Coxarthrosis of the hip joint: causes and mechanism of development, symptoms, treatment
The content of the article:
- The reasons for the development of coxarthrosis
-
The mechanism of development of coxarthrosis
Links of DOA pathogenesis
-
Symptoms of coxarthrosis of the hip joint
- Pain syndrome
- Restricted hip mobility and crunch during movement
- Deformity of the affected joint
-
Treatment of coxarthrosis of the hip joint
- Non-drug therapy
- Drug treatment for coxarthrosis
- Local and local therapy
- Surgical treatment of coxarthrosis
- Video
Coxarthrosis of the hip joint is a difficult localization of DOA (deforming osteoarthritis). This ailment belongs to a group of pathologies, which are based on degenerative-dystrophic damage to all components of the joint and surrounding tissues, which is accompanied by discomfort and decreased mobility of the lower limb.
Coxarthrosis develops gradually and leads to a decrease in the mobility of the lower limb
Osteoarthritis with involvement of the hip joint accounts for more than 40% of all localizations of pathology. This is due to the fact that the joint belongs to the support group, that is, it provides the ability to stand and move, while experiencing a constant load.
The phenomena of arthrosis of the hip joint more often develop in women, due to the special structure of the pelvic bones and excessive stress that occurs during pregnancy and childbirth. In men, a more erased course of the disease is due to a powerful musculo-ligamentous apparatus.
The reasons for the development of coxarthrosis
The main cause of DOA is a long-term imbalance between the level of mechanical load on the articular surface of the cartilage and its compensatory capabilities in response to such a load.
Trauma is a trigger for the development of DOA
Risk factors for developing DOA:
- hereditary: female sex, breakdowns in the gene responsible for the synthesis of collagen type 2, race, hereditary diseases of the joints, violations of their anatomy (dysplasia);
- acquired: age over 40, obesity, metabolic syndrome, endocrine pathology, deficiency in the synthesis of female sex hormones, surgical interventions, the consequences of inflammatory processes;
- environmental factors: belonging to a certain profession (associated with prolonged standing, walking, carrying weights), engaging in certain sports (running, weightlifting, powerlifting), the consequences of injuries.
The mechanism of development of coxarthrosis
In a healthy person, the joints of the two bone endings in the joint are completely covered with a layer of cartilage (strong, smooth and elastic tissue), which provides shock absorption when walking and evenly distributes the load inside the joint.
In order to produce sufficient synovial fluid, the cartilage must be well supplied with blood from the underlying bone, contain a large amount of fluid, collagens and proteoglycans.
The fundamental factors in the development of DOA are the exorbitant loads on the articulation with normal anatomy and the constant trauma of the hip joint areas when the articular surfaces do not match (incorrect structure of the acetabulum).
Links of DOA pathogenesis
First, the metabolism in the cartilage tissue is disturbed with a predominance of decay processes, the rate of collagen formation decreases. The production of inflammatory factors in the synovial cavity increases, which further impede the restoration of cartilage and additionally contribute to the formation of microthrombi in the subchondral bone layer.
In osteoarthritis, the cartilage tissue loses its elasticity and bone growths appear
The extreme load on the joint leads to its gradual thinning. The tissue loses its elasticity, the cartilaginous surface becomes rough and covered with microcracks. Over time, the area of the bone under the cartilage is exposed, its weave becomes denser, cysts, marginal growths (osteophytes) are formed, which even more violate the statics of the joint.
The lack of amortization gradually weakens the ligamentous apparatus, thereby making the joint even more unstable, prone to dislocation. A reflex spasm of the surrounding muscles occurs in response to prolonged pain. Subsequently, contracture, limb shortening, lameness may occur.
Symptoms of coxarthrosis of the hip joint
Pain syndrome
The disease begins with pain with prolonged physical exertion, which quickly disappears after rest. At the beginning of the development of coxarthrosis, pain is felt not in the place of articulation, but in the groin, thigh or knee.
The intensity of the pain is not necessarily directly proportional to the stage of the degenerative processes, since severe discomfort can be caused by spasm of the surrounding muscles.
Types of pain in DOA:
| Pain type | Characteristic | Causes |
| Mechanical | Arise in the late afternoon, subside after rest | Increased pressure on the bone |
| Starting | Appear in the morning, at the beginning of movement, subside after 15 minutes of physical activity | Reactive synovitis, friction of affected cartilage covered with debris on their surface |
| Associated with tendobursitis and periarthritis | Only present with movements involving the affected tendon | The inflammatory process in the corresponding tissues |
| Caused by intraosseous hypertension | Dull, aching, bothering at night, disappearing in the morning | Overflow of venous blood in the vessels of the subchondral bone |
| Reflex (reflected) | Appear and intensify as the joint capsule is stretched, spread along the muscles and nerve plexuses | Reflex muscle spasm. Joint capsule inflammation, nerve compression |
| Blockade | Sudden sharp pain, makes movement impossible, abruptly passes in a certain position | Infringement between the articular surfaces of a piece of detached cartilage |
Restricted hip mobility and crunch during movement
The second sign of coxarthrosis is the limitation of the mobility of the hip and the crunch during movement. The condition aggravates reflex muscle spasm in response to pain. Over time, the head of the femur is pressed into the fossa of the ilium. The patient begins to limp, a cane or crutches becomes necessary.
In the advanced stage of the disease, the leg is always in a forced position - bent at the hip joint, adducted and turned inward, the possibility of abduction and rotation is sharply limited.
Involvement of the spine leads to the manifestation of back pain, compression of the femoral and sciatic nerves.
Deformity of the affected joint
The third sign of DOA is deformity of the affected joint. On palpation, it is painful, increased in size, deformed, solid growths (osteophytes) are felt.
Clinical classification of coxarthrosis:
| DOA stage | Symptoms | Mobility | X-ray changes |
| I | The pain is mild, quickly passes | In full | From a complete absence of change to a slight narrowing of the joint space, single bone growths |
| II |
Intense pain, radiating to the groin, thigh, knee. Discomfort at night Lameness on prolonged walking |
The amplitude is significantly reduced (especially the inward rotation of the hip and its abduction) | The gap is narrowed by 25–35%. Deformation of the femoral head, thickening of its neck, osteophytes, cysts |
| III |
Constant pain, poorly relieved by analgesics Atrophy of the muscles of the thigh, buttocks Forced position of the limb, its shortening Severe lameness, curvature of the spine |
Sharply limited The leg is brought in and turned inward |
Significant narrowing of the gap, bony growths over the entire surface of the joint, the head and neck of the femur are sharply deformed |
Diagnosis of coxarthrosis
The therapist at the next appointment can suspect the development of DOA. The final diagnosis is established by an orthopedic traumatologist.
To confirm the presence of coxarthrosis:
- detailed patient survey;
- visual inspection of the joint, palpation;
- determination of the range of motion;
- Ro-graphy of both hip joints.
Arthroscopy can be performed to clarify the diagnosis.
Additional diagnostic methods:
- Ultrasound of the joint to determine the thickness of the cartilage;
- arthroscopy;
- study of synovial fluid;
- MRI or CT: these studies reveal degenerative changes in cartilage and nearby tissues in the initial stage;
- podography: measuring the surface of the sole of the foot; with coxarthrosis, there is a difference in the length of the limbs;
- scintigraphy: a comprehensive assessment of joint changes using a radioactive isotope.
Treatment of coxarthrosis of the hip joint
In each specific case of coxarthrosis disease, the treatment complex is compiled individually, taking into account the characteristics of the patient. The goal of therapy is to relieve pain, slow down the process of cartilage destruction, and delay the need for joint replacement.
Non-drug therapy
It is important to teach the patient how to properly treat - take prescribed medications, use auxiliary orthopedic aids (canes, orthoses, instep supports). Recommendations should be made for a new pattern of physical activity, weight management and lifestyle changes.
With coxarthrosis, it is important to engage in therapeutic exercises
Physiotherapy treatments:
- Exercise therapy (strengthening the muscles of the thigh, buttocks, back);
- techniques of post-isometric relaxation and traction (traction) to reduce the degree of contracture and shorten the limb;
- massage (stress relief, stimulation of blood circulation);
- thermal procedures;
- phonophoresis with Hydrocortisone;
- magnetic laser therapy;
- mud therapy.
Drug treatment for coxarthrosis
To relieve pain, inflammation, apply:
- analgesics: Paracetamol, Ibuprofen in the form of tablets, ointments, suppositories (during exacerbations);
- NSAIDs (non-steroidal anti-inflammatory drugs): based on celecoxib, meloxicam.
In order to slow down the processes of cartilage degradation, to maximize the delay in surgery, the doctor prescribes chondroprotectors (Chondroitin or Glucosamine sulfate). These drugs can be taken in courses of 3 months, twice a year.
Local and local therapy
A good effect is given by intra-articular administration of drugs based on hyaluronic acid (a component of cartilage tissue that provides its elasticity).
With severe synovitis and ineffectiveness of NSAIDs, glucocorticosteroid injections with a prolonged effect (up to 1.5 months) are shown. This procedure cannot be performed more than once every 4 months.
In the complex treatment of coxarthrosis, an important place is occupied by ointments, gels, plasters and creams based on NSAIDs.
Surgical treatment of coxarthrosis
Surgical treatment of DOA is the most radical method of antiarthritic therapy, which allows you to relieve discomfort and return motor activity to its previous level.
Endoprosthetics is the most radical treatment method
Hip arthroplasty is indicated for patients with:
- persistent pain syndrome, resistant to conservative measures;
- III – IV stage of DOA (according to X-ray data);
- the presence of a rheumatological disease that significantly complicates the course of coxarthrosis;
- aseptic necrosis of areas of the femur;
- significant shortening of one leg, provoking a curvature of the spine;
- joint contracture in combination with radiological signs of its destruction;
- the phenomena of bone or fibrous ankylosis.
The service life of the endoprosthesis is influenced by:
- bone condition;
- patient weight;
- level of physical activity;
- the presence of concomitant pathology.
In the postoperative period, it is important to start rehabilitation measures as early as possible (optimally - the next day after the intervention). After 10 days of hospitalization, the patient is transferred to outpatient treatment.
The time of adaptation to a foreign object (prosthesis) is on average 1–1.5 months. To achieve the fastest recovery at this time, the patient should practice daily dosed walking on crutches, exercise therapy exercises that strengthen the muscles of the thigh and prevent contractures of the hip and knee joints.
In 8-10 weeks after the operation, the patient undergoes a second consultation with an orthopedic traumatologist and X-ray. In the absence of complications, the patient is allowed to fully load the limb (no longer use a cane or crutches).
Video
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Anna Kozlova Medical journalist About the author
Education: Rostov State Medical University, specialty "General Medicine".
The information is generalized and provided for informational purposes only. At the first sign of illness, see your doctor. Self-medication is hazardous to health!
