Osteoarthritis of the hip joint is a progressive dystrophic-degenerative disease. Most often, it develops in old age, when provoking factors arise: non-inflammatory infectious diseases of the joint, trauma, genetic disposition, curvature of the spine.
Coxarthrosis is another name for osteoarthritis of the hip joint, the treatment of which is very difficult, long-term, first conservative and then surgical. The main symptom of the disease is pain, restriction of movement; in the later stages, there is a shortening of the diseased limb and atrophy of the femoral muscles.
However, the term osteoarthritis has recently been abolished and the disease is now known as osteoarthritis of the joints. Previously, osteoarthritis was not considered an inflammatory process, but now inflammation is also recognized in osteoarthritis. As in all the theory of aging, interleukins are secreted by different structures of the cartilage and trigger inflammation, resulting in their degeneration, that is, cracking and decomposition. And therefore, now there is no osteoarthritis, there is only osteoarthritis.
Causes of osteoarthritis of the hip joint
The disease itself is not inherited, but the characteristics that provoke its development, such as weakness of cartilage tissues, various metabolic disorders, genetic characteristics of the skeletal structure, can be transmitted from parents to children. Therefore, the risk of developing osteoarthritis of the joints in the presence of this disease increases in relatives.
However, the main causes of osteoarthritis of the hip joint are associated diseases:
- Perthes disease is a violation of the blood supply and nutrition of the femoral head and the joint in general, it develops in childhood, more often in children;
- Congenital dislocation of the hip, dysplasia of the hip joint;
- Injuries: hip fracture, dislocations, pelvic fractures;
- Necrosis of the femoral head;
- Inflammatory and infectious processes: rheumatoid arthritis, purulent arthritis (read the causes of pain in the hip joint).
Since the disease develops slowly, it can be both unilateral and bilateral. Factors that contribute to osteoarthritis:
- The presence of concomitant diseases of the spine: scoliosis, kyphosis, osteochondrosis, etc. , flat feet, osteoarthritis of the knee joint (see symptoms of osteoarthritis of the knee joint).
- Hormonal changes in the body, circulatory disorders.
- Excessive stress on the joints: sports, hard physical work, overweight.
- Sedentary lifestyle combined with obesity.
- Age: in old age and old age, the risk of developing osteoarthritis increases significantly.
The main diagnostic methods are MRI and CT, radiography. MRI data provides a more accurate picture of the state of soft tissues, and computed tomography of bone tissue pathology, clinical signs and symptoms of osteoarthritis of the hip joint are also taken into account. It is very important to establish not only the presence of pathology, but also the degree of arthrosis and the reasons for its appearance.
For example, if the changes in the images affect the proximal femur, this is a consequence of Perthes disease, if the cervico-diaphyseal angle increases and the acetabulum flattens noticeably, this is hip dysplasia. You can also get information about injuries from X-rays.
Symptoms 1 2 3 degrees of osteoarthritis of the hip joint
The main symptoms of osteoarthritis of the hip joints are the following:
- The most important and constant is constant intense pain in the groin, hip, knee joint, sometimes radiating pain in the leg, in the groin area.
- Stiffness of movement, limitation of joint mobility.
- Restriction of lateral abduction of the affected leg.
- In severe cases, lameness, gait disturbance, leg shortening, atrophy of the femoral muscles.
1 degree of osteoarthritis of the hip joint:
At this stage of the disease, a person experiences pain only during and after physical exertion, due to running or walking for a long time, while the joint itself hurts mainly, very rarely the pain radiates to the hip orknee. In addition, a person's gait is normal, lameness is not observed, the thigh muscles are not atrophied. When diagnosed, the images show bony growths that are located around the inner and outer edges of the acetabulum, no other pathological disorders are observed in the neck and head of the femur.
2nd degree of osteoarthritis:
With 2nd degree osteoarthritis of the hip joint, the symptoms become significant and the pains are already more constant and intense, both at rest and during movement, they radiate to the groin and thigh, with the load the patient is already limping. There is also a limitation of hip abduction, the range of motion of the hip is reduced. In the pictures, the narrowing of the space becomes half the norm, bone growths are located both on the outer and inner edges, the head of the femoral bone begins to increase, deform and shift upward, its edges become uneven.
3 degrees of osteoarthritis of the hip joint:
In this stage of the disease, the pain is painful and constant, both day and night, it becomes difficult for the patient to move independently, so a cane or crutches are used, the range of motion ofthe joint is severely limited, the muscles of the lower leg, thighs and buttocks atrophy. The leg is shortened and the person is forced to lean the body while walking towards the sore leg. Shifting the center of gravity increases the load on the damaged joint. X-ray images show multiple bone growths, the femoral head is expanded, and the joint space is significantly narrowed.
How to treat osteoarthritis of the hip joint?
To avoid surgical intervention, it is very important to establish the correct diagnosis in a timely manner, to differentiate osteoarthritis from other diseases of the musculoskeletal system - reactive arthritis, trochanteric bursitis, etc. At 1 and 2 degrees of osteoarthritis, treatment should be carried out on a complex, conservative medication, with with the help of manual therapy, therapeutic massage, therapeutic gymnastics, but only under the supervision of a qualified orthopedist.
- Week one: simple paracetomol.
- If there is no effect, then NSAIDs (preferably diclofenac or ketorol in a small dose) under the cover of proton pump blockers (but not omeprazole, as it increases bone destruction with prolonged use).
- In addition to chondroprotectors at any stage.
Combining all treatment measures should solve several problems at once:
For this, today there is a large selection of various NSAIDs, non-steroidal anti-inflammatory drugs that, although they relieve pain, but do not affect the development of the disease, cannot stop the process of destruction of cartilage tissue. They have a number of serious side effects, the long-term use of which is also unacceptable due to the fact that these agents affect the synthesis of proteoglycans, contributing to the dehydration of cartilage tissue, which only aggravates the condition. Of course, it is unacceptable to endure pain, but painkillers should be used with caution, under the supervision of a doctor, only during periods of exacerbation of the disease.
NSAIDs include: celecoxib, etoricoxib, texamen, nimesulide, naproxen sodium, meloxicam, ketorolac tromethamine, ketoprofen lysine, ketoprofen, ibuprofen, diclofenac.
Topical deforming osteoarthritis remedies, such as hot ointments, are not very therapeutic, but they reduce pain by acting as a distraction and partially relieve muscle spasm.
Provides better nutrition for cartilage and increases blood circulation
Chondroprotective agents such as glucosamine and chondroitin sulfate are important drugs that can improve the condition of cartilage tissue, but only in the early stages of the disease. A complete description of these drugs in tablets, injections, creams, with average prices and courses of treatment in the article osteoarthritis of the knee joint. To improve blood circulation, to reduce spasm of small vessels, vasodilators are usually recommended: cinnarizine, pentoxifylline, xanthinol nicotinate.
Muscle relaxants, such as tizanidine and tolperisone hydrochloride, may be prescribed only for strict indications. Its use can have both positive and negative effects, muscle relaxation, on the one hand, reduces pain, improves blood circulation, but, on the other hand, muscle spasm and tension - there is a protective reaction of the body and eliminate it can onlyaccelerate the destruction of joint tissues.
Injections with hormonal drugs are carried out only with synovitis, that is, the accumulation of fluid in the joint cavity. Once and no more than 3 times a year (methylprednisolone, hydrocortisone acetate). Hormonal agents relieve pain and inflammation, but they have a pronounced immunosuppressive effect, and their use is not always justified. It is more convenient to carry out injections into the thigh with chondroprotectors - chondroitin sulfate, 5-15 procedures 2-3 times a year. Also shown are intra-articular injections of hyaluronic acid, which is an artificial lubricant for the joints.
The opinion of doctors on the effectiveness of these procedures is divided into supporters and opponents, some consider their implementation justified, others useless. Perhaps laser therapy, magnetic laser therapy and makes sense for osteoarthritis of the hip joint, many doctors do not find other procedures necessary for the treatment of this disease, as the hip joint is a deep joint andmany of these procedures simply cannot accomplish the goal and are a waste of time, effort, and possibly funds for the patient.
Professional massage, hip joint traction (hardware traction), manual therapy, physiotherapy exercises All these therapeutic measures are very useful in complex therapy of the disease, help to strengthen the muscles around the joint, increasetheir mobility and, when properly combined with drug treatment, can help increase the distance from the head to the socket and reduce pressure on the head of the femur. This is especially true in the case of physiotherapy exercises, without their competent selection and regular implementation outside of exacerbations, it is impossible to achieve real improvement in the patient's condition.
If the patient is overweight, then of course the diet can help reduce the load on the diseased joint, but it has no independent therapeutic effect. Doctors also recommend the use of canes or crutches, depending on the degree of joint dysfunction.
For grade 3 osteoarthritis, doctors always insist on surgical intervention, as the destroyed joint can only be restored by replacing it with a stent. According to the indications, a bipolar prosthesis is used, which replaces both the head and socket, or a unipolar prosthesis, which only changes the femoral head without acetabulum.
Today, these operations are performed quite frequently, only after a full examination, in a planned manner under general anesthesia. They provide a complete restoration of hip functions with the competent and careful implementation of all postoperative measures: antimicrobial antibiotic therapy and a rehabilitation period of approximately six months. Such prostheses for the hip joint last up to 20 years, after which they must be replaced.