Osteoarthritis of the hip joint is a degenerative-dystrophic pathology, which is characterized by destruction of the hyaline cartilage.
The disease develops gradually, accompanied by pain and reduced range of motion. In the absence of medical intervention in the initial stage of osteoarthritis, after a few years atrophy of the thigh muscles occurs.
The damaged limb is shortened, and the fusion of the joint space leads to partial or complete immobilization of the hip joint. The causes of the pathology are previous injuries, curvature of the spine, systemic diseases of the musculoskeletal system.
Osteoarthritis is usually found in middle-aged and elderly patients. The diagnosis is made on the basis of the results of instrumental examinations - radiography, MRI, CT, arthroscopy. The treatment of pathology with severity 1 and 2 is conservative. If ankylosis is found or drug therapy is ineffective, surgery is performed (arthrodesis, endoprosthesis).
The mechanism of pathology development
The hip joint is formed by two bones - the ilium and the femur. The lower part of the ilium is represented by its body, which participates in the articulation with the femur, forming the upper part of the acetabulum. During movement, the glenoid fossa is immobile and the head of the femur moves freely. Such a "hinged" device of the hip joint allows it to bend, unfold, rotate, promotes abduction, flexion of the thigh. The smooth, supple, elastic hyaline cartilage, which aligns the acetabulum and the head of the femur, ensures unobstructed sliding of the joint structures. Its main functions are redistribution of loads during movement, prevention of rapid wear of bone tissue.
Under the influence of external or internal factors, the cartilage trophism is disturbed. It does not have its own circulatory system - synovial fluid supplies the tissue with nutrients. In osteoarthritis it thickens, becomes viscous.
The resulting nutrient deficiency provokes drying of the surface of the hyaline cartilage. It is covered with cracks, which leads to permanent microtrauma of the tissues during flexion or lengthening of the hip joint. Cartilage becomes thinner and loses its cushioning properties. The bones deform to "adapt" to the increase in pressure. And against the background of deteriorating metabolism in the tissues, destructive and degenerative changes progress.
Causes and provoking factors
Idiopathic or primary osteoarthritis develops for no reason. It is believed that the destruction of cartilage tissue is due to the natural aging of the body, slowing down the recovery process, reducing the production of collagen and other compounds necessary for the complete regeneration of the structures of the hip joint. Secondary osteoarthritis occurs against the background of a pathological condition already present in the body. The most common causes of secondary disease include:
- previous injuries - damage to the tendon-tendon apparatus, muscle ruptures, their complete separation from the bone base, fractures, dislocations;
- joint development disorder, congenital dysplastic disorders;
- autoimmune pathologies - rheumatoid, reactive, psoriatic arthritis, systemic lupus erythematosus;
- non-specific inflammatory diseases such as purulent arthritis;
- specific infections - gonorrhea, syphilis, brucellosis, ureaplasmosis, trichomoniasis, tuberculosis, osteomyelitis, encephalitis;
- dysfunction of the endocrine system;
- degenerative-dystrophic pathologies - osteochondropathy of the femoral head, osteochondritis disecan;
- hypermobility of the joints due to the production of "super stretchable" collagen, provoking their excessive mobility, weakness of the joints.
Since the cause of osteoarthritis may be hemarthrosis (bleeding in the hip cavity), provoking factors include disorders of hematopoiesis. Prerequisites for the onset of the disease are overweight, excessive physical activity, sedentary lifestyle. Its development is caused by improper organization of sports training, deficiency in the diet of foods high in trace elements, fat- and water-soluble vitamins. Postoperative osteoarthritis occurs several years after surgery, especially if it was accompanied by excision of a large amount of tissue. Hyaline cartilage trophism is disrupted by frequent hypothermia, living in an environmentally unfavorable environment and working with toxic substances.
Osteoarthritis of the hip joint cannot be inherited. But in the presence of certain congenital characteristics (metabolic disorders, skeletal structure), the likelihood of its development increases significantly.
Symptoms
The leading symptoms of osteoarthritis of the hip joint are pain when walking in the hip area, radiating to the groin, knee joint. One suffers from stiffness of movements, stiffness, especially in the morning. To stabilize the joint, the patient begins to limp, his gait changes. Over time, due to muscle atrophy and deformity of the articulation, the limb shortens significantly. Another characteristic feature of the pathology is the limitation of the abduction of the hip joint. For example, difficulties arise when trying to sit on a stool with legs apart.
In osteoarthritis of the first severity, intermittent pain occurs after intense exercise. They are localized in the area of articulation and disappear after prolonged rest.
In second-degree osteoarthritis of the hip, the severity of the pain syndrome increases. Discomfort occurs even at rest, covers the thigh and groin, increases with weight lifting or increased physical activity. To eliminate the pain in the hip joint, a person begins to limp barely noticeably. Restriction of movement in the joint is noted, especially during abduction and internal rotation of the thigh.
Osteoarthritis of the third degree is characterized by constant severe pain that does not subside during the day and night. Difficulties arise when moving, which is why when walking a person is forced to use a cane or crutches. The hip joint is stiff, there is significant atrophy of the muscles of the buttocks, thighs and legs. Due to the weakness of the abductor thigh muscles, the pelvic bones are displaced in the frontal plane. To compensate for the shortening of the leg, the patient bends to the injured limb when moving. This provokes a strong shift in the center of gravity and an increase in stress on the joint. At this stage of osteoarthritis develops severe ankylosis of the joint.
| Degrees | Radiographic signs |
| The first | The changes are not pronounced. The joint gaps are moderately, unevenly narrowed, there is no destruction of the surface of the femur. Insignificant bone growths are observed on the outer or inner edge of the acetabulum |
| The second | The height of the joint space is significantly reduced due to its uneven fusion. The bony head of the femur is displaced upwards, deformed, enlarged, its contours become uneven. Bone growths form on the surface of the inner and outer edge of the glenoid fossa |
| Third | There is a complete or partial fusion of the joint space. The head of the femur is greatly enlarged. Numerous bone growths are located on all surfaces of the acetabulum |
Diagnosis
When making the diagnosis, the doctor takes into account the clinical manifestations of the pathology, the anamnesis, the results of the external examination of the patient and instrumental examinations. Radiography is the most informative. With its help the condition of the hip joint, the stage of its course, the degree of damage to the cartilage tissues are assessed and in some cases the cause of the development is established. If the cervicodiffus node is enlarged and the acetabulum is inclined and flattened, then it is very likely that dysplastic congenital changes in the articulation will be accepted. Perthes disease or juvenile epiphysiolysis is indicated by an impaired shape of the hip bone. Radiography may reveal post-traumatic osteoarthritis, despite the lack of previous trauma in the history. Other diagnostic methods are also used:
- CT helps to detect the growth of the edges of the bone plates formed by osteophytes;
- MRI is performed to assess the condition of connective tissue structures and the degree of their involvement in the pathological process.
If necessary, the inner surface of the joint is examined with arthroscopic instruments. A differential diagnosis is made to rule out gonarthrosis, lumbosacral or thoracic osteochondrosis. Osteoarthritis pain can be disguised as clinical manifestations of radicular syndrome caused by nerve entrapment or inflammation. It is usually possible to rule out neurogenic pathology using a series of tests. Osteoarthritis of the hip joint must be differentiated from trochanteric bursitis of the hip joint, ankylosing spondylitis, reactive arthritis. To rule out autoimmune pathologies, biochemical tests of blood and synovial fluid are performed.
Tactics for drug treatment
Medical treatment is aimed at improving the patient's well-being. For this, drugs from different clinical and pharmacological groups are used:
- non-steroidal anti-inflammatory drugs (NSAIDs) - nimesulide, ketoprofen, diclofenac, ibuprofen, meloxicam, indomethacin, ketorolac. Injectable solutions are used to relieve acute pain, and pills, pills, ointments, gels help to relieve pain of mild or moderate severity;
- glucocorticosteroids - triamcinolone, dexamethasone, hydrocortisone. They are used in the form of intra-articular blockades in combination with anesthetics Procaine, Lidocaine;
- muscle relaxants - Baclofen, Tizanidine. They are included in the schemes for the treatment of skeletal muscle spasm, pinching of sensitive nerve endings;
- drugs that improve blood circulation in the joint - nicotinic acid, aminophylline, pentoxifylline. Prescribed to patients to improve tissue trophism, prevent disease progression;
- chondroprotectors. Effective only in stages 1 and 2 of osteoarthritis.
Rubbing ointments with a warming effect helps to eliminate mild pain. The active ingredients of external agents are capsaicin, cinquefoil, camphor, menthol. These substances are characterized by local irritant, distracting, analgesic action. Compresses on the joints with dimethyl sulfoxide, medical bile will help you cope with puffiness, morning swelling of the thigh. Classical, acupressure or vacuum massage for coxarthrosis is recommended for patients. Daily exercise therapy is an excellent prevention of further progression of osteoarthritis.
Surgical intervention
With the ineffectiveness of conservative therapy or the diagnosis of pathology complicated by ankylosis, surgery is performed. It is impossible to restore the cartilage tissue in the joint damaged by osteoarthritis without surgical prosthetics, but with the right approach to treatment, compliance with all medical prescriptions, maintaining a proper lifestyle, doing therapeutic exercises, regular massage courses, takingvitamins and proper nutrition, you can stop the process of lesion and destruction of cartilage and hip joints.