Osteoarthritis of the hip joint: symptoms, diagnosis, treatment
The content of the article:
- The reasons
-
Pathogenesis
- Anatomical structure of the hip joint
- Properties and functions of the joint fluid
- Symptoms
-
Diagnostics
-
X-ray examination
- Osteoarthritis of the hip joint 1 degree
- Osteoarthritis of the hip joint 2nd degree
- Osteoarthritis of the hip joint 3 degrees
- Auxiliary diagnostic methods
-
-
Treatment
-
Drug therapy
- Non-steroidal anti-inflammatory drugs
- Chondroprotectors
- Glucocorticoids
- Physiotherapy
- Surgery
-
- Prevention
- Video
Osteoarthritis of the hip joint (coxarthrosis, deforming arthrosis, osteoarthritis) is the most common type of joint damage in traumatology and orthopedics. Mostly people over the age of 40 are sick, more often women, the lesion can be both unilateral and bilateral.
Coxarthrosis is one of the most common joint lesions
Coxarthrosis is a degenerative-dystrophic disease characterized by a progressive course, intense pain syndrome, impaired motor function of the limb, its shortening, and the possible development of disability.
Diagnosis of pathology is based on anamnestic and clinical data, radiological signs.
Treatment of coxarthrosis is mainly conservative, however, it is possible to carry out arthroplasty in patients at a young or middle age, with severe damage to the joint, its complete destruction. With timely diagnosis and adequate therapy, the prognosis is favorable.
The reasons
40% of cases of osteoarthritis fall on coxarthrosis. This is due to the fact that the hip joint is exposed to significant forces, taking an active part in walking, running, jumping, maintaining posture and other movements. With such a high load on the joint, any, even minimal trauma, can lead to the development of arthrosis.
Depending on the etiological factor, the disease is divided into primary and secondary. In primary osteoarthritis, the damaging factor has not been established. In another way, it is called cryptogenic.
Secondary coxarthrosis is a consequence of the following reasons:
- congenital developmental anomalies (for example, with dysplasia of the hip joint, etc.);
- necrotic processes (Perthes disease, aseptic necrosis of the femoral head, etc.);
- infectious and inflammatory processes in the joint cavity (arthritis due to tuberculous, chlamydial, staphylococcal and other infections);
- rheumatological lesions (systemic lupus erythematosus, rheumatoid arthritis, etc.);
- post-traumatic coxarthrosis (due to trauma, dislocation of fractures).
In addition to etiological factors, there are factors that increase the risk of damage to the hip joint. These include:
- regular excessive stress on the joint: common in athletes, obese people;
- dyshormonal, dysmetabolic states, impaired blood supply: diabetes mellitus, atherosclerosis, climacteric, postmenopausal periods, etc.;
- pathologies of the musculoskeletal system: kyphosis, scoliosis, flat feet;
- elderly and senile age periods.
Coxarthrosis is a disease without a hereditary predisposition, however, there are cases of family involvement. This is primarily due to the fact that provoking factors can be inherited: metabolic disorders, defects in the structure of the skeleton, joints, ligaments, cartilage, etc.
In this case, if one of the relatives is diagnosed with osteoarthritis, the likelihood of developing the disease in other family members may increase.
Pathogenesis
Anatomical structure of the hip joint
Two bones are involved in the formation of the hip joint: the femur and the iliac. The movable femoral head connects to the fixed iliac acetabulum, allowing the joint to move in multiple planes. In the joint, flexion, extension, rotational movements, abduction and adduction of the hip are possible.
The femoral head and acetabulum are articular surfaces. They are covered with hyaline cartilage, which provides free, unhindered, smooth sliding of the articular surfaces relative to each other. Other functions of cartilage include load distribution in the joint during movement and cushioning.
Properties and functions of the joint fluid
The joint fluid secreted in the joint cavity acts as a lubricant and is also a source of nutrients necessary for the normal functioning of the hyaline cartilage.
Reducing the amount of lubricant leads to the gradual destruction of cartilage tissue
With coxarthrosis, the joint fluid changes its qualitative and quantitative characteristics, becomes thicker, denser, viscous, and acquires an aseptic inflammatory character.
Roughness and the presence of cracks in the hyaline cartilage leads to the fact that any movements in the affected joint are inevitably accompanied by friction of the affected articular heads against each other, which becomes the cause of the aggravation of the pathological process with the development of deformity, degenerative changes and even severe muscle atrophy in the injured limb.
Symptoms
The main symptom accompanying coxarthrosis is pain syndrome. He is one of the first to disturb the patient. The pain is felt in the area of the affected joint, it can radiate to the groin, knee, hip.
The disease is characterized by severe pain syndrome
Further, motor disorders join the complaints: stiffness, stiffness, change in gait, lameness. Ultimately, muscle atrophy and limb shortening develop, which indicates a severe degree of pathology.
One of the characteristic symptoms that testify in favor of coxarthrosis is a violation of limb abduction. For example, when trying to sit astride a chair, the patient feels difficulty, since it is impossible to fully abduct the injured leg.
In the clinical course of the disease, three degrees of severity are distinguished:
| Severity | Features: |
| First degree | It is characterized by the occurrence of pain with localization in the damaged joint, less often in the knee or hip immediately after physical exertion or active movement. At rest, the pain syndrome disappears. With coxarthrosis of the first degree, motor activity is not disturbed, lameness and muscle atrophy are not observed. Movements are carried out in full |
| Second degree | For coxarthrosis of the second degree, a more intense pain syndrome is characteristic, which occasionally occurs at rest and radiates to the thigh or groin area. After significant physical activity, limp may occur. There is a decrease in the range of motion in the joint, especially abduction and internal rotation of the thigh |
| Third degree | Differs in constant intense pain syndrome that does not decrease during the rest period, and even sometimes arises at night |
With severe arthrosis, movements are sharply limited, it is difficult for the patient to move independently, he has to use a cane. There is a pronounced atrophy of the muscles of the buttocks, thigh and lower leg, shortening of the affected limb, which leads to the formation of a forced position of the body (tilt of the body to the sick side), especially when walking.
With a severe course of the disease, it becomes necessary to use a cane when walking
In this way, the patient compensates for the shortening of the limb to maintain balance. As a result, the center of gravity shifts, which leads to an increase in the load on the damaged joint.
Diagnostics
The diagnosis is made based on the patient's complaints, life history, medical history, examination by a doctor and after additional laboratory and instrumental research methods.
X-ray examination
The most informative and common method is X-ray. Each degree of coxarthrosis has its own x-ray picture.
X-ray allows you to determine the degree of joint damage
Osteoarthritis of the hip joint 1 degree
Little informative, non-specific changes are observed, for example:
- mild, uneven narrowing of the joint space;
- the appearance of bony growths in the region of the edge of the acetabulum with simultaneous intactness from the side of the head and neck of the femur.
Osteoarthritis of the hip joint 2nd degree
On the radiograph, there is a significant uneven narrowing of the articular space (more than 50% of the normal height). Changes from the side of the femoral head are visualized: it increases in size, deforms, slightly displaces upward, there is an unevenness of its contours.
Going beyond the cartilaginous lip, bony growths on the acetabulum affect both its inner and outer surfaces.
Osteoarthritis of the hip joint 3 degrees
There is a sharp narrowing of the joint space, there are numerous bony growths, the head of the femur is markedly increased in size and flattened.
Auxiliary diagnostic methods
Auxiliary diagnostic methods are:
- computed tomography: allows you to assess the degree of joint damage, based mainly on the bone structures;
- magnetic resonance imaging: helps to visualize not only dense bone structures, but also soft tissues such as cartilage and surrounding muscles.
Treatment
In most cases, treatment for coxarthrosis is conservative and is aimed at reducing pain syndrome, restoring cartilage trophism, and improving the patient's quality of life.
Non-drug methods are mainly aimed at stabilizing weight to reduce the load on the injured limb. For the same purpose, the doctor may recommend that the patient walk with a cane or crutches. Diet therapy is prescribed for patients with overweight and obesity.
Drug therapy
Non-steroidal anti-inflammatory drugs
Drug therapy includes several groups of drugs, mainly non-steroidal anti-inflammatory drugs (NSAIDs), prescribed for analgesic, decongestant and anti-inflammatory purposes.
NSAIDs are represented by two groups of drugs:
- non-selective: Diclofenac, Ibuprofen, Ketorolac, etc.; are characterized by a strong analgesic effect along with frequent side effects (the most common is ulcerogenesis);
- selective: they act selectively in the focus of inflammation, relieve symptoms quickly and fully, differ in a relatively lower frequency of side effects. One of the representatives of this group, widely used in osteoarthritis, is Meloxicam.
To reduce pain and inflammation, non-steroidal anti-inflammatory drugs, such as Meloxicam, are prescribed
NSAIDs can be prescribed in several dosage forms: tablets and capsules for oral administration, suppositories for rectal administration, solutions for injection (intravenous or intramuscular).
Topical gels or ointments containing NSAIDs may also be prescribed. These funds may contain camphor, menthol and other substances that have a local irritating effect aimed at reducing local muscle hypertonia.
Chondroprotectors
In therapy, chondroprotectors (chondroitin, glucosamine) are also used - drugs that improve the condition of the cartilage. It should be noted that the effect of them can be observed only at the initial stage of the disease. In the case of disease progression and in advanced conditions, the effectiveness of chondroprotectors has not been proven.
Glucocorticoids
The use of glucocorticoids is currently limited due to the proven destructive effect on cartilage. Therefore, they are used extremely rarely when conventional NSAIDs fail to relieve pain. In this case, intra-articular administration of hormonal drugs is possible.
Physiotherapy
Physiotherapy is an important component in the treatment of coxarthrosis. The use of methods aimed at improving microcirculation, trophism of the affected tissue, with anti-exudative and analgesic effects is recommended.
Physiotherapy is part of the treatment of coxarthrosis
Usually, light and laser therapy, ultrasound, UHF, inductotherapy, magnetotherapy, etc. are prescribed.
Surgery
Severe degree 3 coxarthrosis is an indication for surgical treatment, which consists in replacing one's own destroyed hip joint with an artificial one. This operation is called endoprosthetics.
In severe cases, endoprosthetics is performed
Depending on the involvement of different parts of the joint in the pathological process, unipolar or bipolar endoprosthetics can be prescribed. The unipolar prosthesis is intended to replace only the femoral head. Both parts of the articular surfaces (femoral head and acetabulum) are replaced with a bipolar prosthesis.
Endoprosthetics is performed routinely by an orthopedic traumatologist under general anesthesia. A day or several days before surgery, the patient is admitted to the hospital for a full preoperative examination. After the operation, antibiotic therapy is prescribed for several days.
After the operation, rehabilitation measures are shown, including physiotherapy exercises
In the absence of complications during and after the operation, adequate convalescence period, the patient is removed the stitches after 10-12 days, he is discharged from the hospital with further outpatient observation and rehabilitation recommendations.
In most cases, arthroplasty leads to complete restoration of the limb and physical activity. The service life of the endoprosthesis is on average 15–20 years, after which re-endoprosthetics is required (re-replacement of the worn out prosthesis).
Prevention
Prevention of osteoarthritis of the hip joint consists in good nutrition, maintaining body weight at optimal values, preventing obesity or becoming overweight, as this leads to an increase in the load on the joints. It is recommended to try to avoid injuries, engage in moderate physical activity, gymnastics.
At the first signs of osteoarthritis, you should immediately seek medical help for timely and adequate diagnosis and treatment.
Video
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Anna Kozlova Medical journalist About the author
Education: Rostov State Medical University, specialty "General Medicine".
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