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Coxarthrosis

Osteoarthritis of the hip joint (coxarthrosis) is a chronic pathology, accompanied by the gradual destruction of cartilage tissue in the affected area, followed by the involvement of adjacent structures in the process. The disease requires long-term treatment, and in severe cases the only way to regain mobility is through joint replacement.

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general informations

Coxarthrosis belongs to the group of degenerative diseases. It begins gradually with microscopic changes in the structure of the cartilage. Increased stress, inflammatory diseases, disturbances in the blood supply lead to structural transformations and thinning of cartilage tissue and, in turn, deform the contours of the joint area. As a result, the load distribution on the bone contact surfaces changes, and the areas with the maximum pressure begin to wear out more quickly. This triggers a whole cascade of pathological reactions:

  • the appearance of microcracks and areas of compaction in the cartilage tissue;
  • decreased smoothness of joint surfaces;
  • overgrowth of cartilage at the site of thinning and its replacement with bone tissue;
  • the appearance of osteophytes (bone growths) along the edges of the joint site;
  • thickening and decrease in elasticity of the joint capsule;
  • hardening and reduction of resistance of ligaments;
  • changes in the composition of synovial fluid (natural lubrication inside the joint);
  • narrowing of the joint space;
  • fusion of all the elements of the joint (ankylosis).

Left untreated, coxarthrosis inevitably becomes the cause of immobility and disability.

Causes

Depending on the causes of the development of the disease, primary and secondary coxarthrosis are distinguished. In the first case, it occurs on its own, for example, against the background of a hereditary predisposition, in the second it is provoked by other diseases or injuries. In most cases, the process of degeneration of cartilage tissue occurs due to a combination of several factors. The reason may be:

  • Congenital dislocation of the hip;
  • flat feet, scoliosis and other orthopedic problems;
  • Legg-Calve-Perthes disease;
  • joint inflammation (arthritis), regardless of the origin;
  • injuries and microtraumas of the hip joint against the background of overweight, professional sports, etc. ;
  • hip joint dysplasia;
  • Metabolic disorders;
  • endocrine diseases (especially diabetes mellitus);
  • violations of the blood supply of the lower extremities;
  • frequent stress;
  • heredity (coxarthrosis in parents or other close relatives significantly increases the risk of developing it in a child);
  • congenital pathologies and autoimmune connective tissue diseases (joint hypermobility, rheumatoid arthritis, systemic lupus erythematosus, etc. );
  • undergone joint operations.

Age is an important predisposing factor. According to statistics, after 45 years, the likelihood of developing hip osteoarthritis increases significantly.

Symptoms

The main symptoms of coxarthrosis of the hip joint do not depend on the cause of the development. Most patients note:

  • restriction of movement: one of the first symptoms due to the thinning of the cartilage layer and increased friction of the joint surfaces of the bones; in the future, the appearance of cartilage growths further aggravates the problem;
  • pain: the rubbing of bones without a cartilage layer against each other, the gradual involvement of all parts of the joint in the degenerative process, a decrease in the blood supply to the tissues causes painful sensations that increase over time. and as the disease progresses; the pain is searing in nature and often gets worse towards the end of the day;
  • muscle spasm, which results in increased pain symptoms and limited range of motion in the joint;
  • decrease in the length of the legs: this symptom appears in the later stages of the disease due to the narrowing of the joint space and the gradual grinding of the head of the bones due to constant friction; the difference between the legs can be up to 2 cm;
  • lameness: associated with severe pain and limitation of movement, as well as shortening of the leg; is an unfavorable sign indicating serious damage to the joint system.

Steps

In the process of development, coxarthrosis passes through several stages, which depend on the degree of tissue damage.

  • 1 degree. At this point, the patient notes mild joint pain, which appears after intense or prolonged physical activity and quickly disappears after rest. As a rule, the discomfort occurs precisely in the area of the hip joint, but in some cases it extends to the hip or knee. The gait does not change, the movements of the legs are fully preserved. On the roentgenogram, specific changes are noted: subchondral sclerosis.
  • 2nd degree. The pain becomes more intense, occurs after exertion, extends to the entire thigh and groin. After the effort, a slight lameness may appear. Abduction difficulties of the leg are noted. The x-ray shows a significant decrease in the distance between the bones (by 50% or more), deformity of the femoral head and pronounced bony growths.
  • 3 degree. The pains become permanent, walking without a cane becomes impossible. When moving, the patient leans noticeably to the painful side, which further increases the load on the joint. The range of motion is reduced, the muscles of the leg and buttocks atrophy. There is a shortening of the affected limb. The x-ray reveals significant deformation of the joint, a change in the contour of the femoral head and a large number of osteophytes.
  • 4 degree. The pain becomes stronger and does not stop for a minute, the patient loses the ability to move independently. The x-ray shows complete destruction of the articular cartilage, as well as signs of fusion of the bones between them (ankylosis). Cope with the disease at this stage is possible only through surgery.

Diagnostic

An orthopedic traumatologist is responsible for identifying symptoms and choosing treatment. To diagnose and determine the extent of the disease, he uses:

  • investigation: listening to patient complaints, identification of risk factors (trauma, disease, heredity, etc. );
  • examination: assessment of limb mobility, determination of the most painful areas;
  • X-ray: an X-ray image makes it possible to assess the state of the bones and cartilage, the size of the joint space, the presence and location of bone growths; in order to delve into the necessary details, the study is supplemented by computed tomography (computed tomography);
  • laboratory diagnosis: a general blood test allows you to identify signs of an inflammatory, biochemical process - to note certain risk factors, for example, the level of uric acid;
  • MRI (magnetic resonance imaging): allows you to assess the condition not only of bones and cartilage, but also of soft tissues: bones, ligaments, muscles, joint capsule, etc.
  • perforation of the joint.

If it is necessary to carry out differential diagnoses with other diseases, as well as to assess concomitant pathologies, additional tests, instrumental examinations and close specialist consultations are prescribed.

Treatment of coxarthrosis

Treatment for hip joint osteoarthritis depends on its stage and the severity of symptoms. Pathology requires an integrated approach using various methods:

  • medical treatment;
  • non-drug treatment (physiotherapy, exercise therapy);
  • operation;
  • lifestyle and diet correction.

Medical treatment

Medicines prescribed for osteoarthritis of the hip aim to:

  • elimination of pain syndrome;
  • restoration or at least slowing down the destruction of cartilage tissue;
  • improve blood supply and nutrition in the affected area;
  • treatment of concomitant pathologies.

Analgesics are used in the form of tablets, intramuscular and intraarticular injections and topical agents: creams, ointments, patches. In the early stages of the development of the disease, nonsteroidal anti-inflammatory drugs are sufficient for most patients. With severe pain syndrome, hormonal agents are used. The introduction of analgesics directly into the joint capsule has a good effect.

If the course of the disease is accompanied by muscle spasms, muscle relaxants are used. They are used in combination with other pain relievers.

The intake of analgesics should be limited in time and dose, so as not to further damage the cartilage tissue and other side effects (in particular, the development of gastritis and stomach ulcers).

Chondroprotectors are drugs that help restore cartilage tissue. They are only effective with regular long-term use, combined with other methods of treatment, lifestyle, and dietary adjustments. Drugs intended to improve blood microcirculation help to enhance their effect. For a similar purpose, warming ointments are prescribed. Only a doctor is involved in the choice of dosage and diet.

Drug-free treatment

This category includes various physiotherapy and manual techniques, as well as physiotherapy exercises. They help improve microcirculation and restore movement in the damaged joint. Depending on the situation, the doctor prescribes:

  • shock wave therapy;
  • magnetotherapy;
  • electromyostimulation;
  • various types of electrophoresis and phonophoresis (accompanied by the administration of anesthetics);
  • mechanotherapy;
  • massage and exercise therapy.

Operation

If the disease has reached the 3-4 stage of development, drugs and physiotherapy will only alleviate the patient's condition, but will not restore the ability to fully move. In this case, arthroplasty is indicated, that is, full or partial replacement of the damaged joint with a titanium prosthesis.

If there are indications, a lighter version of the intervention is performed: grinding the contact areas of the bones and covering them with special smooth implants that facilitate sliding.

Prevention

Lifestyle can significantly reduce the risk of developing hip osteoarthritis, as well as the rate of its progression. It is important to strictly follow the rules:

  • lead an active lifestyle: swimming in the pool, walking, cycling - physical activity at an amateur level without running for records helps to improve blood supply and inhibits the processes of joint degeneration;
  • normalize body weight to reduce the load on the legs;
  • eliminate injuries, hypothermia and occupational risk factors (vibration, weight lifting, standing work);
  • promptly treat all diseases, including those not directly related to the musculoskeletal system;
  • correct postural disorders in time, wear comfortable shoes.

Diet

With the help of nutritional correction, the patient can not only reduce body weight, but also reduce inflammatory reactions, salt deposits in tissues and metabolic disorders. It is recommended to stick to a balanced menu with sufficient, but not excessive, amounts of carbohydrates, proteins and fats, as well as vitamins and minerals. Particular attention should be paid to unsaturated fats (olive and flaxseed oil), omega-3 acids (found in excess in fish), collagen (meat in jelly, jelly). It is recommended to minimize fast carbohydrates, alcohol, strong coffee, products with artificial flavors, preservatives and flavor enhancers.

Consequences and complications

Coxarthrosis is one of the common causes of disability in older people. Without proper treatment, the pathology inevitably leads to complete disability, especially in bilateral lesions. Pain and reduced mobility do not allow you to work and take care of yourself, which is why it is important to seek treatment on time.