Coxarthrosis: osteoarthritis of the hip joint.

Osteoarthritis of the hip joint or coxarthrosis is a slow and chronic degenerative process in the joint of the head of the femur and the acetabulum of the pelvic bone. With this disease, the bone and cartilage tissues are deformed, which, as it progresses, causes significant limitation of leg movements and disability. All components of the joint participate in the process: bones, joint capsules that cover them, cartilage, ligaments, muscles. The symptoms and treatment of osteoarthritis of the hip joint (coxarthrosis) vary from person to person; The disease usually occurs in middle-aged and elderly people, although these changes can develop after 20 years.

The main signs of osteoarthritis of the hip joint (coxarthrosis) are pain and stiffness of movement. Most often, its development is preceded by injuries, as well as joint pathologies of an inflammatory and non-inflammatory nature. Coxarthrosis is one of the most common osteoarthritis and is associated with significant loading on the hip joint.

In its development, the disease goes through several stages. In the early stages, coxarthrosis can be treated conservatively, but as the process progresses, only surgical treatment is effective. Therefore, it is not advisable to delay visiting a specialist and sign up for a consultation. In clinics you can undergo an examination and receive conservative treatment.

Causes

Coxarthrosis of the hip joint can be primary or secondary, that is, arise against the background of any disease or injury of the musculoskeletal system. Let us consider in more detail the factors influencing the development or leading to coxarthrosis of the hip joint.

• exogenous- these are environmental factors: intense physical activity, the consequences of serious injuries: fractures, dislocations, ligament ruptures, unfavorable working conditions associated with lifting heavy objects, prolonged sitting.
• Endogenous— These are chronic infectious, inflammatory and autoimmune diseases: rheumatoid, reactive and psoriatic arthritis. In addition to metabolic disorders: gout, diabetes.
• Congenital diseases.Dysplasia (disruption of joint formation) and osteochondropathy (malnutrition of joint structures with subsequent necrosis, bone destruction) can also cause coxarthrosis. For example, congenital dislocation of the hip, aseptic necrosis of the femoral head: Perthes disease.
• Genetic predispositionIt often causes coxarthrosis of the hip joints. This includes a mutation in the procollagen type II gene.
• Advanced age.More often, the development of coxarthrosis of the hip joint is due to inevitable age-related changes.
• Floor. Osteoarthritis is thought to occur more frequently in women than men. This is due to the influence of the female sex hormones, estrogens, on mineral metabolism and bone density.
• Excess body weight.There is a direct relationship between excess body weight and the appearance of osteoarthritis. The higher the body weight, the more likely it is to develop osteoarthritis of the hip joint, since excess adipose tissue increases the load on the joints and adipose tissue produces pro-inflammatory substances that damage cartilage tissue.
• Professional sportsIt can lead to the development of coxarthrosis due to excessive stress on the joints and frequent injuries. Potentially dangerous sports include weightlifting, skydiving, and acrobatics.

Under the influence of these factors, changes gradually occur in the joint cavity at the cellular level: decomposition processes begin to prevail over synthesis processes, changes in metabolism, the volume of joint fluid that nourishes the cartilage tissue decreases. and the cartilage becomes thinner. As a result, the joint "drys out" and decreases in volume. Along the edges of the articular surfaces of bones, bone growths appear - osteophytes, which reduce the range of motion in the joint and thereby reduce the load on it.

Symptoms

How quickly does osteoarthritis of the hip joint (coxarthrosis) develop? The symptoms gradually increase, and in the early stages a person may not pay due attention to them and dismiss them as fatigue. This is dangerous, because it is at the beginning of the degenerative process that the treatment produces the greatest effect.

The first clinical symptoms of coxarthrosis are pain, limited range of motion caused by muscle spasms.

The pain can vary in intensity and duration. At first, the unpleasant sensations are mild and short-lived. The provoking factor for its appearance is prolonged walking or intense physical activity.

Limitation of joint mobility occurs due to severe pain. The patient's gait changes: the buttocks protrude backward, the body leans forward as weight is transferred to the injured side, and the person limps.

Swelling in the joint area is also possible, which is usually invisible due to the layer of muscles and fat, creaking in the joints when moving, and functional shortening of the lower extremities.

The presence of certain signs and their severity depends on the stage of coxarthrosis. There are 4 clinical and diagnostic stages of coxarthrosis, which are determined by the degree of damage to the articular cartilage:

• Coxarthrosis 1st degreeIt is characterized by asymptomatic or periodic pain that occurs only after intense physical activity, such as running or walking for a long time. The pain is localized in the joint area and, less often, spreads to the entire thigh and even the knee. After rest it usually disappears. There are no changes on the x-ray of the hip joint or there is a slight narrowing of the joint space. MRI reveals signs of heterogeneity of cartilage tissue.
• For 2 degree coxarthrosis.The pain becomes more intense, appears with little physical activity, and sometimes at rest, and can radiate to the thigh and groin area. Lameness appears after significant physical effort. The range of motion of the joint decreases: abduction and inward rotation of the hip are limited. X-ray photographs reveal clear uneven narrowing of the joint space and isolated osteophytes (growths of bone tissue) along the edge of the glenoid cavity. An MRI in stage 2 coxarthrosis reveals obvious cartilage erosions and cracks with less than half thinning.
• For third degree coxarthrosis.The pain becomes constant and often bothers patients during sleep. Walking is difficult, forcing the patient to adopt a forced body position, relying on a healthy leg or a cane. The range of motion of the joint is very limited. On radiographs, the joint space is virtually absent and multiple osteophytes have formed on the bone surfaces. MRI shows the destruction of more than half of the volume of cartilage tissue. However, the third stage can still be treated conservatively.
• Stage 4 osteoarthritis of the hip joint (coxarthrosis)It is characterized by a significant loss of joint function. The entire leg hurts: joint, groin, gluteal region, hip, knee, ankle. Flat feet develop, the leg shortens and its muscles atrophy. On x-ray: multiple large osteophytes, joint space is absent or reduced to a minimum. Stage 4 is not amenable to conservative treatment; hip replacement is performed. The operation reduces pain, improves leg function and the patient's quality of life.

Diagnosis of osteoarthritis of the hip joint.

The basis for diagnosing osteoarthritis of the hip joint is the initial consultation with a specialist. The doctor clarifies the complaints: where the pain is located, when and why it appears, where it goes, what reduces and intensifies it, what causes it. Visual inspection, palpation, gait evaluation are then required, and special tests are performed to detect joint dysfunction.

The diagnosis of coxarthrosis is made on the basis of clinical signs and data from additional instrumental studies, the main of which is x-ray of the joint. There are no characteristic laboratory signs for the diagnosis of osteoarthritis; however, a clinical blood test may be necessary for the differential diagnosis of coxarthrosis and arthritis. In this case, the specialist will take into account the level of leukocytes, ESR, C-reactive protein and uric acid.

Of the instrumental methods for diagnosing osteoarthritis of the hip joints, radiography is usually sufficient. This is an accessible study that reveals characteristic changes of coxarthrosis: narrowing of the joint space, osteophytes, erosion and ulceration of the cartilage surface, cysts. X-rays of patients with coxarthrosis may also reveal changes that indicate trauma.

CT and MRI can be used as other instrumental diagnostic methods. Computed tomography allows a more detailed study of pathological changes in bone structures, and MRI provides the opportunity to evaluate soft tissue disorders.

Which doctor should I contact?

This pathology is treated by orthopedic traumatologists. But depending on the nature and course of the disease, it may be necessary to consult other specialists:

• surgeon to exclude surgical pathology requiring surgical intervention;
• phthisiatrician to exclude bone tuberculosis;
• oncologist to exclude malignant neoplasms;
• endocrinologist for concomitant metabolic disorders;
• a neurologist, if there is suspicion of compression of the spinal nerve roots by an intervertebral hernia of the lumbosacral spine.

Treatment

The choice of treatment method depends on the stage of the disease. To treat grade 1 bilateral osteoarthritis of the hip joint (coxarthrosis), changing lifestyle and increasing physical activity are usually sufficient. In stage 2, conservative treatment is used, which includes medication and physiotherapy procedures. Stage 3 is less treatable, but surgery can still be avoided, which cannot be said for stage 4. The goal of conservative treatment is to improve quality of life, as well as stop or slow down the rate of development of degenerative changes. in the joint.

Drug therapy for coxarthrosis includes medications that reduce the symptoms of the disease. These are nonsteroidal anti-inflammatory drugs that are used short-term to relieve pain and inflammation. Corticosteroids and muscle relaxants are sometimes used to relieve severe pain and muscle tension.

Non-drug therapy includes:

• Reduce the load on the hip joint.Depending on the situation, the patient may be advised to reduce body weight, create additional support, and transfer body weight to a cane or crutches.
• Therapeutic exercise.A correctly selected set of exercises helps to improve joint mobility, reduce pain, and also prevent muscle atrophy.
• Physiotherapeutic treatment methods.For coxarthrosis of the hip joint, courses are prescribed: magnetic therapy, laser therapy, shock wave therapy.
• PRP therapy.The method involves introducing your own blood plasma into the joint, which helps relieve pain, inflammation and improve the restoration of damaged joint tissue.
• Kinesio tape.This involves the application of special adhesive tapes to the skin, which relieves the load on the joint.
• Acupuncture.A method based on the introduction of sterilized needles into biologically active points. Effectively relieves pain and relaxes the muscles around the joint.

For each patient, doctors develop an individual course of treatment, which may include different methods depending on the severity of symptoms, the stage of the disease, age and health status. An integrated approach to treatment guarantees high effectiveness of procedures and quick recovery; drug therapy alone may not give the expected result.

Hip replacement is used in severe cases of the disease, when the pain cannot be eliminated and joint mobility is significantly limited.

Consequences

Pathological changes in the joint can cause:

• Subluxation and dislocation of the hip joint. In this case, leg movements are sharply limited, severe pain appears, hospitalization in the trauma department, and sometimes surgical intervention, is required.
• Local inflammatory processes: bursitis and tendovaginitis.
• Compression of the sciatic nerve by large osteophytes, which is accompanied by intense, stabbing pain in the back of the leg.
• Ankylosis is complete immobility of the joint, which significantly reduces the patient's quality of life.
• Decreased physical activity, constant pain and limited joint mobility. In the future, this will lead to obesity and depression.
• Stomach and heart diseases if you take non-steroidal anti-inflammatory drugs for a long time and often.

Prevention

For a comfortable and high-quality life without coxarthrosis, the following recommendations should be followed:

• Visit a doctor immediately if you feel pain in your hip joint.
• Be careful when playing strenuous sports, doing physical activities at home and at work, and lifting heavy objects.
• Control body weight through a balanced diet and regular physical activity.
• Avoid heavy physical work and sports overload. It is a moderate physical activity that improves the condition of the joint, maintains its normal mobility and reduces the load on other joints.

Summary

1. Coxarthrosis is one of the most common osteoarthritis, caused by significant loading on the hip joint.
2. The main signs of osteoarthritis of the hip joint (coxarthrosis) are pain and stiffness of movement.
3. There are 4 degrees of coxarthrosis, 1-2 are amenable to conservative treatment, 3-4 - surgically. However, in stage 3, surgery can still be avoided if all doctor's recommendations are followed.
4. Specialists use an integrated approach to the treatment of coxarthrosis, which includes medications, physiotherapy, manual therapy, nutritional correction and physical activity.