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Coxarthrosis

Arthrosis of the hip joint (coxarthrosis) is a chronic pathology accompanied by the gradual destruction of the cartilage tissue of the affected area, followed by the involvement of adjacent structures in the process. The disease requires long-term treatment, and in severe cases, the only way to restore mobility is to replace the joints.

Osteoarthritis of the hip joint

General Information

Coxarthrosis belongs to the group of degenerative diseases. It begins with gradual microscopic changes in cartilage structure. Increased stress, inflammatory diseases, disruption 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 distribution of the load on the contact surfaces of the bones changes, and the zones with maximum pressure begin to wear more quickly. This triggers a whole cascade of pathological reactions:

  • appearance of micro-cracks and areas of compression in cartilage tissue;
  • decrease in the smoothness of articular surfaces;
  • proliferation of cartilage and replacement of bone tissue at the site of thinning;
  • appearance of osteophytes (bone growths) along the edges of the articular region;
  • thickening and loss of elasticity of the joint capsule;
  • hardening and loss of strength of gardens;
  • changes in the composition of synovial fluid (natural lubrication inside the joint);
  • narrowing of the joint space;
  • combination of all elements of the joint (ankylosis).

Without treatment, coxarthrosis inevitably causes inactivity and disability.

Reasons

Primary and secondary coxarthrosis differ depending on the causes of the disease. In the first case, it occurs spontaneously, for example, against the background of hereditary predisposition, and in the second, it causes other diseases or injuries. In most cases, the process of degeneration of cartilage tissue occurs as a result of a combination of several factors. Can cause:

  • congenital dislocation of the hip;
  • flat feet, scoliosis and other orthopedic problems;
  • Legg-Calve-Perthes disease;
  • arthritis, regardless of its origin;
  • overweight, professional sports, etc. background injuries and microtraumas of the hip joint;
  • dysplasia of the hip joint;
  • metabolic diseases;
  • endocrine diseases (especially diabetes);
  • disruption of blood supply to the lower extremities;
  • frequent stress;
  • heredity (coxarthrosis in parents or other close relatives significantly increases the risk of developing a child);
  • congenital pathologies of connective tissue and autoimmune diseases (hypermobility of joints, rheumatoid arthritis, systemic lupus erythematosus, etc. );
  • joint operations were carried out.

Age is an important predisposing factor. According to statistics, the probability of developing coxarthrosis increases significantly after 45 years.

Symptoms

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

  • restriction of movement: one of the first symptoms due to thinning of the cartilage layer and increased friction of the joint surfaces of the bones; the appearance of cartilaginous growths in the future aggravates the problem;
  • pain: friction of bones deprived of a layer of cartilage against each other, the gradual involvement of all elements in the joint in the degenerative process, a decrease in blood supply to the tissues causes increased pain as the disease progresses; the pain is feverish in nature and often worsens towards the end of the day;
  • muscle spasms leading to increased pain symptoms and limited range of motion in the joint;
  • decrease in leg length: this symptom appears in the later stages of the disease due to the narrowing of the joint space and the gradual stoning of the bone heads due to constant friction; the difference between the legs can be up to 2 cm;
  • lameness: associated with severe pain and limited mobility, as well as shortening of the leg; is an unfavorable sign that it has caused serious damage to the joint apparatus.

Stages

In the process of development, coxarthrosis goes through several stages, depending on the degree of tissue damage.

  • 1 degree. In this case, the patient notices mild aching pains in the joint that occur after intense or prolonged physical activity and pass quickly after rest. As a rule, the discomfort occurs entirely in the hip joint area, but in some cases extends to the thigh or knee. The gait does not change, the foot movements are fully protected. The radiograph shows specific changes: subchondral sclerosis.
  • 2nd degree. The pain becomes more severe, occurs after tension, and spreads to the entire thigh and groin. After suffering, a slight lameness may appear. There are difficulties in abducting the leg. X-rays show a significant reduction in the distance between the bones (50% or more), deformity of the femoral head, and bone growth.
  • 3 degrees. The pain is permanent, it is impossible to walk without a cane. When moving, the patient leans significantly on the painful side, which further increases the load on the joint. The range of motion is reduced, the leg and hip muscles are atrophied. There is a shortening of the affected joint. X-ray reveals a significant deformation of the joint, a change in the contour of the femoral head and a large number of osteophytes.
  • 4 degrees. The pain becomes more intense and does not stop for a minute, the patient loses the ability to move independently. X-ray shows complete destruction of articular cartilage and signs of bone fusion (ankylosis). At this stage, the disease can be overcome only through surgery.

Diagnostics

An orthopedic traumatologist is responsible for identifying symptoms and choosing treatment. Uses the following to diagnose and determine the degree of the disease:

  • survey: listening to the patient's complaints, identifying risk factors (trauma, illness, heredity, etc. );
  • examination: assessment of mobility of the extremities, identification of the areas of greatest pain;
  • X-ray: X-ray image allows you to assess the condition of the bones and cartilage, the size of the joint space, the presence and location of bone growths; the study is supplemented by CT (computed tomography) to better see the necessary details;
  • laboratory diagnosis: general blood test allows to determine the signs of an inflammatory process, biochemical - some risk factors, such as uric acid levels;
  • MRI (magnetic resonance imaging): allows you to assess the condition of not only bones and cartilage, but also soft tissues: bones, ligaments, muscles, joint capsules, etc. ;
  • perforation of the joint.

If it is necessary to make a differential diagnosis with other diseases and assess concomitant pathologies, additional tests, instrumental examinations and consultations of narrow specialists are prescribed.

Treatment of coxarthrosis

Treatment of coxarthrosis of the hip joint depends on its stage and severity of symptoms. Pathology requires a holistic approach using different methods:

  • drug treatment;
  • drug-free treatment (physiotherapy, sports therapy);
  • surgery;
  • lifestyle adjustment and diet.

Drug treatment

Drugs prescribed for osteoarthritis of the hip joint:

  • removal of pain syndrome;
  • slow down the regeneration or at least the destruction of cartilage tissue;
  • improving blood supply and nutrition to the affected area;
  • treatment of concomitant pathologies.

Painkillers are used in the form of tablets, intramuscular and intraarticular injections and topical medications: creams, ointments, patches. In the early stages of the disease, non-steroidal anti-inflammatory drugs are sufficient for most patients. Hormonal substances are used with severe pain syndrome. The introduction of analgesics directly into the joint capsule has a good effect.

If the course of the disease is accompanied by muscle spasms, muscle relaxants are used. Used in combination with other analgesics.

The use of painkillers should be limited in time and dose to avoid further damage to cartilage tissue and other side effects (especially the development of gastritis and gastric ulcers).

Chondroprotectors are drugs that help restore cartilage tissue. These are only effective with long-term regular use combined with other treatments, lifestyle and dietary adjustments. Medications that improve blood microcirculation help increase the effect. Warming ointments are prescribed for a similar purpose. Only one doctor is involved in choosing the dose and regimen.

Drug-free treatment

This category includes various physiotherapy and hand techniques, as well as physiotherapy exercises. They help to improve microcirculation and restore movement in the damaged joint. Depending on the situation, the doctor prescribes:

  • shock wave therapy;
  • magnetotherapy;
  • electromyostimulation;
  • various types of electrophoresis and phonophoresis (accompanied by the use of anesthetic drugs);
  • mechanotherapy;
  • massage and exercise therapy.

Surgery

If the disease reaches stage 3-4, medication and physiotherapy will only alleviate the patient's condition, but will not restore full mobility. In this case, arthroplasty is indicated, ie. complete or partial replacement of the damaged joint with a titanium prosthesis.

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

Prevention

Lifestyle can significantly reduce the risk and rate of coxarthrosis. It is important to strictly follow the rules:

  • lead an active lifestyle: swimming in the pool, walking, cycling - physical activity at the amateur level without competing for records helps to improve blood supply and prevents joint degeneration processes;
  • normalize body weight to reduce the load on the legs;
  • eliminate injuries, hypothermia and occupational risk factors (tremors, weight lifting, standing work);
  • timely treat all diseases, including those not directly related to the musculoskeletal system;
  • correct posture disorders in time, wear comfortable shoes.

Diet

With the help of nutritional adjustment, the patient can not only reduce body weight, but also reduce inflammatory reactions, salt deposits in the tissues and metabolic diseases. It is recommended that you follow a balanced menu of sufficient but not too many carbohydrates, proteins and fats, as well as vitamins and minerals. Particular attention should be paid to unsaturated fats (olive and flaxseed oil), omega-3 acids (abundant in fish), collagen (mixed 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. In the absence of appropriate treatment, the pathology inevitably leads to complete disability, especially in bilateral lesions. Pain and limited mobility do not allow you to work and take care of yourself, so it is important to get timely treatment.