Coxarthrosis affects the hip joints of middle-aged and elderly people. The causes of its development are previous injuries, congenital and acquired diseases that are inflammatory or non-inflammatory. The main symptoms of coxarthrosis are pain in the hip joint, morning swelling and stiffness of movement. In the early stages of pathology, treatment is conservative. If it is ineffective against the background of rapid development of coxarthrosis or its late detection, surgical intervention, usually endoprosthetics, is indicated.
Description of the pathology
Coxarthrosis (osteoarthrosis, arthrosis deformans) is a degenerative-dystrophic pathology of the hip joint. In the early stages of development, the structure of the synovial fluid changes. It becomes viscous, thick, and therefore loses its ability to nourish hyaline cartilage. Due to dehydration, the surface becomes dry and covered with various radial cracks. In this condition, hyaline cartilage does not cushion shock well when the bones that make up the joint come into contact.
To adapt to the increased pressure that occurs on them, the bone structure changes shape with the formation of growths (osteophytes). Metabolism in the hip joint deteriorates, which has a negative effect on the muscles and ligaments-tendons of the joint.
Degree
Each stage is characterized by its own symptoms, the severity of which depends on the degree of narrowing of the joint space and the number of bone growths formed.
| Severity of coxarthrosis | Characteristic symptoms and radiographic signs |
|---|---|
| First | The joint space is unevenly narrowed, and a single osteophyte has formed around the acetabulum. Mild discomfort occurs, but more often the disease is not clinically manifested |
| Second | The joint space is narrowed almost 2 times, the head of the femur is displaced, deformed, enlarged, and bone growth is found even outside the cartilage lip. Hip pain becomes constant and is accompanied by significant limitation of movement |
| Third | Complete or partial fusion of the joint space, double bone growth, expansion of the femoral head. The pain occurs day and night and spreads to the thighs and legs. Movement can only be done with the help of crutches or crutches |
Cause of disease
Primary coxarthrosis is a destructive-degenerative lesion of the hip joint, the causes of which have not been established. This means that no prerequisites for premature destruction of hyaline cartilage have been identified. The following pathological conditions can trigger secondary coxarthrosis:
- previous injuries - fracture of the femoral neck or pelvic bone, dislocation;
- hip dysplasia;
- aseptic necrosis of the femoral head;
- congenital hip dislocation;
- inflammation, including infectious diseases of the joints (rheumatoid, reactive arthritis, gout, tendinitis, bursitis, synovitis).
Prerequisites for the development of coxarthrosis are obesity, increased physical activity, inactive lifestyle, metabolic disorders, hormonal disorders, kyphosis, scoliosis, and flat feet.
Disease symptoms
In the early stages of development, coxarthrosis can manifest itself only with mild pain. It usually occurs after vigorous physical activity or a day's work. The person attributed the decline in health to muscle "fatigue" and did not seek medical help. This explains the frequent diagnosis of coxarthrosis at stage 2 or 3, when conservative therapy is ineffective.
Limited joint mobility
The range of motion in the hip joint is reduced due to compensatory growth of bone tissue, damage to the synovial membrane, and replacement of the articular capsule area with fibrous tissue without any functional activity. Mobility may be somewhat limited even with grade 1 coxarthrosis. Difficulty arises when performing rotational movements with the legs.
As the disease progresses, morning stiffness and joint swelling become common. To regain mobility, one needs to warm up for a few minutes. By lunchtime, range of motion is restored, including as a result of the production of hormone-like substances in the body.
Crunch
When walking, bending and (or) extending the hip joint, clicks, pulsations and crackles are clearly heard. The reason for the sound accompaniment of each step is the friction of bone surfaces, including osteophytes, against each other. Crackling can also appear in normal health due to the collapse of carbon dioxide bubbles in the joint cavity. Coxarthrosis is indicated by its combination with dull or sharp pain.
ill
Painful sensations become constant already at the 2nd stage of coxarthrosis. Their severity is somewhat reduced after a long rest. The pain worsens during subsequent relapses or the development of synovitis (inflammation of the synovial membrane) that often accompanies osteoarthritis. During the remission stage, the discomfort decreases slightly. But as soon as a person becomes hypothermic or lifts a heavy object, severe pain appears again.
Muscle cramp
Increased tension in the skeletal muscles of the thigh occurs with coxarthrosis for several reasons. First, the ligaments become weak. Muscle spasm to hold the head of the femur in the acetabulum. Second, increased tone often accompanies inflammation of the synovial membrane. Third, when osteophytes are displaced, nerve endings are compressed, and muscle spasm becomes a compensatory response to acute pain.
Defects
At the final stage of the development of coxarthrosis, the patient begins to suffocate severely. Changes in gait are provoked by flexion contractures and bone surface deformation, making it impossible to maintain a straight leg position. The person also limps to reduce the severity of the pain by transferring weight to the unaffected limb.
Leg shortening
Shortening of the leg by 1 cm or more is typical for grade 3 coxarthrosis. The reasons for the decrease in the length of the lower limb are severe muscle atrophy, thinning and flattening of the cartilage, narrowing of the joint space, and deformation of the femoral head.
Diagnostic methods
The initial diagnosis is made based on the patient's complaints, external examination, medical history, and the results of several functional tests. Many inflammatory and non-inflammatory pathologies masquerade as symptoms of coxarthrosis, so instrumental and biochemical studies are carried out.
X-ray examination
The degree of coxarthrosis is determined by performing an X-ray examination. The resulting image clearly shows the destructive changes in the hip joint. This is the narrowing of the joint space, the deformation of the bone surface, and the formation of osteophytes.
CT scan
A CT scan is prescribed to the patient to determine the degree of flattening and deformation of the hyaline cartilage. The results of the study also make it possible to assess the condition of the apparatus of ligaments-tendons, nerve trunks, muscles, small and large blood vessels.
Magnetic resonance imaging
MRI is one of the most informative studies in the diagnosis of coxarthrosis. To identify blood circulation disorders in the affected joint area, it is done with contrast. Routine studies are prescribed to determine the degree of damage to the ligaments and deformation of the femoral head, and to detect areas of fibrous degeneration of the articular capsule.
Foot length measurement
Before the measurement, the doctor asks the patient to stand up and straighten his legs as much as possible. To get the most reliable data, orthopedic specialists use two bone landmarks. Upper - the anterior axis of the pelvic bone, located on the anterior lateral surface of the abdomen at the outer edge of the inguinal ligament. The second reference point is any bony structure of the knee, ankle or heel. Measuring leg length may not be informative if coxarthrosis affects two hip joints at once.
Laboratory research
Clinical blood and urine tests are performed to assess the patient's general health. And the results of biochemical studies often make it possible to detect pathologies that cause the development of coxarthrosis. Gouty arthritis is characterized by high levels of uric acid and its salts. An increase in the rate of erythrocyte sedimentation and an increase in the number of leukocytes indicates the occurrence of an inflammatory process (bursitis, arthritis, synovitis). To exclude rheumatoid arthritis, rheumatoid factor, C-reactive protein, and antinuclear antibodies are determined.
Hip piercing
Using a puncture, synovial fluid is collected to study its composition and detect changes in consistency. If an infectious inflammatory process is suspected, further biochemical examination of biological samples is indicated.
Treatment options
When determining treatment tactics, orthopedic specialists take into account the severity of coxarthrosis, the form of its course, the cause of development, and the severity of symptoms. Patients are often recommended to wear a bandage with rigid ribs and orthosis from the first day of treatment. The use of orthotics helps slow down cartilage damage and bone deformation.
Medicines
In the treatment of deforming arthrosis, drugs of various clinical and pharmacological groups are used. These are nonsteroidal anti-inflammatory drugs (NSAIDs), muscle relaxants, glucocorticosteroids, chondroprotectors, ointments and gels with a warming effect.
Restrictions
To relieve acute pain that cannot be eliminated by NSAIDs, intra-articular or periarticular drug blockade is prescribed. To carry it out, hormonal agents are used. The analgesic effect of glucocorticosteroids is enhanced by their combination with anesthetics.
Injection
Intramuscular injection of NSAID solution allows you to get rid of severe pain in the hip joint. To relax skeletal muscles, drugs are usually used, which, in addition to muscle relaxants, include anesthetics. In the form of injections, the therapeutic regimen includes B vitamins, drugs to improve blood circulation, and chondroprotectors.
Diet therapy
Overweight patients are advised to lose weight to slow down the spread of pathology to healthy joint structures. The caloric content of the daily menu should be limited to 2000 kilocalories by excluding foods high in fat and simple carbohydrates. Nutritionists recommend that all patients with coxarthrosis adhere to proper nutrition. The diet should contain fresh vegetables, fruits, berries, cereal porridge, fatty sea fish, and dairy products. Following a therapeutic diet stimulates the strengthening of the immune system and improves overall health.
Exercise and massage therapy
In the treatment of coxarthrosis, classical massage, acupressure, and vacuum are used. After several sessions, blood circulation in the hip joint improves and nutrient reserves are replenished. Carrying out massage procedures stimulates the strengthening of the ligament-tendon apparatus and the restoration of soft tissue damaged by osteophyte displacement.
Regular exercise therapy is one of the most effective ways to treat osteoarthritis. A set of exercises is prepared by a physical therapist individually for the patient, taking into account his physical fitness.
Physiotherapy
Patients with coxarthrosis are prescribed up to 10 sessions of magnetic therapy, laser therapy, UHF therapy, UV irradiation and shock wave therapy. The therapeutic effect of the procedure is due to better blood circulation, acceleration of metabolism and regeneration processes. To relieve acute pain, electrophoresis or ultraphonophoresis with glucocorticosteroids, anesthetics and B vitamins is performed. Application with ozokerit or paraffin helps to get rid of discomfort.
Surgical intervention
If conservative treatment is ineffective, pain that cannot be relieved by medication, or the development of coxarthrosis continues, the patient is advised to undergo surgical intervention. The operation is performed immediately in case of pathology of the 3rd degree of severity, because it is not possible to eliminate the destructive changes in the cartilage and bones by taking drugs or exercise therapy.
Arthroplasty
The operation is performed using general anesthesia. The head of the femur is removed from the acetabulum. Destructive changes that can be seen in the tissue are corrected - bone growth is removed, the articular surface is flattened, tissue that has undergone necrosis is removed. During surgery, a cavity is formed and filled with a ceramic implant.
Endoprosthetics
Hip replacement with implants is performed under general anesthesia. To prevent the development of an infectious process, a course of antibiotics is prescribed. After 10 days, the sutures are removed and the patient is discharged from the medical facility. At the recovery stage, patients are shown physiotherapeutic procedures and massage, exercise therapy.
Possible consequences
In the late stages of pathology, flexion and adduction contractures develop. The patient's legs are always bent, so he uses crutches or crutches to move. After complete fusion of the joint space, immobility occurs, the patient cannot do housework, and becomes disabled. Coxarthrosis is often complicated by aseptic necrosis of the femoral head, arthrosis of the knee joint, and arthritis.
Prevention and prognosis
Only grade 1 coxarthrosis responds well to conservative treatment. In other cases, endoprosthetics allow you to fully restore the functional activity of the hip joint. After the installation of the endoprosthesis, the patient quickly returns to an active lifestyle.
To prevent this disease, orthopedists recommend quitting smoking, abusing alcoholic beverages, doing physical therapy and gymnastics every day, and losing excess weight if necessary.