Hip arthrosis (coxarthrosis) is a degenerative disease of the cartilage of the hip joint that leads to permanent joint dysfunction and disability of the patient. Hip arthrosis of the hip joint is more common in elderly patients, and men are more likely to become ill than women.
Classification of hip arthrosis
There are two main types of the disease:
- primary - the development of the disease in the background of overall well-being;
- secondary - inflammatory joint disease develops in the background, after a previous injury, and congenital disorders of the development of the hip joint in the presence of its dysplasia.
Causes of coxarthrosis
The following types are distinguished based on the causes of arthrosis of the hip joint:
- idiopathic - coxarthrosis that develops for no specific reason;
- invative - age-related arthrosis with natural changes in the body, manifested in old age;
- dysplastic (congenital) - arthrosis, which develops in the joint against the background of congenital disorders;
- post-infection - arthrosis, which develops in the joints affected by rheumatoid arthritis and some other infections;
- post-traumatic arthrosis, which develops as a result of traumatic joint damage;
- dyshormonal - coxarthrosis, which develops in the background of diseases of the endocrine system or metabolic disorders due to hormone therapy;
- vascular - the disease develops as a result of circulatory disorders of the joint;
- hereditary - develops as a result of the hereditary properties of cartilage tissue formation (often in combination with deforming osteoarthritis of other joints).
In addition, hip osteoarthritis can result in a violation of the biomechanics of body movement, which is often accompanied by curvature of the spine, intervertebral hernias, or skeletal defects in the lower extremities (e. g. , one of them). Paralysis or poor posture causes excessive strain 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 pathology.
How does hip arthrosis manifest itself?
First, patients with coxarthrosis complain of pain in the hip joint. It is accompanied by lameness, over time, thinning of the thighs and buttocks. The movement of the joint is accompanied by a characteristic cracking; over time, joint mobility decreases. The intensity of the symptoms depends directly on the extent of the disease.
Coxarthrosis 1 degree
The initial stage of the disease is manifested by mild pain that can interfere with significant physical exertion in the morning or at the joint. We can also note the meteosensitivity of the affected joint, which manifests itself in pain as the weather changes. The patient may notice the morning stiffness of the joint, which disappears after movement, with a little warm-up.
Radiological changes are minimal - there may be a slight narrowing of the joint space, a thinning of the cartilage covering the head of the femur.
Grade 2 coxarthrosis
The intensity of the pain increases slightly at this stage of the disease, while the pain radiates to the groin, the knee. There is often a misdiagnosis of coxarthrosis with pain radiating to the knee and popliteal ligaments. The pain begins to interfere not only after physical exertion but also at rest. During the movement of the limb, foreign sounds appear from the joint (clicks, crunches). The range of motion of the joint decreases significantly, especially the rotation (circular), the biomechanics of the movements of the joint deteriorates, and its functionality decreases accordingly. Pain and decreased joint mobility trigger the appearance of mild lameness, which in turn leads to moderate atrophy of the hind muscles from the side of the affected joint.
The roentgenogram shows a narrowing of one-third of the normal width of the joint space, a significant thinning of the cartilage up to the absence of certain areas, the appearance of osteophytes on the joint surfaces, deformity of the femoral head and upward displacement.
Coxarthrosis Grade 3
At this stage of the disease, the pain becomes constant, including at night, and analgesics are difficult to alleviate. The range of motion of the joint is minimized, and the biomechanics of the joint deteriorate significantly. The slightest movements are accompanied by creping, the lameness becomes pronounced, the pelvis is distorted and the limb is shortened from the side of the affected joint. On the affected side, the buttocks and thigh muscles withered. Due to significant lameness, patients are often unable to move independently without a cane or holder.
X-ray examination shows a pronounced deformation of the femoral head, a thickening of the femoral neck. The joint surfaces are covered with bony growths, the joint space is so narrowed that it is practically absent.
Diagnosis of hip arthrosis
Diagnostic procedures begin with questioning and examining the patient, performing a number of laboratory tests, followed by the use of special instrumental techniques to confirm the diagnosis. The following methods are considered the most informative today:
- X-ray examination -allows the contours of the joint surfaces to be viewed, the presence or absence of bone growths on them, the deformity of the femoral head and the width of the joint space to be determined;
- Joint ultrasoundallows not only the examination of joint surfaces but also the identification of dystrophic changes in the ligaments of the joints;
- computed tomography (CT)- allows you to take X-ray type, but clearer and more voluminous layered images;
- magnetic resonance imaging (MRI) -allows the study of the condition of joint structures, joint surfaces, bones, and ligaments with a high degree of visualization. It is currently considered to be the most advanced diagnostic method.
Coxarthrosis treatment
The most effective is the complex treatment of hip arthrosis, taking into account the stage of the disease. It should not be forgotten that the earlier treatment is started, the more likely it is to avoid disease progression, immobilization of the patient and loss of ability to work. Therefore, even with the slightest discomfort of the joint, seemingly insignificant pain, stiffness, or meteor sensitivity, you should consult an orthopedic doctor who will perform an examination, clarify the diagnosis, and prescribe treatment. Cartilage tissue does not recover, so it is better not to wait until the moment when its damage is significant, but to start treatment during the stage of cartilage malnutrition until irreversible changes develop in it.
The scope of treatment depends on the stage of the disease. So with first-degree coxarthrosis, non-narcotic painkillers and NSAIDs are used - these make it possible to eliminate the pain syndrome and eliminate inflammation in the tissues of the joint, preventing it from being further damaged. Due to the fact that pain syndrome and inflammation are not intense at this stage, there is no need for long-term use of such drugs. As a rule, quite enough local means - ointments, gels that contain non-steroidal anti-inflammatory drugs. It is much more important at this stage to ensure the normalization of metabolic processes in cartilage tissue, to minimize its degeneration, for which drugs from the group of chondroprotectors are used. Their task is to restore metabolism in cartilage tissue cells, resulting in improved joint trophism and reduced inflammation intensity. For example, in the treatment of coxarthrosis, a chondroprotective drug is well established, 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 of cartilage - proteoglycans and prevents the processes of cartilage tissue destruction.
Complete treatment of second- and third-degree coxarthrosis is already much more difficult: cartilage is already significantly damaged, joint surfaces are exposed, and large numbers of osteophytes are formed on them, which impede normal joint movement. At this stage, only symptomatic treatment is possible, which allows to reduce joint pain and slow cartilage destruction. At this stage of the disease, the pain is severe, analgesics and non-steroidal anti-inflammatory drugs are used to relieve them, and the best solution would be a combination of topical agents (ointments, creams) and systemic formulations (tablets, injections). .
As the disease worsens, regardless of its stage, the load on the joint should be minimized to avoid further damage to the cartilage. During remission, in addition to taking chondroprotectors to normalize cartilage metabolic processes, exercise, massage and kinesitherapy are recommended. They provide adequate load to the joint, prevent its immobilization and deposition of mineral salts in joint tissues and ligaments, and stimulate microcirculation. Exercise is also of great importance for the general condition of the body: when exercised, biologically active substances are produced in it, which increase mood and general well-being - endorphins and serotonin.
Proper nutrition plays an important role in the complex treatment of hip arthrosis. The patient’s diet should be complete, rich in animal and plant proteins, fiber, vitamins. Proper nutrition is important not only for stimulating joint regeneration but also for maintaining the patient’s body weight within normal limits. Being overweight is an additional burden on the patient’s joint and a factor in the progression of the disease.
In the remission phase, the methods of physiotherapy have proved their worth - electrophoresis, mud therapy, ultrasound and magnetotherapy. They also note the effectiveness of biological and mechanical methods for treating coxarthrosis. The most popular of the biological methods is hirudotherapy (leech therapy), which provides blood dilution and stimulation of capillary microcirculation both in the joint and in the surrounding muscles, which prevents atrophic processes in them. Mechanical methods include joint traction to relieve excess stress on the affected joint and acupuncture. It should be remembered, however, that physiotherapeutic, mechanical, and biological methods of treating coxarthrosis can only be used during remission. As the disease worsens, their use is fraught with progression of inflammation and 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 version of the operation involves restoring mobility in the joint due to the plastics of its own tissues, and the second - replacing the joint surfaces with an endoprosthesis - is a mechanical bond. Surgical intervention makes it possible to restore joint mobility and the patient's ability to work.
Prevention of hip arthrosis
Preventive measures are limited to the use of chondroprotectors, proper nutrition, and reasonable stress on the joints, especially for those who play sports or do hard physical work.
Coxarthrosis is a serious disease that can deprive a patient of the ability to move independently. Disability can be avoided by seeking immediate medical attention from the first joint discomfort, starting with competent, complex treatment of the pathology.