Osteoarthritis of the hip joint is a degenerative-dystrophic pathology, characterized by the destruction of hyaline cartilage.
The disease develops gradually, accompanied by pain and reduced range of motion. In the absence of medical intervention in the initial phase of arthrosis, atrophy of the thigh muscles occurs after a few years.
The injured limb is shortened, and fusion of the joint space leads to partial or complete immobilization of the hip joint. The causes of pathology are previous injuries, curvature of the spine, systemic diseases of the musculoskeletal system.
Osteoarthritis is usually detected in middle-aged patients and the elderly. The diagnosis is made on the basis of the results of instrumental studies - radiography, MRI, CT, arthroscopy. Treatment of pathology of 1 and 2 degrees of severity is conservative. If ankylosis is detected or drug therapy is not effective, surgery (arthrodesis, endoprosthesis) is performed.
Mechanism of pathology development
The hip joint is made up of two bones - the ilium and the femur. The lower part of the ilium is represented by its body, which participates in the articulation with the femur, forming the upper part of the acetabulum. During movement, the glenoid pit is immobile, and the head of the femur moves freely. Such a "hinged" device of the hip joint enables it to bend, bend, rotate, promotes the abduction and adduction of the hip. The smooth, supple, elastic hyaline cartilage that sets the acetabulum and femoral head allows for smooth sliding of the joint structures. Its main functions are redistribution of load during movement, prevention of rapid wear of bone tissues.
Under the influence of external or internal factors, cartilage trophism is disturbed. It does not have its own circulatory system - synovial fluid supplies the tissue with nutrients. With osteoarthritis, it thickens and becomes viscous.
The resulting lack of nutrients causes drying of the surface of the hyaline cartilage. It is covered with cracks, which leads to permanent microtrauma of the tissue during bending or extension of the hip joint. The cartilage becomes thinner and loses its cushioning properties. The bones deform to "adjust" to the increase in pressure. And against the background of deteriorating metabolism in the tissues, destructive and degenerative changes progress.
Causes and provoking factors
Idiopathic or primary osteoarthritis developed for no apparent reason. It is believed that the destruction of cartilage tissue occurs due to the natural aging of the body, slowing down the recovery process, reducing the production of collagen and other compounds necessary for the complete regeneration of hip joint structures. Secondary arthrosis occurs against the background of a pathological condition that is already present in the body. The most common causes of secondary disease include:
- previous injuries - damage to the ligament-tendon apparatus, muscle rupture, their complete separation from the bone base, fractures, sprains;
- joint development disorders, congenital dysplastic disorders;
- autoimmune pathologies - rheumatoid, reactive, psoriatic arthritis, systemic lupus erythematosus;
- nonspecific inflammatory diseases such as purulent arthritis;
- specific infections - gonorrhea, syphilis, brucellosis, ureaplasmosis, trichomoniasis, tuberculosis, osteomyelitis, encephalitis;
- endocrine system disorders;
- degenerative-dystrophic pathologies - osteochondropathy of the femoral head, osteochondritis dissecans;
- hypermobility of the joints, due to the formation of "super stretchable" collagen, causing their excessive mobility, weakness of the ligaments.
Since the cause of the development of arthrosis can be hemarthrosis (bleeding in the cavity of the hip joint), provoking factors include disorders of hematopoiesis. Prerequisites for the appearance of the disease are excess weight, excessive physical activity, inactive lifestyle. Its development is caused by improper organization of sports training, lack of food with foods high in trace elements, fat-soluble and water-soluble vitamins. Postoperative arthrosis occurs several years after the operation, especially if it was accompanied by excision of a large amount of tissue. Hyaline cartilage trophism is disturbed by frequent hypothermia, living in an environmentally unfavorable environment and working with toxic substances.
Osteoarthritis of the hip joint cannot be inherited. But in the presence of certain congenital characteristics (metabolic disorders, bone structure), the probability of its development increases significantly.
Symptoms
The leading symptoms of osteoarthritis of the hip joint are pain when walking in the hip region, radiating to the groin, the knee joint. The person suffers from stiffness of movement, stiffness, especially in the morning. To stabilize the joint, the patient begins to limp, his gait changes. Over time, due to muscle atrophy and joint deformation, the limb noticeably shortens. Another characteristic sign of pathology is the restriction of hip abduction. For example, difficulties arise when you try to sit in a chair with your legs spread.
In osteoarthritis of the first severity, periodic pain occurs after intense physical exertion. They are localized in the area of articulation and disappear after a long rest.
With second-degree osteoarthritis of the hip, the severity of the pain syndrome increases. Discomfort occurs even at rest, extending to the thigh and groin, increased by lifting weights or increased motor activity. To eliminate the pain in the hip joint, the person begins to limp barely noticeably. Restriction of movement in the joint is observed, especially during abduction and internal rotation of the thigh.
Osteoarthritis of the third degree is characterized by constant severe pain that does not subside day and night. Difficulties arise when moving, so a person is forced to use a cane or crutches while walking. The hip joint is stiff, there is significant atrophy of the muscles of the buttocks, thighs and legs. Due to the weakness of the abductor muscles, the femurs of the pelvis are displaced in the frontal plane. To compensate for the shortening of the leg, the patient leans toward the injured limb when moving. This causes a strong shift of the center of gravity and an increase in stress on the joint. At this stage of arthrosis, severe ankylosis of the joint develops.
| Degrees | Radiographic signs |
| The first | The changes are not pronounced. The joint cavities are moderately, unevenly narrowed, there is no destruction of the femoral surface. Smaller bone growths can be seen on the outer or inner edge of the acetabulum |
| Others | The height of the joint space is significantly reduced due to its uneven fusion. The bony head of the femur is moved upwards, deformed, enlarged, its contours become uneven. Bone growths form on the surface of the inner and outer edges of the glenoid pit |
| Third | There is complete or partial fusion of the joint space. The head of the femur is greatly enlarged. Multiple bony outgrowths are found on all surfaces of the acetabulum |
Diagnosis
In making the diagnosis, the physician takes into account the clinical manifestations of the pathology, medical history, the results of the patient's external examination and instrumental studies. Radiography is the most informative. With its help, the condition of the hip joint, the degree of its flow, the degree of damage to the cartilaginous tissues are assessed, and in some cases the cause of development is determined. If the cervical-diffuse node is enlarged and the acetabulum is oblique and flattened, then it is possible to assume with a high degree of probability dysplastic congenital changes in articulation. Perthes' disease or juvenile epiphysiolysis indicates a disturbed shape of the hip bone. Radiography may reveal posttraumatic osteoarthritis, despite the absence of a previous history of trauma. Other diagnostic methods are also used:
- CT helps detect the growth of the edges of bone plates, formed by osteophytes;
- MRI is performed to assess the condition of connective tissue structures and the degree of their involvement in the pathological process.
If necessary, the inner surface of the joint is examined with arthroscopic instruments. Differential diagnosis is made to rule out gonarthrosis, lumbosacral, or thoracic osteochondrosis. Arthrosis pain can be masked by clinical manifestations of radicular syndrome caused by nerve entrapment or inflammation. It is usually possible to rule out neurogenic pathology with the help of a series of tests. Osteoarthritis of the hip joint is necessarily different from trochanteric bursitis of the hip joint, ankylosing spondylitis, reactive arthritis. In order to exclude autoimmune pathologies, biochemical tests of blood and synovial fluid are performed.
Drug treatment tactics
Medical treatment aims to improve patient well-being. Drugs of different clinical and pharmacological groups are used for this:
- nonsteroidal anti-inflammatory drugs (NSAIDs) - nimesulide, ketoprofen, diclofenac, ibuprofen, meloxicam, indomethacin, ketorolac. Solutions for injections are used to relieve acute pain, and tablets, tablets, ointments, gels help to relieve pain of mild or moderate severity;
- glucocorticosteroids - triamcinolone, dexamethasone, hydrocortisone. They are used in the form of intra-articular blockades in combination with the anesthetics Procaine, Lidocaine;
- muscle relaxants - Baclofen, Tizanidine. They are included in the treatment regimens of skeletal muscle spasm, contraction of sensitive nerve endings;
- drugs that improve blood circulation in the joint - nicotinic acid, aminophylline, pentoxifylline. They are prescribed to patients in order to improve tissue trophism, prevent disease progression;
- chondroprotectors. Effective only in stage 1 and 2 osteoarthritis.
Rubbing fat with a warming effect helps to relieve mild pain. The active ingredients of external means are capsaicin, cinquefoil, camphor, menthol. These substances are characterized by locally irritating, interfering, analgesic action. Wraps on the joints with dimethyl sulfoxide, medical bile will help cope with swelling, morning swelling of the thighs. Patients are recommended coxarthrosis with a classic massage of acupressure or vacuum. Daily exercise therapy is an excellent prevention of further progression of osteoarthritis.
Surgical intervention
With the ineffectiveness of conservative therapy or the diagnosis of pathology complicated by ankylosis, surgery is performed. It is impossible to restore cartilage in a joint damaged by osteoarthritis without prosthesis surgery, but with the right approach to treatment, adherence to all medical prescriptions, maintaining a proper lifestyle, performing therapeutic exercises, regular massage courses, taking vitamins and proper nutrition, you can stop the lesion process and destroy cartilageand hip joints.