Osteoarthritis of the hip joint is a progressive dystrophic-degenerative disease. Often, when irritants appear, it develops in old age - infectious, non-inflammatory diseases of the joints, trauma, genetic predisposition, curvature of the spine.Coxarthrosis is another name for osteoarthritis of the hip joint, which is very difficult to treat, long-term, first conservative, then surgical. The main symptoms of the disease are pain, restricted movement, shortening of the patient's limbs in the later stages, and atrophy of the thigh muscles.
However, recently the term osteoarthritis has been abolished and now the disease is called osteoarthritis of the joints. In the past, osteoarthritis was not considered an inflammatory process, but now inflammation is recognized in osteoarthritis. As with all aging theories, interleukins are secreted by various structures in cartilage and trigger inflammation, which causes it to degenerate, that is, to crack and rot. So now there is no osteoarthritis, only osteoarthritis.
Causes of osteoarthritis of the hip joint
The disease itself is not hereditary, but the features that cause its development are the weakness of cartilage tissue, various metabolic diseases, genetic features of the skeletal structure can be passed from parents to children. Therefore, in the presence of this disease in close relatives, the risk of developing osteoarthritis in the joints increases.
However, the main causes of osteoarthritis of the hip joint are the accompanying diseases:
- Perthes' disease is a disorder of blood supply and nutrition to the head of the thigh and the joint in general, which develops in childhood, especially in boys;
- Congenital dislocation of the thigh, dysplasia of the hip joint;
- Injuries - hip fractures, dislocations, pelvic fractures;
- Femoral head necrosis;
- Inflammatory, infectious processes - rheumatoid arthritis, purulent arthritis (read the causes of pain in the hip joint).
As the disease progresses slowly, it can be both unilateral and bilateral. Factors contributing to osteoarthritis:
- Accompanying diseases of the spine - scoliosis, kyphosis, osteochondrosis, etc. , straight legs, osteoarthritis of the knee joint (see symptoms of osteoarthritis of the knee joint).
- Hormonal changes in the body, circulatory disorders.
- Excessive stress on the joints - sports, heavy physical work, overweight.
- Sedentary lifestyle with obesity.
- Age - The risk of developing osteoarthritis increases significantly in the elderly and the elderly.
The main diagnostic methods are MRI and CT, radiography. MRI data show the condition of the soft tissues more accurately, and CT examination of bone tissue pathology, clinical signs of the hip joint, and signs of osteoarthritis are also taken into account. It is very important to determine not only the presence of pathology, but also the degree and causes of osteoarthritis.
For example, if the changes in the images are related to the proximal femur, it is a consequence of Perthes' disease, if the cervical-diaphyseal angle increases and the acetabulum is significantly corrected, it is hip dysplasia. You can also get information about injuries from X-rays.
Symptoms 1 2 3 degree arthrosis of the hip joint
The main symptoms of hip arthrosis are:
- The most important and persistent is severe, persistent pain in the groin, thighs, knees, sometimes radiating pain in the legs, groin area.
- Stiffness of movement, limitation of joint mobility.
- Limit side abduction of the affected foot.
- In severe cases, lameness, gait disorders, leg shortening, atrophy of the thigh muscles.
1st degree arthrosis of the hip joint:
At this stage of the disease, a person feels pain only during and after physical exertion, from a long run or walk, the joint itself hurts, and very rarely the pain spreads to the thigh or knee. Also, a person's gait is normal, there is no lameness, and the thigh muscles do not atrophy. When diagnosed, the images show bone growths around the inner and outer edges of the acetabulum, and no other pathological abnormalities are observed in the neck and head of the femur.
2nd degree osteoarthritis:
In the case of second-degree osteoarthritis of the hip joint, the symptoms are significant, and the pain is already more stable and severe, both at rest and when moving, spreading to the groin and thigh area with a delay in the patient's load. There is also a limitation of hip abduction, the range of motion of the hip is reduced. In photographs, the narrowing of the cavity is half the norm, bone growth occurs on both the outer and inner edges, the head of the femur begins to grow, deform and shift upwards, the edges are uneven.
3 degree arthrosis of the hip joint:
At this stage of the disease, the pain is painful and persistent, the patient has difficulty moving independently day and night, so a crutch or crutch is used, the range of motion of the joint is severely limited, atrophy of the muscles of the lower leg, thigh and hip. There is a shortening of the leg and the person is forced to bend the body as he walks towards the injured leg. A change in the center of gravity increases the load on the damaged joint. X-rays show a lot of bone growth, the femoral head expands, and the joint space narrows significantly.
How to treat osteoarthritis of the hip joint?
To avoid surgery, to make a correct diagnosis in time, to prevent other diseases of the musculoskeletal system of osteoarthritis - reactive arthritis, trochanteric bursitis, etc. using hand therapy, therapeutic massage, therapeutic exercises, but only under the supervision of a qualified orthopedist.
- First week - simple paracetamol.
- If there is no effect, the NSAIDs (preferably diclofenac or low-dose ketorol) under the cover of proton pump blockers (but because they increase bone destruction with long-term use) are not omeprazole.
- Chondroprotectors at any stage.
The combination of all treatment measures should solve several problems at once:
There are many different NSAIDs for this today - non-steroidal anti-inflammatory drugs, although they reduce pain and do not affect the development of the disease, can not stop the destruction of cartilage tissue. There are a number of serious side effects, and long-term use is unacceptable, because these substances affect the synthesis of proteoglycans, which contributes to the dehydration of cartilage tissue, which further aggravates the condition. Of course, tolerating pain is unacceptable, but painkillers should be used with caution only under the supervision of a physician during periods of disease exacerbation.
NSAIDs include: celecoxib, etoricoxib, texamen, nimesulide, naproxen sodium, meloxicam, ketorolac tromethamine, ketoprofen lysine, ketoprofen, ibuprofen, diclofenac.
Topical treatment of deformed arthrosis, such as warming ointments, is not highly therapeutic, but plays a distracting role in reducing pain and partially reducing muscle spasms.
Provide better nutrition for cartilage and increase blood circulation
Chondroprotective agents such as glucosamine and chondroitin sulfate are important drugs for improving cartilage condition, but only in the early stages of the disease. A complete description of these drugs in tablets, injections, creams, with average prices and courses of treatment in the article on osteoarthritis of the knee joint. Vasodilators are generally recommended to improve blood circulation and reduce spasm of small blood vessels - cinnarizine, pentoxifylline, xanthinol nicotinate.
Muscle relaxants such as tizanidine and tolperisone hydrochloride can only be prescribed for strict indications. Their use can have both positive and negative effects, muscle relaxation reduces pain on the one hand, improves blood circulation, but on the other hand muscle spasm and tension - the body has a protective reaction, and its removal can only accelerate the destruction of joint tissue.
Hormonal injections are given only with synovitis, ie accumulation of fluid in the joint cavity. Once a year and not more than 3 times a year (methylprednisolone, hydrocortisone acetate). Hormonal agents relieve pain and inflammation, but have a pronounced immunosuppressive effect, and their use is not always justified. Chondroprotectors - Needles with chondroitin sulfate, it is better to do 5-15 procedures 2-3 times a year. Intra-articular injections of hyaluronic acid are also indicated - this is an artificial lubricant for the joints.
Doctors' opinions on the effectiveness of these procedures are divided into supporters and opponents, some consider it justified, some consider it meaningless. Maybe laser therapy, magnetic laser therapy and arthrosis of the hip joint make sense, many doctors do not find other procedures needed to treat this disease, because the hip joint is a deep joint, and many such procedures simply can not reach the goal and are a waste of time and effort. and perhaps funds for the patient.
Professional massage, hip flexion, manual therapy, physiotherapy exercises. All these therapeutic measures are very useful in the complex therapy of the disease, help to strengthen the muscles surrounding the joint, increase mobility and increase the distance from head to toe when combined with medication. and can help reduce pressure on the head of the femur. This is especially true of physiotherapy exercises, without the competent choice and regular implementation of exacerbations, it is impossible to achieve a real improvement in the patient's condition.
If the patient is overweight, of course, diet can help reduce the burden on the patient's joints, but there is no independent therapeutic effect. Doctors also recommend the use of a cane or crutch, depending on the degree of joint dysfunction.
For grade 3 osteoarthritis, doctors always insist on surgery because the destroyed joint can only be repaired by replacing one endoprosthesis. According to the indications, a bipolar prosthesis is used to replace both the head and the socket, or a unipolar prosthesis is used to replace the femoral head without the acetabulum alone.
Today, such operations are often performed routinely, only after a thorough examination, under general anesthesia. They ensure full restoration of hip function with competent and careful implementation of all postoperative measures - antimicrobial antibiotic therapy and a rehabilitation period of about six months. Such prostheses for the hip joint last up to 20 years and must be replaced after that.