Coxarthrosis affects the hip joints of middle-aged and elderly people. The causes of its development are previous injuries, congenital and acquired diseases of an inflammatory or non-inflammatory nature. The main symptoms of coxarthrosis are pain in the hip joint, morning swelling and stiffness of movements. At the initial stage of the pathology, treatment is conservative. If it is ineffective against the background of rapid progression of coxarthrosis or its late detection, surgical intervention, usually endoprostheses, is indicated.
Description of the pathology
Coxarthrosis (osteoarthritis, deforming osteoarthritis) is a degenerative-dystrophic pathology of the hip joint. At the initial stage of development, the structure of the synovial fluid changes. It becomes viscous, thick, and therefore loses its ability to nourish hyaline cartilage. Due to dehydration, its surface dries out and becomes covered with multiple radial cracks. In this condition, the hyaline cartilage does not absorb shock well when the bones that form the joint come into contact.
To adapt to the increased pressure exerted on them, bone structures deform with the formation of growths (osteophytes). Metabolism in the hip joint deteriorates, which negatively affects the muscles and ligamento-tendinous apparatus of the joint.
Degrees
Each stage is characterized by its own symptoms, the severity of which depends on the degree of narrowing of the joint space and the number of bony outgrowths formed.
| Severity of coxarthrosis | Characteristic symptoms and radiographic signs |
|---|---|
| First of all | The joint space is unevenly narrowed and unique osteophytes have formed around the acetabulum. Mild discomfort occurs, but most often the disease does not manifest itself clinically. |
| Second | The joint space is narrowed by almost 2 times, the head of the femur is displaced, deformed, enlarged, and bony growths are found even outside the cartilaginous lip. Hip pain becomes constant and is accompanied by significant limitation of mobility |
| Third | Complete or partial fusion of the joint space, multiple bony outgrowths, expansion of the femoral head. The pain occurs day and night and spreads to the thighs and legs. Movement is only possible with the help of a cane or crutches |
Causes of disease
Primary coxarthrosis is a destructive-degenerative lesion of the hip joint, the causes of which have not been established. This means that no preconditions for premature destruction of hyaline cartilage have been identified. The following pathological conditions can cause secondary coxarthrosis:
- previous injuries - fracture of the femoral neck or pelvic bones, dislocation;
- hip dysplasia;
- aseptic necrosis of the femoral head;
- congenital hip dislocation;
- inflammatory diseases, including infectious diseases of the joint (rheumatoid arthritis, reactive arthritis, gout, tendinitis, bursitis, synovitis).
Prerequisites for the development of coxarthrosis are obesity, increased physical activity, a sedentary lifestyle, metabolic disorders, hormonal disorders, kyphosis, scoliosis and flat feet.
Symptoms of the disease
At the initial stage of development, coxarthrosis can only manifest itself with slight pain. They usually occur after intense physical exertion or a hard day at work. The person attributes the deterioration of his state of health to muscular "fatigue" and does not seek medical help. This explains the frequent diagnosis of coxarthrosis at stages 2 or 3, when conservative treatment is ineffective.
Limitation of joint mobility
The range of motion of the hip joint is reduced due to compensatory growth of bone tissue, damage to the synovial membrane, and replacement of areas of the joint capsule with fibrous tissue devoid of any functional activity. Mobility may be somewhat limited even with grade 1 coxarthrosis. Difficulties arise when performing rotational movements with the leg.
As the disease progresses, morning stiffness and joint swelling become common. To regain mobility, a person must warm up for several minutes. At lunchtime, range of motion is restored, in part through the production of hormone-like substances in the body.
Crunch
When walking, flexion and (or) extension of the hip joint, clicks, crunches and crackles are clearly heard. The reason for this sound accompaniment of each step is the friction of bone surfaces, including osteophytes, against each other. Cracking noises may also appear in normal health due to the collapse of carbon dioxide bubbles in the joint cavity. Coxarthrosis is indicated by its association with dull or sharp pain.
Pain
Painful sensations become constant from stage 2 of hip osteoarthritis. Their severity decreases somewhat after a long rest. The pain intensifies with the next relapse or the development of synovitis (inflammation of the synovial membrane), which often accompanies osteoarthritis. During the remission phase, the discomfort decreases somewhat. But as soon as a person falls into hypothermia or lifts a heavy object, severe pain reappears.
Muscle spasm
Increased tension in the skeletal muscles of the thigh occurs with coxarthrosis for several reasons. First, the ligaments weaken. The muscles contract to hold the head of the femur in the acetabulum. Secondly, an increase in tone often accompanies inflammation of the synovial membrane. Third, when osteophytes are displaced, nerve endings are compressed and muscle spasms become a compensatory reaction to acute pain.
Lameness
In the later stages of the development of coxarthrosis, the patient begins to severely limp. Gait changes are caused by flexion contractures and deformations of bony surfaces, making it impossible to maintain a straight leg position. The person also limps to reduce the severity of the pain by shifting their weight to the unaffected limb.
Leg shortening
Shortening of the leg by 1 cm or more is typical for grade 3 coxarthrosis. The reasons for the decrease in the length of the lower limb are severe muscle atrophy, thinning and flattening of the cartilage, narrowing of the spacejoint and deformation of the femoral head.
Diagnostic methods
The initial diagnosis is made on the basis of the patient's complaints, external examination, medical history and the results of a number of functional tests. Many inflammatory and non-inflammatory pathologies are disguised as symptoms of coxarthrosis, therefore instrumental and biochemical studies are carried out.
X-ray examination
The stage of coxarthrosis is determined by performing an x-ray examination. The images obtained clearly show destructive changes in the hip joint. This is a narrowing of the joint space, deformation of bone surfaces and the formation of osteophytes.
CT scan
Patients are prescribed a CT scan to determine the degree of flattening and deformation of the hyaline cartilage. The results of the study also make it possible to assess the condition of the ligamento-tendinous apparatus, nerve trunks, muscles, small and large blood vessels.
Magnetic resonance imaging
MRI is one of the most informative studies in the diagnosis of coxarthrosis. To identify circulatory disorders in the area of the affected joint, it is carried out with contrast. A routine study is prescribed to determine the degree of damage to the ligaments and deformation of the femoral head, and to detect areas of fibrous degeneration of the joint capsule.
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, the orthopedist uses two bone landmarks. Superior - the anterior axis of the pelvic bone, located on the anterior lateral surface of the abdomen at the outer edge of the inguinal ligament. The second point of reference is any bony structure in the knee, ankle or heel. Measuring leg length may not be informative if coxarthrosis affects two hip joints at once.
Laboratory research
Clinical blood and urine tests are performed to assess the patient's general health. And the results of biochemical studies often make it possible to detect the pathologies causing the development of coxarthrosis. Gouty arthritis is indicated by high levels of uric acid and its salts. An increase in the erythrocyte sedimentation rate and an increase in the number of leukocytes indicate the occurrence of an inflammatory process (bursitis, arthritis, synovitis). To exclude rheumatoid arthritis, rheumatoid factor, C-reactive protein and antinuclear antibodies are determined.
Hip puncture
Using a puncture, the synovial fluid is collected to study its composition and detect changes in consistency. If an infectious-inflammatory process is suspected, a more in-depth biochemical examination of a biological sample is indicated.
Treatment options
When determining treatment tactics, the orthopedist takes into account the severity of coxarthrosis, the form of its course, the causes of its development and the severity of symptoms. Patients are often recommended to wear bandages with rigid ribs and orthotics from the first days of treatment. The use of orthotics helps slow down the breakdown of cartilage and bone deformation.
Drugs
In the treatment of deforming osteoarthritis, drugs of various clinical and pharmacological groups are used. These are nonsteroidal anti-inflammatory drugs (NSAIDs), muscle relaxants, glucocorticoids, chondroprotectors, ointments and gels with a warming effect.
Blockade
To relieve acute pain that cannot be eliminated by NSAIDs, intra-articular or periarticular drug blockades are prescribed. To achieve them, hormonal agents are used. The analgesic effect of glucocorticosteroids is enhanced by their combination with anesthetics.
Injections
Intramuscular injection of NSAID solutions allows you to eliminate severe pain in the hip joint. To relax skeletal muscles, a drug is usually used, which, in addition to a muscle relaxant, includes an anesthetic. In the form of injections, treatment regimens include B vitamins, drugs to improve blood circulation and chondroprotectors.
Diet therapy
Overweight patients are advised to lose weight in order to slow the spread of pathology to healthy joint structures. The calorie content of the daily menu should be limited to 2000 kilocalories, excluding foods high in fats and simple carbohydrates. Nutritionists recommend that all patients with coxarthrosis adhere to proper nutrition. The diet should contain fresh vegetables, fruits, berries, cereal porridges, fatty sea fish and dairy products. Following a therapeutic diet stimulates the strengthening of the immune system and the improvement of overall health.
Exercise therapy and massage
In the treatment of coxarthrosis, classic, acupressure and vacuum massages are used. After several sessions, blood circulation in the hip joint improves and nutrient reserves are replenished. Carrying out massage procedures stimulates the strengthening of the ligamento-tendinous apparatus and the restoration of soft tissues damaged by the displacement of osteophytes.
Regular exercise therapy is one of the most effective ways to treat osteoarthritis. A set of exercises is developed by a physiotherapist doctor individually for the patient, taking into account his physical form.
Physiotherapy
Patients with coxarthrosis are prescribed up to 10 sessions of magnetic therapy, laser therapy, UHF therapy, UV irradiation and shock wave therapy. The therapeutic effect of the procedures is due to improvement of blood circulation, acceleration of metabolism and regeneration processes. To relieve acute pain, electrophoresis or ultraphonophoresis with glucocorticosteroids, anesthetics and B vitamins is carried out. Applications of ozokerite or paraffin help to eliminate discomfort.
Surgical intervention
If conservative treatment is ineffective, the pain cannot be eliminated with medication or the coxarthrosis progresses steadily, patients are advised to undergo surgical intervention. The operation is carried out immediately in case of pathology of the 3rd degree of severity, since it is impossible to eliminate the resulting destructive changes in cartilage and bones by taking medications or exercise therapy.
Arthroplasty
The operation is carried out under general anesthesia. The head of the femur is removed from the acetabulum. Visible destructive changes in tissues are corrected - bone growths are removed, joint surfaces are leveled, tissues that have undergone necrosis are excised. During surgery, cavities are formed and filled with ceramic implants.
Endoprostheses
Hip implant replacement is performed under general anesthesia. To prevent the development of an infectious process, a course of antibiotics is prescribed. After 10 days, the sutures are removed and the patient is discharged from the medical institution. At the rehabilitation stage, patients undergo physiotherapy, massage and exercise therapy procedures.
Possible consequences
At the final stage of the pathology, flexion and adduction contractures develop. The patient's leg is constantly bent, so he uses a cane or crutches to get around. After complete fusion of the joint space, immobility occurs, the patient cannot do housework and becomes disabled. Coxarthrosis is often complicated by aseptic necrosis of the femoral head, arthrosis of the knee joints and arthritis.
Prevention and prognosis
Only grade 1 coxarthrosis responds well to conservative treatment. In other cases, endoprostheses allow you to completely restore the functional activity of the hip joint. After placement of the stent, the patient quickly returns to an active lifestyle.
To prevent the disease, orthopedists recommend quitting smoking, abusing alcoholic beverages, daily physiotherapy and gymnastics, and losing weight if necessary.