Coxarthrosis: arthrosis of the hip joint

Osteoarthritis of the hip joint or coxarthrosis is a chronic, slow degenerative process in the joint of the head of the femur and the acetabulum of the pelvic bone. In this disease, bone and cartilaginous tissues are deformed, which, as it progresses, leads to significant limitation of movements in the leg and damage. All components of the joint are involved in the process: bones, joint capsules covering them, cartilages, ligaments, muscles. Symptoms and treatment of osteoarthritis of the hip (coxarthrosis) vary from person to person; the disease usually occurs in middle-aged and elderly people, although such changes can develop after 20 years.

The main signs of arthrosis of the hip joint (coxarthrosis) are pain and stiffness of movements. Most often, its development is preceded by injuries, as well as joint pathologies of an inflammatory and non-inflammatory nature. Coxarthrosis is one of the most common arthrosis, which is associated with a significant load on the hip joint.

In its development, the disease goes through several stages. In the early stages, coxarthrosis can be treated conservatively, but as the process progresses, only surgical treatment is effective. That is why you should not delay visiting a specialist and make an appointment for a consultation. In the clinics, you can undergo an examination and receive conservative treatment.

reasons

Coxarthrosis of the hip joint can be primary or secondary, that is, occurring against the background of any disease of the musculoskeletal system or injury. Let's take a closer look at the factors influencing the development or leading to coxarthrosis of the hip joint.

• Exogenous- these are environmental factors: heavy physical exertion, consequences of severe injuries - fractures, sprains, torn ligaments, unfavorable working conditions associated with lifting weights, prolonged sitting.
• Endogenous— these are chronic infectious-inflammatory and autoimmune diseases: rheumatoid, reactive, psoriatic arthritis. As well as metabolic disorders: gout, diabetes.
• Congenital diseases.Dysplasia (impaired formation of joints) and osteochondropathy (malnutrition of joint structures with subsequent necrosis, destruction of bones) can also lead to coxarthrosis. For example, congenital luxation of the hip joint, aseptic necrosis of the femoral head - Perthes disease.
• Genetic predispositionoften causes coxarthrosis of the hip joints. This involves a mutation in the type II procollagen gene.
• Old age.More often, the development of coxarthrosis of the hip joint is due to inevitable age-related changes.
• Floor. Osteoarthritis is thought to occur more often in women than in men. This is due to the influence of the female sex hormone estrogen on mineral metabolism and bone density.
• Excess body weight.There is a direct relationship between excess body weight and the onset of osteoarthritis. The greater the body weight, the more likely to develop arthrosis of the hip joint, because excess fat tissue increases the load on the joints, and fat tissue produces pro-inflammatory substances that damage cartilage tissue.
• Professional sportcan cause the development of coxarthrosis due to excessive load on the joints and frequent injuries. Potentially dangerous sports include weightlifting, skydiving and acrobatics.

Under the influence of these factors, changes gradually occur in the joint cavity at the cellular level: the processes of decay begin to prevail over the processes of synthesis, the metabolism changes, the volume of the joint fluid that nourishes the cartilage tissue decreases and the cartilage becomes thinner. As a result, the joint "dries up" and decreases in volume. On the edges of the articular surfaces of the bones, bone growths appear - osteophytes, which reduce the range of motion in the joint and thus reduce the load on it.

Symptoms

How quickly does arthrosis of the hip joint (coxarthrosis) develop? The symptoms grow gradually and in the first stages a person may not pay the necessary attention to them and write them off as fatigue. This is dangerous because treatment is more effective at the beginning of the degenerative process.

The first clinical symptoms of coxarthrosis are pain, limited range of motion, caused by muscle spasm.

The pain can vary in intensity and duration. In the beginning, the unpleasant sensations are mild and short-lived. The provoking factor for their appearance is prolonged walking or intense physical activity.

Limitation of joint mobility occurs due to severe pain. The patient's gait changes: the buttocks protrude backward, the body leans forward when the weight is transferred to the injured side, and the person limps.

Edema in the joint area is also possible, which is usually imperceptible due to the muscle and fat layer, crunching in the joints when moving, functional shortening of the lower limb.

The presence of certain signs and their severity depends on the stage of coxarthrosis. There are 4 clinical and diagnostic stages of coxarthrosis, which are determined by the degree of damage to the articular cartilage:

• Coxarthrosis 1 degreecharacterized by asymptomatic or intermittent pain that occurs only after vigorous physical activity, such as running or prolonged walking. The pain is localized in the area of the joint, less often it spreads to the entire hip and even to the knee. After a rest it usually disappears. X-ray of the hip joint shows no changes or slight narrowing of the joint space. MRI reveals signs of cartilage tissue heterogeneity.
• In coxarthrosis of the 2nd degreethe pain becomes more intense, occurs with little physical exertion, and sometimes at rest, and may radiate to the thigh and groin area. Lameness appears after significant physical exertion. The range of motion in the joint is reduced: abduction and internal rotation of the hip is limited. X-rays revealed a clear irregular narrowing of the joint space and isolated osteophytes - growths of bone tissue - along the edge of the glenoid cavity. MRI of stage 2 coxarthrosis reveals obvious cartilage erosions and cracks with thinning less than half.
• In coxarthrosis of the 3rd degreethe pain becomes constant and often disturbs patients during sleep. Walking is difficult, which forces the patient to take a forced position of the body, relying on a strong leg or a cane. The range of motion in the joint is severely limited. On radiographs, the joint gap is practically absent, and numerous osteophytes have formed on the bone surfaces. MRI showed destruction of more than half the volume of cartilage tissue. However, the third stage can still be treated conservatively.
• Stage 4 arthrosis of the hip joint (coxarthrosis)characterized by significant loss of joint function. The whole leg hurts: joint, groin, gluteal area, hip, knee, ankle. Flat feet develop, the leg shortens and its muscles atrophy. On X-ray: multiple large osteophytes, the joint space is absent or narrowed to a minimum. Stage 4 is not subject to conservative treatment, hip replacement is performed. The operation reduces pain, improves leg function and the patient's quality of life.

Diagnosis of arthrosis of the hip joint

The basis for diagnosing arthrosis of the hip joint is the initial consultation with a specialist. The doctor clarifies the complaints: where the pain is localized, when and why it appears, where it goes, what reduces and intensifies it, what causes it. Then a visual inspection, palpation, assessment of the gait is required and special tests are carried out to detect joint dysfunction.

The diagnosis of coxarthrosis is made on the basis of clinical signs and data from additional instrumental studies, the main of which is radiography of the joint. There are no characteristic laboratory signs for the diagnosis of arthrosis, but a clinical blood test may be necessary for the differential diagnosis of coxarthrosis and arthritis. In this case, the specialist will take into account the level of leukocytes, ESR, C-reactive protein and uric acid.

Of the instrumental methods for diagnosing arthrosis of the hip joints, radiography is usually sufficient. This is an accessible study that reveals changes characteristic of coxarthrosis: narrowing of the joint gap, osteophytes, erosions and ulcers on the cartilage surface, cysts. X-rays of patients with coxarthrosis may also reveal changes indicative of trauma.

CT and MRI can be used as other instrumental diagnostic methods. Computed tomography allows for a more detailed study of pathological changes in bone structures, and magnetic resonance imaging enables assessment of soft tissue disorders.

Which doctor should I contact?

This pathology is treated by orthopedic traumatologists. But depending on the nature and course of the disease, consultations with other specialists may be necessary:

• surgeon to exclude surgical pathology requiring surgical intervention;
• phthisiologist to rule out bone tuberculosis;
• oncologist to rule out malignant neoplasms;
• endocrinologist for concomitant metabolic disorders;
• a neurologist if compression of the spinal nerve roots by an intervertebral hernia of the lumbosacral spine is suspected.

Treatment

The choice of treatment method depends on the stage of the disease. To treat bilateral arthrosis of the hip joint (coxarthrosis) grade 1, it is often enough to change your lifestyle and increase physical activity. At stage 2, conservative treatment is used, which includes medication and physical therapy procedures. Stage 3 is less curable, but surgery can still be avoided, which cannot be said for stage 4. The goal of conservative treatment is to improve the quality of life, as well as to stop or slow down the rate of development of degenerative changesin the joint.

Drug therapy for coxarthrosis includes drugs that reduce the symptoms of the disease. These are nonsteroidal anti-inflammatory drugs that are used short-term to relieve pain and inflammation. Corticosteroids and muscle relaxants are sometimes used to relieve severe pain and muscle tension.

Non-drug therapy includes:

• Reducing the load on the hip joint.Depending on the situation, the patient may be advised to reduce body weight, create additional support and transfer body weight to a cane or crutches.
• Remedial gymnastics.A properly selected set of exercises helps to improve joint mobility, reduce pain and prevent muscle atrophy.
• Physiotherapy methods of treatment.For coxarthrosis of the hip joint, courses are prescribed: magnetic therapy, laser therapy, shock wave therapy.
• PRP therapy.The method involves introducing one's own blood plasma into the joint, which helps relieve pain, inflammation and improve the recovery of damaged joint tissue.
• Kinesio taping.This is the placement of special patches on the skin, which relieves the load on the joint.
• Acupuncture.A method based on the introduction of sterile needles into biologically active points. It effectively relieves pain and relaxes the muscles around the joint.

For each patient, doctors develop an individual course of treatment, which may include different methods depending on the severity of symptoms, the stage of the disease, age and state of health. The integrated approach to treatment guarantees high efficiency of the procedures and quick recovery, only drug therapy may not give the expected result.

Hip replacement is used in severe cases of the disease, when the pain cannot be eliminated and the mobility of the joints is significantly limited.

Consequences

Pathological changes in the joint can lead to:

• Subluxation and luxation of the hip joint. In this case, movements in the leg are sharply limited, severe pain occurs, hospitalization in the trauma department, sometimes surgical intervention is necessary.
• Local inflammatory processes: bursitis and tendovaginitis.
• Compression of the sciatic nerve by large osteophytes, which is accompanied by severe, shooting pain down the back of the leg.
• Ankylosis is complete immobility of the joint, which significantly reduces the patient's quality of life.
• Reduced physical activity, constant pain and limited joint mobility. In the future, this leads to obesity and depression.
• Stomach and heart diseases if you take non-steroidal anti-inflammatory drugs for a long time and often.

Prevention

For a comfortable and quality life without coxarthrosis, you should adhere to the following recommendations:

• See a doctor immediately if you experience hip pain.
• Be careful when playing strenuous sports, performing household and office physical activities, and lifting heavy objects.
• Control body weight through a balanced diet and regular physical activity.
• Avoid heavy physical work and sports overloads. It is moderate physical activity that improves the condition of the joint, maintains its normal mobility and reduces the load on the other joints.

Summary

1. Coxarthrosis is one of the most common arthrosis, which is caused by a significant load on the hip joint.
2. The main signs of arthrosis of the hip joint (coxarthrosis) are pain and stiffness of movements.
3. There are 4 degrees of coxarthrosis, 1-2 are amenable to conservative treatment, 3-4 - surgical. However, at stage 3, surgery can still be avoided if you follow all the doctor's recommendations.
4. Specialists use an integrated approach to treating coxarthrosis, which includes medication, physical therapy, manual therapy, nutritional correction, and physical activity.