Coxarthrosis: arthrosis of the hip joint

Hip joint arthrosis or coxarthrosis is a chronic and slow degenerative process in the articulation of the head of the femur and the acetabulum of the pelvic bone. With this disease, the bone tissue and cartilage change shape, which, as it progresses, leads to significant limitations of movement in the legs and deformities. All components of the joint are involved in the process: bone, articular capsule that covers it, cartilage, ligaments, muscles. Symptoms and treatment of hip joint arthrosis (coxarthrosis) vary from person to person; this disease usually occurs in middle-aged and elderly people, although such changes can develop after 20 years.

The main symptoms of hip joint arthrosis (coxarthrosis) are pain and stiffness of movement. Often, its development is preceded by injury, as well as inflammatory and non-inflammatory joint pathology. Coxarthrosis is one of the most common arthrosis, which is associated with a significant load on the hip joint.

In its development, this disease goes through several stages. In the early stages, coxarthrosis can be treated conservatively, but as the process progresses, only surgical treatment is effective. Therefore, you should not delay a visit to a specialist and register for a consultation. At the clinic you can undergo an examination and receive conservative treatment.

Cause

Coxarthrosis of the hip joint can be primary or secondary, that is, arise against the background of any disease of the musculoskeletal system or injury. Let's consider in more detail the factors that influence the development or lead to coxarthrosis of the hip joint.

• Exogenous- these are environmental factors: heavy physical activity, as a result of major injuries - fractures, dislocations, torn ligaments, poor working conditions associated with heavy lifting, prolonged sitting.
• endogenous— these are chronic infectious-inflammatory and autoimmune diseases: rheumatoid, reactive, psoriatic arthritis. As well as metabolic disorders: gout, diabetes.
• Congenital disease.Dysplasia (impaired joint formation) and osteochondropathy (lack of nutrients in the joint structure with subsequent necrosis, bone destruction) can also cause coxarthrosis. For example, congenital dislocation of the hip, aseptic necrosis of the femoral head - Perthes disease.
• Genetic predispositionoften causes coxarthrosis of the hip joint. These include mutations in the type II procollagen gene.
• Elderly age.More often, the development of coxarthrosis of the hip joint is due to inevitable age-related changes.
• The floor. It is believed that osteoarthritis occurs 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.
• Overweight.There is a direct relationship between excess weight and the occurrence of arthrosis. The greater the body weight, the greater the possibility of developing arthrosis of the hip joint, because excess adipose tissue increases the load on the joint, and adipose tissue produces pro-inflammatory substances that damage cartilage tissue.
• Professional sportscan cause the development of coxarthrosis due to excessive pressure on the joint and frequent injuries. Potentially dangerous sports include weightlifting, parachuting and acrobatics.

Under the influence of these factors, changes gradually occur in the articular cavity at the cellular level: the decay process begins to overcome the synthesis process, metabolism changes, the amount of joint fluid that nourishes the cartilage tissue decreases, and the cartilage becomes thinner. As a result, the joints "dry" and decrease in volume. Along the edges of the articular surface of the bones, bone growths appear - osteophytes, which reduce the range of motion in the joint and thereby reduce the load on it.

symptoms

How quickly does arthrosis of the hip joint (coxarthrosis) develop? Symptoms increase gradually, and in the first stage a person may not pay due attention to them and write them off as fatigue. This is dangerous, because it is at the beginning of the degenerative process that the treatment brings a greater effect.

The first clinical symptom of coxarthrosis is pain, limited range of motion caused by muscle spasms.

Pain can vary in intensity and duration. At first, the unpleasant sensations are mild and short-lived. The factor that provokes their appearance is prolonged walking or intense physical activity.

Limitation of joint movement occurs due to severe pain. The patient's gait changes: the back protrudes backward, the body leans forward when transferring body weight to the injured part, and the person limps.

Swelling in the joint area is also possible, which is usually not visible due to the layer of muscle and fat, crackling in the joints when moving, shortening of the function of the lower limbs.

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:

• 1st degree coxarthrosischaracterized by asymptomatic or periodic pain that occurs only after intense physical activity, such as running or long walking. The pain is localized in the joint area, less often it spreads to the whole thigh and even the knee. After resting, it usually disappears. There is no change in the x-ray of the hip joint or there is slight narrowing of the joint space. MRI reveals signs of cartilage tissue heterogeneity.
• For 2 degree coxarthrosispain becomes stronger, appears with little physical activity, and sometimes at rest, and can radiate to the thigh and groin area. Lameness appears after significant physical exertion. Range of motion in the joint is reduced: abduction and rotation into the hip is limited. X-rays reveal clear, irregular narrowing of the joint space and isolated osteophytes—growths of bone tissue—along the rim of the glenoid cavity. MRI at the 2nd stage of coxarthrosis reveals clear erosions and cracks of the cartilage with its thinning less than half.
• For 3rd degree coxarthrosisthe pain becomes constant and often disturbs the patient during sleep. Walking is difficult, which forces the patient to take a forced position of the body, depending on the healthy leg or crutches. The range of motion in the joint is dramatically limited. On radiographs, the joint space is almost non-existent, and multiple osteophytes have formed on the bone surface. MRI showed the destruction of more than half of the total cartilage tissue. However, the third stage can still be treated conservatively.
• Stage 4 hip joint arthrosis (coxarthrosis)characterized by significant loss of joint function. The whole leg hurts: joints, groin, gluteal area, hips, knees, ankles. Flat feet develop, legs shorten, and the muscles atrophy. On the radiograph: multiple large osteophytes, the joint space is absent or reduced to a minimum. Stage 4 cannot receive 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 an initial consultation with a specialist. The doctor explains the complaint: where the pain is localized, when and why it occurs, where it goes, what reduces and intensifies it, what causes it. Then visual inspection, palpation, gait assessment are required, and special tests are conducted to detect joint dysfunction.

The diagnosis of coxarthrosis is made based on clinical signs and data from additional instrumental studies, the main of which is joint radiography. There are no characteristic laboratory signs for the diagnosis of arthrosis, however, clinical blood tests 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 joint, radiography is generally sufficient. This is an accessible study that reveals the characteristic changes of coxarthrosis: narrowing of the joint space, osteophytes, erosion and ulceration of the cartilage surface, cysts. X-rays of patients with coxarthrosis may also reveal changes that indicate trauma.

CT and MRI can be used as other instrumental diagnostic methods. Computed tomography allows a more detailed study of pathological changes in bone structure, and magnetic resonance imaging provides an opportunity to evaluate soft tissue disorders.

Which doctor should I contact?

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

• surgeon to exclude surgical pathology that requires surgical intervention;
• phthisiatrician to exclude bone tuberculosis;
• oncologists to exclude malignant neoplasms;
• endocrinologist for concomitant metabolic disorders;
• neurologist, if there is suspicion of spinal nerve root compression by intervertebral hernia of the lumbosacral spine.

Treatment

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

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

Non-drug therapies include:

• Reduces the load on the hip joint.Depending on the situation, the patient may be advised to reduce the weight, make additional support and transfer the weight to crutches or crutches.
• Therapeutic exercise.Properly selected sets of exercises help improve joint mobility, reduce pain, and even prevent muscle atrophy.
• Physiotherapy treatment methods.For coxarthrosis of the hip joint, courses are prescribed: magnetic therapy, laser therapy, shock wave therapy.
• PRP therapy.This method involves the introduction of your own blood plasma into the joint, which helps relieve pain, inflammation, and improve the recovery of damaged joint tissue.
• Kinesio Recording.This is the use of special adhesive tape on the skin, which relieves the load on the joints.
• Acupuncture.The method is based on the introduction of a sterile needle into a biologically active point. Effectively relieves pain and relaxes the muscles around the joints.

For each patient, the doctor develops an individual course of treatment, which may include different methods depending on the severity of symptoms, stage of the disease, age and health status. An integrated approach to treatment guarantees a high effectiveness of the procedure and a quick recovery; Drug therapy alone may not provide the expected results.

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

Consequences

Pathological changes in the joints can cause:

• Subluxation and dislocation of the hip joint. In this case, movement in the leg is very limited, severe pain appears, hospitalization in the trauma department, and sometimes surgical intervention is required.
• Local inflammatory processes: bursitis and tendovaginitis.
• Compression of the sciatic nerve by a large osteophyte, which is accompanied by severe pain, shooting along the back of the leg.
• Ankylosis is the complete immobility of the joints, significantly reducing 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 disease if you take non-steroidal anti-inflammatory drugs for a long time and often.

Prevention

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

• Visit a doctor immediately if you experience pain in the hip joint.
• Be careful when engaging in strenuous sports, performing physical activities at home and work, and lifting heavy objects.
• Control your weight through a balanced diet and regular physical activity.
• Avoid heavy physical work and excessive sports load. It is a simple physical activity that improves the condition of the joints, maintains normal mobility and reduces the load on 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 symptoms of hip joint arthrosis (coxarthrosis) are pain and stiffness of movement.
3. There are 4 degrees of coxarthrosis, 1-2 can receive conservative treatment, 3-4 - through surgery. However, with stage 3, surgery can still be avoided if you follow all the doctor's recommendations.
4. Specialists use an integrated approach to the treatment of coxarthrosis, which includes drugs, physiotherapy, manual therapy, dietary correction and physical activity.