Osteoarthritis of the hip joint: treatment, symptoms, degrees

Osteoarthritis of the hip joint is a progressive dystrophic degenerative disease. Most often it develops in old age, when provoking factors appear - infectious and non-inflammatory diseases of the joint, trauma, genetic disposition, curvature of the spine.

Coxarthrosis is another name for osteoarthritis of the hip joint, the treatment of which is very difficult, in the long term, first conservative, then surgical. The main symptom of the disease is pain, restriction of movement, in the later stages shortening of the diseased limb occurs and atrophy of the femoral muscles.

However, recently the term osteoarthritis has been abolished and now the disease is called osteoarthritis of the joints. Previously, osteoarthritis was not considered an inflammatory process, but now inflammation is also recognized in osteoarthritis. As in all the theory of aging, interleukins are secreted by different cartilage structures and trigger inflammation, which leads to its degeneration, that is, cracking and rotting. And so there is no more osteoarthritis now, there is only osteoarthritis.

Causes of osteoarthritis of the hip joint

The disease itself is not inherited, but the features that provoke its development, such as weakness of cartilage tissue, various metabolic disorders, genetic features of the skeletal structure, can be passed on from parents to children. Therefore, the risk of developing osteoarthritis of the joints in the presence of this disease in the next of kin increases.

However, the main causes of osteoarthritis of the hip joint are associated diseases:

  • Perthes disease is a violation of the blood supply and nutrition of the femoral head and the joint in general, develops in childhood, more often in boys;
  • Congenital dislocation of the hip, dysplasia of the hip joint;
  • Injuries - hip fracture, dislocations, pelvic fractures;
  • Necrosis of the femoral head;
  • Inflammatory and 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:

  • The presence of concomitant diseases of the spine - scoliosis, kyphosis, osteochondrosis, etc. , flat feet, 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 combined with obesity.
  • Age - in the elderly and the elderly, the risk of developing osteoarthritis increases significantly.

The main diagnostic methods are MRI and CT scan, radiography. MRI data provides a more accurate picture of the condition of the soft tissue, and the CT scan of the pathology of the bone tissue, clinical signs and symptoms of osteoarthritis of the hip joint are also taken into account. It is very important to establish not only the presence of pathology, but also the degree of osteoarthritis and the reasons for its occurrence.

For example, if the changes in the images concern the proximal femur, then this is a consequence of Perthes disease, if the neck-shaft angle increases and the acetabulum is visibly flattened, it iship dysplasia. You can also learn more about injuries through x-rays.

Symptoms 1 2 3 degrees of osteoarthritis of the hip joint

The main symptoms of osteoarthritis of the hip joints are as follows:

  • The most important and constant is severe and constant pain in the groin, hip, knee joint, sometimes radiating down the leg, in the groin area.
  • Stiffness of movements, limitation of joint mobility.
  • Restriction of lateral abduction of the affected leg.
  • In severe cases, lameness, gait disturbance, shortening of the leg, atrophy of the femoral muscles.
Symptoms

1 degree of osteoarthritis of the hip joint:

At this stage of the disease, a person feels pain only during and after physical exertion, due to prolonged running or walking, while the joint itself mainly hurts, very rarely the pain radiates to the hip or knee. In addition, a person's gait is normal, lameness is not observed, the muscles of the thigh are not atrophied. When diagnosed, the images show bony growths located around the inner and outer edges of the acetabulum, other pathological disorders of the neck and head of the femur are not observed.

2nd degree of osteoarthritis:

With osteoarthritis of the 2nd degree of the hip joint, the symptoms become significant and the pains already become more constant and intense, both at rest and during movement, they radiate to the groin and thigh, with the load the patient is already limping. There is also a limitation of hip abduction, the range of motion of the hip is reduced. In the photographs, the narrowing of the gap becomes half the norm, bone growths are found on both the outer and inner edges, the head of the femoral bone begins to increase, deform and move towards thehigh, its edges become uneven.

3 degrees of osteoarthritis of the hip joint:

At this stage of the disease the pain is painful and constant, day and night, it becomes difficult for the patient to move independently, so a cane or crutches are used, the range of motion of thejoint is severely limited, the muscles of the leg, thigh and buttocks atrophy. There is a shortening of the leg and the person is forced to tilt the body while walking towards the sore leg. Shifting the center of gravity increases the load on the damaged seal. X-ray images show multiple bony growths, the femoral head expands, and the joint space is significantly narrowed.

How to treat osteoarthritis of the hip?

In order to avoid surgical intervention, it is very important to make the correct diagnosis in a timely manner, to differentiate osteoarthritis from other diseases of the musculoskeletal system - reactive arthritis, trochanteric bursitis, etc. At 1 and 2 degrees of osteoarthritis, treatment should be carried out with a complex and conservative drug, withwith the help of manual therapy, therapeutic massage, therapeutic gymnastics, but only under the supervision of a qualified orthopedist.

  • First week - simple paracetomol.
  • If there is no effect, then NSAIDs (preferably diclofenac or small dose ketorol) under the guise of proton pump blockers (but not omeprazole, as it increasesbone destruction with prolonged use).
  • More chondroprotectors at all times.

Combining all of the treatment measures should resolve several issues at once:

Reduce pain

For this, today there is a huge selection of various NSAIDs - nonsteroidal anti-inflammatory drugs, which, although they relieve pain, but do not affect the development of the disease, can not stopthe process of destruction of cartilage tissue. They have a number of serious side effects, the long-term use of which is also unacceptable due to the fact that these agents affect the synthesis of proteoglycans, contributing to the dehydration of cartilage tissue, which only worsens thecondition. Of course, it is unacceptable to endure pain, but pain relievers should be used with caution, under the supervision of a doctor, only during periods of exacerbation of the disease.

NSAIDs include: celecoxib, etoricoxib, texamen, nimesulide, naproxen sodium, meloxicam, ketorolac tromethamine, ketoprofen lysine, ketoprofen, ibuprofen, diclofenac.

Topical remedies for osteoarthritis deformans, such as warming ointments, are not highly therapeutic, but they reduce pain by acting as a distraction and partially relieve muscle spasms.

Provides better nutrition for the cartilage and increases blood circulation

Chondroprotective agents such as glucosamine and chondroitin sulfate are important drugs that can improve the condition of cartilage tissue, but only in the early stages of the disease. A complete description of these drugs in tablets, injections, creams, with average prices and treatment courses in the article Osteoarthritis of the knee joint. To improve blood circulation, to reduce the spasm of small vessels, vasodilators are usually recommended - 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 on the one hand reduces pain, improves blood circulation, but on the other hand, muscle spasms and tension - there is a protective reaction of the bodyand its elimination can only accelerate the destruction of joint tissue.

Intra-articular injections

Hormonal injections are performed only with synovitis, that is, the accumulation of fluid in the joint cavity. Once and no 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. It is more expedient to inject chondroprotectors - chondroitin sulfate into the thigh, 5 to 15 procedures 2-3 times a year. Also pictured are intra-articular injections of hyaluronic acid - this is an artificial lubricant for the joints.

Physiotherapy

Doctors' opinion on the effectiveness of these procedures is divided into supporters and opponents, some consider their implementation justified, others unnecessary. Maybe laser therapy, magnetic laser therapy and makes sense for osteoarthritis of the hip joint, many doctors cannot find other necessary procedures for the treatment of this disease, because theThe hip joint is a deep joint and many such procedures are simply not able to achieve the goal and are a waste of time, effort and possibly funds for the patient.

Professional massage, hip joint traction (hardware traction), manual therapy, physiotherapy exercises All of these therapeutic measures are very useful in the complex therapy of the disease, they help to strengthen the muscles around the joint, increase its mobility and, when properly combined with drug therapy, can help increase the distance from the head to the socket and reduce pressure on the head of the femur. This is especially true of physiotherapy exercises, without its competent selection and regular implementation outside of exacerbations, it is impossible to achieve real improvement in the patient's condition.

If the patient is overweight, then, of course, the diet can help reduce the load on the diseased joint, but it has no independent therapeutic effect. Doctors also recommend using canes or crutches, depending on the degree of joint dysfunction.

For grade 3 osteoarthritis, doctors always insist on surgery, as the destroyed joint can only be restored by replacing it with a stent. Depending on the indications, a bipolar prosthesis is used, which replaces both the head and the socket, or a unipolar prosthesis, which changes only the femoral head without the acetabulum.

Today, such operations are performed quite often, only after a thorough examination, in a planned manner under general anesthesia. They provide a complete restoration of the functions of the hip with competent and careful implementation of all postoperative measures - antimicrobial antibiotic therapy and a rehabilitation period of about six months. These hip joint prostheses last up to 20 years, after which they must be replaced.

31.12.2020