Coxarthrosis affects the hip joints in 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 leading symptoms of coxarthrosis are pain in the hip joint, morning swelling and stiffness of movement. In the initial stage of pathology, the treatment is conservative. If it is ineffective against the background of rapid progression of coxarthrosis or its late detection, surgical intervention, usually endoprosthetics, is indicated.
Description of the pathology
Coxarthrosis (osteoarthrosis, arthrosis deformans) is a degenerative-dystrophic pathology of the hip joint. In the initial stage of development, the structure of the synovial fluid changes. It becomes viscous, dense 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.
In order to adapt to the increased pressure that occurs on them, bone structures are deformed with the formation of growths (osteophytes). The metabolism in the hip joint worsens, which negatively affects the muscles and ligamentous-tendon 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 bone growths formed.
| Severity of coxarthrosis | Characteristic symptoms and radiographic signs |
|---|---|
| First | The joint space is unevenly narrowed, and individual osteophytes have formed around the acetabulum. Mild complaints occur, but more often the disease does not manifest itself clinically |
| A second | The joint space is narrowed almost twice, the head of the femur is displaced, deformed, enlarged, and bone growths are even outside the cartilaginous lip. The pain in the hip becomes constant and is accompanied by a significant limitation of mobility |
| Third | Complete or partial fusion of the joint space, multiple bony growths, enlargement of the femoral head. The pain occurs day and night and spreads to the thighs and legs. Movement is possible only 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 determined. This means that the prerequisites for the premature destruction of hyaline cartilage have not been identified. The following pathological conditions can cause secondary coxarthrosis:
- previous injuries - fracture of the neck of the femur or pelvic bones, dislocation;
- hip dysplasia;
- aseptic necrosis of the femoral head;
- congenital hip dislocation;
- inflammatory, including infectious joint diseases (rheumatoid, reactive arthritis, gout, tendinitis, bursitis, synovitis).
Prerequisites for the occurrence of coxarthrosis are obesity, increased physical activity, sedentary lifestyle, metabolic disorders, hormonal disorders, kyphosis, scoliosis and flat feet.
Symptoms of the disease
In the initial stage of development, coxarthrosis can manifest itself only with mild pain. They usually occur after intense physical exertion or a hard day at work. A person attributes the deterioration of health to muscle "fatigue" and does not seek medical help. This explains the frequent diagnosis of coxarthrosis in stage 2 or 3, when conservative therapy is ineffective.
Limitation of joint mobility
The range of motion in the hip joint is reduced due to compensatory growth of bone tissue, damage to the synovial membrane, and replacement of the joint capsule area by fibrous tissues without any functional activity. Mobility may be somewhat limited even in stage 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 a few minutes. By lunch, the range of motion is restored, including as a result of the production of hormone-like substances in the body.
The crunch
When walking, bending and (or) extending the hip joint, clicks, creaks and crackles are clearly heard. The reason for this audible accompaniment to each step is the friction of bone surfaces, including osteophytes, against each other. Crackling can also occur in normal health due to the collapse of carbon dioxide bubbles in the joint cavity. Coxarthrosis is indicated in combination with dull or sharp pain.
Pain
Painful sensations become constant already in stage 2 of coxarthrosis. Their weight decreases somewhat after a long rest. The pain intensifies during the next relapse or the development of synovitis (inflammation of the synovial membrane), which often accompanies osteoarthritis. In the remission phase, the discomfort decreases to some extent. But as soon as the person gets cold or lifts a heavy object, severe pain occurs again.
Muscle spasm
Increased tension in the skeletal muscles of the upper leg occurs in coxarthrosis for several reasons. First, the ligaments weaken. Muscles contract to hold the femoral head in the acetabulum. Second, increased tone often accompanies inflammation of the synovial membrane. Third, when osteophytes are displaced, nerve endings are compressed, and muscle spasm becomes a compensatory response to acute pain.
Lameness
In the later stages of the development of coxarthrosis, the patient begins to limp severely. Changes in gait are caused by flexion contractures and deformations of bone surfaces, which makes it impossible to maintain a straight leg position. The person also limps to reduce pain by transferring body weight to the unaffected limb.
Shortening the legs
Shortening of the leg by 1 cm or more is typical of stage 3 coxarthrosis. The reasons for the reduction in the length of the lower limb are severe muscle atrophy, thinning and flattening of the cartilage, narrowing of the joint space and deformation of the head of the femur.
Diagnostic methods
The initial diagnosis is made based on the patient's complaints, external examination, medical history and the results of a series of functional tests. Many inflammatory and non-inflammatory pathologies are disguised as symptoms of coxarthrosis, so instrumental and biochemical studies are carried out.
x-ray examination
The stage of coxarthrosis is determined by X-ray examination. The resulting images clearly show destructive changes in the hip joint. This is the narrowing of the joint space, the deformation of bone surfaces and the formation of osteophytes.
CT scanner
A CT scan is prescribed to patients 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 ligamentous-tendon apparatus, nerve trees, muscles, small and large blood vessels.
M. R. I
MRI is one of the most informative studies in the diagnosis of coxarthrosis. In order to identify circulation disorders in the area of the affected joint, it is performed with contrast. A routine study is prescribed to determine the degree of ligament damage 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 get the most reliable data, the orthopedist uses two bony landmarks. The upper - front axis of the pelvic bone, located on the front lateral surface of the abdomen on the outer edge of the inguinal ligament. Another reference point is any bony structure of the knee, ankle or heel. Leg length measurement may not be informative if coxarthrosis affects two hip joints at once.
Laboratory research
Clinical blood and urine tests are performed to assess the general health of the patient. And the results of biochemical studies often enable the detection of pathologies that caused the development of coxarthrosis. Gouty arthritis is indicated by high levels of uric acid and its salts. An increase in the sedimentation rate of erythrocytes and an increase in the number of leukocytes indicate the occurrence of an inflammatory process (bursitis, arthritis, synovitis). Rheumatoid factor, C-reactive protein and antinuclear antibodies are determined to rule out rheumatoid arthritis.
Hip puncture
By means of a puncture, synovial fluid is collected in order to study its composition and detect changes in consistency. If an infectious-inflammatory process is suspected, further biochemical examination of the 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 development and the severity of symptoms. Patients are often recommended to wear rigid rib casts and orthotics from the first days of treatment. The use of orthotic aids helps to slow down the breakdown of cartilage and the deformation of bones.
Medicines
Medicines from different clinical and pharmacological groups are used in the treatment of deforming arthrosis. These are non-steroidal anti-inflammatory drugs (NSAIDs), muscle relaxants, glucocorticosteroids, chondroprotectors, ointments and gels with a warming effect.
Blockade
To relieve acute pain that cannot be eliminated by NSAIDs, intra-articular or peri-articular drug blockades are prescribed. Hormonal means are used for their implementation. The analgesic effect of glucocorticosteroids is enhanced by their combination with anesthetics.
Injections
Intramuscular injection of NSAID solutions allows you to get rid of severe pain in the hip joint. A drug is usually used to relax the skeletal muscles, which, in addition to the muscle relaxant, also includes an anesthetic. In the form of injections, therapeutic regimens include B vitamins, drugs to improve blood circulation, and chondroprotectors.
Diet therapy
Overweight patients are advised to lose weight in order to slow down the spread of pathology to healthy joint structures. The caloric content of the daily menu should be limited to 2000 kilocalories by excluding foods rich in fat and simple carbohydrates. Nutritionists recommend that all patients with coxarthrosis adhere to a proper diet. The diet should contain fresh vegetables, fruits, berries, cereals, 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
Classical, acupressure and vacuum massage are used in the treatment of coxarthrosis. After several sessions, blood circulation in the hip joint improves and nutrient reserves are restored. Carrying out massage procedures stimulates the strengthening of the ligamentous-tendon apparatus and the restoration of soft tissues damaged by the movement of osteophytes.
Regular exercise therapy is one of the most effective ways to treat osteoarthritis. A set of exercises is compiled by a physical therapy doctor individually for the patient, taking into account his physical fitness.
Physiotherapy
Patients with coxarthrosis are prescribed up to 10 sessions of magnetotherapy, laser therapy, UHF therapy, UV radiation and shock wave therapy. The therapeutic effect of the procedures is due to improved blood circulation, acceleration of metabolism and regeneration processes. To relieve acute pain, electrophoresis or ultraphonophoresis is performed with glucocorticosteroids, anesthetics and B vitamins. Applications with ozokerite or paraffin help to relieve discomfort.
Surgical intervention
If conservative treatment is ineffective, pain that cannot be removed by medication or stable progression of coxarthrosis, patients are advised to undergo surgery. The operation is performed immediately in the case of pathology of the 3rd degree of severity, because it is impossible to eliminate the resulting destructive changes in the cartilage and bones by taking drugs or exercising.
Arthroplasty
The operation is performed under general anesthesia. The femoral head is removed from the acetabulum. Visible destructive changes in the tissue are corrected - bone growths are removed, joint surfaces are leveled, tissue that has undergone necrosis is excised. During the operation, cavities are formed which are filled with ceramic implants.
Endoprosthetics
Hip replacement with an implant 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 hospital. In the rehabilitation phase, patients are shown physiotherapeutic and massage procedures, exercise therapy.
Possible consequences
In 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 move. After the joint space is fully joined, immobility occurs, the patient cannot do household chores 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, endoprosthetics allow you to completely restore the functional activity of the hip joint. After installing the endoprosthesis, the patient quickly returns to an active lifestyle.
In order to prevent the disease, orthopedists recommend giving up smoking, abuse of alcoholic beverages, daily physical therapy and gymnastics, and, if necessary, losing excess weight.