Arthrosis of the hip joint

Arthrosis of the hip joint on radiography

Arthrosis of the hip joint (coxarthrosis) is a degenerative disease of the cartilage of the hip joint, which results in joint dysfunction and persistent disability of the patient. More often, arthrosis of the hip joint can be found in elderly patients, and men are more often ill than women.

Classification of hip joint arthrosis

There are two main types of disease:

  • primary - the onset of the disease with a background of complete well -being;
  • secondary - develops against the background of inflammatory joint disease, after previous injuries, as well as when there are congenital disorders in the development of the hip joint, dysplasia.

Causes of coxarthrosis

Based on the causes of the development of arthrosis of the hip joint, the following types are distinguished:

  • idiopathic - coxarthrosis, which develops for no particular reason;
  • involved - arthrosis associated with age -related changes that are natural to the body, manifesting themselves in old age;
  • dysplasia (congenital) - arthrosis that develops in the joints against the background of congenital anomalies of its development;
  • post -infectious - arthrosis that develops in the joints affected by rheumatoid arthritis, and also caused by some other infections;
  • post -traumatic - arthrosis, which develops as a result of traumatic damage to the joints;
  • dyshormonal - coxarthrosis, which develops against the background of metabolic disorders due to diseases of the endocrine system or hormone therapy;
  • vascular - the disease develops as a result of circulatory disorders in the joints;
  • hereditary - develops as a result of hereditary characteristics of the development of cartilage tissue (often combined with other osteoarthritis deformities of the joints).

In addition, osteoarthritis of the hip joint can be the result of violations of biomechanics of body movement, which often accompanies curvature of the spine, intervertebral hernias or defects in the skeletal bones in the lower leg (for example, shortening of one of them). Lameness or poor posture puts excessive pressure on the hip joint, which can trigger coxarthrosis. Other causes of coxarthrosis are inactivity, however excessive physical activity (sports or work) can also cause joint pathology.

How does osteoarthritis of the hip joint manifest itself?

Stages of development of coxarthrosis

First of all, patients with coxarthrosis complain of pain in the hip joint. It is accompanied by lameness, over time, atrophy of the thigh and gluteal muscles appears. Movement in the joints is accompanied by special features; over time, joint movement decreases. The intensity of symptoms directly depends on the stage of the disease.

Coxarthrosis 1 degree

The early stages of the disease are manifested by mild pain, which can bother in the morning or after significant physical exercise on the joints. Meteosensitivity in the affected joints can also be observed, which is indicated by pain as the weather changes. Patients may notice morning stiffness in the joints, which disappears after movement, a slight warming.

Radiological changes are minimal - there may be a slight narrowing of the joint space, a thinning of the cartilage that covers the head of the femur.

Grade 2 coxarthrosis

The intensity of pain at this stage of the disease increases slightly, while the pain radiates to the groin, knees. There are many cases of misdiagnosis of coxarthrosis associated with pain radiating to the knee and popliteal ligaments. The pain starts to bother not only after doing physical exercise, but also at rest. During limb movement, external sounds emerge from the joints (clicks, cracks). The range of movement in the joint is significantly reduced, especially the rotation (circular), the biomechanics of movement in the joint is disturbed and, therefore, its function is reduced. Pain and decreased mobility in the joint give rise to the appearance of slight lameness, which in turn leads to mild atrophy of the gluteal muscles of the side of the affected joint.

On the roentgenogram, one can see narrowing of the joint space by one -third of the normal width, marked thinning of the cartilage to its absence in some areas, the appearance of osteophytes on the articular surface, deformation of the femoral head, and its upward displacement.

Coxarthrosis grade 3

At this stage of the disease, the pain becomes persistent, including at night, pain relievers are difficult to overcome. The range of motion at the joint is reduced to a minimum, the biomechanics of the joint is significantly affected. Slight movement is accompanied by crepitus, lameness becomes apparent, there is significant pelvic deviation and shortening of the limb from the side of the affected joint. The gluteal and femoral muscles in the part affected by atrophy. Due to significant lameness, patients are often unable to move freely without the use of crutches or supports.

X-ray examination showed significant deformation of the femoral head, thickening of the femoral neck. The articular surface is covered with bone growth, the joint space is narrowed so that it is almost non -existent.

Diagnosis of arthrosis of the hip joint

The diagnostic steps begin by interviewing the patient and examining him, taking a number of laboratory tests, after which special instrumental techniques are used to confirm the diagnosis. The following methods are considered the most informative today:

  • X -ray examination -allows you to see the contours of the articular surfaces, the presence or absence of bone growth on them, to determine the presence of femoral head defects and the width of the joint space;
  • Ultrasound of the jointsallows not only to examine the articular surface, but also to identify dystrophic changes in the articular ligaments;
  • computed tomography (CT)- allows to obtain layer-by-layer images of the X-ray type, but clearer and larger;
  • magnetic resonance imaging (MRI)allows you to study the state of joint structures, articular surfaces, bones and ligaments with a high degree of visualization. Currently, it is considered the most advanced diagnostic method.

Treatment of coxarthrosis

The most effective is the complex treatment of arthrosis of the hip joint, taking into account the stage of the disease. It should be remembered: the earlier treatment is started, the more likely it is to prevent the development of the disease, the immobilization of the patient and the loss of his ability to work. Therefore, even with slight discomfort in the joints, pain, stiffness, seemingly insignificant meteosensitivity of the joints, you need to see an orthopedic doctor who will perform an examination, clarify the diagnosis and prescribe treatment. Cartilage tissue is irreversible, so it is better not to wait for the moment when the damage is significant, but to begin treatment at the stage of malnutrition in the cartilage, until there is an irreversible change in it.

Coxarthrosis therapy in the elderly using exercise therapy

The scope of treatment depends on the stage of the disease. Therefore, with first -degree coxarthrosis, non -narcotic analgesics and NSAIDs are used - they allow you to get rid of the pain syndrome, as well as get rid of inflammation in the joint tissues, preventing further tissue damage. Since at this stage the pain and inflammation syndrome is not intense, there is no need for long-term use of such drugs. As a rule, enough with local methods - ointments, gels containing NSAIDs. This is much more important at this stage to ensure the normalization of metabolic processes in cartilage tissue, to minimize its degeneration, for which drugs from the group of chondroprotectors are used. Their job is to restore metabolism in cartilage tissue cells, as a result of which joint trophism is improved and the intensity of inflammation is decreased. For example, in the treatment of coxarthrosis, chondroprotective drugs have proven themselves well, their active ingredients are a source of natural components of healthy cartilage tissue. It stimulates the production of the most important structural component of cartilage - proteoglycans and prevents the process of destruction of cartilage tissue.

Treatment of coxarthrosis of the second and third degree is already much more difficult: the cartilage is already significantly damaged, the articular surface is exposed, osteophytes are formed on them in large numbers, which impedes the normal movement of the joints. At this stage, only symptomatic treatment is possible, which makes it possible to reduce pain in the joints and slow down the process of cartilage destruction. The pain at this stage of the disease is very strong, analgesics and NSAIDs are used to relieve it, and the best solution is a combination of the use of local agents (ointments, creams) and dosage forms of systemic action (tablets, injections).

During an exacerbation of the disease, regardless of its degree, the load on the joints should be reduced to avoid damage to the cartilage. During remission, in addition to taking chondroprotectors to normalize metabolic processes in cartilage tissue, exercise therapy, massage, and kinesitherapy are recommended. They provide a reasonable load on the joints, prevent immobilization and deposition of mineral salts on the tissues and ligaments of the joints, and stimulate microcirculation. Exercise therapy is also very important for the general state of the body: when moving, biologically active substances are produced in it that improve mood and general well -being - endorphins and serotonin.

Proper nutrition plays an important role in the complex treatment of hip arthrosis. The patient's diet should be complete, rich in animal protein, vegetables, fiber, vitamins. Proper nutrition is important not only to stimulate joint regrowth, but also to keep the patient's weight within normal limits. Being overweight is an additional burden on diseased joints and a factor in the development of the disease.

At the stage of remission, physiotherapy methods have proven themselves well - electrophoresis, mud therapy, ultrasound and magnetotherapy. In addition, the effectiveness of biological and mechanical methods for treating coxarthrosis was observed. Among the biological methods, the most popular is hirudotherapy (leech therapy), which provides blood thinning and stimulation of capillary microcirculation in the joints and surrounding muscles, which inhibits atrophic processes in them. Mechanical methods include joint traction to relieve excess pressure on the affected joint and acupuncture. However, it should be borne in mind: physiotherapeutic, mechanical and biological methods for the treatment of coxarthrosis can only be used in the period of remission. With the increase of the disease, its use is fraught with the development of inflammation and destruction of cartilage tissue.

If conservative methods of treating coxarthrosis are not successful, the patient may be offered surgical treatment - arthroplasty and joint replacement. The first variant of the operation involves the restoration of mobility in the joint due to the plasticity of the tissue itself, the second - the replacement of the articular surface with endoprosthesis - a mechanical joint. Surgical intervention allows you to restore joint mobility and the patient’s ability to work.

Prevention of arthrosis of the hip joint

Preventive measures are reduced to taking chondroprotectors, proper nutrition and proper stress on the joints, especially for those who play sports or hard physical work.

Coxarthrosis is a serious disease that can impair a patient’s ability to move freely. Defects can be avoided by immediately seeking medical help at the first discomfort in the joints, depending on competent pathological treatment from the first stage.