Osteoarthritis of the hip joint (coxarthrosis) is a degenerative disease of the cartilage of the hip joint, which leads to persistent dysfunction of the joint and patient disability. More often, osteoarthritis 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 for no specific reason;
- involution - 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 - osteoarthritis that develops in the joints affected by rheumatoid arthritis, as well as due to 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 hormone therapy;
- vascular - the disease develops due to circulatory disorders in the joint;
- hereditary - which develops due to 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 the curvature of the spine, intervertebral hernias or defects in the bone skeleton of the lower extremities (for example, the shortening of one of them). Lameness or poor posture puts excessive stress on the hip joint, which can trigger coxarthrosis. Another common cause of coxarthrosis is inactivity, however excessive physical activity (sports or work) can also cause joint disease.
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 appears atrophy of the thigh and gluteal muscles. Movement in the joint is accompanied by a characteristic creak; over time, the mobility of the joint decreases. The intensity of the symptoms directly depends on the degree of the disease.
Coxarthrosis 1 degree
The initial stage of the disease is manifested by a slight pain, which can be uncomfortable in the morning or after significant physical exertion on the joint. Meteosensitivity of the affected joint may also be noted, manifesting as pain when the weather changes. The patient may notice morning stiffness in the joint, which disappears after movement, a little warming.
Radiological changes are minimal: there may be a slight narrowing of the joint space, thinning of the cartilage that covers 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, to the knee. There are frequent cases of misdiagnosis of coxarthrosis associated with radiated pain in the knee and popliteal ligaments. Pain begins to bother not only after physical exertion, but also at rest. During the movement of the limb, extraneous sounds appear from the joint (click, creak). The range of motion in the joint is significantly reduced, in particular rotational (circular), the biomechanics of movements in the joint is impaired and, as a result, its functionality is impaired. Pain and reduced mobility in the joint provoke the appearance of a slight lameness, which in turn leads to moderate atrophy of the gluteal muscles on the side of the affected joint.
On the roentgenogram one can note the narrowing of the joint space by one third of the normal width, a significant thinning of the cartilage up to its absence in some areas, the appearance of osteophytes on the joint surfaces, deformation of the femoral head, and its displacement towards the 'tall.
Coxarthrosis grade 3
At this stage of the disease, the pain becomes constant, including at night, painkillers are difficult to relieve. The range of motion in the joint is minimized, the biomechanics of the joint are significantly impaired. The slightest movements are accompanied by crepitus, lameness becomes pronounced, there is a significant distortion of the pelvis and a shortening of the limb from the side of the affected joint. The gluteal and hamstring muscles on the affected side are atrophied. Due to the 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 bone growths, the joint space is narrowed so much that it is practically absent.
Diagnosis of arthrosis of the hip joint
Diagnostic measures begin with the patient interview and examination, carrying out a series 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 growths on them, to determine the presence of deformity 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)- it allows to obtain layer-by-layer radiographic images, but clearer and more voluminous;
- magnetic resonance imaging (MRI) -allows you to study the state of joint structures, joint surfaces, bones and ligaments with a high degree of visualization. At present, it is considered the most advanced diagnostic method.
Treatment of coxarthrosis
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 disease progression, immobilization of the patient and loss of his ability to work. Therefore, even with the slightest discomfort in the joint, seemingly insignificant pain, stiffness, meteorosensitivity of the joint, it is necessary 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 cartilage malnutrition, until irreversible changes have developed.
The purpose 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 to eliminate the 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, long-term use of such drugs is not necessary. As a rule, it is enough to deal with local means: ointments, gels containing NSAIDs. It is much more important at this stage to ensure the normalization of metabolic processes in the cartilage 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 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 proved itself effective, the active ingredient 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 processes of destruction of the cartilage tissue.
Comprehensive treatment of second and third degree coxarthrosis is already much more difficult: the cartilage is already significantly damaged, the joint 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 allows to reduce pain in the joint and slow down the processes of destruction of cartilage. 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 cartilage tissue, physical therapy, massage and kinesitherapy are recommended. They provide a reasonable load on the joint, prevent the immobilization and deposit of mineral salts in the tissues and joint ligaments and stimulate microcirculation. Physical therapy is also of great importance for the general state of the body: when moving, biologically active substances are produced that increase mood and general well-being - endorphins and serotonin.
Proper 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. Proper nutrition is important not only to stimulate joint regeneration, but also to keep 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 remission phase, physiotherapy methods have proven themselves effective: electrophoresis, mud therapy, ultrasound and magnetotherapy. In addition, the effectiveness of biological and mechanical methods for the treatment of coxarthrosis is noted. Among the 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, preventing atrophic processes in them. Mechanical methods include joint traction to relieve excess 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 treatment of 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 plastic 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 working capacity.
Prevention of osteoarthritis of the hip joint
Preventive measures come down 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 promptly requesting medical help at the first discomfort in the joint, after competent complex treatment of the pathology from its first stage.