular surfaces, deformation of the femoral head, and its upward displacement.
Coxarthrosis grade 3
At this stage of the disease, pain becomes constant, including nighttime, pain relievers are difficult to relieve. The range of motion in the joint is reduced to a minimum, the biomechanics of the joint is significantly impaired. The slightest movements are accompanied by crepitus, lameness becomes pronounced, there is a significant distortion of the pelvis and 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 often cannot 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 is narrowed so much that it is practically absent.
Diagnosis of arthrosis of the hip joint
Diagnostic measures begin with interviewing the patient and examining him, taking 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 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)- makes it possible 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, articular 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 avoid the progression of the disease, immobilization of the patient and the loss of his ability to work. Therefore, even with the slightest discomfort from the joint, seemingly insignificant pain, stiffness, meteosensitivity of the joint, you need to 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 malnutrition of the cartilage, until irreversible changes have developed in it.
The scope of treatment depends on the stage of the disease. So, with coxarthrosis of the first degree, non-narcotic analgesics and NSAIDs are used - they allow you to eliminate pain syndrome, as well as eliminate inflammation in the tissues of the joint, preventing further damage to its tissues. Due to the fact that at this stage the pain syndrome and inflammation are not intense, there is no need for long-term use of such drugs. 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 the cartilaginous tissue, to minimize its degeneration, for which drugs from the group of chondroprotectors are used. Their task is to restore metabolism in the cells of the 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 itself well, 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 in the cartilage - proteoglycans and prevents the destruction of cartilage tissue.
A full-fledged treatment of coxarthrosis of the second and third degree is already much more difficult: the cartilage is already significantly damaged, the articular surfaces are exposed, osteophytes are formed on them in large numbers, which impede 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 cartilage destruction. The pain at 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 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 the course of taking chondroprotectors to normalize metabolic processes in the cartilaginous tissue, exercise therapy, massage, and kinesitherapy are recommended. They provide a reasonable load on the joint, prevent its immobilization and the deposition of mineral salts in the joint tissues and ligaments, and stimulate microcirculation. Exercise therapy is also of great importance for the general state of the body: when moving, biologically active substances are produced in it that increase mood and general well-being - endorphins and serotonin.
Proper nutrition plays an important role in the complex treatment of arthrosis of the hip joint. The patient's diet should be complete, rich in animal and vegetable proteins, fiber, vitamins. Proper nutrition is important not only to stimulate joint regeneration, but also to maintain the patient's body weight within normal limits. Overweight is an additional load on the diseased joint and a factor in the progression of the disease.
In the stage of remission, the methods of physiotherapy - electrophoresis, mud therapy, ultrasound and magnetotherapy - have proven themselves well. In addition, the effectiveness of biological and mechanical methods of treating coxarthrosis is noted. Among 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 muscles surrounding it, which prevents atrophic processes in them. Mechanical methods include joint traction to relieve 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, 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 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 arthrosis of the hip joint
Preventive measures are reduced to taking chondroprotectors, proper nutrition and reasonable stress on the joints, especially for those who play sports or hard physical work.
Coxarthrosis is a serious disease that can deprive the patient of the ability to move independently. Disability can be avoided by timely seeking medical help already at the first discomfort in the joint, provided that the pathology is properly treated from its very first stage.