Congelum

Osteoarthritis of the hip joint: symptoms, treatment and prevention

The hip joint is the largest joint in our body.It has a hinged configuration that allows movement in different planes.At the same time, the joint is surrounded by strong ligaments and muscles.Hip joints bear the main load when walking, running or carrying heavy loads.Coxarthrosis (another name for osteoarthritis of the hip joint) is quite common in people, old and young.Once it starts, it can go undiagnosed for a long time, because noticeable limitation of hip movements does not occur immediately.

Often, patients, without being examined by a doctor or presenting all their complaints, begin to treat lumbosacral osteochondrosis or arthrosis of the knee joints without any visible effect.Meanwhile, the untreated disease progresses and leads to lameness, constant pain, leg shortening, and the inability to bend and extend.And treatment at this stage is possible only surgically, that is, the joint must be replaced with a prosthesis.

Causes of coxarthrosis

healthy joint and arthrosis of the hip joint

Primary osteoarthritis of the hip joint develops more often in people over 40 years of age.Its causes have not been studied yet.The hyaline cartilage that covers the articular 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, the movements 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:

  • Hip dysplasia.This term refers to the congenital underdevelopment of the components of this joint in a child.As a result, the femoral head is not properly centered in the acetabulum.There are three types of hip dysplasia: preluxation, subluxation, and dislocation of the hip.With a congenital dislocation, the head of the femur is out of the socket and, if proper treatment is not carried out, then arthrosis develops.
  • Aseptic necrosis.The bone tissue of the femoral head begins to dissolve due to impaired blood supply.Bone tissue is focally resorbed, the joint head is deformed.Arthrosis develops secondarily.
  • Legg-Calvé-Perthes disease.This is osteochondropathy of the femoral head, which occurs in children aged 3 to 14 years, mainly in boys.It occurs, as a rule, as a result of complications after infectious processes, as well as injuries, physical overload and metabolic diseases.The cartilaginous area of the head is not well supplied with blood, which leads to necrosis of this area and deformation of the joint.
  • Inflammation, infections.If arthritis of the hip joint has developed, the synovial fluid loses its lubricating properties, the lining of the joint thickens, the hyaline cartilage is subjected to mechanical stress, and at the same time metabolic disorders occur in the joint.
  • Injuries: bruises, fractures of the femur, acetabulum, hip dislocations, chronic trauma, that is microtrauma received systematically.
  • Hip joint overload associated with sports and professional activities.For example, long non-stop walking, the effects of vibration, constant jumping and carrying heavy loads are undesirable for the joint.The muscular corset of a child or teenager cannot always compensate for such loads.
  • Increased body weight, especially at a young age, when the cartilage is not yet able to withstand large axial loads.In addition, such 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 if parents or more distant relatives have joint diseases.
  • Osteoporosis.The vulnerable area for this disease is the neck of the femur.Its structure becomes rarer, pathological fractures are possible.All this secondary leads to arthrosis.
  • Diabetes mellitus.In this case, arthrosis develops due to vascular disorders.
  • Polyneuropathy with impaired sensation in the legs.
  • Diseases of other parts of the musculoskeletal system.These include: scoliosis, arthrosis and knee injuries, flat feet.The distribution of the load on the hip joints changes, the shock-absorbing properties decrease, and as a result, the wear of the cartilage suffers.

Symptoms of coxarthrosis

pain in the hip joint due to arthrosis

To prevent the disease and its early diagnosis, it is important to recognize the signs of initial arthrosis of the hip joint (stage 1 coxarthrosis):

  • Pain that appears periodically after physical activity.Specific pain sensations can be localized in the groin, side, hip or knee area.After the break, they go away, so no importance is attached to them.Meanwhile, this is an alarming sign.
  • Slight limitation of hip rotation (internal and external).This can be easily checked while lying on your back by rotating the entire leg clockwise and counterclockwise.
  • An x-ray may reveal a slight uneven narrowing of the joint space.

With second-stage arthrosis, the signs are more pronounced:

  • The pain appears in the projection of the joint, most often in the inguinal fold, and is also observed at rest.
  • Limitations appear not only when turning the leg, but also when abducting the thigh to the side.Movements in the joints are somewhat painful, especially in extreme positions (with maximum abduction of the thigh, bending of the leg towards the stomach).
  • On an X-ray, you can see a moderate narrowing of the joint space and isolated bony growths at the edges of the acetabulum.Cysts can also form in the bony structure of the femoral head.

Hip joint arthrosis of the 3rd stage is easily diagnosed, its symptoms are severe:

  • Joint pain during exercise, at night.
  • Lameness, patients often use a cane.
  • Marked limitation of joint movements, as a result of which it is difficult for a person to put on socks or put on shoes.
  • The leg becomes thinner due to hypotrophy of the thigh and lower leg muscles.The muscles of the gluteal region also weaken.
  • It is possible to shorten the leg due to incomplete extension and deformation of the femoral head.As a result, scoliosis of the lumbar region (lateral curvature) is formed and pain appears in the lumbosacral region.
  • The signs of the 3rd stage, detected by X-rays, are a pronounced narrowing of the joint space to its complete absence, bone growth, deformation of the head and neck of the hip joint.

Diagnosing

Clarification of subjective complaints, collection of anamnesis, evaluation of symptoms, as well as clarification of the stage - radiography, CT and MRI are of great importance in the diagnosis.Computed tomography allows you to study the bone structure of the hip joint in detail, and the magnetic resonance method visualizes soft tissues, the condition of the joint capsule and the presence of synovitis.

Treatment

Therapy for coxarthrosis 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.

  1. Conservative treatment
    • Drug 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 by large muscles and subcutaneous tissue.Long courses of non-steroidal anti-inflammatory drugs are not recommended due to side effects on the cardiovascular system and gastrointestinal tract.To help them, the doctor can prescribe medications that relieve muscle spasm - a muscle relaxant.In cases of 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 intraarticularly;in milder cases tablet forms can be taken.These drugs are aimed at improving the restoration processes in cartilage tissue and slowing down its degeneration.The doctor may also prescribe vascular medications to improve local blood circulation.
    • Physiotherapy.Her procedures improve blood circulation in the joint area and relax the muscles.These are UHF, magnetic therapy, laser treatment, diadynamic current, electrophoresis.Purpose - according to individual indications.
    • Therapeutic massage.An indispensable treatment method for coxarthrosis: it relieves muscle spasms, has a beneficial effect on blood circulation, and when performed systematically, strengthens muscles.
    • Therapeutic gymnastics.It improves blood circulation and strengthens the muscular joints of the joint.Recommended exercises for coxarthrosis (performed on a strong support):
      • "bicycle" in a lying position;
      • lying on your back, grab your knee with your hand and pull it towards your stomach and do the same with the other leg;
      • while lying on your back, bend your knees, press your feet on the floor and lift your pelvis, keep it in this position;
      • lying on your back, move your thigh as far as possible to the side;
      • sitting in a chair, squeeze the ball between the thighs;
      • lying on your back, turn your legs in and out;
      • standing with the right leg at a slight height and holding the support with the hands, move the left leg forward and back and left and right, then do the same, changing the leg.
  2. Surgical treatment.Endoprosthetics, i.e. replacement of a joint with an artificial one, is performed in the 3rd stage of coxarthrosis in the presence of limb shortening, constant pain and strong contractures.Endoprosthetics can be cemented (in the presence of osteoporosis) or without cement.The prosthesis itself can be unipolar (replacement of only the head) and total (replacement of both components).Already the day after the operation, some elements of exercise therapy are carried out while lying in bed, the patient can stand up, but for now without supporting the leg, and a few days later - with crutches.After 2-3 months, crutches will no longer be needed and full weight bearing on the leg will be allowed.Patients who have undergone endoprosthetics are recommended to undergo rehabilitation consisting of physical therapy, massage and physiotherapy.In most cases, limb function is restored.The service life of the prosthesis is from 10 to 20 years, after which 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.

  • Avoiding lifting weights and jumping (especially from heights).Try not to stand for long periods of time.
  • Body weight control (reduce the consumption of flour products, table salt, sweet, strong tea and coffee in the diet).Being overweight increases the risk of hip osteoarthritis.
  • Dose physical exercises aimed at strengthening the muscles of the thighs and buttocks (cyclist or exercise bike, 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 its adequate treatment are the keys to a positive prognosis for this disease.

Which doctor should I contact?

If you have pain in the leg or hip joint, you should consult a doctor.He will describe the primary diagnostic measures, in particular, x-rays of the hip joint.Once the stage of the disease has been established, the patient will be referred to a rheumatologist or orthopedist.A nutritionist and endocrinologist can provide additional help to lose weight and slow the progression of the disease.It would be helpful for women to consult a gynecologist to prescribe hormone replacement therapy to prevent osteoporosis.