Coxarthrosis: arthrosis of the hip joint

Arthrosis of the hip joint or coxarthrosis is a chronic, slow degenerative process in the articulation of the head of the femur and the acetabulum of the pelvis. With this disease, the bone and cartilage tissues are deformed, which, as it progresses, leads to significant limitation of leg movements and disability. All components of the joint are involved in the process: bones, articular capsules surrounding them, cartilages, ligaments, muscles. Symptoms and treatment of osteoarthritis of the hip (coxarthrosis) vary from person to person, the disease usually occurs in middle-aged and elderly people, although such changes can develop after 20 years.

The main symptoms of arthrosis of the hip joint (coxarthrosis) are pain and stiffness of movement. Often, its development is preceded by injuries, as well as joint pathologies of an inflammatory and non-inflammatory nature. Coxarthrosis is one of the most common arthrosis associated with a significant load on the hip joint.

The disease goes through several stages in its development. In the early stages, coxarthrosis can be treated conservatively, but as the process progresses, only surgical treatment is effective. Therefore, you should not delay a visit to a specialist and sign up for a consultation. You can undergo an examination in clinics and receive conservative treatment.

Reasons

Coxarthrosis of the hip joint can be primary or secondary, that is, it arises against the background of any disease or injury of the musculoskeletal system. Let's consider in more detail the factors that affect the development of the hip joint or cause coxarthrosis.

• exogenous- these are environmental factors: heavy physical activity, consequences of major injuries - fractures, dislocations, torn ligaments, unfavorable working conditions associated with lifting heavy loads, prolonged sitting.
• Endogenous— these are chronic infectious-inflammatory and autoimmune diseases: rheumatoid, reactive, psoriatic arthritis. And metabolic disorders: gout, diabetes.
• Congenital diseases.Dysplasia (disruption of joint formation) and osteochondropathy (malnutrition of joint structures with subsequent necrosis, destruction of bones) can also cause coxarthrosis. For example, congenital dislocation of the hip, aseptic necrosis of the femoral head - Perthes disease.
• Genetic predispositionoften causes hip joint coxarthrosis. It involves a mutation in the type II procollagen gene.
• Old age.More often, the development of coxarthrosis of the hip joint is associated with inevitable age-related changes.
• Floor. Osteoarthritis is believed to occur more frequently in women than in men. This is due to the effect of the female sex hormone estrogen on mineral metabolism and bone density.
• Excessive body weight.There is a direct relationship between excess body weight and the occurrence of arthrosis. The higher the body weight, the more likely it is to develop arthrosis of the hip joint, because excess fat tissue increases the load on the joints, and fat tissue produces anti-inflammatory substances that damage the cartilage tissue.
• Professional sportsdue to excessive stress on the joints and frequent injuries, it can lead to the development of coxarthrosis. Potentially dangerous sports include weightlifting, skydiving and acrobatics.

Under the influence of these factors, gradual changes occur at the cellular level in the joint space: decay processes begin to prevail over synthesis processes, metabolism changes, the volume of joint fluid that nourishes the cartilage tissue decreases, cartilage becomes thinner. As a result, the joint "dries" and decreases in volume. Bone growths appear along the edges of the articular surfaces of the bones - osteophytes, which reduce the range of motion in the joint and thereby reduce the load on it.

Symptoms

How quickly does arthrosis of the hip joint (coxarthrosis) develop? Symptoms increase gradually, and in the first stages, a person may not pay due attention to them and write them off as fatigue. This is dangerous, because the treatment at the beginning of the degenerative process has a greater effect.

The first clinical signs of coxarthrosis are pain, limitation of movements caused by muscle spasm.

Pain can vary in intensity and duration. At first, unpleasant sensations are mild and short-lived. The provoking factor for their appearance is long-term walking or intense physical activity.

Due to severe pain, joint mobility is limited. The patient's gait changes: the hips go backwards, the body leans forward when the weight is transferred to the injured side, the person limps.

Swelling in the joint area is also possible, which is usually invisible due to the layer of muscle and fat, creaking in the joints when moving, functional shortening of the lower limb.

The presence of certain symptoms and their severity depends on the stage of coxarthrosis. There are 4 clinical and diagnostic stages of coxarthrosis, which are determined by the degree of damage to the articular cartilage:

• Coxarthrosis 1st degreecharacterized by asymptomatic or periodic pain that occurs only after intense physical activity such as jogging or long walking. The pain is localized in the joint area, less often spreads to the entire thigh and even the knee. It usually disappears after rest. X-ray of the hip joint shows no changes or a slight narrowing of the joint space. MRI reveals signs of cartilage tissue heterogeneity.
• For 2 degree coxarthrosisthe pain is stronger, appears with little physical activity, and sometimes at rest, and can spread to the thigh and groin. Lameness appears after considerable physical exertion. Range of motion at the joint is reduced: abduction and internal rotation of the hip is limited. X-ray photographs show a clear uneven narrowing of the joint cavity and isolated osteophytes - growth of bone tissue on the edge of the glenoid cavity. In the 2nd stage of coxarthrosis, MRI reveals open erosion and cracks in the cartilage with less than half thinning.
• For 3rd degree coxarthrosispain is constant and often disturbs patients during sleep. Walking is difficult, which forces the patient to take a forced position of the body, leaning on a healthy leg or a cane. The range of motion in the joint is severely limited. On radiographs, the joint space is practically absent, and many osteophytes have formed on the bone surfaces. MRI shows that more than half of the volume of cartilage tissue is destroyed. But the third stage can still be treated conservatively.
• 4th stage arthrosis of the hip joint (coxarthrosis)characterized by significant loss of joint function. The whole leg hurts: joint, groin, gluteal region, hip, knee, ankle. Flat feet develop, legs become shorter, muscles atrophy. On the radiograph: numerous large osteophytes, the joint space is absent or reduced to a minimum. Stage 4 is not amenable to conservative treatment, hip replacement is performed. The operation reduces pain, improves leg function and the patient's quality of life.

Diagnosis of hip joint arthrosis

An initial consultation with a specialist is the key to diagnosing arthrosis of the hip joint. The doctor clarifies the complaints: where the pain is localized, when and why it occurs, where it goes, what reduces and strengthens it, what causes it. Then visual inspection, palpation, gait assessment are required, and special tests are performed to detect joint dysfunction.

The diagnosis of coxarthrosis is made on the basis of clinical signs and data from additional instrumental studies, the basis of which is radiography of the joint. There are no characteristic laboratory signs for the diagnosis of arthrosis, but a clinical blood test may be required for the differential diagnosis of coxarthrosis and arthritis. In this case, the specialist will take into account the level of leukocytes, ESR, C-reactive protein and uric acid.

For the diagnosis of arthrosis of the hip joints, radiography from instrumental methods is usually sufficient. This is an accessible study that reveals the changes characteristic of coxarthrosis: narrowing of the joint space, osteophytes, erosion and ulceration of the cartilage surface, cysts. X-rays of patients with coxarthrosis can also reveal changes that indicate trauma.

CT and MRI can be used as other instrumental diagnostic methods. Computed tomography allows for a more detailed study of pathological changes in bone structures, and magnetic resonance imaging allows for evaluation of soft tissue disorders.

Which doctor should I see?

This pathology is treated by orthopedic traumatologists. However, depending on the nature and course of the disease, consultations with other specialists may be required:

• a surgeon to exclude surgical pathology requiring surgical intervention;
• phthisiatrist to rule out bone tuberculosis;
• oncologist to rule out malignant neoplasms;
• endocrinologist for concomitant metabolic disorders;
• a neurologist, if there is a suspicion of compression of the spinal nerve roots by an intervertebral hernia of the lumbosacral spine.

Treatment

The choice of treatment method depends on the stage of the disease. Changing your lifestyle and increasing physical activity is often enough to treat grade 1 bilateral arthrosis of the hip joint (coxarthrosis). In the 2nd stage, conservative treatment is used, which includes drugs and physiotherapeutic procedures. Stage 3 is less treatable but still avoids surgery, not to mention stage 4. The goal of conservative treatment is to improve the quality of life, as well as to stop or slow down the rate of development of degenerative changes in the joint.

Drug treatment for coxarthrosis includes drugs that reduce the symptoms of the disease. These are nonsteroidal anti-inflammatory drugs that are used short-term to relieve pain and inflammation. Corticosteroids and muscle relaxants are sometimes used to relieve severe pain and muscle tension.

Non-drug therapy includes:

• Reducing the load on the hip joint.Depending on the situation, the patient may be advised to reduce body weight, create additional support, and transfer body weight to a cane or shin.
• Therapeutic exercise.A properly selected set of exercises helps to improve joint mobility, reduce pain, and prevent muscle atrophy.
• Physiotherapy treatment methods.Courses are prescribed for coxarthrosis of the hip joint: magnetic therapy, laser therapy, shock wave therapy.
• PRP therapy.The method involves injecting your own blood plasma into the joint, which helps to relieve pain, inflammation and improve the regeneration of damaged joint tissue.
• Kinesio taping.This is the application of special adhesive tapes to the skin, which relieves the load on the joint.
• Acupuncture.A method based on inserting sterile needles into biologically active points. Effectively relieves pain and relaxes the muscles around the joint.

For each patient, doctors prepare an individual course of treatment that may include different methods depending on the severity of symptoms, stage of the disease, age and health status. An integrated approach to treatment guarantees high efficiency of procedures and quick recovery, single drug treatment may not give the expected result.

Hip replacement is used in severe cases of the disease, when it is impossible to relieve pain and significantly limit the mobility of the joints.

Results

Pathological changes in the joint can cause:

• Subluxation and dislocation of the hip joint. In this case, movements in the leg are sharply limited, severe pain appears, hospitalization in the trauma department, sometimes surgical intervention is required.
• Local inflammatory processes: bursitis and tendovaginitis.
• Compression of the sciatic nerve by large osteophytes is accompanied by severe, shooting pain along the back of the leg.
• Ankylosis is the complete immobility of the joint, which significantly reduces the patient's quality of life.
• Decreased physical activity, constant pain and limited joint mobility. In the future, this leads to obesity and depression.
• Stomach and heart diseases if you take non-steroidal anti-inflammatory drugs for a long time and often.

Prevention

For a comfortable and quality life without coxarthrosis, you should follow the following recommendations:

• If you feel pain in the hip joint, see a doctor immediately.
• Be careful when engaging in vigorous sports, performing household and work physical activities, and lifting heavy objects.
• Manage your body weight with a balanced diet and regular physical activity.
• Avoid heavy physical labor and sports load. This is a moderate physical activity that improves the condition of the joint, maintains its normal mobility and reduces the load on other joints.

Summary

1. Coxarthrosis is one of the most common arthrosis caused by a significant load on the hip joint.
2. The main symptoms of arthrosis of the hip joint (coxarthrosis) are pain and stiffness of movement.
3. Coxarthrosis has 4 degrees, 1-2 are suitable for conservative treatment, 3-4 - surgical. But in the 3rd stage, if you follow all the doctor's recommendations, surgery can still be avoided.
4. Specialists use a complex approach in the treatment of coxarthrosis, which includes drugs, physiotherapy, manual therapy, nutritional correction and physical activity.