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Coxarthrosis

Arthritis of the hip (coxarthrosis) is a chronic pathology, which is accompanied by the gradual destruction of the cartilage tissue of the affected area, which entails the involvement of adjacent structures in the process. This disease requires long-term treatment, in severe cases, the only way to regain mobility is joint replacement.

hip arthritis

General information

Coxarthrosis belongs to the group of degenerative diseases. It begins gradually with microscopic changes in the structure of cartilage. Increased stress, inflammatory diseases, disorders of blood supply lead to structural changes and thinning of cartilage tissue, which, in turn, deform the contours of the joint area. As a result, the load distribution across the contact surfaces of the bones changes, and areas of maximum pressure begin to wear out more rapidly. This causes a variety of pathological reactions:

  • the appearance of small cracks and areas of compaction in the cartilage tissue;
  • reduce the smoothness of the joint surface;
  • overgrown cartilage at the site thins out and is replaced by bone tissue;
  • the appearance of osteogenic (growing bone) substances along the edges of the joint site;
  • thickening and decreased elasticity of the joint capsule;
  • stiffness and decreased strength of the ligaments;
  • change in the composition of the synovial fluid (natural lubrication inside the joint);
  • narrowing of joint space;
  • fusion of all elements of the joint (ankylosing spondylitis).

If left untreated, coxarthrosis inevitably leads to immobility and disability.

Reason

Depending on the cause of the development of the disease, primary and secondary coxarthrosis are distinguished. In the first case, it occurs on its own, for example, against the background of a genetic predisposition, in the second, it is provoked by other diseases or injuries. In most cases, cartilage degeneration occurs due to a combination of several factors. The reason could be:

  • congenital hip dislocation;
  • flat feet, scoliosis and other orthopedic problems;
  • Legg-Calve-Perthes disease;
  • arthritis (arthritis), regardless of origin;
  • Injuries and minor injuries of the hip joint due to overweight, professional sports, etcv. ;
  • hip dysplasia;
  • metabolic disorder;
  • endocrine diseases (especially diabetes);
  • violation of blood supply to the lower extremities;
  • frequent stress;
  • hereditary (coxarthrosis in parents or other close relatives significantly increases the risk of developing this disease in a child);
  • Congenital and autoimmune diseases of the connective tissue (joint hypermobility, rheumatoid arthritis, systemic lupus erythematosus, etc. );
  • through joint activities.

Age is an important influencing factor. According to statistics, after the age of 45, the likelihood of coxarthrosis increases significantly.

Symptom

The main symptoms of coxarthrosis of the hip do not depend on the cause of development. Most patients note:

  • limited mobility: one of the earliest symptoms due to thinning of the cartilage layer and increased friction on the articular surface of the bones; in the future, the appearance of cartilage proliferation aggravates the problem;
  • pain: friction of bones stripped of cartilage against each other, the gradual participation of all elements of the joint in the degenerative process, a decrease in blood supply to tissues causes pain sensations that increase as the disease progresses; the pain is spontaneous and usually gets worse at the end of the day;
  • muscle spasms, leading to increased pain symptoms and limited range of motion of the joints;
  • reduced leg length: this symptom appears in the later stages of the disease due to the gradual narrowing of the joint cavity and the gradual grinding of the bones due to constant friction; the difference between the pins can be up to 2 cm;
  • lameness: associated with severe pain and limitation of movement, as well as shortening of the legs; is an adverse sign that the joint apparatus is severely damaged.

Stages

During development, coxarthrosis goes through several stages, which depend on the extent of tissue damage.

  • 1 degree. At this time, the patient noted mild pain in the joints that appeared after intense or prolonged physical activity and quickly passed after rest. As a rule, discomfort occurs precisely in the area of the hip joint, but in some cases it extends to the hip or knee. The gait does not change, the leg movements are preserved intact. On the roentgenogram, specific changes are noted: subchondral sclerosis.
  • Grade 2. Pain becomes more severe, arises after exertion, spreads to the entire thigh and groin. After exertion, mild lameness may occur. Difficulty in foot abduction foundX-rays show a significant decrease in interosteal space (50% or more), femoral head deformity, and marked bony growth.
  • 3 degrees. The pain became permanent, walking without a cane became impossible. When moving, the patient pays attention to the side of the pain, which increases the load on the joint. Range of motion is reduced, calf and gluteal muscles atrophy. There is shortening of the affected limb. X-ray showed a significant deformity of the joint, a change in the contour of the femoral head, and a large number of osteoblasts.
  • 4 degrees. The pain grew stronger and did not stop for a minute, the patient lost the ability to move independently. X-rays show complete destruction of the articular cartilage, as well as signs of bone fusion (ankylosing spondylitis). To cope with the disease at this stage can only be surgery.

Diagnose

An orthopedic surgeon is responsible for identifying symptoms and selecting treatment options. To diagnose and determine the extent of the disease, he uses:

  • survey: listen to patient complaints, identify risk factors (injury, disease, genetics, etc. );
  • examination: assess the mobility of the extremities, determine the most painful areas;
  • X-ray: X-ray images help to evaluate the condition of the bones and cartilage, the size of the joint cavity, the presence and location of bony growths; To see the necessary details more thoroughly, the study was supplemented by CT (computed tomography);
  • laboratory diagnosis: a general blood test allows you to identify signs of inflammatory processes, biochemical - note some risk factors, for example, the level of uric acid;
  • MRI (magnetic resonance imaging): allows you to assess the condition not only of bones and cartilage, but also of soft tissues: bones, ligaments, muscles, joint capsule, etc. v. ;
  • perforation of the joint.

If it is necessary to carry out differential diagnosis with other diseases, as well as evaluate for concomitant diseases, additional tests, instrumental examination and consultation of narrow specialists are indicated.

Treatment of coxarthrosis

Treatment for coxarthrosis of the hip depends on the stage and severity of symptoms. Pathology requires an integrated approach using different methods:

  • therapeutic drugs;
  • non-drug treatment (physical therapy, therapeutic exercise);
  • surgery;
  • lifestyle and dietary adjustments.

Medicines for treatment

Medications prescribed for arthritis of the hip are intended to:

  • eliminate pain syndrome;
  • restore or at least slow down the destruction of cartilage tissue;
  • improve blood supply and nutrition to the affected area;
  • concomitant treatment of diseases.

Analgesics are used in the form of tablets, intramuscular and intraocular injections and topical agents: creams, ointments, patches. In the early stages of disease development, non-steroidal anti-inflammatory drugs are sufficient for most patients. With severe pain syndrome, hormonal agents are used. Putting painkillers directly into the joint tablet works well.

If the course of the disease is accompanied by muscle spasticity, use muscle relaxants. They are used in combination with other pain relievers.

Taking pain relievers should be limited in time and dosage, so as not to cause further damage to cartilage tissue and other side effects (especially the development of gastritis and stomach ulcers).

Chondroprotectors are drugs that help restore cartilage tissue. They are only effective with regular long-term use, in combination with other treatments, lifestyle and dietary modifications. Drugs that improve blood microcirculation enhance the effect. For a similar purpose, warming ointments are prescribed. Only the doctor is involved in the selection of dosage and regimen.

Non-drug treatment

This category includes various manual and physical therapy techniques, as well as physical therapy exercises. They help improve microcirculation and restore motion in damaged joints. Depending on the case, the doctor prescribes:

  • shock wave therapy;
  • acupuncture therapy;
  • electrical stimulation;
  • types of electrophoresis and phonophoresis (accompanied by the use of anesthetics);
  • physiotherapy;
  • massage therapy and exercise.

Surgery

If the disease has reached the advanced stage 3-4, drugs and physical therapy will only alleviate the patient's condition but cannot restore full mobility to the patient. In this case, arthroplasty is indicated, i. e. complete or partial replacement of the damaged joint with titanium prostheses.

If indicated, a milder version of the intervention is performed: grinding the exposed areas of the bones and covering them with special smooth implants that facilitate sliding.

Prevent

Lifestyle can significantly reduce the risk of developing coxarthrosis, as well as the rate at which the disease progresses. It is important to strictly follow the rules:

  • lead an active lifestyle: swimming in the pool, walking, cycling - non-record amateur physical activities improve blood supply and inhibit degenerative processes;
  • normalize body weight to reduce the load on the legs;
  • eliminate trauma, hypothermia and occupational risk factors (vibration, weight lifting, standing work);
  • promptly treat all diseases, including those not directly related to the musculoskeletal system;
  • Correct posture disorders in time, wear comfortable footwear.

Diet

With the help of nutritional adjustment, patients can not only reduce body weight, but also reduce inflammatory reactions, salt deposition in tissues and metabolic disorders. You should follow a balanced menu with enough but not too much carbohydrates, proteins and fats as well as vitamins and minerals. Particular attention should be paid to unsaturated fats (olive and flaxseed oils), omega-3 acids (found in fish), collagen (jelly meat, aspic). It is recommended to minimize fast carbohydrates, alcohol, strong coffee, products with artificial flavors, preservatives and flavor enhancers.

Consequences and complications

Coxarthrosis is one of the most common causes of disability in the elderly. Without proper treatment, the disease inevitably leads to complete disability, especially bilateral damage. Pain and limited mobility don't allow you to work and take care of yourself, which is why getting treatment on time is so important.