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 at different levels.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 arthrosis of the hip joint) is quite common in people, both old and young.Once it starts, it can go undiagnosed for a long time because the visible limitation of hip movements does not appear immediately.

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

Causes of coxarthrosis

healthy joint and arthropathy of the hip joint

Primary arthropathy of the hip joint develops more often in people over 40 years of age.Its causes have not yet been studied.The hyaline cartilage that covers the articular surfaces and provides gliding begins to thin and break down.Due to the increased friction and pressure on the bones, bone spurs appear on them.The joint is deformed, movements in it are limited.In primary coxarthrosis, both the knee joints and the spine are often affected.

Secondary arthropathy develops in the context 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 centered as it should be in the acetabulum.There are three types of hip dysplasia: predislocation, subluxation, and dislocation of the hip.With a congenital dislocation, the femoral head is out of socket and, if not properly treated, arthropathy develops.
  • Aseptic necrosis.The bone tissue of the femoral head begins to dissolve due to reduced blood supply.Bone tissue is focally absorbed, the joint head is deformed.Arthropathy develops secondarily.
  • Legg-Calvé-Perthes disease.It 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.
  • Inflammations, 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 subject to mechanical stress, and at the same time metabolic disorders appear in the joint.
  • Injuries: bruises, fractures of the femur, acetabulum, hip dislocations, chronic trauma, i.e. micro-traumas that are taken systematically.
  • Overloading of the hip joint associated with sports and professional activities.For example, long walking without rest, vibrations, constant jumping and carrying heavy loads are undesirable for the joint.The muscle 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.
  • The coxarthrosis itself is not hereditary, but genetically relatives may have a certain structure of cartilage tissue, metabolic disorders that lead to the development of arthropathy.Therefore, it is worth considering whether parents or more distant relatives have joint diseases.
  • Osteoporosis.The vulnerable area for this disease is the femoral neck.Its structure becomes rarer, pathological fractures are possible.All these secondarily lead to joints.
  • Diabetes mellitus.In this case, arthropathy develops due to vascular disorders.
  • Polyneuropathy with reduced sensation in the legs.
  • Diseases of other parts of the musculoskeletal system.These include: scoliosis, joint 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 cartilage coating suffers.

Symptoms of coxarthrosis

hip joint pain due to arthrosis

For the prevention of the disease and its early diagnosis, it is important to know the signs of incipient arthropathy of the hip joint (stage 1 of coxarthrosis):

  • Pain that occurs periodically after physical activity.Specific pain sensations may be located in the groin, side, hip or knee.After resting they leave, so they are not given any attention.Meanwhile, this is a worrying 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 arthropathy of the 2nd stage, the signs are more pronounced:

  • Pain occurs in the projection of the joint, most often in the inguinal fold, and is also noted at rest.
  • Limitations occur not only during leg flexion, but also during lateral hip abduction.Movements in the joint are somewhat painful, especially in extreme positions (with maximum abduction of the hip, 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 ends of the acetabulum.Cysts may also form in the bony structure of the femoral head.

Arthropathy of the hip joint of the 3rd stage is easily diagnosed, its symptoms are severe:

  • Joint pain on exercise, at night.
  • Lameness, patients often use a cane.
  • Significant limitation of movement in the joint, making it difficult for someone to put on socks or put on shoes.
  • The leg becomes thinner due to scholarship of the thigh and shin muscles.The muscles of the gluteal region also weaken.
  • Shortening of the leg is possible due to incomplete extension and deformation of the femoral head.As a result, scoliosis of the lumbar region (lateral curvature) is formed and pain occurs in the lumbosacral region.
  • Signs of the 3rd stage, revealed by X-rays, are the intense narrowing of the joint space to its complete absence, bone growths, deformation of the head and neck of the hip joint.

Diagnostics

In the diagnosis, clarification of subjective complaints, collection of memories, evaluation of symptoms, as well as clarification of the stage - X-ray, CT and MRI are of great importance.Computed tomography allows you to study the bone structure of the hip joint in detail, and the magnetic resonance method depicts the soft tissues, the condition of the joint and the presence of arthritis.

Treatment

Treatment for coxarthrosis depends on the stage of the process and, in most cases, involves a whole series of procedures.Of course, the earlier treatment begins, the greater its effectiveness.

  1. Conservative treatment
    • Pharmacotherapy.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 cardiovascular and gastrointestinal side effects.To help them, the doctor can prescribe drugs that relieve muscle spasm - a muscle relaxant.In cases of severe inflammation, intra-articular glucocorticoids may be required.Chondroprotectants are one of the main groups of drugs for the treatment of coxarthrosis.They are administered both intramuscularly and intra-articularly.in milder cases, tablets can be taken.These drugs are aimed at improving the repair processes in the cartilage tissue and slowing down its degeneration.The doctor may also prescribe vascular drugs to improve local blood circulation.
    • Physiotherapy.Her procedures improve blood flow in the joint area and relax the muscles.These are UHF, magnetic therapy, laser therapy, direct currents, electrophoresis.Purpose - according to individual indications.
    • Therapeutic massage.An essential treatment method for coxarthrosis: it relieves muscle spasms, has a beneficial effect on blood circulation and when done systematically, strengthens the muscles.
    • Therapeutic exercise.It improves blood flow and strengthens the muscle corset of the joint.Exercises recommended for the coxal joint (performed on solid support):
      • "bicycle" in a supine position.
      • Lie 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 soles into the floor and lift your pelvis, hold in this position.
      • lying on your back, move your thigh as far as possible to the side.
      • Sitting in a chair, press the ball between your thighs.
      • lying on your back, turn your legs in and out.
      • standing with your right leg on a slight rise and holding the support with your hands, swing your left leg back and forth and left and right, then do the same, changing your leg.
  2. Surgical treatment.Endoprosthetic, i.e. the replacement of a joint with an artificial one, is done in the 3rd stage of coxarthrosis in the presence of limb shortening, constant pain and severe contraction.The endoprosthetic can be cemented (in the presence of osteoporosis) or cementless.The prosthesis itself can be unipolar (replacement of only the head) and total (replacement of both parts).Already the day after the operation, some elements of exercise therapy are performed while in bed, the patient can stand up, but for now without supporting his 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 physical therapy.In most cases, limb function is restored.The service life of the prosthesis is from 10 to 20 years, then 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.

  • Avoid lifting weights and jumping (especially from heights).Try not to be on your feet for long periods of time.
  • Weight control (reduce the consumption of flour products, table salt, sweets, strong tea and coffee in the diet).Being overweight increases the risk of hip arthritis.
  • Dosage physical exercises aimed at strengthening the muscles of the thighs and buttocks (cycling 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 is the key to a positive prognosis of this disease.

Which doctor should I contact?

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