What is coxarthrosis of the hip and how to treat it, symptoms, full description

Hip arthropathy affects the hip joints of middle-aged and older adults. It occurs due to previous injury, inflammatory or non-inflammatory congenital and acquired diseases. The main symptoms of hip arthrosis are hip pain, morning swelling, and stiffness of motion. In the initial stages of pathology, treatment is conservative. If ineffective in cases of rapid progression of hip arthrosis or late detection, surgical intervention is required, usually with an endoprosthesis.

Pathological description

Hiparthrosis (osteoarthrosis, osteoarthrosis) is a degenerative dystrophic pathology of the hip joint. During the initial stages of development, the structure of the synovial fluid changes. It becomes sticky and thick, thus losing its ability to nourish hyaline cartilage. Due to dehydration, its surface is dry and covered with multiple radial cracks. In this case, the hyaline cartilage doesn't cushion the impact well when the bones that form the joint come into contact.

In order to adapt to the increased pressure placed on it, the bone structure deforms and forms growths (osteophytes). The metabolism of the hip joint deteriorates, which negatively affects the muscle and ligament-tendon apparatus of the joint.

degree

Each stage has its own symptoms, the severity of which depends on the degree of joint space narrowing and the amount of bone growth.

Severity of Hip Arthropathy	Characteristic symptoms and radiographic signs
first	The joint space narrows unevenly and a single osteophyte forms around the acetabulum. Mild discomfort occurs, but more often the disease has no clinical manifestations
second	The joint space is almost doubled, the femoral head is displaced, deformed, enlarged, and bone growth is even found outside the cartilage lip. Hip pain persists with significant limitation of movement
third	Complete or partial fusion of the joint space, multiple bone growths, and expansion of the femoral head. The pain occurs day and night and spreads to the thighs and calves. Can only move with the help of a cane or crutch

disease cause

Primary coxarthropathy is a destructive degenerative disease of the hip joint whose cause has not yet been determined. This means that no prerequisites for premature destruction of hyaline cartilage are found. The following pathological conditions can cause secondary hip arthropathy:

• Previous injury - fracture or dislocation of femoral neck or pelvis;
• hip dysplasia;
• Aseptic necrosis of femoral head;
• Congenital hip dislocation;
• Inflammation, including infectious diseases of the joints (rheumatoid, reactive arthritis, gout, tendonitis, bursitis, synovitis).

Prerequisites for the development of hip joint disease are obesity, increased physical activity, sedentary lifestyle, metabolic disorders, hormonal disorders, kyphosis, scoliosis and flat feet.

disease symptoms

In the initial stages of development, coxarthrosis presents with only mild pain. They usually occur after intense physical exertion or a hard day's work. The person attributes worsening health to muscle "fatigue" and does not seek medical help. This explains why hip arthrosis is often diagnosed as stage 2 or 3 when conservative treatments have failed.

Limited joint movement

The range of motion of the hip joint is reduced due to compensatory growth of bone tissue, damage to the synovium, and replacement of the joint capsule area by fibrous tissue lacking any functional movement. Even with grade 1 hip arthropathy, mobility may be somewhat limited. Difficulty occurs when performing rotational movements with the legs.

As the disease progresses, morning stiffness and joint swelling become common. In order to regain mobility, a person must warm up for several minutes. By lunchtime, range of motion is restored due to the production of hormone-like substances in the body.

austerity

Clicks, crunches, and crackles can be clearly heard when walking, flexing, and/or extending the hip joint. The cause of this sound with each step is the friction of bone surfaces, including osteophytes, against each other. A crunching sound also occurs under normal health conditions due to the bursting of carbon dioxide bubbles in the joint cavity. Symptoms of hip joint disease include dull or severe pain.

pain

In the second stage of hip joint disease, the pain has become constant. Its severity will lessen after a long period of rest. The pain may worsen during the next recurrence or during the development of synovitis (inflammation of the synovial membrane) that often accompanies osteoarthritis. During the remission phase, discomfort is lessened. But once the person becomes hypothermic or lifts heavy objects, severe pain will reappear.

muscle spasms

Hip joint disease can cause increased tone in the skeletal muscles of the thigh for a variety of reasons. First, the ligaments weaken. Muscle spasm holds the femoral head in place in the acetabulum. Second, increased tone often accompanies synovial inflammation. Third, when osteophytes displace, nerve endings become compressed and muscle spasms become a compensatory response to acute pain.

limp

Later in the development of coxarthrosis, the patient begins to limp severely. Gait changes are caused by flexion contractures and bony surface deformations that make it impossible to maintain a straight leg position. The patient may also limp, reducing the severity of the pain by shifting weight to the unaffected limb.

shortened legs

Shortening of the leg by 1 cm or more is a classic symptom of grade 3 hip arthrosis. The reasons for the reduction in the length of the lower limbs are severe muscle atrophy, thinning and flattening of cartilage, narrowing of joint spaces, deformation of the femoral head, etc.

diagnosis method

The initial diagnosis is made based on the patient's complaint, external examination, medical history, and the results of multiple functional tests. Many inflammatory and non-inflammatory pathologies are masquerading as symptoms of coxarthropathy and thus instrumental and biochemical studies have been performed.

X-ray examination

The stage of hip arthrosis can be determined with X-rays. The resulting images clearly show the destructive changes in the hip joint. This is joint space narrowing, bone surface deformation, and osteophyte formation.

CT scan

The patient is prescribed a CT scan to determine the degree of flattening and deformation of the hyaline cartilage. The results also allow assessment of the condition of the ligamentous-tendon apparatus, nerve trunks, muscles, small and large blood vessels.

Magnetic resonance imaging

MRI is one of the most informative studies for diagnosing hip arthropathy. In order to identify circulatory disturbances in the affected joint area, a contrast examination is required. Routine examination is performed to determine the extent of ligament damage and femoral head deformation and to detect areas of capsular fibrosis.

Leg length measurement

Before the measurement, the doctor asks the patient to stand up and straighten his legs as much as possible. To obtain the most reliable data, orthopedic surgeons use two bone landmarks. Superior - the anterior axis of the pelvic bone, located on the anterolateral surface of the abdomen and the outer edge of the inguinal ligament. The second reference point is any bony structure at the knee, ankle, or heel. If hip arthropathy affects both hip joints, measuring leg length may not be informative.

laboratory research

Clinical blood and urine tests are performed to assess the patient's general health. The results of biochemical studies can often detect the pathology that contributes to the development of hip arthropathy. Gouty arthritis is characterized by high levels of uric acid and its salts. An increase in the erythrocyte sedimentation rate and an increase in the number of leukocytes indicates the development of an inflammatory process (bursitis, arthritis, synovitis). To rule out rheumatoid arthritis, rheumatoid factor, C-reactive protein, and antinuclear antibodies are measured.

hip puncture

Synovial fluid is collected by puncture to study its composition and detect changes in consistency. If an infectious inflammatory process is suspected, further biochemical examination of biological samples is required.

Treatment programs

When determining treatment strategies, orthopedic surgeons consider the severity of hip arthropathy, the pattern of disease progression, the cause of its development, and the severity of symptoms. Patients are usually recommended to wear bandages and orthotics with rigid ribs from the first days of treatment. Using orthopedic devices can help slow cartilage destruction and bone deformation.

drug

In the treatment of deformed joints, drugs from various clinical and pharmacological groups are used. These medications include nonsteroidal anti-inflammatory drugs (NSAIDs), muscle relaxants, corticosteroids, chondroprotectants, ointments and gels with a warming effect.

blockade

To relieve acute pain that cannot be eliminated by NSAIDs, intra-articular or periarticular drug blockade is required. To achieve these goals, hormonal drugs are used. The combined use of glucocorticoids and anesthetics can enhance their analgesic effects.

injection

Intramuscular injection of an NSAID solution can eliminate severe pain in the hip joint. To relax skeletal muscles, drugs are often used, which in addition to muscle relaxants also include anesthetics. Treatment options include injections of B vitamins, medications to improve circulation, and cartilage protectants.

diet therapy

Overweight patients are advised to lose weight to slow the spread of lesions to healthy joint structures. The calorie content of the daily menu should be limited to 2000 calories, excluding foods high in fat and simple carbohydrates. Nutritionists recommend that all patients with hip arthritis adhere to proper nutrition. The diet should include fresh vegetables, fruits, berries, cereal porridge, fatty sea fish and dairy products. Following a therapeutic diet can strengthen your immune system and improve your overall health.

Sports therapy and massage

Classic massage, acupressure and vacuum massage are used in the treatment of hip joint disease. After several courses of treatment, blood circulation in the hip joint is improved and nutritional reserves are replenished. Performing massage procedures stimulates the strengthening of the ligamentous tendon apparatus and the recovery of soft tissues damaged by osteophyte displacement.Regular exercise therapy is one of the most effective ways to treat osteoarthritis. The physical therapist will develop an individual set of exercises for the patient based on the patient's physical health.

physiotherapy

Hip patients receive up to 10 sessions of magnetic therapy, laser therapy, UHF therapy, ultraviolet radiation and shock wave therapy. The therapeutic effects of this procedure are attributed to the improvement of blood circulation, acceleration of metabolic and regenerative processes. To relieve acute pain, electrophoresis or ultrasonic electrophoresis may be performed using corticosteroids, anesthetics, and B vitamins. Using ozokerite or paraffin wax can help eliminate discomfort.

Surgical treatment

If conservative treatment fails, medications fail to relieve pain, or the hip joint continues to progress, surgical intervention is recommended. If the severity of the pathology is grade three, surgery should be performed immediately, since it is impossible to undo the destructive changes produced in the cartilage and bone with drugs or exercise therapy.

Arthroplasty

The surgery is performed under general anesthesia. Remove the femoral head from the acetabulum. Visible destructive changes in the tissue are corrected - bone growth is removed, joint surfaces are flattened, and dead tissue is removed. During the surgery, a cavity is created and filled with a ceramic implant.

endoprosthesis

Hip replacement surgery with implants is performed under general anesthesia. To prevent the development of the infectious process, it is necessary to take a course of antibiotics. After 10 days, the sutures were removed and the patient was discharged. During the recovery phase, patients undergo physical therapy, massage procedures, and exercise therapy.

possible consequences

In the final stages of pathology, flexion and adduction contractures develop. The patient's legs are often bent, so he needs a cane or crutches to move around. After the joint space is completely fused, the patient is unable to move, unable to do housework, and becomes disabled. Hip arthropathy is often complicated by aseptic necrosis of the femoral head, knee arthropathy, and arthritis.

prevention and prognosis

Only grade 1 hip arthropathy responds well to conservative treatment. In other cases, an endoprosthesis allows you to regain full functional movement in your hip joint. After the endoprosthesis is installed, the patient quickly returns to an active lifestyle.To prevent this disease, orthopedic surgeons recommend quitting smoking, drinking alcohol, engaging in daily physical therapy and gymnastics, and losing weight if necessary.