Coxarthrosis: arthrosis of the hip joint

Arthrosis of the hip joint or coxarthrosis is a chronic, slow degenerative process in the articulation of the head of the femur and the acetabulum of the pelvic bone. In this disease, deformation of the bone and cartilage tissue occurs, which, as it progresses, leads to a significant restriction of movement in the leg and disability. All components of the joint are involved in the process: bones, joint capsules that cover them, cartilage, ligaments, muscles. Symptoms and treatment of arthrosis of the hip joint (coxarthrosis) vary from person to person, the disease usually occurs in middle-aged and elderly people, although such changes can develop after 20 years.

The main signs of arthrosis of the hip joint (coxarthrosis) are pain and stiffness of movement. Most often, its development is preceded by injuries, as well as inflammatory and non-inflammatory joint pathologies. Coxarthrosis is one of the most common arthrosis, which is associated with a significant load on the hip joint.

In its development, the disease goes through several stages. In the early stages, coxarthrosis can be treated conservatively, but as the process progresses, only surgical treatment is effective. Therefore, do not delay visiting a specialist and sign up for a consultation. In clinics, you can undergo an examination and conservative treatment.

Causes

Coxarthrosis of the hip joint can be primary or secondary, i. e. arise against the background of any disease of the musculoskeletal system or injury. Let's consider in more detail the factors that influence the development or lead to coxarthrosis of the hip joint.

• Exogenous- these are environmental factors: heavy physical activity, consequences of major injuries - fractures, dislocations, tearing of ligaments, unfavorable working conditions related to heavy lifting, prolonged sitting.
• Endogenous— these are chronic infectious-inflammatory and autoimmune diseases: rheumatoid, reactive, psoriatic arthritis. As well as metabolic disorders: gout, diabetes.
• Congenital diseases.Dysplasia (impaired joint formation) and osteochondropathy (malnutrition of joint structures with subsequent necrosis, bone destruction) can also lead to coxarthrosis. For example, congenital dislocation of the hip, aseptic necrosis of the femoral head - Perthes disease.
• Genetic predispositionoften causes coxarthrosis of the hip joints. This involves a mutation in the type II procollagen gene.
• Older years.More often, the development of coxarthrosis of the hip joint is a consequence of inevitable age changes.
• Cat. Osteoarthritis is thought to occur more often in women than in men. This is due to the influence of the female sex hormone estrogen on mineral metabolism and bone density.
• Excess body weight.There is a direct connection between excess body weight and the appearance of arthrosis. The higher the body weight, the more likely it is to develop arthrosis of the hip joint, because excess fat increases the load on the joints, and fat produces pro-inflammatory substances that damage cartilage tissue.
• Professional sportscan cause the development of coxarthrosis due to excessive load on the joints and frequent injuries. Potentially dangerous sports include weightlifting, skydiving and acrobatics.

Under the influence of these factors, changes at the cellular level gradually occur in the joint cavity: decay processes begin to prevail over synthesis processes, metabolism changes, the volume of joint fluid that nourishes the cartilage tissue decreases, and the cartilage becomes thinner. As a result, the joint "dries" and reduces in volume. Along the edges of the articular surfaces of the bones, bone growths appear - osteophytes, which reduce the range of motion in the joint and thereby reduce the load on it.

Symptoms

How quickly does arthrosis of the hip joint (coxarthrosis) develop? Symptoms gradually increase, and in the first stages a person may not pay due attention to them and write them off as fatigue. This is dangerous, because it is precisely at the beginning of the degenerative process that the treatment gives a greater effect.

The first clinical symptoms of coxarthrosis are pain, limited range of motion caused by muscle spasm.

Pain can vary in intensity and duration. At first, the unpleasant sensations are mild and short-lived. The provoking factor for their appearance is long-term walking or intense physical activity.

Limitation of joint mobility occurs due to severe pain. The patient's gait changes: the buttocks protrude backwards, the body leans forward when transferring weight to the injured side, and the person limps.

Swelling in the joint area, which is usually invisible due to the muscle and fat layer, creaking in the joints when moving, functional shortening of the lower limb is also possible.

The presence of certain signs and their severity depends on the stage of coxarthrosis. There are 4 clinical and diagnostic stages of coxarthrosis, which are determined by the degree of articular cartilage damage:

• Coxarthrosis of the 1st degreecharacterized by asymptomatic or periodic pain that occurs only after intense physical activity, such as running or long walking. The pain is localized in the joint area, less often it spreads to the entire thigh and even the knee. After rest it usually disappears. X-ray of the hip joint shows no changes or a slight narrowing of the joint space. MRI reveals signs of cartilage tissue heterogeneity.
• For 2 degree coxarthrosisthe pain becomes more intense, occurs with little physical activity, and sometimes at rest, and may radiate in the thigh and groin area. Hoarseness occurs after significant physical exertion. The range of motion in the joint is reduced: abduction and inward rotation of the hip are limited. X-rays reveal clear uneven narrowing of the joint space and isolated osteophytes – growths of bone tissue – along the edge of the glenoid cavity. MRI in stage 2 coxarthrosis reveals obvious cartilage erosions and cracks with its thinning by less than half.
• For coxarthrosis of the 3rd degreethe pain becomes constant and often disturbs patients during sleep. Walking is difficult, which forces the patient to take a forced position of the body, relying on the healthy leg or a stick. The range of motion in the joint is severely limited. On X-rays, the joint space is practically absent, and multiple osteophytes are formed on the bone surfaces. MRI shows the destruction of more than half of the cartilage tissue volume. However, the third stage can still be treated conservatively.
• 4th stage of arthrosis of the hip joint (coxarthrosis)characterized by significant loss of joint function. The whole leg hurts: wrist, groin, gluteal region, hip, knee, ankle. Flat feet develop, the leg shortens, and its muscles atrophy. On X-ray: multiple large osteophytes, the joint space is absent or narrowed to a minimum. Stage 4 is not amenable to conservative treatment, hip replacement is performed. The operation reduces pain, improves the functioning of the leg and the patient's quality of life.

Diagnosis of arthrosis of the hip joint

The basis for diagnosing arthrosis of the hip joint is an initial consultation with a specialist. The doctor explains the complaints: where the pain is localized, when and why it occurs, where it goes, what reduces and increases it, what causes it. Then a visual examination, palpation, gait assessment and special tests are performed to detect joint dysfunction.

The diagnosis of coxarthrosis is made on the basis of clinical signs and data from additional instrumental studies, the main of which is radiography of the joint. There are no characteristic laboratory signs for the diagnosis of arthrosis, however, a clinical blood test may be required for the differential diagnosis of coxarthrosis and arthritis. In this case, the specialist will take into account the level of leukocytes, ESR, C-reactive protein and uric acid.

Of the instrumental methods for diagnosing arthrosis of the hip joints, radiography is generally sufficient. This is an accessible study that reveals changes characteristic of coxarthrosis: narrowing of the joint space, osteophytes, erosions and ulcerations of the cartilage surface, cysts. X-rays of patients with coxarthrosis may also reveal changes that indicate trauma.

CT and MRI can be used as other instrumental diagnostic methods. Computed tomography enables a more detailed study of pathological changes in bone structures, and magnetic resonance provides the possibility of evaluating soft tissue disorders.

Which doctor should I contact?

This pathology is treated by orthopedic traumatologists. But depending on the nature and course of the disease, consultation with other specialists may be necessary:

• surgeon to rule out surgical pathology requiring surgical intervention;
• phthisiatrician to rule out bone tuberculosis;
• oncologist to rule out malignant neoplasms;
• endocrinologist for accompanying metabolic disorders;
• neurologist, if there is a suspicion of spinal nerve root compression by intervertebral hernia of the lumbosacral spine.

Treatment

The choice of treatment method depends on the stage of the disease. For the treatment of bilateral arthrosis of the hip joint of the 1st degree (coxarthrosis), it is often enough to change the lifestyle and increase physical activity. In stage 2, conservative treatment is used, which includes drugs and physiotherapeutic procedures. Stage 3 is less curable, but surgery can still be avoided, which cannot be said for stage 4. The goal of conservative treatment is to improve the quality of life, as well as to stop or slow down the rate of development of degenerative changes in the joint.

Drug therapy for coxarthrosis includes drugs that reduce the symptoms of the disease. These are nonsteroidal anti-inflammatory drugs that are used short-term to relieve pain and inflammation. Corticosteroids and muscle relaxants are sometimes used to relieve severe pain and muscle tension.

Drug-free therapy includes:

• Reducing the load on the hip joint.Depending on the situation, the patient may be advised to reduce body weight, create additional support and transfer body weight to a cane or crutches.
• Therapeutic exercise.A properly selected set of exercises helps improve joint mobility, reduce pain, and also prevent muscle atrophy.
• Physiotherapy methods of treatment.For coxarthrosis of the hip joint, the following courses are prescribed: magnetic therapy, laser therapy, shock wave therapy.
• PRP therapy.The method involves introducing one's own blood plasma into the joint, which helps relieve pain, inflammation and improve the regeneration of damaged joint tissue.
• Kinesio taping.It is about applying special adhesive tapes to the skin, which relieves the joint.
• Acupuncture.A method based on the introduction of sterile needles into biologically active points. Effectively relieves pain and relaxes the muscles around the joint.

For each patient, doctors develop an individual course of treatment, which may include different methods depending on the severity of symptoms, the stage of the disease, age and state of health. An integrated approach to treatment guarantees high efficiency of procedures and quick recovery, while drug therapy alone may not give the expected result.

Hip replacement is used in severe cases of the disease, when the pain cannot be eliminated, and the mobility of the joint is significantly limited.

Consequences

Pathological changes in the joint can lead to:

• Subluxation and dislocation of the hip joint. In this case, movements in the leg are severely limited, severe pain appears, hospitalization in the trauma department, and sometimes surgical intervention is required.
• Local inflammatory processes: bursitis and tendovaginitis.
• Compression of the sciatic nerve by large osteophytes, accompanied by severe, shooting pain along the back of the leg.
• Ankylosis is the complete immobility of the joint, which significantly reduces the patient's quality of life.
• Reduced physical activity, constant pain and limited joint mobility. In the future, it leads to obesity and depression.
• Stomach and heart diseases if you take non-steroidal anti-inflammatory drugs for a long time and often.

Prevention

For a comfortable and quality life without coxarthrosis, you must adhere to the following recommendations:

• See a doctor immediately if you feel pain in the hip joint.
• Be careful when engaging in strenuous sports, performing physical activities at home and at work, and lifting heavy objects.
• Control your weight with a balanced diet and regular physical activity.
• Avoid heavy physical work and sports overload. Just moderate physical activity improves the condition of the joint, maintains its normal mobility and reduces the load on other joints.

Summary

1. Coxarthrosis is one of the most common arthrosis, which is caused by a significant load on the hip joint.
2. The main signs of arthrosis of the hip joint (coxarthrosis) are pain and stiffness of movement.
3. There are 4 stages of coxarthrosis, 1-2 are amenable to conservative treatment, 3-4 - surgical. However, with stage 3, surgery can still be avoided if you follow all the doctor's recommendations.
4. Specialists use an integrated approach to the treatment of coxarthrosis, which includes drugs, physiotherapy, manual therapy, dietary correction and physical activity.