Congelum

Osteoarthritis of the hip joint: symptoms, treatment and prevention

The hip joint is the largest joint in our body.It has a hinged configuration that allows movement in different planes.At the same time, the joint is surrounded by strong ligaments and muscles.The hip joints bear the main load when walking, running or carrying heavy loads.Coxarthrosis (another name for arthrosis of the hip joint) is quite common in people, both older and younger.Once started, it can remain undiagnosed for a long time, as visible limitation of hip movement does not occur immediately.

Often patients, without being examined by a doctor or without presenting all their complaints, begin to treat lumbosacral osteochondrosis or arthrosis of the knee joints without any visible effect.Meanwhile, the untreated disease progresses and leads to lameness, constant pain, shortening of the leg, and inability to bend and extend.And treatment at this stage is possible only surgically, that is, the joint must be replaced with prosthetics.

Causes of coxarthrosis

healthy joint and arthrosis of the hip joint

Primary arthrosis of the hip joint most often develops in people over 40 years of age.Its causes have not yet been studied.The hyaline cartilage that covers the joint surfaces and ensures sliding begins to thin and collapse.Due to increased friction and pressure on the bones, bone spurs appear on them.The joint is deformed, movements within it are limited.In primary coxarthrosis, both the knee joints and the spine are often affected.

Secondary arthrosis develops against the background of various diseases:

  • Hip dysplasia.This term refers to the congenital underdevelopment of the components of this joint in a child.As a result, the head of the femur is not centered as it should be in the acetabulum.There are three types of dysplasia: preluxation, subluxation and hip dislocation.In a congenital dislocation the head of the femur lies outside the socket and, if adequate treatment is not carried out, osteoarthritis subsequently develops.
  • Aseptic necrosis.The bone tissue of the femoral head begins to dissolve due to impaired blood supply.The bone tissue is focally resorbed, the joint head is deformed.Osteoarthritis develops secondarily.
  • Legg-Calvé-Perthes disease.This is osteochondropathy of the femoral head, which occurs in children from 3 to 14 years old, mainly in boys.It occurs, as a rule, as a result of complications after infectious processes, as well as injuries, physical overload and metabolic diseases.The cartilaginous area of the head is not well supplied with blood, which leads to necrosis of this area and deformation of the joint.
  • Inflammations, infections.If arthritis of the hip joint has developed, the synovial fluid loses its lubricating properties, the lining of the joint thickens, the hyaline cartilage is subjected to mechanical stress, and at the same time metabolic disorders occur in the joint.
  • Injuries: contusions, fractures of the femur, acetabulum, hip dislocations, chronic traumas, i.e. microtraumas received systematically.
  • Overload of the hip joint associated with sporting and professional activities.For example, walking for a long time without rest, vibrating, constantly jumping and carrying heavy loads are not desirable for the joint.The muscle corset of a child or adolescent cannot always compensate for such loads.
  • Increased body weight, especially at a young age, when the cartilage is not yet able to withstand large axial loads.Furthermore, these patients usually have metabolic problems.
  • Coxarthrosis itself is not hereditary, but genetically relatives may have a certain structure of cartilaginous tissue, metabolic disorders that lead to the development of arthrosis.Therefore, it is worth considering whether parents or more distant relatives have joint diseases.
  • Osteoporosis.The vulnerable area for this disease is the neck of the femur.Its structure becomes more rarefied, pathological fractures are possible.All this secondary leads to arthrosis.
  • Diabetes mellitus.In this case, arthrosis develops due to vascular disorders.
  • Polyneuropathy with reduced sensation in the legs.
  • Diseases of other parts of the musculoskeletal system.These include: scoliosis, osteoarthritis and knee injuries, flat feet.The distribution of load on the hip joints changes, the shock-absorbing properties decrease, and as a result, the cartilage lining suffers.

Symptoms of coxarthrosis

hip joint pain due to osteoarthritis

To prevent the disease and its early diagnosis, it is important to know the signs of incipient arthrosis of the hip joint (coxarthrosis stage 1):

  • Pain that occurs periodically after physical activity.Specific painful sensations may be localized in the groin, side, hip or knee area.After rest they leave, so no importance is given to them.Meanwhile, this is an alarming sign.
  • Slight limitation of hip rotation (inward and outward).This can be easily controlled by lying on your back, rotating the entire leg clockwise and counterclockwise.
  • An x-ray may reveal slight irregular narrowing of the joint space.

With arthrosis of the 2nd stage, the signs are more pronounced:

  • The pain occurs in the projection of the joint, most often in the inguinal fold, and is also noticeable at rest.
  • Restrictions appear not only when turning the leg, but also when abducting the hip to the side.The movements of the joint are quite painful, especially in extreme positions (with maximum abduction of the hip, bending of the leg towards the stomach).
  • On x-ray you can observe moderate narrowing of the joint space and isolated bony growths on the edges of the acetabulum.Cysts can also form in the bone structure of the femoral head.

Osteoarthritis of the hip joint of the 3rd stage is easily diagnosed, its symptoms are serious:

  • Joint pain during exercise, at night.
  • Lameness, patients often use a cane.
  • Marked limitation of movement of the joint, due to which it is difficult for a person to put on socks or put on shoes.
  • The leg becomes thinner due to hypotrophy of the thigh and lower leg muscles.The muscles of the gluteal region also weaken.
  • It is possible to shorten the leg due to its incomplete extension and deformation of the femoral head.As a result, scoliosis of the lumbar region (lateral curvature) is formed, and pain appears in the lumbosacral region.
  • Signs of the 3rd stage, detected by X-rays, are a pronounced narrowing of the joint space up to its complete absence, bone growths, deformation of the head and neck of the hip joint.

Diagnostics

In diagnosis, it is of great importance to clarify subjective complaints, collect anamnesis, evaluate symptoms, and also clarify the stage: x-ray, CT and MRI.Computed tomography allows you to study in detail the bone structure of the hip joint, and the magnetic resonance method visualizes soft tissues, the condition of the joint capsule and the presence of synovitis.

Treatment

Therapy for coxarthrosis depends on the stage of the process and, in most cases, includes a whole series of procedures.Naturally, the earlier treatment is started, the greater its effectiveness.

  1. Conservative treatment
    • Drug therapy.To relieve pain, nonsteroidal anti-inflammatory drugs in tablets, suppositories or intramuscular injections are used.Dosage forms such as ointments, gels, creams are not effective enough due to the enveloping of the hip joint with large muscles and subcutaneous tissue.Long courses of nonsteroidal anti-inflammatory drugs are not recommended due to side effects on the cardiovascular system and gastrointestinal tract.To help them, the doctor may prescribe drugs that relieve muscle spasm: a muscle relaxant.In case of severe inflammation, intra-articular glucocorticoids may be necessary.Chondroprotectors represent one of the main groups of drugs for the treatment of coxarthrosis.They are administered both intramuscularly and intraarticularly;in milder cases it is possible to take the form of tablets.These drugs are aimed at improving the processes of restoration of cartilage tissue and slowing down its degeneration.Your doctor may also prescribe vascular medications to improve local blood circulation.
    • Physiotherapy.His procedures improve blood flow in the joint area and relax the muscles.These are UHF, magnetotherapy, laser treatment, diadynamic currents, electrophoresis.Purpose: according to individual indications.
    • Therapeutic massage.An indispensable treatment method for coxarthrosis: it relieves muscle spasms, has a beneficial effect on blood circulation and, when carried out systematically, strengthens the muscles.
    • Therapeutic gymnastics.Improves blood flow and strengthens the muscular corset of the joint.Recommended exercises for coxarthrosis (performed on a solid support):
      • “bicycle” in a supine position;
      • lying on your back, grab your knee with your hand and pull it towards your stomach, and do the same with the other leg;
      • while lying on your back, bend your knees, press the soles of your feet to the ground and lift your pelvis, maintain this position;
      • lying on your back, move your thigh as much as possible to the side;
      • sitting on a chair, squeeze the ball between your thighs;
      • lying on your back, turn your legs in and out;
      • Standing with your right foot slightly elevated and holding the support with your hands, swing your left leg back and forth and left and right, then do the same, changing legs.
  2. Surgical treatment.Endoprosthesis, i.e. the replacement of a joint with an artificial one, is performed at the 3rd stage of coxarthrosis in the presence of shortening of the limb, constant pain and severe contracture.Endoprostheses can be cemented (in the presence of osteoporosis) or uncemented.The prosthesis itself can be unipolar (replacement of the head only) and total (replacement of both components).Already on the day after the operation, some elements of physical therapy are carried out while lying in bed, the patient can stand up, but for now without supporting the leg and a few days later on crutches.After 2-3 months crutches will no longer be necessary and full weight bearing on the leg will be allowed.Patients who have undergone an endoprosthesis are advised to undergo rehabilitation consisting of physical therapy, massage and physical therapy.In most cases, limb function is restored.The lifespan of the prosthesis is from 10 to 20 years, then it is replaced with a new one.

Prevention of coxarthrosis

Preventive measures are very important, especially if you have a history of hip dysplasia, fractures, severe bruises or purulent processes in this area.

  • Avoid heavy lifting and jumping (especially from heights).Try not to stand for long periods of time.
  • Body weight control (reduce the consumption of flour products, table salt, sweet and strong tea and coffee in the diet).Being overweight increases the risk of hip arthritis.
  • Dosed physical exercises aimed at strengthening the muscles of the thighs and buttocks (cycling or stationary bike, swimming, therapeutic exercises).
  • If there are diseases related to metabolism (diabetes mellitus, atherosclerosis), they must be compensated.

Compliance with preventive measures, early diagnosis of coxarthrosis and its adequate treatment are the key to a positive prognosis for this disease.

Which doctor should I contact?

If you experience pain in your leg or hip joint, you should see a doctor.He will prescribe primary diagnostic measures, in particular X-rays of the hip joint.Once the stage of the disease is established, the patient will be referred to a rheumatologist or orthopedist.A nutritionist and endocrinologist can provide additional assistance in losing weight and slowing the progression of the disease.It would be helpful for women to consult a gynecologist to prescribe hormone replacement therapy to prevent osteoporosis.