The hip joint is the largest joint in our body.It has a hinge configuration that allows movement in different planes.At the same time, joints are surrounded by healthy ligaments and muscles.The hip joints bear the main load when walking, running or carrying heavy loads.Coxarthrosis (another name for hip arthritis) is quite common in people, both young and old.Once it starts, it can go undiagnosed for a long time, because the obvious limitation of hip movement doesn't happen right away.
Often, patients, without being examined by a doctor or without presenting all their complaints, begin treatment for lumbar osteoarthritis or knee osteoarthritis without any obvious effect.Meanwhile, if the disease is not treated, it will progress to limping, constant pain, shortening of the legs, and the inability to stretch and straighten.And treatment at this stage can only be done with surgery, which means replacing the joint with a prosthetic limb.
Causes of coxarthrosis
Primary arthritis of the hip joint develops more often in people over 40 years of age.Its cause has not yet been researched.The hyaline cartilage that covers the joint surfaces and provides gliding begins to thin and collapse.Due to increased friction and pressure on the bones, bone spurs appear on them.The joint is deformed, movement in it is limited.In primary coxarthrosis, both the knee joint and spine are often affected.
Secondary arthritis develops against the background of various diseases:
- Hip dysplasia.This term refers to the congenital underdevelopment of the components of this joint in the child.As a result, the femoral head is not as centered as it should be in the acetabulum.There are three types of dysplasia: hip predislocation, hip subluxation, and hip dislocation.With congenital dislocation, the femoral head is located outside the socket and if appropriate treatment is not instituted, arthrosis will develop.
- Aseptic necrosis.The bone tissue of the femoral head begins to dissolve due to reduced blood supply.Bone tissue is locally resorbed, the joint head is deformed.Arthritis develops secondary.
- Legg-Calvé-Perthes disease.This is degenerative cartilage disease of the femoral head, occurring in children from 3 to 14 years old, mainly in boys.As a rule, occurs due to complications after the infectious process, as well as trauma, physical overload and metabolic diseases.The cartilage area of the head does not receive adequate blood supply, leading to necrosis of this area and joint deformity.
- Inflammation, infection.If hip arthritis has developed, the synovial fluid loses its lubricating properties, the joint membrane thickens, the hyaline cartilage is subjected to mechanical pressure, and metabolic disorders in the joints occur.
- Injuries: bruises, fractures of the femur, acetabulum, hip dislocation, chronic injuries, that is, small injuries systematically received.
- Hip joint overload associated with sports and professional activities.For example, long walks without rest, vibration effects, constant jumping and heavy lifting are undesirable for the joints.A child's or teenager's muscle corset does not always compensate for such a load.
- Body weight increases, especially at a young age, when cartilage is not yet able to withstand large axial loads.In addition, such patients often have metabolic problems.
- Coxarthrosis itself is not hereditary, but genetic relatives may have a certain cartilage tissue structure, metabolic disorders that lead to the development of joint disease.Therefore, it is necessary to consider whether parents or distant relatives have joint disease.
- Osteoporosis.The area most vulnerable to this disease is the femoral neck.Its structure becomes thinner, pathological fractures are possible.All this secondary to arthritis.
- Diabetes.In this case, arthritis develops due to vascular disorders.
- Polyneuropathy with impaired sensation in the legs.
- Diseases of other parts of the musculoskeletal system.These include: scoliosis, arthritis and knee injuries, flat feet.The load distribution on the hip joint changes, shock absorption properties decrease, and as a result, the cartilage layer is affected.
Symptoms of coxarthrosis
To prevent the disease and diagnose it early, it is important to know the signs of early stage osteoarthritis (coxarthrosis stage 1):
- The pain occurs periodically after physical activity.Specific pain may be localized to the groin, side, hip or knee.After resting, they disappear so they are no longer valued.Meanwhile, this is an alarming sign.
- Slight limitation of hip rotation (inward and outward).This can be easily checked when you lie on your back, rotating your entire leg clockwise and counterclockwise.
- X-rays may show mild irregular narrowing of the joint space.
With stage 2 arthritis, the signs are more obvious:
- Pain occurs at the prominence of the joint, most commonly in the inguinal fold, and is also noted at rest.
- Limitations appear not only when rotating the legs, but also when abducting the hips to the side.Movements in the joints are somewhat painful, especially in extreme positions (maximum hip abduction, bending the legs towards the abdomen).
- On the X-ray, you can see moderate joint space narrowing and isolated bony growth at the edge of the acetabulum.Cysts can also form in the bony structure of the femoral head.
Stage 3 hip osteoarthritis is easily diagnosed, the symptoms are very severe:
- Joint pain when exercising, at night.
- Limping, patients often have to use a walking stick.
- Marked limitation of joint movements, due to which it is difficult for a person to put on socks or shoes.
- Legs become thinner due to atrophy of thigh and leg muscles.The muscles of the buttocks also weaken.
- Shortening of the leg is possible due to incomplete extension and deformity of the femoral head.As a result, lumbar scoliosis (lateral curvature) is formed and pain appears in the lumbosacral region.
- Signs of stage 3, detected through X-rays, are a marked narrowing of the joint space until its complete absence, bone growth, head and neck deformity of the hip joint.
Diagnose
During diagnosis, it is important to clarify subjective complaints, collect medical history, evaluate symptoms and clarify the stage - radiographs, CT and MRI.Computed tomography allows you to study in detail the bone structure of the hip joint, and magnetic resonance helps to visualize soft tissues, the condition of the joint capsule and the presence of synovitis.
Treatment
Treatment of coxarthrosis depends on the stage of the process and in most cases includes a full range of procedures.Of course, the earlier treatment is started, the more effective it will be.
- Conservative treatment
- Drug treatment.To relieve pain, nonsteroidal anti-inflammatory drugs are used in the form of tablets, suppositories or intramuscular injections.Dosage forms such as ointments, gels, creams are not effective enough due to the large muscles and subcutaneous tissue surrounding the hip joint.Nonsteroidal anti-inflammatory drugs should not be used for long periods of time due to side effects on the cardiovascular system and gastrointestinal tract.To help them, the doctor may prescribe drugs that reduce muscle spasms - muscle relaxants.In cases of severe inflammation, intra-articular glucocorticoids may be needed.Chondroprotectors are one of the main groups of drugs for treating coxarthrosis.They are given both intramuscularly and intra-articularly;In milder cases, tablets can be used.These drugs are aimed at improving the recovery process in cartilage tissue and slowing down its degeneration.Your doctor may also prescribe vascular medications to improve local blood circulation.
- Physical therapy.Her procedures improve blood flow in the joint area and relax muscles.These are UHF, magnetic therapy, laser treatment, electrodynamic current, electrophoresis.Purpose - according to individual instructions.
- Massage therapy.An indispensable treatment for coxarthrosis: relieves muscle spasms, has a beneficial effect on blood circulation and, when done systematically, strengthens muscles.
- Exercise therapy.Improves blood flow and strengthens the muscles of the joints.Recommended exercises for coxarthrosis (performed on a sturdy support):
- “bicycle” in supine position;
- Lie on your back, grab your knee with your hand and pull it towards your stomach, do the same with the other leg;
- while lying on your back, bend your knees, press the soles of your feet to the floor and lift your pelvis, maintaining this position;
- lying on your back, move your thighs to the side as far as possible;
- Sit in a chair, squeeze the ball between your thighs;
- lie on your back, turn your legs in and out;
- Stand with your right leg slightly elevated and hold the support with your hands, swing your left leg back and forth and left and right, then do the same, switching legs.
- Surgical treatment.Arthroscopy, that is, joint replacement with an artificial joint, is performed at the 3rd stage of coxarthrosis in cases of shortening of the limb, constant pain and severe contractures.The endoprosthesis may be cemented (when osteoporosis is present) or uncemented.The prosthesis itself can be unipolar (replaces only the head) and total (replaces both components).The next day after the operation, some elements of exercise therapy are carried out while lying in bed, the patient can get up, but at the moment there is no need to support the leg, and a few days later - on crutches.After 2-3 months, the patient will no longer need to use crutches and will allow full weight to rest on the leg.Patients who have undergone arthroscopic surgery are encouraged to undergo rehabilitation that includes physical therapy, massage, and physiotherapy.In most cases, limb function is restored.The lifespan of a prosthetic leg is from 10 to 20 years, after which it is replaced with a new prosthetic leg.
Prevention of coxarthrosis
Preventive measures are important, especially if you have a history of hip dysplasia, fractures, severe bruising, or pus in the area.
- Avoid lifting heavy objects and jumping (especially from heights).Try not to stand on your feet for long periods of time.
- Control body weight (reduce consumption of flour products, table salt, sweet and strong tea and coffee in the diet).Being overweight increases the risk of hip arthritis.
- Quantitative physical exercises aimed at strengthening the muscles of the thighs and buttocks (cycling or exercise cycling, swimming, therapeutic exercises).
- If there are diseases related to metabolism (diabetes mellitus, atherosclerosis), they must be compensated.
Compliance with preventive measures, early detection of coxarthrosis and appropriate treatment are the keys to a positive prognosis for this disease.
Which doctor should I contact?
If you feel pain in your legs or hip joints, you should consult your doctor.He will prescribe the main diagnostic measures, especially X-rays of the hip joint.Once the stage of the disease has been determined, the patient will be referred to a rheumatologist or orthopedist.Nutritionists and endocrinologists can provide additional support in losing weight and slowing the progression of the disease.It is helpful for women to consult a gynecologist to prescribe hormone replacement therapy to prevent osteoporosis.