Coxarthrosis of the hip joint is a degenerative-dystrophic process that occurs in the articular joint of the femoral head and the acetabulum of the pelvis. The disease is more characteristic of middle-aged and elderly people, although it can also occur in young people, including children. Most often, its development is preceded by injuries, as well as a number of inflammatory and non-inflammatory pathologies, and pain and stiffness of movements become the main signs of the degenerative-dystrophic process in the hip joint. During its development, the disease goes through several stages, and if it can be treated conservatively in the early stages, then in the last stages, the treatment of coxarthrosis of the hip joints is effective only through surgery. Otherwise, the pathology will cause severe disorders or even complete immobilization.
What is coxarthrosis of the hip joint and the mechanism of its development
Coxarthrosis, also called osteoarthritis and deforming arthrosis, is a complex disease of the hip joints (HJ) accompanied by progressive cartilage destruction. Over time, this leads to deformation of the surfaces of adjacent bones, as well as the formation of bony growths on them, which are called osteophytes.
The two hip joints are the largest joints in the body. Each of them is formed by the femur and the acetabulum of the pelvis. The head of the femur is located in the cup-shaped recess of the pelvic bone and moves freely in different directions. This joint structure allows for flexion and abduction, adduction and abduction, and rotation of the hip.
So that movement does not cause discomfort, the surfaces of the bones that touch each other are covered with an elastic layer called hyaline cartilage. It allows the femoral head to slide easily into the acetabulum. Also, hyaline cartilage provides stabilization and balancing of the hip joint during movement.
The entire joint is encased in a kind of thing called the joint capsule. It contains a synovial membrane that synthesizes synovial fluid. It moisturizes the surface of the cartilage, ensures the flow of water and nutrients into it, that is, it is responsible for maintaining the normal structure of the cartilage tissue.
Above the joint capsule is a group of muscles of the thigh and pelvis, with the help of which the joint moves. The hip joint is also surrounded by a group of ligaments that ensure the stability of its position within physiological limits.
Since the hip joint is subjected to heavy loads on a daily basis, it is prone to rapid wear and tear and damage. The risk of such changes significantly increases the effect of a number of unfavorable factors that are practically inevitable in the modern world, but we will discuss them below. This explains the high prevalence of coxarthrosis.
As a result of the influence of negative factors, the production of synovial fluid is disturbed. Its quantity gradually decreases and its qualitative composition also changes: it becomes viscous, thick and is no longer able to fully nourish the cartilage. This leads to acute nutritional deficiency and progressive dehydration of the hyaline cartilage. As a result of such changes, the strength and elasticity of cartilage tissue decreases, peels, cracks and decreases in volume. All this prevents the smooth sliding of the femoral head in the acetabulum of the pelvis, which leads to the appearance of signs of coxarthrosis of the hip.
Gradually, the inter-articular gap narrows, the friction between the articular bone surfaces increases, and the pressure of the bones on the hyaline cartilage increases. This leads to even greater damage and wear and tear, which does not affect the biomechanics of the hip joint and human well-being.
With the progression of pathological changes, the hyaline layer gradually disappears completely, which leads to the exposure of the bone surfaces and a critical increase in the load on the bone joint. During movements, the head of the femur is no longer covered by anything and directly touches the surface of the acetabulum of the pelvis. In addition to severely restricting mobility and causing excruciating pain, the bones are pressed against each other, flattening at the same time.
Bone growths (osteophytes) are formed on their surface during deformation of the bones of the articulation. They can have sharp edges and seriously injure the surrounding muscles. This causes severe pain in the groin, legs and buttocks. Therefore, the patient subconsciously tries to save the injured hip joint and avoid movement in it. The lack of adequate load on the muscles causes them to gradually atrophy, which further aggravates the movement problems. This causes lameness.
Reasons for development
Coxarthrosis of the hip joint can be primary or secondary. In the first case, the reasons for its development cannot be found, that is, the disease develops by itself without an obvious reason. Secondary coxarthrosis is the result of a number of changes in the condition of the musculoskeletal system or lifestyle characteristics, namely:
- Injuries of the hip joint, including bone fractures, dislocations, bruises, strain or rupture of adjacent ligaments, chronic microinjuries, etc. Sh.
- exhausting physical labor;
- lifeless lifestyle;
- obesity;
- chronic infectious processes in the body;
- Rheumatoid arthritis, gout, tendonitis, bursitis;
- Endocrine diseases, metabolic and hormonal disorders, including diabetes;
- congenital malformations of the hip joint (dislocation, dysplasia);
- aseptic necrosis of the femoral head;
- various types of spine pathologies;
- genetic predisposition;
- Addiction to smoking.
In most cases, the development of coxarthrosis of the hip joint is caused by inevitable age-related changes, and the presence of other factors from the above only increases the risk of its occurrence and increases the rate of progression.
Symptoms and quality
During coxarthrosis, 4 degrees of development are distinguished, of which 1 is the simplest. Initially, the disease may be asymptomatic or manifest with mild pain. More often they appear after heavy physical exertion, long walks or at the end of a busy day. In the first stages of the disease, discomfort is usually attributed to fatigue and is considered the norm. Therefore, extremely rarely, coxarthrosis of the hip joint is diagnosed at the first stage of development.
Visible signs of coxarthrosis begin at the 2nd stage of its progression, when the joint space is almost half narrowed and the femoral head is displaced and deformed. In stage 3, the pain becomes unbearable and can even bother a person at night, tending to radiate to the hips, shins, groin and buttocks. Since the joint space is practically non-existent and many osteophytes are formed on the bone surfaces, independent movement is impossible in such situations. Therefore, patients are forced to use a cane or crutches.
So, the main symptoms of coxarthrosis of the hip joint are:
- Limitation of movement - initially, patients may notice difficulty in performing rotational movements of the leg, but over time they are joined by morning stiffness and swelling of the HJ. Because of them, a person needs a few minutes to warm up and, so to speak, walk, to restore the normal range of motion. Gradually, the patient finds it more and more difficult to perform leg movements.
- Characteristic cramp - occurs when walking, as well as when flexing or extending the hip joint. It is the result of bone surfaces rubbing against each other, and coxarthrosis is accompanied by sharp or dull pain.
- Pain syndrome - initially pains appear after physical exertion and somewhat disappear after a long rest. An acute attack can be provoked by weight lifting or hypothermia, since coxarthrosis is often complicated by inflammation of the synovial membrane. As the disease progresses, the pain becomes more frequent, longer and stronger.
- Spasm of the femoral muscles is the result of stretching of the nerves and weakening of the ligamentous apparatus, so the muscle spasm is compensatory to keep the femoral head in the acetabulum. Also, muscle spasm can be provoked by the addition of synovitis.
- Lameness - occurs in the last stages of the development of the disease, since the deformation of the bone surfaces leads to the contracture of the flexor muscles. Therefore, a person cannot fully straighten the leg and keep it in this position. Also, the patient may involuntarily limp in order to transfer the weight to the healthy half of the body, as this helps to reduce the intensity of the pain.
- Shortening of the leg - observed with coxarthrosis of the 3rd degree. As a result of narrowing of the joint space, decreased muscle tone, and flattening of the femoral head, the leg on the side of the affected hip joint can shorten by 1 cm or more.
At the same time, degenerative-dystrophic changes can be observed in one or both hip joints. Accordingly, characteristic symptoms are observed on one side or both at the same time, but in the latter case, their severity can be different on the left and right.
diagnosis
The doctor can suspect the presence of coxarthrosis of the hip joint based on the patient's complaints, external examination and the results of functional tests. During the visual inspection, be sure to measure the length of the legs. For this, the patient is asked to stand up and straighten the legs as much as possible. The measurement is taken between the front axis of the pelvic bones and any bony structures of the knee, ankle or heel. But if both hip joints suffer from coxarthrosis at the same time, the data obtained will be uninformative.
But since the symptoms characteristic of coxarthrosis can be accompanied by other inflammatory and non-inflammatory diseases, instrumental examination methods are mandatory for the patient to accurately diagnose the pathology. It can be:
- computed tomography or X-ray of the hip joint - the images show destructive changes in it, narrowing of the joint space, formation of osteophytes and deformation of the bone surfaces;
- MRI is the most informative method of examination, which allows you to accurately assess the nature of changes in cartilage structures, ligaments, and the nature of blood circulation in the hip area.
Patients are also given laboratory tests to assess their general health and detect diseases that may cause coxarthrosis. this:
- UAC and OAM;
- blood chemistry;
- rheumatic tests;
- Femoral puncture with biochemical study.
The diagnostic task is to differentiate hip coxarthrosis from gonarthrosis (damage to the knee joint), as well as radicular syndrome, which occurs during osteochondrosis, as well as protrusion and herniation of intervertebral discs. Also, the symptoms of coxarthrosis can resemble the manifestations of trochanteric bursitis and the atypical course of ankylosing spondylitis, which requires a full examination to find out the true causes of pain and limitation of movement.
conservative treatment
Conservative treatment of hip coxarthrosis is effective only in the initial stages of the disease. It is selected for each patient individually and may include a whole range of different methods, each of which complements the others. Therefore, as part of the treatment of coxarthrosis of the hip joint, patients may be prescribed:
- drug therapy;
- exercise therapy;
- physiotherapy;
- Plasmolifting.
In order for conservative treatment to be effective, patients must eliminate the effects of a number of factors that contribute to the development of hip coxarthrosis. If you are overweight, it is very important to reduce it as much as possible. This will reduce the load on the damaged joint and the risk of progression of the degenerative-dystrophic process.
You should also quit smoking and adjust your physical activity regime, avoid overloading, but don't sit all the time. To prevent further destruction of the hip joint, it is recommended to wear special bandages and orthoses. They provide safe fixation of the joint and support it during movement.
medical treatment
The nature of drug therapy is selected strictly individually. In most cases, patients are prescribed:
- Non-steroidal anti-inflammatory drugs - drugs that simultaneously have an analgesic and anti-inflammatory effect (available in the form of tablets, injections and local means);
- Corticosteroids - drugs with a strong anti-inflammatory effect, which are prescribed if non-steroidal anti-inflammatory drugs do not give a pronounced effect;
- Chondroprotectors - help to activate cartilage tissue regeneration processes, but their effectiveness has not been proven;
- Muscle relaxants - drugs that reduce muscle tone and eliminate spasms, which are necessary during spasms of certain muscles or groups against the background of severe pain;
- drugs to improve blood circulation - most often used in the form of injection solutions and help to improve the trophism of the tissues surrounding the joint;
- Vitamins of group B - are shown to normalize the transmission of nerve impulses, which is especially important when the nerves are compressed by deformed bone structures.
In acute pain, which cannot be eliminated with the help of tablets, intra-articular or peri-articular blocks can be performed. They are performed only by qualified medical personnel in a medical facility and involve the injection of anesthetic solutions with corticosteroids into or immediately around the joint cavity.
Exercise therapy
Therapeutic exercise is an effective method against decreased muscle tone and limited mobility. Thanks to a correctly selected set of exercises, it is possible to increase the range of motion and reduce the severity of pain. They also prevent muscle atrophy and help eliminate spasms if coxarthrosis is accompanied by stretching of nerve fibers, which reflexively causes spasm of individual muscles.
Exercise therapy classes can improve blood circulation in the area of the degenerative-dystrophic process. Due to this, the degree of trophism of the diseased joint increases and the course of regenerative processes accelerates.
A set of exercises for each patient should be developed individually by a specialist. At the same time, not only the degree of destruction of the hip joint is taken into account, but also the level of physical development of the patient.
Physiotherapy
Physiotherapy procedures and massage have anti-inflammatory, pain-relieving, toning, anti-swelling effects. In addition, they help to maintain the normal tone of the leg muscles, preventing their atony and atrophy.
In coxarthrosis of the hip joint, a course of 10-15 procedures is prescribed:
- ultrasound therapy;
- magnetotherapy;
- laser therapy;
- electrophoresis;
- ultraphonophoresis;
- UHF;
- Paraffin treatment.
Also, many patients are offered mud therapy. Such procedures have a positive effect only in the first stage of the development of coxarthrosis of the hip joint or during rehabilitation after surgical treatment. Thanks to the therapeutic mud, it is possible to improve the quality of blood circulation and speed up the recovery of motor abilities of the damaged joint.
Plasmolifting
Plasmolifting or PRP-therapy is a procedure that involves injecting the patient's own blood platelet-rich plasma into the hip joint cavity. This allows you to activate the restoration processes of hyaline cartilage.
But, according to some scientists, such a procedure can lead to the formation of malignant tumors. This point of view is based on the fact that plasmolifting promotes the generation of a large number of stem cells, the effects of which on the body have not yet been fully studied.
Surgical treatment of hip joint coxarthrosis
Despite significant discomfort in the hip joint, many seek medical help late, when pathological changes in the joint reach 3 or even 4 degrees of severity and functionality is irreversibly reduced.
With advanced pathology, surgery is a necessary measure. Only timely surgical intervention will help restore normal mobility and save the patient from excruciating pain, that is, achieve a significant improvement in the quality of human life. No medication, physical therapy procedures can restore a severely destroyed cartilage. At best, painful intra-articular injections and drugs can reduce the pain. But this will be a temporary phenomenon, after which the pain will return with the same or even greater force.
Indications for hip surgery are:
- disappearance of inter-articular space;
- persistent pain in the hip joint that does not go away;
- critical mobility disorders;
- hip fracture.
Depending on the severity of joint destruction and bone deformation, patients may be offered different types of surgical treatment, namely:
- arthrodesis;
- endoprosthesis;
- osteotomy.
Arthrodesis
Arthrodesis is an affordable operation that involves strong fixation of the articular bones with metal plates. The result is complete immobilization of the joint. Therefore, with the help of arthrodesis, it is only possible to correct the supporting function of the leg, eliminate pain, but there is no need to talk about restoring mobility or significantly improving the quality of life.
Endoprosthesis
Endoprosthetics with arthroplasty is the only way to radically solve the problem of coxarthrosis of the hip joint by restoring all its functions and motor abilities. This is a high-tech method for solving the problem of coxarthrosis, which allows you to completely forget about it for 15-30 years, as well as about pain and limitation of movement. Thanks to the use of modern endoprostheses, it is possible to achieve a complete restoration of the auxiliary motor functions and ensure the patient's normal life.
The operation involves resection of the femoral head and neck. Surgical preparation of the acetabular bed is also carried out, which involves removal of osteophytes, smoothing of its surface and resection of necrotic tissues. Arthroplasty can be used to treat elderly patients with coxarthrosis of the hip.
The operation is performed under general anesthesia and lasts about an hour. Depending on the severity of the degenerative-dystrophic process, the operation can be performed by one of the following methods:
- Superficial - involves grinding the acetabulum and femoral head with subsequent covering with smooth implants that replace the destroyed hyaline cartilage (the method is rarely used due to the possibility of inflammation in periarticular tissues);
- unipolar - removing the femoral head and replacing it with an endoprosthesis (used when the cartilage on the surface of the acetabulum is preserved and only the femoral head is destroyed);
- bipolar - similar to the previous technique, differing only in the design of the endoprosthesis used, which has a low coefficient of friction and ensures smoother movements in the joint bed;
- total is the most effective and safe method for solving the problem of coxarthrosis of the hip joint, which involves a complete resection of the femoral head by cutting the neck part, as well as the acetabular fossa, and replacing them with a full-fledged artificial one. Articulating joint.
Thus, patients may be recommended to install different types of endoprostheses. Most hip replacements are made in the USA and UK. Chemically and biologically inert metals are used for their production: cobalt, chromium, titanium alloys. Ceramics are also often used. In most modern models, polymer pads are additionally used, which makes it possible to give artificial TBS natural shock absorption, stabilization and sliding properties.
After the operation, antibiotics are prescribed to prevent the development of infectious complications, and after 10 days the suture is removed. The size of the postoperative scar is about 8 cm. At the same time, the patient was discharged from the clinic. Rehabilitation after endoprosthetics is easy, but still requires physiotherapy, massage and exercise therapy.
osteotomy
Osteotomy is a surgical intervention, which is a temporary measure before the cardinal replacement of the artificial endoprosthesis of the hip joint. The essence of the operation is to straighten the axis of the femur due to its intentional fracture. The resulting fragments are set in the most appropriate position, thereby slightly relieving the diseased joint. As a result, it is possible to temporarily reduce the severity of pain and improve mobility.
Thus, coxarthrosis of the hip is a rather terrible disease that can completely deprive a person of the ability to move independently. It progresses over a long period of time, and its symptoms, especially in the early stages, are often perceived by patients as a normal condition after physical exertion. But this is precisely the insidiousness of the disease, because only in the initial stage of its development can it be treated non-surgically. But if the degenerative-dystrophic process has already completely destroyed the hyaline cartilage and caused the bone surfaces to be affected and especially their flattening, only surgery can help the patient. Fortunately, the modern level of medicine and surgery, in particular, makes it possible to achieve a full restoration of the normal state of the hip joint and its functions.