The hip joint is the largest joint in our body.It features a hinge configuration that allows movement in different planes.At the same time, the joint is surrounded by strong ligaments and muscles.When walking, running or carrying heavy loads, the hip joints bear the brunt of the load.Coxarthrosis (another name for osteoarthritis of the hip joint) is quite common in both old and young people.Once it begins, it can go undetected for a long time because visible restriction of hip movements does not occur immediately.
Often, patients begin treatment for lumbosacral osteochondrosis or arthrosis of the knee joints without a medical examination or without any complaints, without any visible effect.Meanwhile, the untreated disease progresses, causing lameness, constant pain, shortening of the leg, and the inability to bend and stretch.And treatment at this stage is only possible surgically, which means the joint must be replaced with a prosthesis.
Causes of coxarthrosis
Primary osteoarthritis of the hip joint develops more often in people over 40 years old.The causes have not yet been researched.The hyaline cartilage, which covers the joint surfaces and provides lubrication, begins to thin and collapse.Due to the increased friction and pressure on the bones, bone spurs form on them.The joint is deformed and movements in it are restricted.In primary coxarthrosis, both the knee joints and the spine are often affected.
Secondary arthrosis occurs against the background of various diseases:
- Hip dysplasia.This term refers to a congenital underdevelopment of the components of this joint in a child.As a result, the femoral head is not as centered as it should be in the hip socket.There are three types of dysplasia: preluxation, subluxation and dislocation of the hip.In the case of a congenital dislocation, the femoral head is located outside the socket and, if no appropriate treatment is given, osteoarthritis will result.
- Aseptic necrosis.Due to the impaired blood supply, the bone tissue of the femoral head begins to dissolve.The bone tissue is focally broken down and the joint head is deformed.Osteoarthritis develops secondarily.
- Legg-Calvé-Perthes disease.This is an osteochondropathy of the femoral head that occurs in children aged 3 to 14 years, mainly boys.Usually occurs as a result of complications after infectious processes, as well as injuries, physical overload and metabolic diseases.The cartilaginous area of the head is not well supplied with blood, which leads to necrosis of this area and deformation of the joint.
- Inflammation, infections.If osteoarthritis of the hip joint has developed, the synovial fluid loses its lubricating properties, the joint mucosa 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 dislocations, chronic trauma, d.h.systematically suffered microtraumas.
- Overloading of the hip joint in connection with sporting and professional activities.For example, walking for a long time without a break, vibration effects, constant jumping and carrying heavy loads are undesirable for the joint.The muscular corset of a child or young person cannot always compensate for such stress.
- Increased body weight, 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 genetically determined relatives may have a specific structure of cartilage tissue and metabolic disorders that lead to the development of arthrosis.It is therefore worth considering whether parents or more distant relatives have joint diseases.
- Osteoporosis.The area at risk for this disease is the femoral neck.Its structure becomes thinner, pathological fractures are possible.All of this leads secondarily to osteoarthritis.
- Diabetes mellitus.In this case, osteoarthritis occurs due to vascular diseases.
- Polyneuropathy with sensory disturbances in the legs.
- Diseases of other parts of the musculoskeletal system.These include: scoliosis, osteoarthritis and knee injuries, flat feet.The load distribution on the hip joints changes, the shock-absorbing properties decrease and the cartilage lining suffers as a result.
Symptoms of coxarthrosis
In order to prevent the disease and diagnose it early, it is important to know the signs of early osteoarthritis of the hip joint (stage 1 coxarthrosis):
- Pain that occurs regularly after physical activity.Specific pain sensations may be localized in the groin, side, hip or knee.After rest, they disappear, so no importance is given to them.This is now an alarming sign.
- Slight limitation of hip rotation (inwards and outwards).This can be easily checked by lying on your back and rotating the entire leg clockwise and counterclockwise.
- An x-ray may reveal slight, uneven narrowing of the joint space.
With arthrosis in the 2nd stage, the signs are more pronounced:
- Pain occurs in the joint projection, most often in the inguinal fold, and is also noted at rest.
- Restrictions occur not only when rotating the leg, but also when abducting the hip to the side.Movements in the joint are somewhat painful, especially in extreme positions (maximum abduction of the hip, flexion of the leg towards the stomach).
- The x-ray shows moderate joint space narrowing and isolated bone growths on the edges of the hip socket.Cysts can also form in the bone structure of the femoral head.
Osteoarthritis of the hip joint in the 3rd stage is easy to diagnose, its symptoms are serious:
- Pain in the joint during exercise, at night.
- Lameness, patients often use a stick.
- Significant restriction of movement in the joint, making it difficult to put on socks or shoes.
- Hypotrophy of the thigh and lower leg muscles causes the leg to become thinner.The muscles in the buttocks region also become weaker.
- Due to incomplete extension and deformation of the femoral head, shortening of the leg is possible.This causes scoliosis of the lumbar spine (lateral curvature) and pain in the lumbosacral area.
- Signs of the 3rd stage that can be detected by x-rays are a pronounced narrowing of the joint space up to its complete absence, bone growth, deformation of the head and neck of the hip joint.
diagnosis
When diagnosing, the clarification of subjective complaints, the taking of the anamnesis, the assessment of the symptoms and the clarification of the stage - X-ray, CT and MRI - are of great importance.Computed tomography allows you to examine the bone structure of the hip joint in detail, and the magnetic resonance method allows you to visualize soft tissues, the condition of the joint capsule and the presence of synovitis.
Treatment
The treatment of coxarthrosis depends on the stage of the process and in most cases includes a whole series of interventions.Of course, the earlier treatment is started, the greater the effectiveness.
- Conservative treatment
- Drug therapy.To relieve pain, nonsteroidal anti-inflammatory drugs are used in tablets, suppositories or intramuscular injections.Dosage forms such as ointments, gels, creams are not effective enough because the hip joint is surrounded by large muscles and subcutaneous tissue.Due to side effects on the cardiovascular system and gastrointestinal tract, prolonged use of nonsteroidal anti-inflammatory drugs is not recommended.To help them, the doctor may prescribe medication that relieves muscle spasms - a muscle relaxant.For severe inflammation, intra-articular glucocorticoids may be required.Chondroprotectors are one of the main groups of drugs used to treat coxarthrosis.They are administered both intramuscularly and intraarticularly;In milder cases, tablets can be taken.These drugs are aimed at improving the recovery processes in cartilage tissue and slowing down its degeneration.The doctor may also prescribe vascular medications to improve local blood flow.
- Physiotherapy.Your procedures improve blood circulation in the joint area and relax the muscles.These are UHF, magnetic therapy, laser treatment, diadynamic currents, electrophoresis.Purpose - according to individual information.
- Therapeutic massage.An indispensable treatment method for coxarthrosis: relieves muscle spasms, has a positive effect on blood circulation and, when used systematically, strengthens the muscles.
- Therapeutic gymnastics.Improves blood circulation and strengthens the muscular corset of the joint.Recommended exercises for coxarthrosis (performed on a firm surface):
- “Bicycle” in supine position;
- Lie on your back, grab your knee with your hand, pull it towards your stomach and do the same with the other leg.
- lying on your back, bend your knees, press the soles of your feet to the floor and lift your pelvis, hold in this position;
- Lie on your back and move your thigh to the side as far as possible.
- Sit in a chair and squeeze the ball between your thighs.
- lying on your back, twisting your legs in and out;
- Stand with your right foot on a slight elevation and hold the support with your hands.Swing your left leg back and forth and left and right.Then do the same and switch your leg.
- Surgical treatment.Endoprosthetics, that is, the replacement of a joint with an artificial one, is carried out in the 3rd stage of coxarthrosis with shortening of the limb, constant pain and severe contracture.Endoprosthetics can be cemented (for osteoporosis) or cementless.The prosthesis itself can be unipolar (replacement of only the head) and complete (replacement of both components).The very next day after the operation, some elements of exercise therapy are carried out while lying down, the patient can stand up, but initially without supporting the leg, and a few days later – on crutches.After 2-3 months, crutches are no longer necessary and full weight bearing on the leg is possible.Patients who have undergone arthroplasty are recommended rehabilitation consisting of physiotherapy, massage and physiotherapy.In most cases, limb function is restored.The service life of the prosthesis is 10 to 20 years, after which it is replaced with a new one.
Prevention of coxarthrosis
Preventive measures are very important, especially if there has been a history of hip dysplasia, fractures, severe bruises 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.
- Control of body weight (reduce the consumption of flour products, table salt, sweet, strong tea and coffee in the diet).Being overweight increases the risk of hip osteoarthritis.
- Dosed physical exercises to strengthen the thigh and buttock muscles (cycling or exercise bike, swimming, therapeutic exercises).
- If there are metabolic diseases (diabetes mellitus, arteriosclerosis), these must be compensated for.
Compliance with preventive measures, early detection of coxarthrosis and its adequate treatment are the key to a positive prognosis of this disease.
Which doctor should I contact?
If you feel pain in your leg or hip joint, you should see a doctor.He will prescribe primary diagnostic measures, in particular x-rays of the hip joint.Once the stage of the disease is determined, the patient is referred to a rheumatologist or orthopedist.A nutritionist and endocrinologist can provide additional support in losing weight and slowing the progression of the disease.It would make sense for women to visit a gynecologist to prescribe hormone replacement therapy to prevent osteoporosis.