The hip joint is the largest joint in our body. It has a hinged configuration that allows movement in various planes. At the same time, the joint is surrounded by strong ligaments and muscles. The hip joints take on the main load when walking, running, carrying weights. Coxarthrosis (another name for hip joint osteoarthritis) is quite common in people, both old and young. Having started, it can remain undiagnosed for a long time, because the visible limitation of hip movements does not occur immediately.
Often patients, without having been examined by a doctor or not having declared all ailments, begin to treat lumbosacral osteochondrosis or osteoarthritis of the knee joints without a visible effect. Meanwhile, the untreated disease progresses and leads to lameness, constant pain, shortening of the leg, and inability to perform push-ups. And the treatment at this stage is possible only operatively, that is, the joint must be replaced.
Causes of coxarthrosis
Primary hip joint osteoarthritis most often develops in people over the age of 40. Its causes have not yet been studied. The hyaline cartilage, which covers the joint surfaces and provides smoothness, begins to thin and break. Due to increased friction and pressure on the bones, bone growths appear on them. The joint is deformed, the movements contained in it are limited. In primary coxarthrosis, both the knee joints and the spine are often affected.
Secondary arthrosis develops against the background of various diseases:
- Dysplasia of the hip joint. This term means congenital underdevelopment of the components of this joint in a child. As a result, the femoral head is not correctly centered in the acetabulum. Three types of dysplasia are possible: preluxation, subluxation, and hip dislocation. With congenital dislocation, the head of the femur is located outside the cavity, and if appropriate treatment is not performed, osteoarthritis develops in the future.
- Aseptic necrosis. The bone tissue of the femoral head begins to dissolve due to a violation of the blood supply. Bone tissue focal dissolves, the head of the joint is deformed. Arthrosis develops for the second time.
- Legg-Calve-Perthes disease. This is osteochondropathy of the femoral head, which occurs in children aged 3 to 14, mainly in boys. It occurs, as a rule, due to complications after infectious processes, as well as injuries, physical overload, metabolic diseases. The cartilage area of the head is not well supplied with blood, which leads to necrosis of this area and deformation of the joint.
- Inflammation, infection. If arthritis of the hip joint develops, the synovial fluid loses its lubricating properties, the joint shell thickens, the hyaline cartilage is exposed to mechanical stress, and at the same time metabolic disorders occur in the joint.
- Injuries: bruises, fractures of the hip, acetabulum, hip dislocation, chronic trauma, i. e. systematically received microtraumas.
- Overload of the hip joint associated with sports, professional activities. For example, it is undesirable for the joint to walk for a long time without rest, vibration effects, constant jumps, carrying heavy loads. The muscular corset of a child or teenager cannot always compensate for such loads.
- Weight gain, especially at a young age, when the cartilage is not yet able to withstand a large axial load. Furthermore, these patients usually have metabolic problems.
- Coxarthrosis itself is not inherited, but genetically relatives may have a certain structure of cartilage tissue, metabolic disorders that lead to the development of arthrosis. Therefore, it is worth considering the presence of joint diseases in parents or more distant relatives.
- Osteoporosis. The vulnerable area in this disease is the neck of the femur. Its structure becomes more rarefied, pathological fractures are possible. All this leads to osteoarthritis again.
- Diabetes. In this case, osteoarthritis develops due to vascular disorders.
- Polyneuropathy with reduced sensitivity of 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, as a result the cartilage cover suffers.
For the prevention of the disease and its early diagnosis, it is important to know the signs of incipient arthrosis of the hip joint (1st stage coxarthrosis):
- Pain that occurs periodically after physical exertion. Specific pain sensations can be located in the groin, lateral, thigh or knee area. After rest, they pass, so they are not given importance. In the meantime, this is an alarming sign.
- Slight limitation of hip rotation (in and out). This is easily checked while lying on your back by rotating the entire leg clockwise and counterclockwise.
- On the roentgenogram, you can find a slight uneven narrowing of the joint space.
With arthrosis of the 2nd stage, the signs are more pronounced:
- Pain occurs in the projection of the joint, most often in the inguinal fold, and is noted at rest.
- Restrictions appear not only when turning the leg, but also when abducting the hip to the side. The movements of the joint are somewhat painful, especially in extreme positions (with maximum hip abduction, flexion of the leg to the stomach).
- On the x-ray, you can see a moderate narrowing of the joint space and single bony growths of the edges of the acetabulum. Cysts can also form in the bone structure of the femoral head.
Stage 3 hip osteoarthritis is easily diagnosed, its symptoms are pronounced:
- Joint pain during exertion, at night.
- Lameness, patients often use a cane.
- Pronounced limitation of movements in the joint, due to which it is difficult for a person to put on socks, put on shoes.
- The leg becomes thinner due to the wasting of the thigh and lower leg muscles. The muscles of the gluteal region also weaken.
- It is possible to shorten the leg due to its incomplete extension and deformation of the femoral head. As a result, scoliosis of the lumbar spine (lateral curvature) is formed, pains appear in the lumbosacral region.
- The signs of the 3rd stage, detected by X-rays, are a pronounced narrowing of the joint space up to its complete absence, bone growths, deformation of the head and neck of the hip joint.
In diagnostics, it is of great importance to clarify subjective complaints, collect anamnesis, evaluate symptoms, and also clarify the stage: X-ray, CT and MRI. Computed tomography allows you to study in detail the bone structure of the hip joint, and the magnetic resonance method visualizes the soft tissues, the state of the joint capsule and the presence of synovitis.
Coxarthrosis therapy depends on the stage of the process and, in most cases, includes a whole range of procedures. Of course, the earlier the treatment is started, the greater its effectiveness.
- Conservative treatment
- Pharmacological therapy.To relieve pain, non-steroidal anti-inflammatory drugs are used in tablets, suppositories or intramuscular injections. Dosage forms such as ointments, gels, creams are not effective enough due to the surrounding of the hip joint with large muscles and subcutaneous tissue. Long-term courses of non-steroidal anti-inflammatory drugs are not recommended due to side effects on the cardiovascular system, gastrointestinal tract. To help them, the doctor may prescribe drugs that relieve muscle spasm - a muscle relaxant. With severe inflammation, intra-articular glucocorticoids may be needed. Chondroprotectors are one of the main groups of drugs for the treatment of coxarthrosis. They are administered both intramuscularly and intra-articularly; in milder cases they can be taken as tablets. These drugs aim to improve the recovery processes in the cartilage tissue, slowing down its degeneration. The doctor may also prescribe vascular drugs to improve local circulation.
- Physiotherapy.Its procedures improve blood flow in the joint area and relax the muscles. These are UHF, magnetotherapy, laser therapy, diadynamic currents, electrophoresis. Appointment - according to individual indications.
- Massage therapy.An indispensable method of treatment for coxarthrosis: relieves muscle spasms, has a beneficial effect on blood circulation and, when carried out systematically, strengthens the muscles.
- Physiotherapy.It improves blood flow and strengthens the muscle corset of the joint. Exercises recommended for coxarthrosis (performed on a solid support):
- "Bike" in the supine position;
- lying on your back, take the knee with your hand and pull it to the stomach, as well as the other leg;
- in the supine position, bend the knees, press the soles of the feet to the floor and raise the pelvis, linger in this position;
- lying on your back, bring your thigh as far to the side as possible;
- sitting on a chair, squeeze the ball between your thighs;
- lying on your back, turn your legs in and out;
- standing with your right foot on a small elevation and holding on to the support with your hands, swing your left leg back and forth and left and right, then do the same by switching legs.
- Operative treatment. . . Endoprosthesis, i. e. the replacement of a joint with an artificial one, is performed at the 3rd stage of coxarthrosis in the presence of shortening of the limbs, constant pain, severe contracture. Endoprostheses can be cemented (in the presence of osteoporosis) and non-cemented. The prosthesis itself is unipolar (replacement of the head only) and total (replacement of both components). Already the day after the operation, some elements of physical therapy are performed in a lying position on the bed, the patient can get up, but so far without support on the leg, after a few days - on crutches. After 2-3 months, crutches will not be needed, full load on the leg will be allowed. Rehabilitation is recommended to patients who have undergone endoprostheses, which consists of physiotherapy exercises, a course of massage, physiotherapy. In most cases, limb function is restored. The service life of the prosthesis is from 10 to 20 years, then it is replaced with a new one.
Prevention of coxarthrosis
Preventive measures are very important, especially if you have a history of hip dysplasia, fractures, severe bruising, or purulent processes in this area.
- Exclusion of the transfer of weights, jumps (especially from above). Try not to stand for a long time.
- Weight control (reduce the consumption of flour products, table salt, sweet and strong tea and coffee in the diet). If you are overweight, your risk of hip joint osteoarthritis increases.
- Dosed physical exercises aimed at strengthening the muscles of the thighs and buttocks (bicycle or stationary bike, swimming, therapeutic exercises).
- If there are metabolic diseases (diabetes mellitus, atherosclerosis), they must be compensated for.
Compliance with preventive measures, early diagnosis of coxarthrosis and its adequate treatment are the key to a positive prognosis for this disease.
Which doctor to contact
If you experience pain in your leg or hip joint, you should see a therapist. He will prescribe primary diagnostic measures, especially an x-ray of the hip joint. After establishing the stage of development of the disease, the patient will be referred to a rheumatologist or orthopedist. A dietician and endocrinologist can provide additional help in reducing weight and slowing the progression of the disease. It will be useful for women to consult a gynecologist for the appointment of hormone replacement therapy for the prevention of osteoporosis.