Coxarthrosis of the hip joint is a degenerative-dystrophic process that occurs in the articular joint of the femoral head and the pelvic acetabulum. The disease is more typical of middle-aged and elderly people, although it can also occur in young people, including children. In most cases, its development is preceded by injuries, as well as a number of pathologies of an inflammatory and non-inflammatory nature, and pain and stiffness of movements become the main signs of a degenerative-dystrophic process in the hip joint. In its development, the disease goes through several stages, and if in the early stages it can be treated conservatively, then in the later stages, the treatment of coxarthrosis of the hip joints is effective only by surgery. Otherwise, the pathology will lead to serious disorders or even complete immobilization.
What is coxarthrosis of the hip joint and the mechanism of its development?
Coxarthrosis, also called arthrosis and deforming arthrosis, is a complex disease of the hip joints (HJ), accompanied by a progressive destruction of the cartilage. Over time, this leads to deformation of the adjacent bone surfaces, as well as the formation of bone growths on them, called osteophytes.
According to statistics, coxarthrosis accounts for about 12% of all diseases of the musculoskeletal system. In terms of frequency of occurrence, it is second only to gonarthrosis of the knee joint, but the risks of disability are much higher.
The two hip joints are the largest joints in the body. Each of them is formed by the femur bone and the pelvic socket. The femoral head is located in the cup-shaped recess of the pelvic bone and moves freely in different directions. This joint structure makes it possible to flex and unfold, adduct and abduct, and also rotate the thigh.
To prevent movement from causing discomfort, the surfaces of the bones that touch each other are covered with an elastic layer called hyaline cartilage. It is he who allows the femoral head to easily slide into the acetabulum. Additionally, hyaline cartilage provides stabilization and cushioning of the hip joint during movements.
The entire joint is submerged in a kind of box called the joint capsule. Contains the synovial membrane that synthesizes synovial fluid. It is she who lubricates the cartilage surface, ensures the flow of water and nutrients to it, that is, is responsible for maintaining the normal structure of cartilage tissue.
Above the joint capsule is a group of femoral and pelvic muscles, with the help of which the joint is set in motion. The hip joint is also surrounded by a group of ligaments that ensure the stability of its position within physiological limits.
Since the hip joint is subjected to heavy loads every day, it is prone to rapid wear and tear and injury. The risk of such changes significantly increases the effect of a number of unfavorable factors that are practically unavoidable in the modern world, but will be discussed below. This explains the high prevalence of coxarthrosis.
As a result of the influence of negative factors, a violation of the production of synovial fluid occurs. Gradually, its quantity decreases, and its qualitative composition also changes: it becomes viscous, thick and can no longer fully nourish cartilage. This leads to acute nutritional deficiencies and progressive dehydration of the hyaline cartilage. As a result of such changes, the strength and elasticity of the cartilage tissue decrease, they exfoliate, crack and decrease in volume. All this prevents the smooth sliding of the femoral head in the pelvic acetabulum, which gives rise to the appearance of signs of hip coxarthrosis.
Gradually, the interarticular gap narrows, the friction between the articulating bone surfaces increases, and the pressure of the bones on the hyaline cartilage increases. This leads to even greater injuries and wear and tear, which cannot but affect the biomechanics of the hip joint and the well-being of a person.
Failure of the hip joint negatively affects not only the biomechanics of the lower extremities, but also the entire musculoskeletal system. This often results in disability.
As the pathological changes progress, the hyaline layer gradually disappears completely, which leads to the exposure of bone surfaces and a critical increase in the load on the bone joint. During movements, the femoral head is no longer covered by anything and rubs directly against the surface of the pelvic socket. Besides the fact that it seriously limits mobility and causes excruciating pain, the bones are pressed against each other, at the same time flattening.
As the bones of the joint deform, bony growths (osteophytes) form on their surface. They can have sharp edges and seriously injure surrounding muscles. This causes the appearance of severe pain in the groin, legs and buttocks. Therefore, the patient unconsciously tries to save the affected hip joint and prevent movement in it. The lack of adequate load on the muscles leads to their gradual atrophy, which further aggravates mobility problems. This results in lameness.
Reasons for development
Coxarthrosis of the hip joint can be primary or secondary. In the first case, the reasons for its development cannot be found, that is, the disease develops on its own for no apparent reason. Secondary coxarthrosis is the result of a number of changes in the state of the musculoskeletal system or lifestyle characteristics, in particular:
- hip joint injuries, including bone fractures, dislocations, bruises, sprains or tears of the surrounding ligaments, chronic micro-damage, etc. ;
- exhausting physical work;
- sedentary lifestyle;
- obesity;
- chronic infectious processes in the body;
- rheumatoid arthritis, gout, tendinitis, bursitis;
- endocrine diseases, metabolic and hormonal disorders, including diabetes mellitus;
- congenital malformations of the hip joint (dislocation, dysplasia);
- aseptic necrosis of the femoral head;
- spinal pathologies of various types;
- genetic predisposition;
- smoking addiction.
In the vast majority of cases, the development of coxarthrosis of the hip joint is due to unavoidable age-related changes, and the presence of other factors among the above only increases the risk of its occurrence and increases the rate of its occurrence. progression.
Symptoms and grades
During coxarthrosis, 4 degrees of development are distinguished, of which 1 is the easiest. Initially, the disease may be asymptomatic or manifest as mild pain. They most often occur after heavy physical exertion, a long walk, or at the end of a busy day. In the early stages of the development of the disease, discomfort is usually attributed to fatigue and is considered the norm. Therefore, very rarely, coxarthrosis of the hip joint is diagnosed at the first stage of development.
Perceptible signs of coxarthrosis begin to appear in the second stage of its progression, when the joint space is narrowed by almost half and the femoral head is displaced and deformed. With the transition to the 3rd stage, the pains become unbearable and can bother a person even at night, they tend to radiate to the hips, shins, groin and buttocks. Since the joint space is already practically absent, and multiple osteophytes are formed on the bone surfaces, independent movement in such situations is impossible. Therefore, patients are forced to use a cane or crutches.
So, the main symptoms of coxarthrosis of the hip joint are:
- Mobility Restrictions: Initially, patients may note the onset of difficulty performing rotational movements of the leg, but over time, they are joined by morning stiffness and HJ swelling. Because of them, a person needs several minutes to warm up and, as it were, walk to restore a normal range of motion. Gradually, it becomes more and more difficult for the patient to perform leg movements.
- A characteristic crunch - occurs when walking, as well as flexion or extension of the hip joint. It is a consequence of the friction of bone surfaces with each other and with coxarthrosis is accompanied by sharp or dull pain.
- Pain syndrome - initially, the pains appear after physical exertion and disappear a little after a long rest. An acute attack can be provoked by weight lifting or hypothermia, since coxarthrosis is often complicated by the addition of inflammation of the synovial membrane. As the disease progresses, the pain becomes more frequent, lasts longer, and gets worse.
- Spasm of the thigh muscles: this is a consequence of the pinching of the nerves and the weakening of the ligamentous apparatus, due to which the muscles have a compensatory spasm to keep the head of the femur in the acetabulum. Also, muscle spasm can be provoked by the addition of synovitis.
- Lameness - occurs in the later stages of the development of the disease, since the deformation of the bone surfaces causes the appearance of contracture of the flexor muscles. Therefore, a person cannot fully straighten the leg and hold it in this position. In addition, the patient may involuntarily limp to transfer weight to the healthy half of the body, as this helps reduce the intensity of pain.
- Shortening of the leg - observed with coxarthrosis of the third degree. The leg on the side of the affected hip joint may be shortened by 1 cm or more as a result of joint space narrowing, decreased muscle tone, and flattening of the femoral head.
In the late stage of development, the femoral head fuses with the acetabulum, leading to complete immobilization of the leg and disability.
At the same time, degenerative-dystrophic changes can be observed in one or both hip joints. Consequently, the characteristic symptoms will be observed on one or both sides at once, but in the latter case, their severity on the left and right sides may differ.
Diagnosis
The doctor may suspect the presence of coxarthrosis of the hip joint based on the patient's complaints, external examination and the results of functional tests. Be sure to measure the length of the legs during a visual inspection. To do this, the patient is asked to get up and stretch his legs as far as possible. The measurement is taken between the anterior axis of the pelvic bones and any bony structure of the knee, ankle, or heel. But if both hip joints are simultaneously affected by coxarthrosis, the data obtained will be uninformative.
But since the typical symptoms of coxarthrosis can accompany other inflammatory and non-inflammatory diseases, instrumental examination methods are mandatory for the patient to accurately diagnose the pathology. Could be:
- CT or radiography of the hip joint - the images show destructive changes in it, narrowing of the joint space, formation of osteophytes and deformation of bone surfaces;
- MRI is the most informative examination method that allows you to accurately assess the nature of changes in cartilage structures, ligaments, and the nature of blood circulation in the hip area.
Patients are also assigned laboratory tests to assess their general health and to detect diseases that can cause coxarthrosis. It's:
- UAC and OAM;
- blood chemistry;
- rheumatic tests;
- puncture of the hip joint with a biochemical study.
The task of diagnosis is to differentiate hip coxarthrosis with gonarthrosis (knee joint damage), as well as the radicular syndrome that occurs with osteochondrosis, as well as protrusions and hernias of intervertebral discs. In addition, the symptoms of coxarthrosis can resemble the manifestations of trochanteric bursitis and an atypical course of ankylosing spondylitis, which requires a complete examination to find out the true causes of pain and mobility restrictions.
Conservative treatment
Conservative treatment of hip coxarthrosis is effective only in the initial stages of the disease. It is selected for each patient individually and can include a whole range of different methods, each of which will complement the others. Therefore, as part of the treatment of coxarthrosis of the hip joint, patients may be prescribed:
- drug therapy;
- exercise therapy;
- physiotherapy;
- plasmolifting.
For conservative treatment to be effective, patients must eliminate the effect of a number of factors that contribute to the development of coxarthrosis of the hip. If you are overweight, it is very important to reduce it as much as possible. This will reduce the load on the affected joint and the risk of progression of the degenerative-dystrophic process.
You should also stop smoking and normalize the mode of physical activity, avoid overload, but not sit all the time. To prevent further destruction of the hip joint, it is recommended to use special bandages and orthoses. They provide secure fixation of the joint and support it during movement.
Medical treatment
The nature of drug therapy is selected strictly individually. In most cases, patients are prescribed:
- NSAIDs - drugs that have analgesic and anti-inflammatory effects simultaneously (available as tablets, injections, and topical agents);
- corticosteroids - drugs with a powerful anti-inflammatory effect, which are prescribed if NSAIDs do not give a pronounced effect;
- chondroprotectors - contribute to the activation of cartilage tissue regeneration processes, but their effectiveness has not been proven;
- muscle relaxants - drugs that reduce muscle tone and eliminate spasms, which is necessary when spasms occur in certain muscles or groups against the background of severe pain;
- preparations to improve blood circulation - most often used in the form of solutions for injection and help to improve the trophism of the tissues surrounding the joint;
- B vitamins - have been shown to normalize the transmission of nerve impulses, which is especially important when nerves are compressed by deformed bone structures.
For acute pain that cannot be eliminated with the help of tablets, intraarticular or periarticular blocks can be performed on patients. They are carried out exclusively by qualified health personnel in a medical institution and consist of the introduction into the joint cavity or directly into the surrounding area of anesthetic solutions with corticosteroids.
exercise therapy
Therapeutic exercise is an effective method to treat decreased muscle tone and limited mobility. Thanks to a correctly selected set of exercises, it is possible to increase the range of motion and reduce the intensity of pain. They also prevent muscle atrophy and help to eliminate spasms if coxarthrosis is accompanied by pinching of nerve fibers, which reflexively causes spasm of individual muscles.
Exercise therapy classes can improve blood circulation in the area of the degenerative-dystrophic process. Due to this, the quality of the trophism of the diseased joint increases and the course of regenerative processes is accelerated.
For each patient, a specialist must individually develop a set of exercises. At the same time, not only the degree of destruction of the hip joint is taken into account, but also the level of physical development of the patient.
Physiotherapy
Physiotherapeutic procedures and massage have an anti-inflammatory, analgesic, tonic and anti-edematous effect. In addition, they help maintain normal muscle tone in the legs, preventing their atony and atrophy.
With coxarthrosis of the hip joint, courses of 10-15 procedures are prescribed:
- ultrasound therapy;
- magnet therapy;
- laser therapy;
- electrophoresis;
- ultraphonophoresis;
- ultrahigh frequency;
- paraffin treatment
Also, many patients are offered mud therapy. Such procedures have a positive effect only at the first stage of the development of coxarthrosis of the hip joint or during rehabilitation after surgical treatment. Thanks to therapeutic mud it is possible to achieve an improvement in the quality of blood circulation and accelerate the restoration of the motor skills of the affected joint.
plasma lift
Plasmolifting or PRP-therapy is a procedure that involves the introduction of platelet-rich plasma from the patient's own blood into the cavity of the hip joint. This allows you to activate the processes of restoration of hyaline cartilage.
But, according to some scientists, such a procedure can provoke the formation of malignant tumors. This point of view is based on the fact that plasmolifting promotes the formation of a large number of stem cells, the effect of which on the body has not yet been fully studied.
Surgical treatment of coxarthrosis of the hip joint
Despite significant discomfort in the hip joint, many seek medical help too late, when pathological changes in the joint reach 3 or even 4 degrees of severity, and functionality is irreversibly reduced.
With advanced pathology, surgery is a necessary measure. Only timely surgical intervention will help restore normal mobility and save the patient from excruciating pain, that is, achieve a significant improvement in the quality of human life. No medication, physiotherapeutic procedure, can restore severely destroyed cartilage. At best, painful intra-articular injections and medications can reduce pain. But this will be a temporary phenomenon, after which the pain will return again with the same or even greater strength.
Indications for hip surgery are:
- disappearance of the interarticular space;
- persistent pain in the hip joint, which cannot be relieved;
- critical mobility disorders;
- hip fracture.
Depending on the severity of joint destruction and bone deformity, patients may be offered various types of surgical treatment, including:
- arthrodesis;
- endoprosthesis;
- osteotomy
arthrodesis
Arthrodesis is an affordable operation that involves strong fixation of the articular bones with metal plates. The result is complete immobilization of the joint. Thus, with the help of arthrodesis, it is possible to correct only the supporting function of the leg, eliminate pain, but there is no need to talk about restoring mobility or significantly improving the quality of life.
Today, arthrodesis is practically not used, since it deprives a person of the opportunity to fully move.
stent
Endoprosthesis with arthroplasty is the only way to radically solve the problem of coxarthrosis of the hip joint with the restoration of all its functions and motor abilities. This is a high-tech method of solving the problem of coxarthrosis, which allows you to completely forget about it for 15-30 years, as well as about pain and mobility restrictions. Thanks to the use of modern endoprostheses, it is possible to achieve complete restoration of motor support functions and provide the patient with a normal life.
The operation consists of the resection of the femoral head and part of its neck. The surgical preparation of the acetabular bed is also performed, which involves the removal of osteophytes, the alignment of its surface and the resection of the tissues that have suffered necrosis. Endoprostheses can even be used to treat elderly patients with hip coxarthrosis.
The operation is performed under general anesthesia and takes about an hour. Depending on the severity of the degenerative-dystrophic process, the operation can be performed using one of the following methods:
- superficial - involves grinding the acetabulum and femoral head with additional coating with smooth implants that replace the destroyed hyaline cartilage (the method is rarely used due to the possibility of inflammation in the periarticular tissues);
- unipolar - removal of the femoral head and its replacement with an endoprosthesis (used when cartilage on the surface of the acetabulum is preserved and only the femoral head is destroyed);
- bipolar - technique similar to the previous one, differing only in the design of the endoprosthesis used, which has a lower coefficient of friction and provides smoother movements in the joint bed;
- total is the most effective and safe method to solve the problem of coxarthrosis of the hip joint, which consists of a complete resection of the femoral head with the capture of part of its neck, as well as the acetabular fossa and its replacement by a full-fledged artificial articular joint.
Therefore, patients can be recommended to install various types of stents. Most hip replacements are made in the US and the UK. Chemically and biologically inert metals are used for their manufacture: cobalt, chromium, titanium alloys. Ceramics are also often used. In most modern models, polymer pads are additionally used, which allow to provide natural damping, stabilizing and sliding properties to the artificial TBS.
When performing endoprosthesis, the success of the operation is almost 100%.
After the operation, antibiotics are prescribed to prevent the development of infectious complications, and the stitches are removed after 10 days. The size of the postoperative scar is approximately 8 cm. . At the same time, the patient is discharged from the clinic. Rehabilitation after stent grafting is simple, but still requires physical therapy, massage, and exercise therapy.
osteotomy
Osteotomy is a surgical intervention that is a temporary measure before a cardinal replacement of the hip joint with an artificial endoprosthesis. The essence of the operation is to align the axis of the femur due to its intentional fracture. The resulting fragments are placed in the most suitable position, thereby slightly unloading the diseased joint. As a result, it is possible to temporarily reduce the intensity of pain and improve mobility.
Therefore, hip coxarthrosis is quite a formidable disease that can completely deprive a person of the opportunity to move independently. It progresses for a long time, and its symptoms, especially in the early stages, are often perceived by patients as a normal condition after physical exertion. But it is precisely in this that the insidiousness of the disease lies, since only in the initial stage of its development can it be treated non-surgically. But if the degenerative-dystrophic process has already completely destroyed the hyaline cartilage and led to the exposure of the bone surfaces, and even more so to their flattening, then only surgery can help the patient. Fortunately, the modern level of medicine and surgery, in particular, makes it possible to achieve a complete restoration of the normal state of the hip joint and its functions.