Coxarthrosis of the hip joint is a degenerative-dystrophic process that occurs in the joint joint of the head of the femur and the acetabulum of the pelvis. The disease is more common in middle-aged and elderly people, but it can also occur in young people, including children. Most often, its development is preceded by injuries, as well as a number of pathologies of an inflammatory and non-inflammatory nature, and pain and stiffness of movements become the main signs of a degenerative-dystrophic process in the hip joint. In its development, the disease goes through several stages, and if in the early stages it can be treated conservatively, then in the last stages, the treatment of coxarthrosis of the hip joints is effective only through surgery. Otherwise, the pathology will lead to severe disorders or even complete immobilization.
What is coxarthrosis of the hip joint and the mechanism of its development
Coxarthrosis, also called osteoarthritis and deforming arthrosis, is a complex disease of the hip joints (HC) accompanied by progressive cartilage destruction. Over time, this leads to deformation of the surfaces of adjacent bones, as well as to the formation of bone growths on them, called osteophytes.
The two hip joints are the largest joints in the body. Each of them is formed by the femur and the acetabulum of the pelvis. The head of the femur is located in the cup-shaped recess of the pelvis and moves freely in different directions. This joint structure allows for flexion and extension, adduction and abduction, and rotation of the hip.
To prevent movement from causing discomfort, the surfaces of the bones that touch each other are covered with an elastic layer called hyaline cartilage. It is he who allows the head of the femur to easily slide into the acetabulum. In addition, hyaline cartilage provides stabilization and cushioning of the hip joint during movements.
The entire joint is encased in a kind of sheath called the joint capsule. It contains the synovial membrane, which synthesizes the synovial fluid. It is the one that lubricates the surface of the cartilage, ensures the flow of water and nutrients into it, i. e. it is responsible for maintaining the normal structure of the cartilage tissue.
Above the joint capsule is a group of femoral and pelvic muscles that move the joint. The hip joint is also surrounded by a group of ligaments that ensure the stability of its position within physiological limits.
Because the hip joint is subjected to heavy loads every day, it is prone to rapid wear and tear and injury. The risk of such changes significantly increases the effect of a number of adverse factors that are practically unavoidable in the modern world, but they will be discussed below. This explains the wide spread of coxarthrosis.
As a result of the influence of negative factors, there is a violation of the production of synovial fluid. Gradually, its quantity decreases, its qualitative composition also changes: it becomes viscous, dense and is no longer able to fully nourish the cartilage. This leads to acute nutritional deficiency and progressive dehydration of the hyaline cartilage. As a result of such changes, the strength and elasticity of cartilage tissue decreases, it exfoliates, cracks and decreases in volume. All this prevents the smooth sliding of the head of the femur into the acetabulum of the pelvis, which leads to the appearance of signs of hip coxarthrosis.
Gradually, the interarticular space narrows, there is increased friction between the articulating bone surfaces, and the pressure of the bones on the hyaline cartilage increases. This leads to even more injury and wear and tear, which cannot help but affect the biomechanics of the hip joint and a person's well-being.
As the pathological changes progress, the hyaline layer gradually disappears completely, which leads to bare bone surfaces and a critical increase in the load on the bone joint. During movements, the head of the femur is no longer covered with anything and rubs directly against the surface of the acetabulum of the pelvis. In addition to the fact that it severely limits mobility and causes excruciating pain, the bones are pressed against each other, flattening at the same time.
As the joint bones are deformed, bone growths (osteophytes) form on their surface. They can have sharp edges and seriously injure the surrounding muscles. This provokes the appearance of severe pain in the groin, legs and buttocks. Therefore, the patient unconsciously tries to spare the affected hip joint and avoid movements in it. Lack of adequate muscle loading leads to their gradual atrophy, which further exacerbates mobility problems. This leads to lameness.
Reasons for development
Coxarthrosis of the hip joint can be primary and secondary. In the first case, the reasons for its development cannot be found, i. e. the disease develops independently for no apparent reason. Secondary coxarthrosis is the result of a number of changes in the state of the musculoskeletal system or lifestyle characteristics, in particular:
- injuries of the hip joint, including bone fractures, sprains, bruises, sprains or tears of the surrounding ligaments, chronic microdamages, etc. ;
- exhausting physical work;
- sedentary way of life;
- obesity;
- chronic infectious processes in the body;
- rheumatoid arthritis, gout, tendinitis, bursitis;
- endocrine diseases, metabolic and hormonal disorders, including diabetes;
- congenital malformations of the hip joint (dislocation, dysplasia);
- aseptic necrosis of the femoral head;
- various types of pathologies of the spine;
- genetic predisposition;
- smoking addiction.
In the majority of cases, the development of coxarthrosis of the hip joint is due to inevitable age-related changes, and the presence of other factors from the above only increases the risk of its occurrence and increases the rate of progression.
Symptoms and degrees
During coxarthrosis, 4 stages of development are distinguished, of which 1 is the easiest. Initially, the disease may be asymptomatic or manifest as mild pain. More often they appear after heavy physical exertion, a long walk or at the end of a stressful work day. In the first stages of the development of the disease, discomfort is usually due to fatigue and is considered the norm. That is why coxarthrosis of the hip joint is extremely rarely diagnosed at the 1st stage of development.
Tangible signs of coxarthrosis begin to appear at the 2nd stage of progression, when the joint space narrows almost by half, and the head of the femur is displaced and deformed. With the transition to the 3rd stage, the pains become unbearable and can disturb a person even at night, they tend to radiate to the hips, shins, groin and buttocks. Since the joint gap is practically absent and numerous osteophytes are formed on the bone surfaces, independent movement in such situations is impossible. Because of this, patients are forced to use a cane or crutches.
So, the main symptoms of coxarthrosis of the hip joint are:
- Limitations of mobility - initially, patients may notice the appearance of difficulties in performing rotational movements of the leg, but over time they are joined by morning stiffness and swelling of the HJ. Because of them, one needs a few minutes to warm up and so to speak to walk to restore a normal range of motion. Gradually, it becomes more and more difficult for the patient to perform leg movements.
- Characteristic crunch - occurs when walking, as well as during flexion or extension of the hip joint. This is a consequence of the bone surfaces rubbing against each other and in coxarthrosis is accompanied by sharp or dull pain.
- Pain syndrome - initially the pain appears after physical exertion and subsides slightly after a long rest. An acute attack can be provoked by lifting weights or hypothermia, since coxarthrosis is often complicated by the addition of inflammation of the synovial membrane. As the disease progresses, the pain becomes more frequent, lasts longer and worsens.
- Spasm of the femoral muscles - is a consequence of pinching of the nerves and weakening of the ligamentous apparatus, so the muscle spasm is compensated to hold the head of the femur in the acetabulum. Also, muscle spasm can be provoked by the addition of synovitis.
- Lameness - occurs in the last stages of the development of the disease, because the deformation of the bone surfaces provokes the appearance of contracture of the flexor muscles. Because of this, a person cannot fully straighten the leg and keep it in this position. Also, the patient may involuntarily limp to transfer the weight to the healthy half of the body, as this helps reduce the intensity of the pain.
- Shortening of the leg - observed in coxarthrosis of the 3rd degree. The leg on the side of the affected hip may be shortened by 1 cm or more as a result of narrowing of the joint space, decreased muscle tone, and flattening of the femoral head.
At the same time, degenerative-dystrophic changes can be observed in one or both hip joints. Accordingly, the characteristic symptoms will be observed either on one side or on both at once, but in the second case their severity on the left and right may differ.
Diagnosis
The doctor can suspect the presence of coxarthrosis of the hip joint based on the patient's complaints, the external examination and the results of functional tests. Be sure to measure leg length during visual inspection. For this, the patient is asked to stand up and straighten his legs as much as possible. The measurement is taken between the anterior axis of the pelvic bones and any bony structure of the knee, ankle or heel. But if both hip joints are simultaneously affected by coxarthrosis, the data obtained will be uninformative.
But since the symptoms characteristic of coxarthrosis can accompany a number of other inflammatory and non-inflammatory diseases, instrumental research methods are mandatory for the patient to accurately diagnose the pathology. Could be:
- CT scan or x-ray of the hip joint - the images show destructive changes in it, narrowing of the joint space, formation of osteophytes and deformation of the bone surfaces;
- MRI is the most informative research method that allows you to accurately assess the nature of changes in cartilaginous structures, connections and the nature of blood circulation in the area of the hip joint.
Patients are also prescribed laboratory tests to assess their general state of health and detect diseases that can cause coxarthrosis. It:
- UAC and OAM;
- blood chemistry;
- rheumatic tests;
- hip puncture with biochemical examination.
The task of diagnostics is to differentiate coxarthrosis of the hip joint with gonarthrosis (damage to the knee joint), as well as radicular syndrome, which occurs with osteochondrosis, as well as protrusions and herniations of the intervertebral discs. Also, the symptoms of coxarthrosis can resemble manifestations of trochanteric bursitis and an atypical course of ankylosing spondylitis, which requires a full examination to determine the true causes of pain and mobility limitations.
Conservative treatment
Conservative treatment of hip coxarthrosis is effective only in the initial stages of the disease. It is selected individually for each patient and may include a whole range of different methods, each of which will complement the others. Therefore, as part of the treatment of coxarthrosis of the hip joint, patients can prescribe:
- drug therapy;
- exercise therapy;
- physical therapy;
- plasmolifting.
For conservative treatment to be effective, patients must eliminate the effect of a number of factors that contribute to the development of coxarthrosis of the hip joint. If you are overweight, it is very important to reduce it as much as possible. This will reduce the load on the affected joint and the risk of progression of the degenerative-dystrophic process.
You should also quit smoking and normalize your physical activity regime, avoid overwork, but don't sit all the time. To prevent further destruction of the hip joint, it is recommended to wear special bandages and orthoses. They provide secure fixation of the joint and support it during movement.
Medical treatment
The nature of drug therapy is chosen strictly individually. In most cases, patients are prescribed:
- NSAIDs - drugs that simultaneously have analgesic and anti-inflammatory effects (available in the form of tablets, injections and topical means);
- corticosteroids - drugs with a powerful anti-inflammatory effect, which are prescribed if NSAIDs do not give a pronounced effect;
- chondroprotectors - contribute to the activation of cartilage tissue regeneration processes, but their effectiveness has not been proven;
- muscle relaxants - drugs that reduce muscle tone and eliminate spasms, which is necessary in case of spasm of certain muscles or groups against the background of severe pain;
- preparations to improve blood circulation - most often used in the form of injection solutions and help to improve the trophism of the tissues around the joint;
- vitamins of group B - are shown to normalize the transmission of nerve impulses, which is especially important when nerves are compressed by deformed bone structures.
For acute pain that cannot be eliminated with the help of tablets, patients can be given intra-articular or peri-articular blockades. They are performed exclusively by qualified health workers in a medical facility and involve the introduction of anesthetic solutions with corticosteroids into the joint cavity or directly into the area around it.
exercise therapy
Physical therapy is an effective method for dealing with the reduction of muscle tone and the limitation of mobility. Thanks to a properly selected set of exercises, it is possible to increase the range of motion and reduce the severity of pain. They also prevent muscle atrophy and help to eliminate spasms if coxarthrosis is accompanied by pinching of nerve fibers, which reflexively leads to spasm of individual muscles.
Exercise therapy classes can improve blood circulation in the area of the degenerative-dystrophic process. Thanks to this, the trophic quality of the diseased joint increases and the course of regenerative processes is accelerated.
For each patient, an individual set of exercises should be developed by a specialist. At the same time, not only the degree of destruction of the hip joint is taken into account, but also the level of physical development of the patient.
Physiotherapy
Physiotherapy procedures and massage have an anti-inflammatory, analgesic, toning, anti-edematous effect. In addition, they help maintain normal leg muscle tone, preventing their atony and atrophy.
For coxarthrosis of the hip joint, courses of 10-15 procedures are prescribed:
- ultrasound therapy;
- magnetic therapy;
- laser therapy;
- electrophoresis;
- ultraphonophoresis;
- UHF;
- paraffin treatment.
Mud therapy is also offered to many patients. Such procedures have a positive effect only at the first stage of the development of coxarthrosis of the hip joint or during rehabilitation after surgical treatment. Thanks to the healing mud, it is possible to improve the quality of blood circulation and speed up the recovery of the motor abilities of the affected joint.
Plasmolifting
Plasmolifting or PRP therapy is a procedure that involves the introduction of platelet-rich plasma from the patient's own blood into the cavity of the hip joint. This allows you to activate the recovery processes of hyaline cartilage.
But according to some scientists, such a procedure can cause the formation of malignant tumors. This point of view is based on the fact that plasmolifting promotes the formation of a large number of stem cells, the effect of which on the body has not yet been fully studied.
Surgical treatment of coxarthrosis of the hip joint
Despite the considerable discomfort in the hip joint, many people seek medical help too late, when pathological changes in the joint reach 3 or even 4 degrees of severity and functionality is irreversibly reduced.
In advanced pathology, surgery is a necessary measure. Only timely surgical intervention will help restore normal mobility and save the patient from excruciating pain, i. e. achieve a significant improvement in the quality of human life. No drugs, physical therapy procedures can restore the badly damaged cartilage. At best, painful intra-articular injections and medications can reduce the pain. But this will be a temporary phenomenon, after which the pain will return again with the same or even greater force.
Indications for hip surgery are:
- disappearance of the interarticular space;
- constant pain in the hip joint that cannot be relieved;
- critical mobility disorders;
- hip fracture.
Depending on the severity of joint destruction and bone deformity, patients may be offered different types of surgical treatment, namely:
- arthrodesis;
- endoprosthetics;
- osteotomy.
Arthrodesis
Arthrodesis is an affordable operation that involves strong fixation of the joint bones with metal plates. The result is complete immobilization of the joint. Therefore, with the help of arthrodesis, it is possible to correct only the supporting function of the leg, to eliminate pain, but there is no need to talk about restoring mobility or significantly improving the quality of life.
Endoprosthetics
Endoprosthesis with arthroplasty is the only way to radically solve the problem of coxarthrosis of the hip joint with the restoration of all its functions and motor abilities. This is a high-tech method of solving the problem of coxarthrosis, which allows you to completely forget about it for 15-30 years, as well as about pain and mobility limitations. Thanks to the use of modern endoprostheses, it is possible to achieve a full restoration of locomotor functions and ensure a normal life for the patient.
The operation involves resection of the head of the femur and part of its neck. Surgical preparation of the acetabular bed is also performed, which includes removal of osteophytes, alignment of its surface and resection of tissues that have undergone necrosis. Arthroplasty can even be used to treat adult patients with coxarthrosis of the hip joint.
The operation is performed under general anesthesia and takes about an hour. Depending on the severity of the degenerative-dystrophic process, the operation can be performed by one of the following methods:
- superficial - involves grinding the acetabulum and the head of the femur with an additional coating with smooth implants that replace the destroyed hyaline cartilage (the method is rarely used due to the possibility of inflammation in the periarticular tissues);
- unipolar - removal of the head of the femur and its replacement with an endoprosthesis (used when the cartilage is preserved on the surface of the acetabulum and only the head of the femur is destroyed);
- bipolar - similar to the previous technique, differing only in the design of the endoprosthesis used, which has a lower coefficient of friction and provides smoother movements in the joint bed;
- total is the most effective and safe method for solving the problem of coxarthrosis of the hip joint, which includes a complete resection of the head of the femur with the capture of part of its neck, as well as the acetabular socket and their replacement with a full-fledged artificial joint.
In this way, patients can be recommended to install different types of endoprostheses. Most hip replacements are manufactured in the US and UK. Chemically and biologically inert metals are used for their production: cobalt, chromium, titanium alloys. Ceramics are also often used. In most modern models, polymer pads are additionally used, which allow to provide natural shock absorbers, stabilizing and sliding properties of the artificial TBS.
After the operation, antibiotics are prescribed to prevent the development of infectious complications, and the stitches are removed after 10 days. The size of the postoperative scar is approximately 8 cm. At the same time, the patient is discharged from the clinic. Rehabilitation after arthroplasty is simple, but still requires physical therapy, massage and exercise therapy.
osteotomy
Osteotomy is a surgical intervention that is a temporary measure before a cardinal replacement of the hip joint with an artificial endoprosthesis. The essence of the operation is to align the axis of the femur due to its intentional fracture. The resulting fragments are placed in the most suitable position, thereby slightly relieving the diseased joint. As a result, it is possible to temporarily reduce the strength of pain and improve mobility.
Thus, coxarthrosis of the hip joint is a rather dangerous disease that can completely deprive a person of the ability to move independently. It progresses over a long time and its symptoms, especially in the early stages, are often perceived by patients as a normal condition after physical exertion. But this is precisely where the insidiousness of the disease lies, since only in the initial stage of its development can it be dealt with in a non-surgical way. But if the degenerative-dystrophic process has already completely destroyed the hyaline cartilage and led to the bare surfaces of the bones and even more to their flattening, only surgery can help the patient. Fortunately, the modern level of medicine, and surgery in particular, makes it possible to achieve a complete restoration of the normal state of the hip joint and its functions.