Osteoarthritis of the hip joint (coxarthrosis) is a degenerative disease of the cartilage of the hip joint, which leads to permanent joint dysfunction and disability of the patient. Osteoarthritis of the hip joint is more common in older patients, and men are more likely to get it than women.
Classification of hip arthrosis
There are two main types of disease:
- primary - the onset of the disease in the background of complete well-being;
- secondary - develops in the background of inflammatory joint disease, after a previous injury, as well as in the presence of congenital disorders of the development of the hip joint, its dysplasia.
Causes of coxarthrosis
Based on the reasons for the development of osteoarthritis of the hip joint, the following types are distinguished:
- idiopathic - coxarthrosis, which develops for no particular reason;
- involutive - arthrosis associated with age-related changes natural to the body, manifested in old age;
- dysplastic (congenital) - arthrosis that develops in the joint in the background of congenital anomalies of its development;
- postinfectious - arthrosis that develops in the joints affected by rheumatoid arthritis, as well as due to some other infections;
- posttraumatic - arthrosis, which develops as a result of traumatic joint damage;
- dyshormonal - coxarthrosis, which develops in the background of metabolic disorders due to diseases of the endocrine system or hormonal therapy;
- vascular - the disease develops as a result of circulatory disorders in the joint;
- hereditary - occurs as a result of hereditary characteristics of the development of cartilage tissue (often in combination with deforming osteoarthritis of other joints).
In addition, osteoarthritis of the hip joint can be the result of a violation of the biomechanics of body movements, which is often accompanied by curvature of the spine, intervertebral hernia or defects in the bone skeleton of the lower extremities (for example, shortening one of them). Lameness or poor posture put too much strain on the hip joint, which can trigger coxarthrosis. Another common cause of coxarthrosis is inactivity, however, excessive physical activity (sport or work) can also cause joint pathology.
How does osteoarthritis of the hip joint manifest itself?
First of all, patients with coxarthrosis complain of pain in the hip joint. It is followed by lameness, with time atrophy of the thighs and gluteal muscles appears. Movements in the joint are accompanied by characteristic contraction; over time, joint mobility decreases. The intensity of the symptoms directly depends on the degree of the disease.
Grade 1 coxarthrosis
The initial phase of the disease is manifested by mild pain, which can bother you in the morning or after significant physical effort on the joint. Meteosensitivity of the affected joint can also be noticed, which is manifested by pain when the weather changes. The patient may notice morning stiffness in the joint, which disappears after movement, a little warming.
Radiological changes are minimal - there may be a slight narrowing of the joint space, thinning of the cartilage that covers the head of the femur.
Grade 2 coxarthrosis
The intensity of pain at this stage of the disease increases slightly, while the pain radiates to the groin, knee. Common cases of misdiagnosis of coxarthrosis are associated with pain radiating to the knee and popliteal ligaments. The pain begins to torment not only after physical exertion, but also at rest. During the movement of the extremities, foreign sounds (clicking, crunching) appear from the joint. The range of motion in the joint is significantly reduced, especially rotational (circular), the biomechanics of movement in the joint is damaged and, accordingly, its functionality is reduced. Pain and reduced mobility in the joint provoke the appearance of mild lameness, which in turn leads to moderate atrophy of the gluteal muscles on the part of the affected joint.
The radiograph can show a narrowing of the joint space by a third of the normal width, a significant thinning of the cartilage to the absence in some areas, the appearance of osteophytes on the joint surfaces, deformation of the femoral head and its upward movement.
Coxarthrosis grade 3
At this stage of the disease, the pain becomes constant, including at night, and pain relievers are difficult to alleviate. The range of motion in the joint is reduced to a minimum, the biomechanics of the joint is significantly damaged. The smallest movements are accompanied by crepitus, lameness becomes pronounced, there is a significant distortion of the pelvis and shortening of the extremities on the side of the affected joint. The gluteal and thigh muscles on the affected side are atrophied. Due to significant lameness, patients are often unable to move independently without the use of a cane or support.
X-ray examination reveals a pronounced deformation of the femoral head, thickening of the femoral neck. The articular surfaces are covered with bony outgrowths, the joint space is so narrowed that it is practically absent.
Diagnosis of hip arthrosis
Diagnostic measures begin by interviewing the patient and examining, taking a series of laboratory tests, after which special instrumental techniques are used to confirm the diagnosis. The following methods are considered the most informative today:
- X-ray examination -allows you to see the contours of the articular surfaces, the presence or absence of bone growths on them, to determine the presence of deformations of the femoral head and the width of the articular space;
- Ultrasound of jointsenables not only examination of joint surfaces, but also recognition of dystrophic changes in joint ligaments;
- computed tomography (CT)- enables obtaining images by X-ray layers, but clearer and more extensive;
- magnetic resonance imaging (MRI) -allows you to study the condition of joint structures, joint surfaces, bones and ligaments with a high degree of visualization. It is currently considered the most advanced diagnostic method.
Treatment of coxarthrosis
The most effective is a complex treatment of osteoarthritis of the hip joint, taking into account the stage of the disease. It should be borne in mind: the earlier treatment is started, the more likely it is to avoid disease progression, immobilization of the patient and loss of his working ability. Therefore, even with the slightest discomfort in the joint, seemingly insignificant pain, stiffness, meteosensitivity of the joint, you should consult an orthopedist who will perform an examination, clarify the diagnosis and prescribe treatment. Cartilage tissue does not regenerate, so it is better not to wait for the moment when its damage is significant, but to start treatment in the phase of cartilage malnutrition, until irreversible changes develop in it.
The extent of treatment depends on the stage of the disease. So, in coxarthrosis of the first degree, non-narcotic analgesics and NSAIDs are used - they enable you to eliminate the pain syndrome, as well as eliminate inflammation in the tissues of the joint, preventing further damage to its tissues. Since the pain and inflammation syndrome are not intense at this stage, there is no need for long-term use of such drugs. As a rule, it is enough to work with local means - ointments, gels that contain NSAIDs. At this stage, it is much more important to ensure the normalization of metabolic processes in cartilage tissue, to minimize its degeneration, for which drugs from the group of chondroprotectors are used. Their task is to restore the metabolism in the cells of the cartilage tissue, as a result of which the trophism of the joint improves, and the intensity of the inflammation decreases. For example, in the treatment of coxarthrosis, a chondroprotective drug whose active substance is a source of natural components of healthy cartilage has proved to be good. It stimulates the production of the most important structural components in cartilage - proteoglycans and prevents the processes of destruction of cartilage tissue.
Full-fledged treatment of second and third degree coxarthrosis is already much more difficult: the cartilage is already significantly damaged, the joint surfaces are exposed, and osteophytes are formed on them in large numbers, which interfere with the normal movement of the joint. At this stage, only symptomatic treatment is possible, which enables the reduction of joint pain and slowing down the process of cartilage destruction. The pain in this phase of the disease is intense, analgesics and NSAIDs are used to alleviate them, and the best solution would be a combination of the use of local means (ointments, creams) and a dosage form of systemic action (tablets, injections).
During the worsening of the disease, regardless of the stage, the load on the joint should be reduced to a minimum in order to avoid further damage to the cartilage. During remission, in addition to taking chondroprotectors to normalize metabolic processes in cartilage tissue, exercise, massage and kinesitherapy are recommended. They provide a reasonable load on the joint, prevent its immobilization and deposition of mineral salts in the joint tissues and ligaments, and stimulate microcirculation. Exercise therapy is also of great importance for the general condition of the body: during movement it produces biologically active substances that increase mood and general well-being - endorphins and serotonin.
Proper nutrition plays an important role in the complex treatment of hip osteoarthritis. The patient's diet should be complete, rich in animal and plant proteins, fiber, vitamins. Proper nutrition is not only important to encourage joint regeneration, but also to keep the patient’s body weight within normal limits. Being overweight is an additional burden on the diseased joint and a factor in the progression of the disease.
In the remission phase, the methods of physiotherapy - electrophoresis, mud therapy, ultrasound and magnetotherapy - proved to be good. In addition, the effectiveness of biological and mechanical methods of treating coxarthrosis has been observed. Among biological methods, the most popular is chiropractic (leech therapy), which enables blood thinning and stimulation of capillary microcirculation both in the joint and in the muscles that surround it, which prevents atrophic processes in them. Mechanical methods include extracting the joints to relieve excess stress on the affected joint and acupuncture. However, it should be borne in mind: physiotherapeutic, mechanical and biological methods of treating coxarthrosis can be used only in the period of remission. As the disease worsens, their use is burdened by the progression of inflammation and the destruction of cartilage tissue.
In case conservative methods of coxarthrosis treatment do not work, the patient may be offered surgical treatment - arthroplasty and joint replacement. The first variant of the operation involves the restoration of mobility in the joint due to the plasticity of its own tissues, the second - the replacement of joint surfaces with an endoprosthesis - a mechanical joint. Surgery allows you to restore joint mobility and the patient's ability to work.
Prevention of hip arthrosis
Preventive measures are reduced to taking chondroprotectors, proper nutrition and reasonable stress on the joints, especially for those who do sports or hard physical work.
Coxarthrosis is a serious disease that can deprive a patient of the ability to move independently. Disability can be avoided by urgently seeking medical help at the first joint discomfort, subject to competent complex treatment of the pathology from the first phase.