The hip joint is the largest joint in our body.It has a hinged configuration that allows movement in different planes.At the same time, the joint is surrounded by strong ligaments and muscles.The hip joint bears the main load when walking, walking, or carrying heavy loads.Coxarthrosis (another name for hip joint arthrosis) is quite common in people, both old and young.Once it starts, it can remain undiagnosed for a long time, because the limitation of hip movement that appears does not occur immediately.
Often, patients, without being examined by a doctor or without communicating all their complaints, begin to treat lumbosacral osteochondrosis or arthrosis of the knee joint without visible results.Meanwhile, untreated disease progresses and leads to lameness, constant pain, shortening of the legs, and the inability to bend and extend.And treatment at this stage is only possible surgery, that is, the joint should be replaced with a prosthetic.
Causes of coxarthrosis
Primary arthrosis of the hip joint develops more often in people over 40 years of age.The cause has not been studied.The hyaline cartilage that covers the articular surface and provides gliding begins to thin and collapse.Due to increased friction and pressure on the bones, bone spurs appear on them.The joint is deformed, movement in it is limited.In primary coxarthrosis, both knee joints and spine are often affected.
Secondary arthrosis develops against the background of various diseases:
- Hip dysplasia.This term refers to the congenital regression of this joint component in children.As a result, the femoral head is not centered as it should be in the acetabulum.There are three types of hip dysplasia: preluxation, subluxation and hip dislocation.With a congenital dislocation, the femoral head is located outside the socket and, if appropriate treatment is not carried out, arthrosis then develops.
- Aseptic necrosis.The femoral head bone tissue begins to dissolve due to compromised blood supply.Bone tissue is focally absorbed, the joint head is deformed.Arthrosis develops secondarily.
- Legg-Calvé-Perthes disease.This is osteochondropathy of the femoral head, which occurs in children aged 3 to 14 years, especially in boys.Occurs, as a rule, as a result of complications after an infectious process, as well as injuries, physical exertion, and metabolic diseases.The cartilaginous area of the head is not supplied with blood, which leads to necrosis of this area and deformation of the joint.
- Inflammation, infection.If arthritis of the hip joint has developed, the synovial fluid loses its lubricating properties, the joint layer thickens, the hyaline cartilage is subjected to mechanical stress, and at the same time metabolic disorders occur in the joint.
- Injuries: bruises, fractures of the femur, acetabulum, hip dislocation, chronic trauma, that is, microtraumas are systematically accepted.
- Hip joint advantages associated with sports and professional activities.For example, long walks without rest, vibration effects, continuous jumping, and carrying heavy loads are undesirable for the joints.A child's or adolescent's muscle corset cannot balance the load.
- Weight gain, especially at a young age, when the cartilage is not yet able to withstand large axial loads.In addition, such patients usually have metabolic problems.
- Coxarthrosis itself is not inherited, but genetic relatives may have cartilage tissue structure, metabolic disorders that lead to the development of arthrosis.Therefore, it is worth considering whether parents or more distant relatives have a common disease.
- Osteoporosis.The vulnerable area for this disease is the femoral neck.The structure becomes rarer, pathological fractures are possible.All these secondary leads to arthrosis.
- Diabetes mellitus.In this case, arthrosis develops due to vascular disorders.
- Polyneuropathy with impaired sensation in the legs.
- Diseases of other parts of the musculoskeletal system.These include: scoliosis, arthrosis and knee injuries, flat feet.The distribution of the load on the hip joint changes, the shock-absorbing properties decrease, and as a result, the cartilage coating suffers.
Symptoms of coxarthrosis
To avoid the disease and its early diagnosis, it is important to know the signs of early arthrosis of the hip joint (stage 1 coxarthrosis):
- Pain that occurs periodically after physical activity.Specific pain sensations can be localized in the groin, side, hip or knee area.After resting they leave, so they are not given any importance.Meanwhile, this is a worrying sign.
- Slight limitation of hip rotation (inward and outward).This can be easily checked while lying on your back, rotating the entire leg clockwise and counterclockwise.
- X-rays can reveal slight narrowing of the joint space.
With arthrosis of the 2nd degree, the signs are more obvious:
- Pain occurs in the projection of the joint, most often in the inguinal fold, and is also observed at rest.
- Restrictions appear not only when turning the legs, but also when abducting the hips to the side.Movements in the joints are quite painful, especially in extreme positions (with maximum abduction of the hips, bending the legs towards the stomach).
- On an X-ray, you can see moderate narrowing of the joint space and isolated bone growth on the edge of the acetabulum.Cysts can also form in the bony structure of the femoral head.
Arthrosis of the hip joint of the 3rd degree is easy to diagnose, the symptoms are severe:
- Joint pain during exercise, at night.
- Lameness, patients often use crutches.
- Limitation of movement in the joints, as a result of which it is difficult for a person to put on socks or put on shoes.
- Legs become thinner due to hypotrophy of the thigh and lower leg muscles.The muscles of the gluteal area also weaken.
- It is possible to shorten the leg due to incomplete extension and deformation of the femoral head.As a result, scoliosis of the lumbar region (lateral curvature) is formed, and pain appears in the lumbosacral region.
- The signs of the 3rd stage, revealed by X-ray, are the narrowing of the joint space until its complete absence, bone growth, deformation of the head and neck of the hip joint.
Diagnostics
In diagnosis, it is very important to explain subjective complaints, collect anamnesis, evaluate symptoms, and also to clarify the stage - Radiography, CT and MRI.Computed tomography allows you to study in detail the bone structure of the hip joint, and the magnetic resonance method describes soft tissues, the state of the joint capsule, and the presence of synovitis.
Treatment
Therapy for coxarthrosis depends on the stage of the process and, in most cases, includes various procedures.Of course, the earlier treatment is started, the greater the effectiveness.
- Conservative treatment
- Drug therapy.To relieve pain, non-steroidal anti-inflammatory drugs are used in tablets, suppositories or intramuscular injections.Dosage forms such as ointments, gels, creams are not effective enough because around the hip joint by large muscles and subcutaneous tissue.Long courses of non-steroidal anti-inflammatory drugs are not recommended due to side effects on the cardiovascular system and gastrointestinal tract.To help them, doctors can prescribe drugs that relieve muscle spasms - muscle relaxants.In cases of severe inflammation, intra-articular glucocorticoids may be required.Chondroprotectors are one of the main groups of drugs for the treatment of coxarthrosis.They are administered intramuscularly and intraarticularly;In milder cases, tablet form can be taken.These drugs aim to improve the recovery process in the cartilage tissue and slow down its deterioration.Doctors can also prescribe vascular drugs to improve local blood circulation.
- Physiotherapy.The procedure increases blood flow in the joint area and relaxes the muscles.These are UHF, magnetic therapy, laser treatment, diadynamic current, electrophoresis.Purpose - according to individual indications.
- Therapeutic massage.A very necessary treatment method for coxarthrosis: Relieves muscle spasms, has a beneficial effect on blood circulation, and when carried out systematically, strengthens muscles.
- Therapeutic gymnastics.Increase blood flow and strengthen joint muscle corset.Recommended exercises for coxarthrosis (performed with solid support):
- "Bicycle" in a supine position;
- Lie on your back, take your knee with your hands and pull it towards your stomach, and do the same with the other leg;
- While lying on your back, bend your knees, press the soles of your feet to the floor and lift your pelvis, hold in this position;
- Lying on your back, move your thighs as far as possible to the side;
- Sit on a chair, squeeze the ball between your thighs;
- lie on your back, turn your legs in and out;
- Stand with your right leg at a slight height and hold the support with your hand, swing your left leg back and to the left and to the right, then do the same, changing your leg.
- Surgical treatment.Endoprosthetics, i.e. joint replacement with an artificial one, is performed at the 3rd stage of coxarthrosis in the presence of limb shortening, constant pain, and severe contractions.Endoprosthetics can be cemented (in the presence of osteoporosis) or without cement.The prosthesis itself can be unipolar (replacement of only the head) and total (replacement of both components).Already the next day after the operation, some elements of exercise therapy are performed while lying in bed, the patient can stand, but now without supporting his legs, and a few days later - on crutches.After 2-3 months, crutches are no longer needed and full weight on the legs will be allowed.Patients who have undergone endoprosthetics are recommended to undergo rehabilitation consisting of physical therapy, massage, and physical therapy.In most cases, limb function is restored.The service life of the prosthesis is from 10 to 20 years, then it is replaced with a new one.
Prevention of coxarthrosis
Preventive measures are very important, especially if you have a history of hip dysplasia, fractures, severe bruising or purulent processes in this area.
- Avoid heavy lifting and jumping (especially from heights).Try not to be on your feet for long periods of time.
- Weight control (reduce the consumption of flour products, table salt, sweets, strong tea and coffee in the diet).Being overweight increases the risk of hip arthrosis.
- Dose physical training aimed at strengthening the muscles of the thighs and back (cycling or exercise, swimming, therapeutic exercises).
- If there are diseases related to metabolism (diabetes mellitus, atherosclerosis), they must be compensated.
Compliance with preventive measures, early detection of coxarthrosis and adequate treatment are the keys to a positive prognosis for this disease.
Which doctor should I contact?
If you experience pain in your legs or hip joints, you should consult a doctor.He will prescribe the main diagnostic measures, in particular, X-ray of the hip joint.Once the stage of the disease has been established, the patient will be referred to a rheumatologist or orthopedist.Nutritionists and endocrinologists can provide additional assistance in losing weight and slowing the progression of the disease.It is useful for women to consult a gynecologist to prescribe hormone replacement therapy to prevent osteoporosis.