Coxarthrosis of the hip joint grade 3: causes of development, symptoms, treatment, prognosis
The content of the article:
- The reasons for the development of coxarthrosis
- The mechanism of development of the disease
- Symptoms of coxarthrosis of the hip joint 3 degrees
- Diagnosis of coxarthrosis
-
Treatment of coxarthrosis of the hip joint 3 degrees
Surgery
-
Rehabilitation after endoprosthetics
- General recommendations
- Exercises
- Massage
- Forecast
- Video
Coxarthrosis of the hip joint of the 3rd degree is an extreme degree of manifestation of the degenerative-dystrophic process, depriving a person of the opportunity to work and leading to disability.
At the last stage of coxarthrosis, there is a complete destruction of the joint, which requires endoprosthetics
Signs of osteoarthritis deformans (DOA) are observed in patients over 40 years of age. Depending on the rate of destruction of the cartilage, from the moment the first symptoms appear to its final destruction, it can take from 5 to 15 years.
The disease often occurs against the background of anatomical and functional inferiority of the hip joint (congenital or acquired).
The reasons for the development of coxarthrosis
The main risk factors for arthrosis are:
- prolonged overload of the joint in people with a large body mass, athletes (gymnasts, wrestlers, divers);
- consequences of injury to the hip joint;
- recurrent arthritis of various etiologies;
- Perthes disease: congenital insufficiency of blood supply and nutrition of articular tissues;
- congenital dislocation of the hip;
- dysplasia of the hip joint;
- necrosis of the femoral head;
- diabetes mellitus, metabolic syndrome, dyshormonal processes;
- passive lifestyle;
- involutive changes accompanying the aging process of the body.
The disease can develop in one joint (right-sided or left-sided coxarthrosis), in severe cases, the process is two-sided.
The mechanism of development of the disease
In the first two stages of DOA, there is a gradual degradation of cartilage (it becomes thinner, microcracks appear on the surface), sclerotic processes in the subchondral bone layer, and the formation of osteophytes. Without treatment, joint damage continues to progress.
As the disease progresses, there is a thinning of the cartilage tissue and the growth of osteophytes.
At the last stage of coxarthrosis, the cartilage becomes so thin that the cracks in it reach the subchondral layer, and in some places the cartilage tissue may be completely absent. The synovial cavity is filled with fragments of it, which interferes with full movement.
In order to increase the area of contact of the articular surfaces and thereby reduce the load along the edges of the bone, an even larger number of osteophytes are formed. Overloading the subchondral region leads to the formation of cysts and impaired blood supply to the bone. Friction of exposed areas of the bone against each other contributes to increased pain.
Symptoms of coxarthrosis of the hip joint 3 degrees
This stage of deforming osteoarthritis is characterized by the fact that all manifestations of the disease reach their maximum.
The main symptoms of coxarthrosis grade 3:
| Symptom | Characteristic |
| Pain | Constant (including at night), aggravated by the slightest movement of the limb. The patient is uncomfortable even palpation of the surrounding tissues |
| Crunching | Can be heard clearly even from a distance |
| Restricted mobility | The patient can move independently only with assistive devices for short distances. Internal rotation, abduction and flexion are most difficult |
| Deformation | Visually noticeable, multiple bone growths are palpable on palpation. The limb is greatly shortened, takes a forced position (brought and turned inward) |
The muscles of the buttocks and thighs are weakened and atrophied. With a one-sided process, a difference in the volume of the limbs is visually noticeable. The patient has a worsening of the curvature of the spine in the lumbar spine (lordosis). At this stage of the progression of coxarthrosis, the gait becomes antalgic - when trying to load the affected limb, the pelvis descends.
In the third stage of the DOA of the hip joint, complications are often observed:
- secondary bursitis, synovitis;
- pathological dislocations;
- secondary fracture of the femoral neck;
- aseptic necrosis of the femoral head;
- protrusion of the acetabulum.
Diagnosis of coxarthrosis
It is not difficult to suspect the presence of DOA of the hip joint with such a vivid clinical picture.
X-rays are taken to confirm the diagnosis
After interviewing the patient and examining him, the doctor will prescribe additional studies:
- X-ray of two hip joints;
- Ultrasound with measurement of cartilage thickness;
- arthroscopy;
- MRI or CT.
X-ray changes in coxarthrosis grade 3:
- significant narrowing or complete absence of the joint space;
- multiple osteophytes (mushroom-shaped femoral head);
- subchondral sclerosis, cysts;
- bone tissue with areas of osteoporosis;
- change in the configuration of the femoral head;
- deepening of the acetabulum;
- aseptic necrosis of the femoral head;
- subluxations.
Treatment of coxarthrosis of the hip joint 3 degrees
It is impossible to cure a joint affected by osteoarthritis, it cannot be restored. Basic therapy with chondroprotectors and intra-articular glucocorticosteroids are ineffective.
To relieve pain, analgesics are prescribed, for example Paracetamol
Therapy of the advanced stage of DOA is aimed at relieving pain, teaching the use of auxiliary instruments and preparing for surgery (muscle strengthening, physiotherapy, apparatus traction, treatment of concomitant pathology, weight correction).
To reduce the intensity of the pain syndrome, the following are prescribed:
- non-steroidal anti-inflammatory drugs (NSAIDs): preferably from the group of selective COX-2 blockers;
- non-narcotic pain relievers: Paracetamol;
- narcotic analgesics: Tramadol is used for severe pain resistant to other drugs.
Surgery
The only effective treatment for grade 3 coxarthrosis, which gives a chance to restore mobility, is hip arthroplasty.
Types of interventions:
- unipolar (a certain part of the joint is replaced with an endoprosthesis);
- total (the head and the articulation cap are subject to replacement).
This type of intervention refers to planned procedures (the patient undergoes all the necessary examinations the day before). A few days before the operation, he goes to the hospital, where the prevention of infectious complications and thrombus formation is carried out.
In elderly patients with a weakened bone apparatus and the need to use a walker in the postoperative period, a cement-type prosthesis is installed.
The hip joint replacement surgery is performed under general anesthesia and lasts from 1.5 to 3 hours. The duration depends on the type of endoprosthesis, the scale of destruction, and the patient's state of health.
Possible postoperative complications:
- inflammation or infection at the incision site;
- thrombus formation;
- graft rejection reaction;
- dislocation of the endoprosthesis;
- exacerbation of chronic pathology.
A patient's stay in the hospital in the absence of complications does not exceed 8-10 days. During this period, the postoperative wound heals and the patient trains to serve himself in everyday life on his own.
Rehabilitation after endoprosthetics
In articles devoted to modern studies of the dependence of quality of life indicators on the volume of rehabilitation, doctors insist on the use of a wide range of restorative measures immediately after arthroplasty.
It is important to use assistive devices after endoprosthetics during the rehabilitation period.
Rehabilitation of the patient starts on the second day after the intervention under the supervision of a physiotherapy specialist. Doctors provide the patient with physical activity as early as possible (they teach how to get out of bed correctly, move around the bed with assistive devices).
General recommendations
At home, the patient should follow these guidelines:
- Walk on crutches without stepping on the operated limb.
- Perform at least three of the proposed list of exercises aimed at strengthening the muscles of the thigh (in particular, the quadriceps).
- Wear compression stockings to prevent thromboembolism for one month.
- Eating a diet that prevents weight gain.
- Systematically take the prescribed medication.
Exercises
Exercises should be performed 6-8 times a day, starting with 10-20 repetitions and gradually increasing them to 50-70. Regular and systematic exercise therapy classes guarantee a quick recovery of working capacity.
Exercises must be performed under the guidance of an instructor
Exercise types:
- bending the knee up to 80% while lying on the bed and extending to a straight position without lifting the heel off the bed;
- extension in the knee joint to a level position by raising the foot (under the knee there should be a roller 25–40 cm high);
- extension of the knee while sitting on the edge of the bed (imitation of hitting the ball).
Massage
The massage procedure for DOA of the hip joint provides:
- decreased tone of tense muscles;
- increased contractility of weakened muscles;
- improvement of blood circulation, nutrition and regeneration in the joint;
- weakening of neurological manifestations.
At home, the patient can massage the joint and adjacent muscles on their own (avoiding the incision area) or seek professional help. It is optimal to start with procedures lasting 10-15 minutes 2-3 times a day. The massage should be stopped immediately if discomfort occurs.
The question of whether it is possible to do without crutches and full load of the operated limb is decided at a second consultation with an orthopedic surgeon after 8–10 weeks.
Forecast
In patients with coxarthrosis (especially in the presence of congenital dysplasia), complete disability may occur within a few years. Without surgery, the articular surfaces will gradually grow together and the limb will completely lose mobility.
In the modern world, total arthroplasty remains the only, inevitable and most effective method of treating grade 3 coxarthrosis, allowing the patient to regain the ability to move and work independently.
Video
We offer for viewing a video on the topic of the article.
Anna Kozlova Medical journalist About the author
Education: Rostov State Medical University, specialty "General Medicine".
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