The hip joint is the largest joint in our body.It has a hinge configuration that allows it to move in different planes.At the same time, the joint is surrounded by strong ligaments and muscles.Hip joints carry the main load when walking, running or carrying heavy loads.Coxarthrosis (another name for arthrosis of the hip joint) is quite common in both old and young people.After the start, it is a long time since the visible limitation of hip movements does not occur immediately.
Often, without being examined by a doctor or presenting all their complaints, patients start treatment for lumbosacral osteochondrosis or arthrosis of the knee joints without any visible effect.Meanwhile, untreated disease leads to barefoot, constant pain, leg shortening, and inability to bend and stretch.At this stage, treatment is possible only surgically, that is, the joint must be replaced with a prosthesis.
Causes of coxarthrosis
Hip joint arthrosis develops more in people over 40 years of age.Its reasons have not been studied yet.The hyaline cartilage that covers the articular surfaces and provides gliding becomes thin and begins to break down.Due to the increased friction and pressure on the bones, bone waves appear in them.The joint is deformed, movements in it are limited.In primary coxarthrosis, both the knee joints and the spine are often affected.
Middle arthrosis develops against the background of various diseases:
- Hip dysplasia.This term refers to the congenital development of the components of this child.As a result, the femoral head is not centered in the acetabulum.There are three types of hip dysplasia: preluxation, subluxation and dislocation of the hip.With a congenital dislocation, the femoral head is located outside the socket, and if proper treatment is not carried out, arthrosis develops later.
- Aseptic necrosis.The bone tissue of the femoral head begins to dissolve due to the bleeding blood supply.Bone tissue is focused, the head of the joint is deformed.Arthrosis develops secondarily.
- Legg-Calvé-perthes disease.This is an osteochondropathy of the femoral head that occurs in children aged 3-19 years, mainly in boys.It usually occurs as a result of complications after infectious processes, as well as after injuries, physical overload and metabolic diseases.The glans 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 develops, the synovial fluid loses its lubricating properties, the lining of joint thickenings, the hyaline cartilage is subjected to mechanical stress, and at the same time, metabolic disorders occur in the joints.
- Injuries: bruises, fractures of the femur, acetabulum, hip dislocations, chronic trauma, that is, microtraumas systematically received.
- Overloading of the hip joint associated with sports and professional activities.For example, long walks without rest, vibration effects, constant jumping and carrying heavy loads are undesirable.A child's or teenager's muscle corset cannot always compensate for such loads.
- Increased body weight, especially at a young age, when the cartilage is still unable to withstand large axial loads.In addition, such patients usually have metabolic problems.
- Coxarthrosis itself is not inherited, but genetically, relatives can have a certain structure of cartilage tissue, metabolic disorders that lead to the development of arthrosis.Therefore, it is also worth considering whether parents or more distant relatives have co-morbidities.
- Osteoporosis.A sensitive area for this disease is the neck of the femur.Its structure is more rare, pathological fractures are possible.All this leads to secondary 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.Changes in the distribution of load in hip joints, a decrease in shock-absorbing properties, and as a result, the cartilage cover suffers.
Symptoms of coxarthrosis
In order to prevent the disease and its early diagnosis, it is important to know the symptoms of arthrosis associated with Hip Joint (Stage 1 Coxarthrosis):
- Periodic pain after physical activity.Specific pain sensations can be localized in the groin area, side, hip or knee.After resting, they left, so no importance is given.Meanwhile, this is an alarming sign.
- Slight limitation of hip rotation (internal and external).It can be easily checked while lying on your back while rotating the entire leg clockwise and counterclockwise.
- An X-ray may reveal a slightly uneven narrowing of the joint space.
With stage 2 arthrosis, the signs are more pronounced:
- Pain is most often noted in the inguinal fold, joint, joint, and at rest.
- Limitations appear only when turning the leg, but also when abducting the hip to the side.Joint movements are a little painful, especially in extreme positions (with maximum bending of the stomach).
- On an X-ray, you can see a moderate narrowing of the joint space and isolated bone growths on the edges of the acetabulum.Cysts can also form in the bone structure of the femoral head.
Arthrosis of the hip joint of the 3rd stage is easily diagnosed, the symptoms are severe:
- Joint pain during exercise at night.
- Lamity, patients often use a cane.
- Limitation of movements in the joint joint, as a result, it is difficult for a person to put on socks or put on shoes.
- Due to the hypotrophy of the muscles of the thigh and lower leg, the leg becomes thinner.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 (lateral curvature) of the lumbar region occurs and pain appears in the Lumbosacral region.
- The signs of the 3rd stage revealed by X-rays are pronounced, complete lack of joint space, up to bone growths, deformation of the head and neck of the hip joint.
Diagnostics
In the diagnosis, it is of great importance to clarify the subjective complaints, to collect the anamnesis, to evaluate the symptoms, as well as to clarify the stage - X-ray, CT and MRI.Computed tomography allows a detailed study of the bone structure of the hip joint, and the magnetic resonance method allows imaging of soft tissues, the condition of the joint capsule, and synovitis.
Treatment
Therapy for coxarthrosis depends on the stage of the process and in most cases includes all procedures.Of course, the earlier the treatment is started, the more effective it is.
- 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 large muscles and subcutaneous tissue of the hip joint.Long-term use of non-steroidal anti-inflammatory drugs is not recommended due to side effects in the cardiovascular system and gastrointestinal tract.To help them, the doctor can prescribe drugs that relieve muscle spasm - muscle relaxants.In cases of severe inflammation, articular glucocorticoids may be required.Chondroprotectors are one of the main groups of drugs for the treatment of coxarthrosis.It is administered both intramuscularly and intraagularly;In national cases, tablet forms may be drawn.These drugs are aimed at improving the regeneration processes in the cartilage tissue and slowing down its degeneration.The doctor may also prescribe intravenous drugs to improve local blood circulation.
- Physiotherapy.Its procedures improve blood flow in the joint area and relax the muscles.These are uhf, magnetic therapy, laser treatment, diadynamic currents, electrophoresis.Purpose - According to individual indicators.
- Therapeutic massage.An indispensable treatment method for coxarthrosis: it relieves muscle spasms, has a beneficial effect on blood circulation, and strengthens muscles when performed systematically.
- Therapeutic gymnastics.It improves blood flow and strengthens the muscle corset of the joint.Recommended exercises for coxarthrosis (performed with a solid support):
- "Bicycle" in a supine position;
- Lying on your back, grab your knee with your hand and pull it towards your stomach and do the same with your other leg;
- While lying on your back, bend your knees, press your soles to the floor and raise your pelvis, keep it in this position;
- Lying on the back, take your thigh to the side as far as possible;
- Sitting in a chair, squeeze the ball between your thighs;
- Lying on the back, burn your legs and outside;
- Standing with your right leg slightly elevated and holding the support with your hands, slide your left leg back and left and right, change your leg.
- Surgery.Endoprosthetics, i.e. replacement of an extra joint, is performed in the 3rd stage of coxarthrosis, in the presence of leg reduction, constant pain and severe contracture.Endoprosthetics 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 components).The next day after surgery, some elements of exercise therapy are performed while lying in bed, the patient can stand up, but after a few days - he cannot stand on the couches.After 2-3 months, cutches will no longer be needed and will bear full weight on the leg.Patients undergoing 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, and then it is replaced with a new one.
Prevention of coxarthrosis
Preventive measures are very important, especially if there is hip dysplasia, fractures, severe decay or rusted processes in this area.
- Avoiding heavy lifting and jumping (especially from heights).Try not to be on your feet for long periods of time.
- Body weight control (drink flour products, table salt, sweet, strong tea and coffee).Being overweight increases the risk of hip osteoarthritis.
- Physical exercises aimed at strengthening the muscles of the thighs and hips, bicycle or exercise bike, swimming, therapeutic exercises).
- If there are diseases related to metabolism (diabetes mellitus, atherosclerosis), it should be compensated.
Compliance with preventive measures, early detection of coxarthrosis and adequate treatment are the keys to a positive prognosis for 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 initial diagnostic measures, especially X-rays of the hip joint.After establishing the stage of the disease, the patient will be referred to a rheumatologist or orthopedist.A nutritionist and endocrinologist can further help with weight loss and slowing the progression of the disease.It would be useful for women to consult a gynecologist to prescribe hormone replacement therapy to prevent osteoporosis.