Osteoarthritis of the hip joint is a progressive dystrophic-degenerative disease. Most of the time it develops in old age, with the occurrence of provocative factors - infectious, non-inflammatory diseases of the joint, trauma, genetic disposition, curvature of the spine.
Coxarthrosis is another name for osteoarthritis of the hip joint, the treatment of which is very complex, long-term, first conservative and then surgical. The main symptom of the disease is pain, restricted movement; in the later stages, shortening of the diseased limb and atrophy of the femoral muscles occurs.
However, the term arthrosis has recently been abolished and the disease is now known as joint osteoarthritis. Previously, osteoarthritis was not considered an inflammatory process, but now inflammation is also recognized in osteoarthritis. As in the whole theory of aging, interleukins are secreted by different cartilage structures and trigger inflammation, which results in their degeneration, that is, cracks and cavities. And therefore, there is no osteoarthritis now, there is only osteoarthritis.
Causes of arthrosis of the hip joint
The disease itself is not hereditary, but features that cause its development such as weakness of cartilage tissues, various metabolic disorders, genetic characteristics of the skeletal structure can be transmitted from parents to children. Therefore, it increases the risk of developing joint arthrosis in the presence of this disease in close relatives.
However, the main causes of osteoarthritis of the hip joint are associated diseases:
- Perthes disease is a violation of the blood supply and nutrition to the head of the femur and joint in general, develops in childhood, most often in boys;
- Congenital dislocation of the hip, dysplasia of the hip joint;
- Injuries - hip fractures, dislocations, pelvic fractures;
- Necrosis of the femoral head;
- Inflammatory and infectious processes - rheumatoid arthritis, purulent arthritis (read the causes of pain in the hip joint).
As the disease develops slowly, it can be unilateral or bilateral. Factors that contribute to arthrosis:
- The presence of concomitant diseases of the spine - scoliosis, kyphosis, osteochondrosis, etc. , flat feet, osteoarthritis of the knee joint (see symptoms of osteoarthritis of the knee joint).
- Hormonal changes in the body, circulatory disorders.
- Excessive tension in the joints - sports, heavy physical work, overweight.
- Sedentary lifestyle combined with obesity.
- Age - in old age, the risk of developing arthrosis increases significantly.
The main diagnostic methods are magnetic resonance and computed tomography, radiography. Magnetic resonance data provide a more accurate image of the condition of the soft tissues and the computed tomography of bone tissue pathology, clinical signs and symptoms of osteoarthritis of the hip joint are also taken into account. It is very important to establish not only the presence of the pathology, but also the degree of the arthrosis and the reasons for its occurrence.
For example, if the changes in the images refer to the proximal femur, then this is a consequence of Perthes' disease, if the cervico-diaphyseal angle increases and the acetabulum is visibly flattened, this is hip dysplasia. You can also learn about x-ray injuries.
Symptoms 1 2 3 degrees of arthrosis of the hip joint
The main symptoms of osteoarthritis of the hip joints are as follows:
- The most important and constant is the intense and constant pain in the groin, hip, knee joint, sometimes with irradiation of pain in the leg, in the groin area.
- Rigidity of movement, limited joint mobility.
- Lateral abduction restriction of the affected leg.
- In severe cases, lameness, gait disorders, shortening of the leg, atrophy of the femoral muscles.
1 degree of arthrosis of the hip joint:
At this stage of the illness, the person feels pain only during and after physical effort, running or prolonged walking, while the joint itself hurts mainly, very rarely the pain radiates to the hip or knee. In addition, a person's gait is normal, there is no lameness, the thigh muscles are not atrophied. When diagnosed, the images show bone growth located around the inner and outer edges of the acetabulum, with no other pathological disorders being observed in the neck and head of the femur.
2nd degree of arthrosis:
With 2nd degree arthrosis of the hip joint, the symptoms become significant and the pains become more constant and intense, both at rest and during movement, radiate to the groin and thigh, with the load the patientalready limp. There is also a limitation of hip abduction, the range of motion of the hip is reduced. In the photos, the narrowing of the gap becomes half the norm, bone growth is found both on the outer and inner edges, the head of the femoral bone begins to increase, deform and move upwards, its edges become irregular.
3 degrees of arthrosis of the hip joint:
At this stage of the disease, the pain is painful and constant, day and night, it becomes difficult for the patient to move independently, so a cane or crutches are used, the range of motion of the joint is severely limited, the musclesof the leg, thigh and buttocks atrophy. The leg is shortened and the person is forced to tilt the body while walking towards the sore leg. The change in the center of gravity increases the load on the damaged joint. X-ray images show multiple bone growths, the femoral head expands and the joint space is significantly narrowed.
How to treat arthrosis of the hip joint?
To avoid surgery, it is very important to establish the correct diagnosis in a timely manner, to differentiate arthrosis from other diseases of the musculoskeletal system - reactive arthritis, trochanteric bursitis, etc. with the help of manual therapy, massage therapy, medical gymnastics, but only under the supervision of a qualified orthopedist.
- Week one - simple paracetomol.
- If there is no effect, use NSAIDs (preferably diclofenac or ketorol in a small dose) under the cover of proton pump blockers (but not omeprazole, as it increases bone destruction with prolonged use).
- More chondroprotectors at any stage.
The combination of all treatment measures should solve several problems at once:
Reduce the pain
For that today there is a large selection of several NSAIDs - non-steroidal anti-inflammatory drugs, which, although they alleviate pain, but do not affect the development of the disease, cannot prevent the process of destruction of cartilage tissue. They have several serious side effects, whose long-term use is also unacceptable due to the fact that these agents affect the synthesis of proteoglycans, contributing to the dehydration of the cartilaginous tissue, which only worsens the condition. Obviously, it is unacceptable to endure pain, but painkillers should be used with caution, under the supervision of a doctor, only during periods of exacerbation of the disease.
NSAIDs include: celecoxib, etoricoxib, texame, nimesulide, naproxen sodium, meloxicam, ketorolac tromethamine, ketoprofen lysine, ketoprofen, ibuprofen, diclofenac.
Topical treatments for deforming arthrosis, such as warming ointments, are not highly therapeutic, but they relieve pain by acting as a distraction and partially relieve muscle spasm.
Provides better nutrition for cartilage tissue and increases blood circulation
Chondroprotective agents, such as glucosamine and chondroitin sulfate, are important drugs that can improve the condition of cartilage tissue, but only in the early stages of the disease. A complete description of these drugs in tablets, injections, creams, with average prices and courses of treatment in the article Arthrosis of the knee joint. To improve blood circulation, to reduce small vessel spasm, vasodilators are generally recommended - cinnarizine, pentoxifylline, xanthinol nicotinate.
Muscle relaxants, such as tizanidine and tolperisone hydrochloride, can only be prescribed for strict indications. Its use can have positive and negative effects, muscle relaxation on the one hand reduces pain, improves blood circulation, but on the other hand, muscle spasm and tension - there is a protective reaction in the body and removing it can only accelerate the destruction ofarticular tissues.
Hormonal injections are performed only in synovitis, that is, the accumulation of fluid in the joint cavity. Once, and at most 3 times a year (methylprednisolone, hydrocortisone acetate). Hormonal agents relieve pain and inflammation, but have a pronounced immunosuppressive effect and their use is not always justified. It is more convenient to do injections in the thigh with chondroprotectors - chondroitin sulfate, 5-15 procedures 2-3 times a year. Also shown are intra-articular injections of hyaluronic acid - this is an artificial lubricant for joints.
The opinion of doctors about the effectiveness of these procedures is divided into supporters and opponents, some consider their implementation justified, others meaningless. Perhaps laser therapy, magnetic laser therapy and makes sense for osteoarthritis of the hip joint, many doctors do not find other procedures necessary for the treatment of this disease, since the hip joint is a deep joint and many of these procedures are simply notable to achieve the goal and are a waste of time, effort and possibly funds for the patient.
Professional massage, hip joint traction (hardware traction), manual therapy, physiotherapy exercises All of these therapeutic measures are very useful in complex disease therapy, help to strengthen the muscles that surround the joint, increase its mobility and, when properly combined with drug treatment, they can help increase the distance from the head to the cavity and reduce the pressure on the head of the femur. This is especially true for physical therapy exercises, without their competent selection and regular implementation outside of exacerbations, it is impossible to achieve a real improvement in the patient's condition.
If the patient is overweight, then, of course, the diet can help reduce the burden on the aching joint, but it has no independent therapeutic effect. Doctors also recommend using canes or crutches, depending on the degree of joint dysfunction.
In the case of grade 3 arthrosis, doctors always insist on surgical intervention, since a destroyed joint can only be restored by replacing it with an endoprosthesis. According to the indications, a bipolar prosthesis is used, which replaces the head and the socket, or a unipolar prosthesis, which only changes the femoral head without the acetabulum.
Today, these operations are performed quite frequently, only after a thorough examination, in a planned manner, under general anesthesia. They provide a complete restoration of hip functions with competent and complete implementation of all post-operative measures - antibiotic antimicrobial therapy and a rehabilitation period of about six months. These hip joint prostheses last up to 20 years, after which they need to be replaced.