Coxarthrosis of the hip joint, its symptoms and treatment by degree

Coxarthrosis of the hip joint, a complex pathology of arthrosis, leads to serious changes in the joint. Unfortunately, disability of older people with disabilities is common. In fact, hip joint disease statistics account for almost half of all pathologies of the musculoskeletal system. I will give an example of the life of a case after surgical treatment and a rare complication during rehabilitation.

Coxarthrosis of the hip joint: a little about the disease

Arthrosis is a degenerative-dystrophic change that contributes to the complete destruction of cartilage with loss of joint function.

Coxarthrosis - here the hip joints are destroyed, practically, it's the same arthrosis.

In its mechanism, the joint of the hip with the pelvis is similar to door hinges. The head of the femur is connected to the ischium as a hinge. Who has a special anatomical formation - the acetabulum. This structure provides maximum joint mobility. Which makes a complete cycle of movements, or rather of flexion, extension, rotation, etc.

Normally, the joint surfaces are smooth, there is enough fluid inside, which ensures unimpeded sliding. With the development of the disease, the lubricant becomes thicker, more viscous, which is reflected in the condition of the cartilage. The synovial fluid no longer fully fulfills its functions. Because of this, the shock absorber pads dry out, become covered with cracks, become rough.

  • First of all. Due to the lack of necessary sliding, the friction of the bones increases, injuring them.
  • Secondly. As the progression progresses, the deformation of the bone surfaces is added to the altered cartilage tissue. The body thus tries to compensate for the increased load.
  • Thirdly. Increased load leads to complete atrophy of the femoral muscles and weakness of the ligaments.

Important: osteoarthritis of the hip joint is a progressive disease. The changes can lead to a complete loss of physical activity by a person. Eventually leading to disability. And completely upsetting the usual way of life. The disease and its treatment are extremely important not only medically, but are also a big social problem.

Reasons for the development of coxarthrosis and its types

At least the exact cause of the appearance of coxarthrosis, which destroys the hip joint, is not. There are only guesses. Most cases of the development of pathology of the hip joint are associated with congenital hip dislocation and dysplasia (inferiority) of the joint.

Therefore, there are 2 types of coxarthrosis;

  1. primary (resulting from an unknown etiology);
  2. secondary (associated with injuries, diseases).

Primary osteoarthritis is characterized by a combination of factors:

  • heredity;
  • influence of biological and mechanical processes;
  • overweight;
  • Metabolic disorders;
  • there is also a theory of pathological tissue repair in response to harmful agents (inflammation, friction, infection).

Often this type of coxarthrosis is associated with damage to the spine and inflammation of the knee joints (arthritis, arthrosis).

In the secondary variant, the reasons for the development are clearer. These include:

  • dysplastic disorders. In half of cases of congenital pathology, dysplastic coxarthrosis of the hip joint of the 1st degree occurs.
  • Hip dislocation (congenital).
  • Life trauma. Pelvic fractures, femoral neck, dislocations, subluxations.
  • Legg-Calvé-Perthes disease. Osteochondropathy of the femoral head with the development of its necrosis. This disease occurs in children with impaired blood supply and nutrition to the joint.

Moreover, the pathology can affect both formations at once or be one-sided. In addition to the direct causes of appearance, there are predisposing factors that provoke the development of the disease. Often the disease occurs with increased loads on the limbs of athletes. As well as people with difficult physical working conditions. Significantly increases the likelihood of osteoarthritis in overweight.

Also, provoking factors include:

  • Violation of metabolic processes, joint nutrition, hormonal disturbances.
  • Adynamia.
  • Postural disorder. Especially scoliosis, kyphosis, which lead to the deformation of the bones of the pelvis.
  • Age after 40 years. It is estimated that after this date, the diagnosis of "coxarthrosis of the hip joint 1. 2 degrees" is made in every 10 patients. After 60 years, each third is already observed. And when they reach the age of 70 or more, almost 80% of those who applied suffer from this pathology.

There is no specific gene responsible for transmitting pathological changes in the joints. However, the hereditary factor is always traceable. A person may receive structural features of cartilage tissue, impaired metabolism and skeletal pathology from relatives. It is the combination of this genetic information that can cause the onset of osteoarthritis of the hip.

Classification

The main division of the disease is according to the severity. There are 3 stages, which differ not only in symptoms, but also in changes on the x-ray. It is these indicators that serve as the basis for diagnosis.

Diploma

panels

I

  • Minor changes in the gap are observed, which are poorly visualized on X-rays.
  • The articular edges are slightly pointed, this is the initial manifestation of osteophytes.
  • Mobility issues are mild.

II

  • Increased constriction (from the norm it differs almost 3 times).
  • Severe osteophytes.
  • The onset of sclerosis is the degeneration of cartilage into denser connective tissue.
  • Significant movement restriction.

III

  • Gross deformity of the joint.
  • The joint space is absent.
  • The stiffness develops.
  • The appearance of joint mice (a piece of bone, cartilage or connective tissue, freely moving inside the joint cavity).
  • Massive bony growths.

This division is the most common. There are also types of classifications according to Kellgren. It has 4 stages plus zero degrees - the equivalent of a healthy joint.

Symptoms

The basis of all diseases of the musculoskeletal system is pain. Coxarthrosis of the hip joint 1-2 degrees has less pronounced symptoms than in the end stage 3. Initially, pain occurs during exertion. Especially after long walks, climbing stairs. Later, pain becomes a constant companion, significantly worsening the quality of life.

Coxarthrosis 1 degree

Unpleasant sensations are concentrated only in the joint area (groin, buttocks are practically unaffected), rarely reflected in the thigh or knee. The pain is relieved by rest.

At this stage, no more manifestations are detected - the gait remains unchanged, there are no disturbances in the movements. In the dysplastic variant, on the contrary, an increase in mobility is observed due to changes in connective tissue, often in the initial stages of the disease, due to increased flexibility, patients like to do gymnastics and yoga. Movement problems only come in 3 stages.

With symptoms of grade 1 coxarthrosis of the hip joint, treatment can be carried out without surgical intervention. Rational therapy allows you to eliminate unpleasant symptoms, stopping the progression.

2 degree of disease

The pain, although not constant, occurs at rest. Irradiation becomes noticeable - thigh, groin, knee. Stiffness is observed - movements are limited in lifting, trying to remove to the side, difficulty in circular movements of the leg (pain is especially often increased). Lameness becomes noticeable, which appears after intensive walking or running.

When moving, a characteristic arthritic crunch is heard - rough, dry.

3 degree osteoarthritis

The pain becomes constant, not passing after rest and sleep. Unpleasant sensations do not leave the patient even at night. There are walking problems, to facilitate movement, it is necessary to use a cane. The lameness is permanent.

At this stage, atrophy of the muscles of the limb occurs, the leg itself is shortened. These changes cause the patient to lean on the affected side, which further increases the load on the joint. Restriction of mobility is observed in almost all directions.

Changes in bilateral coxarthrosis of the hip joint change the patient's gait, due to which all formations involved in the process of walking suffer. There are pains in the lower back, the posture is disturbed, the axial position of the pelvis changes.

Persistent lameness in late stage osteoarthritis of the hip joint

Diagnostic

An examination by an orthopedist, as well as a thorough analysis of complaints, plays an important role in determining the disease. The patient's activity should be assessed - the ability to climb stairs, comfort when putting on shoes and socks, walking activity, using a cane.

It is recommended to check the general condition - blood, urine, biochemistry, ECG, determination of markers for HIV and syphilis.

Coxarthrosis of the hip joint of the 1st degree has the most blurred symptoms. That is why it is worth doing an X-ray examination to visualize changes in the joint space. This method allows not only to establish the disease. And also often find the cause of the event - dysplasia, Perthes disease.

Often, knee pain is much more pronounced with deforming coxarthrosis of the hip joint of the 1st degree, so it should be distinguished from gonarthrosis. In addition, the differential diagnosis includes an examination of the spine to exclude radicular syndrome (it gives radiating pain in the thigh, knee).

In doubtful cases, MRI is used (allows you to examine soft tissues in detail) and CT (to visualize bone formations).

Treatment

The disease cannot be completely cured, but modern medicine is able to restore the lost ability to move, allowing you to live a full life.

The use of physiotherapy, drugs is effective for 1-2 degrees of disease. In the terminal stage, only surgery helps. In another case, they operate if the methods of conservative therapy used do not bring relief.

1st degree treatment

Unfortunately, it is impossible to completely eliminate pathology. At grade 1, treatment is aimed at stabilizing the condition.

During treatment it is necessary to follow a number of general recommendations:

  1. Normalization of physical activity - it is recommended to reduce excessive loads (long hikes, running, jumping).
  2. The use of shoes with good shock-absorbing soles, special soles.
  3. Weightloss.
  4. Compulsory exercise therapy.

Important: many patients completely refuse gymnastics and any pain loads. This is often associated with fear of increased pain, the possibility of aggravating the situation. Practice proves this opinion wrong - regular exercise therapy helps strengthen muscles, protect them from atrophy, reduce pain and improve joint function.

A diet for coxarthrosis of the hip joint of the 1st degree is not provided, a moderate diet is prescribed for weight loss. It is also useful to add foods containing gelatin, canned fish with bones and dairy products to the diet.

conservative

Nonsteroidal anti-inflammatory drugs are used as a medical method. Due to the large number of side effects, it is recommended to drink medicine with severe pain. You can combine their reception with gastroprotectors.

Persistent pain is relieved by intra-articular injections of steroid drugs; it is also possible to perform pain blocks.

For support designate:

  1. Muscle relaxants - relieve tension, reduce pain in the leg.
  2. Chondroprotectors - improve the restoration of cartilage tissue.
  3. Vasodilators (nicotinic acid) - help relieve vasospasm, and also increase tissue microcirculation.

Warming compresses are also used in the complex (traditional treatment methods can also be used). They do not have a therapeutic effect, but they help relieve muscle spasms.

Be sure to use physiotherapy - UHF, magnetotherapy, induction currents, massage.

Hip replacement surgery

In order to restore freedom of movement in stage 3, to relieve severe pain, the patient is prepared for a planned stent operation. This is a special operation to replace a destroyed formation with an artificial formation. Interventions completely restore the patient's motor skills. Helps to fully return to the usual way of life.

Depending on the prevalence of the process, the prosthesis can be either unipolar (only the worn head of the femur is replaced) or bipolar (the surface of the acetabulum is also modified). After the operation, rehabilitation is mandatory in order to return the patient to an active life as soon as possible.

For patients over 60, the rehabilitation period is set even before surgical treatment, so the recovery process takes place in a shorter time. The lifespan of an artificial joint is approximately 20 years, but it is important to follow the recommendations:

  • Exclusion of running, long walking, jumping.
  • Avoid lifting heavy objects.
  • Avoid too much being in a forced static position (especially for people working standing up).

case of life

Stent surgery was requested by my friend's husband. In the diagnosis, he did not receive coxarthrosis, but a hernia of the lumbar spine was successfully removed. His condition did not improve, the examination continued and finally, having found out what was happening, he was sent for a quota operation.

After the replacement, everything grew safely, but the second hip joint also required surgery. A year later, again the quota of the operation, which was successfully completed. And then, from the first minutes after anesthesia, rehabilitation and the exact application of the doctor's recommendations are required.

And what about our friend? Already on the way home from the hospital, he began to load the prosthetic joint (he sat down for a long time, stepped on his foot). I forgot how carefully I behaved the first time. As a result, the ligaments and muscles that did not have time to get used to the implant did not hold and it popped off.

Sure, they put it on, put a cast on it, and then everything seemed to work. But he complains that he cannot move his leg to the side, it hurts, he feels discomfort while walking. Although he does various exercises and exercises to develop both joints, it is also work and a desire to move independently.

Prevention

We analyzed the symptoms and treatment of coxarthrosis in the hip joints, as well as their stages.

  1. Only daily physical education will help to avoid serious complications and live to old age without crutches. In Soviet times, serious work was done to prevent diseases of the musculoskeletal system and strengthen the immune system. Now the lost experience is difficult to renew, it is clear with the mind, but it is too lazy to do so.
  2. Excess weight wears the joints to disgrace, arthroplasty is better, but does not lose extra pounds. My friend is convinced of this, even without trying to eat less sugary and less starchy foods. Good nutrition is very important.
  3. I consider that lifting weights is not a lesser evil for the whole skeleton.
  4. Bad habits (alcohol, smoking) remove calcium, magnesium and other beneficial substances from the body.

Just dig, everything is interconnected.

Take care of yourself and your joints by exercising every day!