"What to do? "- men and women ask themselves when they have pain in the hip joints. Osteoarthritis is one of the most common causes of this symptom. In this article we will tell you why the hip joints hurt in men or women when walking and at rest, where the pain goes, in what other pathologies it occurs and how to treat it.
Osteoarthritis of the hip (coxarthrosis)- degenerative-dystrophic disease. It often appears in people after age 40, often following an injury, but usually begins without an obvious cause.
The disease is characterized by a slow and gradually progressive course. In the early stages, conservative treatment methods (medications, physiotherapy) are often used. However, at later stages, in order to restore normal functioning of the joint, it is necessary in some cases to undergo surgery to replace the joint.
Many people suffer from coxarthrosis: this fact is due to the fact that the load on the hip joint is usually large. In women, this condition occurs a little more often.
Factors that can increase the risk of developing this disease include heavy and prolonged loads on the hip joint. Coxarthrosis often occurs in seemingly opposite categories of people: sports professionals and obese people. Other risk factors include diseases that affect blood circulation, metabolism and hormonal balance, as well as pathologies of the musculoskeletal system (eg, foot, spine). Coxarthrosis is also more common in older people.
The mechanism of development of hip osteoarthritis
Anatomically, the hip joint includes two bones:
- the ilium, which has the acetabulum;
- femoral, which has a head. Doctors call the femur bone the femur for short.
The two parts of these bones are connected to each other to form a joint. When a person moves his leg, the joint surfaces of the two mentioned parts rub against each other.
To prevent them from being damaged in the process, they are covered with elastic cartilage and joint fluid is secreted there, which plays the role of lubricant. This happens in a healthy person. The hip joint essentially functions like a hinge.
When a person suffers from coxarthrosis, the joint fluid becomes thicker and the cartilage becomes less elastic and cracks appear on it. As a result, the surfaces of the ilium and femur are less protected during friction and are more easily abraded and damaged. As a result, over time they begin to change shape.
Symptoms of hip osteoarthritis
Among the main signs of this pathology are pain. They are located at the joint itself, as well as in the groin, at the top of the thigh.
The following symptoms are also typical:
- limited movement;
- when a person tries to move his leg to the right (if we are talking about coxarthrosis on the right side) or to the left (when the left joint is affected), then he does not fully succeed;
- the gait becomes different from what it usually is in a healthy person, the patient limps;
- decrease in leg muscle mass;
- the affected leg becomes shorter.
Early stage of hip osteoarthritis
At an early stage of the development of the disease, pain sometimes occurs periodically, mainly after physical exertion. For example, after a person has run or taken a long walk. The sensations are concentrated where the hip joint itself is, sometimes in the upper leg or even at the knee. When a person rests, the pain usually subsides. Walking remains normal at this stage. The person can move his leg freely, the muscles are fine.
An X-ray exam reveals that the joint space is narrowed, but not yet that much. Where the edges of the acetabulum are, bone spurs can be identified. At this stage, the head and neck of the femur are unchanged.
Progress
In the next stage, the person suffers more pain which occurs both during physical activity and at rest. They are strong, they go up to the thigh, up to the groin. After trying to run, a person may limp, just like after a walk. Moving your leg sideways becomes more difficult and your range of motion is limited.
An X-ray examination shows that the joint space is narrowed, and severely so. The images reveal displacement and distortion of the femoral head. Bony growths are visible in the acetabulum area.
Advanced stage of hip osteoarthritis
Here the person is already suffering from intense and constant pain. They can occur not only during the day at rest, but also at night. It becomes difficult for the patient to walk, so he buys a cane. Moving your leg becomes even more difficult than before. At this stage, atrophy of the leg and buttock muscles often occurs, which leads to shortening of the affected leg. To make walking easier, a person leans to the side, which further increases the load on the large joint.
An X-ray examination at this stage can find that the joint space is very narrowed, the head of the femur is enlarged, and there are many bony growths.
Diagnosis of hip osteoarthritis
It is carried out through a complete examination, which includes:
- questioning of the patient by the doctor;
- examination by a doctor;
- auxiliary studies, the main one, of course, is X-rays.
On x-rays, you can sometimes detect the cause of osteoarthritis - for example, you may see signs of previous injuries, dysplasia, and other conditions.
Tomography (CT and MRI) also helps with diagnosis. Using the first you can study changes in the bones, and with the second you can study what happens to soft tissues.
What can hip osteoarthritis be confused with?
We wrote above that pain from coxarthrosis can occur not only in the hip joint, but also in the knee and throughout the entire upper leg.
This means that if such symptoms appear, the doctor must first exclude the following pathologies:
- osteochondrosis (since it also causes pain in the upper leg);
- osteoarthritis of the knee joint (manifested by knee pain).
The pain syndrome caused by osteochondrosis differs from that caused by osteoarthritis of the hip. With osteochondrosis, the pain appears suddenly and is most often provoked by something: for example, a person turned around sharply or lifted something heavy. In this case, the pain usually spreads from the buttock to the back of the leg.
With osteochondrosis, even if the pain is severe, a person can move their leg to the left or right. But with coxarthrosis - not always.
In case of osteoarthritis of the knee joint, pathological changes are detected on the x-ray of the knee joint.
It should be remembered that a person can have several diseases at once. For example, osteoarthritis of the knee and hip joints. Or osteochondrosis and osteoarthritis of several joints.
It is important to distinguish hip osteoarthritis from trochanteritis. The latter is an inflammatory disease of part of the femur, called in Latin Trochanter major (trochanter major) - the greater trochanter. Trochanteritis occurs quickly, compared to osteoarthritis, the pain is stronger and a person can move his leg freely.
In some cases, with pain that suggests osteoarthritis of the hip, another condition is present (for example, ankylosing spondylitis, known as ankylosing spondylitis, etc. ). With them, as a rule, pain occurs at night, disappears during the day and may even decrease with physical activity.
Treatment of coxarthrosis
If you experience joint pain, you should consult an orthopedic traumatologist.
Treatment includes conservative therapy (medications, physiotherapy) and surgical intervention.
Conservative therapy
Conservative treatment is prescribed in the early stages.
This includes:
- ordinary pain relievers that a person drinks in the form of tablets or takes in the form of injections (injections), ointments;
- hormones injected into the joint;
- agents that restore the structure of cartilage (they are also taken orally and injected into the joint);
- other medications prescribed by a doctor, depending on the patient’s condition. These include medications that relax muscles, dilate blood vessels, etc.
All medications should be taken strictly as prescribed by the doctor. This is especially true for conventional painkillers: with prolonged use, they can have a detrimental effect on the stomach and lead to serious complications, including bleeding. Therefore, the duration of courses should only be determined by a doctor.
Physiotherapy is also used in the treatment of hip osteoarthritis.
Many people benefit from laser and ultrasound treatment (called laser therapy and ultrasound therapy, respectively).
Magnetic therapy, inductothermy, light therapy and a number of other methods are used.
Therapy uses physiotherapy (physiotherapy) and massage.
It is worth saying a few words about diet. It does not directly treat hip osteoarthritis. However, when a person weighs less, the load on the joint decreases, making the disease easier.
Surgical treatment of hip osteoarthritis
When the disease has already reached an advanced stage, the truly "effective" method is surgery, when the diseased joint is replaced by an artificial joint. These are called stents.
Different parts of the joint may change. For example, only the head of the femur. This is a unipolar prosthesis. When the femoral head and the acetabulum are replaced, such a prosthesis is called bipolar.
The replacement of the endoprosthesis is done under general anesthesia. The person is first carefully examined. After surgery, antibiotic therapy and anticoagulants are prescribed. The sutures are removed on the tenth to twelfth day, then the person is transferred under the supervision of a doctor to a clinic or medical center, where care is provided on an outpatient basis.
After the operation, the person is prescribed a set of rehabilitation measures.
In ninety-five percent of cases, after surgery, a person is able to walk, work, and in some cases even play sports. An artificial joint "works" for fifteen to twenty years, then another operation may be necessary.
Shock wave therapy is one of the effective methods of treating chronic diseases of the musculoskeletal system, based on the influence of acoustic waves. The procedure provides quick results, and after shock wave therapy, you can get long-term therapeutic treatment. effect.