Coxarthrosis affects the hip joints of middle-aged and elderly people. The causes of its development are previous injuries, congenital and acquired diseases of an inflammatory or non-inflammatory nature. The main symptoms of coxarthrosis are pain in the hip joint, swelling in the morning and stiffness of movement. In the initial stage of the pathology, the treatment is conservative. If it is ineffective against the background of rapid progression of coxarthrosis or its late detection, surgical intervention, usually endoprosthetic, is indicated.
Description of the pathology
Coxarthrosis (osteoarthrosis, arthrosis deformans) is a degenerative-dystrophic pathology of the hip joint. In the initial stage of development, the structure of the synovial fluid changes. It becomes viscous, thick and therefore loses its ability to nourish hyaline cartilage. Due to dehydration, its surface dries up and is covered with numerous radial cracks. In this condition, the hyaline cartilage does not absorb shock well when the bones that make up the joint come into contact.
To adapt to the increased pressure that occurs on them, bone structures deform with the formation of growths (osteophytes). The metabolism in the hip joint deteriorates, which negatively affects the muscles and ligamento-tendon apparatus of the joint.
Diplomas
Each stage is characterized by its own symptoms, the severity of which depends on the degree of narrowing of the joint space and the number of bone growths formed.
| The severity of coxarthrosis | Characteristic symptoms and radiographic signs |
|---|---|
| First | The joint space is unevenly narrowed and solitary osteophytes are formed around the acetabulum. Mild discomfort appears, but more often the disease does not manifest itself clinically |
| Secondly | The joint space narrows almost 2 times, the head of the femur is displaced, deformed, enlarged, and bone growths are found outside the cartilaginous edge. Hip pain becomes constant and is associated with significant mobility limitations |
| Third | Complete or partial fusion of the joint space, multiple bony growths, expansion of the femoral head. The pain occurs day and night and spreads to the thigh and leg. Movement is possible only with the help of a stick or crutches |
Causes of the disease
Primary coxarthrosis is a destructive-degenerative lesion of the hip joint, the causes of which have not been determined. This means that no prerequisites for the premature destruction of hyaline cartilage were identified. The following pathological conditions can provoke secondary coxarthrosis:
- previous injuries - fracture of the neck of the femur or pelvic bones, dislocation;
- hip dysplasia;
- aseptic necrosis of the femoral head;
- congenital hip dislocation;
- inflammatory, including infectious joint diseases (rheumatoid, reactive arthritis, gout, tendinitis, bursitis, synovitis).
Prerequisites for the development of coxarthrosis are obesity, increased physical activity, a sedentary lifestyle, metabolic disorders, hormonal disorders, kyphosis, scoliosis and flat feet.
Symptoms of the disease
In the initial stage of development, coxarthrosis can appear only with mild pain. They usually occur after intense physical exertion or a hard day at work. The person attributes the deterioration of health to muscle "fatigue" and does not seek medical help. This explains the frequent diagnosis of coxarthrosis in stages 2 or 3, when conservative therapy is ineffective.
Limitation of joint mobility
The range of motion in the hip joint decreases due to compensatory growth of bone tissue, damage to the synovial membrane, and replacement of areas of the articular capsule with fibrous tissue without any functional activity. Mobility may be somewhat limited even with grade 1 coxarthrosis. Difficulties arise when performing rotational movements with the leg.
As the disease progresses, morning stiffness and joint swelling become common. To regain mobility, a person should warm up for several minutes. By lunchtime, range of motion is restored, including as a result of the production of hormone-like substances in the body.
crunch
When you walk, bend and (or) extend the hip joint, the sounds of clicking, clicking and popping are clearly heard. The reason for this sound accompaniment of each step is the rubbing of bone surfaces, including osteophytes, against each other. Crackling can occur even in normal conditions due to the collapse of carbon dioxide bubbles in the joint cavity. Coxarthrosis is indicated by its combination with dull or sharp pain.
Pain
Painful sensations become constant already in the 2nd stage of coxarthrosis. Their severity decreases somewhat after a long rest. The pain intensifies during the next relapse or the development of synovitis (inflammation of the synovial membrane) that often accompanies osteoarthritis. During the remission phase, the discomfort decreases somewhat. But as soon as a person becomes hypothermic or lifts a heavy object, severe pain appears again.
Muscle spasm
Increased tension in the skeletal muscles of the hip occurs with coxarthrosis for several reasons. First, the ligaments weaken. The muscles spasm to hold the femoral head in the acetabulum. Secondly, increased tone often accompanies inflammation of the synovial membrane. Third, when osteophytes are displaced, nerve endings are compressed and muscle spasm becomes a compensatory response to acute pain.
halting
In the later stages of the development of coxarthrosis, the patient begins to limp severely. Changes in gait are provoked by flexion contractions and deformation of bone surfaces, making it impossible to maintain a straight leg position. The person also limps to reduce the severity of the pain by transferring body weight to the unaffected limb.
Leg shortening
Shortening of the leg by 1 cm or more is typical for grade 3 coxarthrosis. The reasons for the reduction in the length of the lower limbs are severe muscle atrophy, thinning and flattening of the cartilage, narrowing of the joint space and deformation of the femoral head. .
Diagnostic methods
The initial diagnosis is made on the basis of the patient's complaints, external examination, medical history and the results of a series of functional tests. Many inflammatory and non-inflammatory pathologies are masked as symptoms of coxarthrosis, so instrumental and biochemical studies are performed.
X-ray examination
The stage of coxarthrosis is determined by performing an X-ray examination. The resulting images clearly show destructive changes in the hip joint. This is a narrowing of the joint space, deformation of the bone surfaces and the formation of osteophytes.
CT scan
CT scanning is prescribed to patients to determine the degree of flattening and deformation of the hyaline cartilage. The results of the study also make it possible to assess the condition of the ligamento-tendon apparatus, nerve trunks, muscles, small and large blood vessels.
Magnetic resonance imaging
MRI is one of the most informative studies in the diagnosis of coxarthrosis. To identify blood circulation disorders in the area of the affected joint, it is performed with contrast. A routine study is prescribed to determine the degree of ligament damage and deformity of the femoral head and to detect areas of fibrous degeneration of the joint capsule.
Measurement of leg length
Before the measurement, the doctor asks the patient to stand up and straighten his legs as much as possible. To obtain the most reliable data, the orthopedist uses two bony reference points. Upper - the front axis of the pelvic bone, located on the anterior lateral surface of the abdomen at the outer edge of the inguinal ligament. The second reference point is any bony structure of the knee, ankle or heel. Leg length measurement may not be informative if coxarthrosis affects two hip joints at once.
Laboratory research
To assess the patient's general condition, clinical blood and urine tests are performed. And the results of biochemical studies often make it possible to detect the pathologies that caused the development of coxarthrosis. Gouty arthritis is indicated by high levels of uric acid and its salts. An increase in the sedimentation rate of erythrocytes and an increase in the number of leukocytes indicate the occurrence of an inflammatory process (bursitis, arthritis, synovitis). To rule out rheumatoid arthritis, rheumatoid factor, C-reactive protein and antinuclear antibodies are determined.
Hip puncture
Using a syringe, synovial fluid is collected to study its composition and detect changes in consistency. If an infectious-inflammatory process is suspected, further biochemical examination of a biological sample is indicated.
Treatment options
When determining treatment tactics, the orthopedist takes into account the severity of coxarthrosis, the form of its course, the causes of development and the severity of symptoms. Patients are often recommended to wear rigid rib bandages and orthoses from the first days of treatment. The use of orthotic devices helps to slow down cartilage breakdown and bone deformation.
medicaments
In the treatment of deforming arthrosis, drugs of different clinical and pharmacological groups are used. These are non-steroidal anti-inflammatory drugs (NSAIDs), muscle relaxants, glucocorticosteroids, chondroprotectors, ointments and gels with a warming effect.
Blockade
To relieve acute pain that cannot be eliminated by NSAIDs, intra-articular or peri-articular drug blockades are prescribed. For their performance, hormonal agents are used. The analgesic effect of glucocorticosteroids is increased by their combination with anesthetics.
Injections
Intramuscular injection of NSAID solutions allows you to eliminate severe pain in the hip joint. To relax the skeletal muscles, a drug is usually used, which, in addition to a muscle relaxant, includes an anesthetic. In the form of injections, therapeutic regimens include B vitamins, drugs to improve blood circulation, and chondroprotectors.
Diet therapy
Overweight patients are advised to lose weight to slow down the spread of pathology in healthy joint structures. The caloric content of the daily menu should be limited to 2000 kilocalories, excluding high-fat foods and simple carbohydrates. Nutritionists recommend that all patients with coxarthrosis adhere to proper nutrition. The diet should contain fresh vegetables, fruits, berries, cereal porridge, fatty sea fish and dairy products. Following a therapeutic diet stimulates the strengthening of the immune system and the improvement of general health.
Exercise therapy and massage
In the treatment of coxarthrosis, classical massage, acupressure and vacuum are used. After several sessions, blood circulation in the hip joint improves and nutrient reserves are replenished. Carrying out massage procedures stimulates the strengthening of the ligamento-tendon apparatus and the restoration of soft tissues damaged by the displacement of osteophytes.
Regular exercise therapy is one of the most effective ways to treat osteoarthritis. A set of exercises is compiled by a doctor of physical therapy individually for the patient, taking into account his physical ability.
Physiotherapy
Patients with coxarthrosis are prescribed up to 10 sessions of magnetic therapy, laser therapy, UHF therapy, UV radiation and shock wave therapy. The therapeutic effect of the procedures is due to the improvement of blood circulation, acceleration of metabolism and regeneration processes. To relieve acute pain, electrophoresis or ultraphonophoresis is performed with glucocorticosteroids, anesthetics and B vitamins. Ozokerite or paraffin applications help to eliminate discomfort.
Surgical intervention
If conservative treatment is ineffective, pain that cannot be eliminated with drugs or stable progression of coxarthrosis, patients are advised to undergo surgical intervention. The operation is performed immediately in case of pathology of the 3rd degree of severity, since it is impossible to eliminate the resulting destructive changes in cartilage and bones by taking medications or exercise therapy.
Arthroplasty
The operation is performed using general anesthesia. The femoral head is removed from the acetabulum. Visible destructive changes in the tissue are corrected - bone growths are removed, articular surfaces are leveled, tissue that has undergone necrosis is removed. During the operation, cavities are formed and filled with ceramic implants.
Endoprosthetics
Hip replacement with an implant is performed under general anesthesia. To prevent the development of an infectious process, a course of antibiotics is prescribed. After 10 days, the sutures are removed and the patient is discharged from the medical facility. In the rehabilitation phase, patients are shown physiotherapeutic and massage procedures, exercise therapy.
Possible consequences
In the final stage of the pathology, flexion and adduction contractures develop. The patient's leg is constantly bent, so he uses a cane or crutches to move. After complete fusion of the key space, immobility occurs, the patient cannot do housework and becomes disabled. Coxarthrosis is often complicated by aseptic necrosis of the femoral head, arthrosis of the knee joints, and arthritis.
Prevention and prognosis
Only grade 1 coxarthrosis responds well to conservative treatment. In other cases, endoprosthetics allow you to completely restore the functional activity of the hip joint. After installing the endoprosthesis, the patient quickly returns to an active lifestyle.
To prevent the disease, orthopedists recommend giving up smoking, abusing alcoholic beverages, doing physical therapy and gymnastics every day and losing excess weight if necessary.