Coxarthrosis affects the hip joints of middle-aged and elderly people. The reasons for its development are previous injuries, congenital and acquired diseases of an inflammatory or non-inflammatory nature. The leading symptoms of coxarthrosis are pain in the hip joint, morning swelling and stiffness of movements. In the initial stage of the pathology, the treatment is conservative. If it is ineffective against the background of the rapid progression of coxarthrosis or its late detection, surgical intervention, usually endoprosthetics, is indicated.
Description of the pathology
Coxarthrosis (osteoarthrosis, deforming arthrosis) is a degenerative-dystrophic pathology of the hip joint. In the initial stage of development, the structure of the synovial fluid changes. It becomes viscous, thick and therefore loses its ability to nourish the hyaline cartilage. Due to dehydration, its surface dries up and is covered with numerous radial cracks. In this condition, the hyaline cartilage does not cushion shocks well when the bones that make up the joint come into contact.
In order to adapt to the increased pressure that occurs on them, bone structures are deformed with the formation of growths (osteophytes). The metabolism in the hip joint deteriorates, which negatively affects the muscles and tendon-tendon apparatus of the joint.
Degrees
Each stage is characterized by its own symptoms, the severity of which depends on the degree of narrowing of the joint space and the number of bone growths formed.
| Severity of coxarthrosis | Characteristic symptoms and radiographic signs |
|---|---|
| First | The joint gap is unevenly narrowed, single osteophytes have formed around the acetabulum. Slight discomfort occurs, but more often the disease does not manifest itself clinically |
| Second | The joint gap is narrowed almost 2 times, the head of the femur is displaced, deformed, enlarged, and bone growths are found even outside the cartilage lip. Pain in the hip joint becomes constant and is accompanied by a significant limitation of mobility |
| third | Complete or partial fusion of the joint space, multiple bony processes, widening of the femoral head. The pain occurs day and night and spreads to the hips and legs. Movement is possible only with the help of a cane or crutches |
Causes of the disease
Primary coxarthrosis is a destructive-degenerative damage to the hip joint, the causes of which have not been established. This means that the prerequisites for premature destruction of the hyaline cartilage have not been established. The following pathological conditions can provoke secondary coxarthrosis:
- previous injuries - fracture of the neck of the femur or pelvic bones, displacement;
- hip dysplasia;
- aseptic necrosis of the femoral head;
- congenital dislocation of the hip joint;
- inflammatory, including infectious joint diseases (rheumatoid, reactive arthritis, gout, tendinitis, bursitis, synovitis).
Prerequisites for the development of coxarthrosis are obesity, increased physical activity, sedentary lifestyle, metabolic disorders, hormonal disorders, kyphosis, scoliosis and flat feet.
Symptoms of the disease
In the initial stage of development, coxarthrosis can manifest itself only with mild pain. They usually appear after intense physical exertion or a hard day's work. The person attributes the deterioration of health to muscle "fatigue" and does not seek medical help. This explains the frequent diagnosis of coxarthrosis at stage 2 or 3, when conservative therapy is ineffective.
Limitation of joint mobility
The range of motion in the hip joint is reduced due to compensatory growth of bone tissue, damage to the synovial membrane, and replacement of areas of the joint capsule with fibrous tissues devoid of any functional activity. Mobility may be somewhat limited even with grade 1 coxarthrosis. Difficulties arise when performing rotational movements with the legs.
As the disease progresses, morning stiffness and joint swelling become common. To regain mobility, one should warm up for a few minutes. By noon, the range of motion is restored, including as a result of the production of hormone-like substances in the body.
I'm crunching
When walking, bending and (or) stretching the hip joint, clicks, crunches and crackles are clearly heard. The reason for this audible accompaniment with each step is the rubbing of bone surfaces, including osteophytes, against each other. Crackling can also occur in normal health due to the collapse of carbon dioxide bubbles in the joint cavity. Coxarthrosis manifests itself in combination with dull or sharp pain.
pain
Painful sensations become constant already at stage 2 of coxarthrosis. Their weight decreases to some extent after a long rest. The pain intensifies with the next relapse or development of synovitis (inflammation of the synovial membrane), which often accompanies osteoarthritis. During the remission stage, the discomfort decreases somewhat. But as soon as a person falls into hypothermia or lifts a heavy object, severe pain appears again.
Muscle spasm
Increased tension in the skeletal muscles of the hip occurs in coxarthrosis for several reasons. First, the bonds weaken. Muscles spasm to hold the head of the femur in the acetabulum. Second, increased tone often accompanies inflammation of the synovial membrane. Third, when osteophytes are displaced, nerve endings are compressed and muscle spasm becomes a compensatory response to acute pain.
Lameness
In the later stages of development of coxarthrosis, the patient begins to limp severely. Changes in gait are provoked by flexion contractures and deformation of bone surfaces, which makes it impossible to maintain a straight leg. The person also limps to reduce the intensity of the pain by shifting their body weight to the unaffected limb.
Shortening of legs
Shortening of the leg by 1 cm or more is characteristic of coxarthrosis of the 3rd degree. The reasons for the reduction in the length of the lower limb are severe muscle atrophy, thinning and flattening of the cartilage, narrowing of the joint space and deformation of the head of the femur.
Diagnostic methods
The initial diagnosis is made based on the patient's complaints, external examination, medical history and the results of a number of functional tests. Many inflammatory and non-inflammatory pathologies are masked as symptoms of coxarthrosis, so instrumental and biochemical studies are performed.
x-ray examination
The stage of coxarthrosis is determined by X-ray examination. The resulting images clearly show destructive changes in the hip joint. This is a narrowing of the joint space, deformation of the bone surfaces and formation of osteophytes.
CT
CT is prescribed to patients to determine the degree of flattening and deformation of the hyaline cartilage. The results of the study also make it possible to assess the condition of the tendon-tendon apparatus, nerve trunks, muscles, small and large blood vessels.
Magnetic resonance
MRI is one of the most informative studies in the diagnosis of coxarthrosis. In order to identify blood circulation disorders in the area of the affected joint, it is performed with contrast. A routine examination is prescribed to determine the degree of ligament damage and deformity of the femoral head and to detect areas of fibrous degeneration of the joint capsule.
Leg length measurement
Before the measurement, the doctor asks the patient to stand up and straighten his legs as much as possible. To obtain the most reliable data, the orthopedist uses two bone landmarks. Upper - the front axis of the pelvic bone, located on the anterior lateral surface of the abdomen on the outer edge of the inguinal ligament. The second starting point is any bony structure of the knee, ankle or heel. Leg length measurement may not be informative if coxarthrosis affects two hip joints at the same time.
Laboratory researches
To assess the patient's general health, clinical blood and urine tests are performed. And the results of biochemical tests often allow to detect pathologies that caused the development of coxarthrosis. Gouty arthritis is manifested by high levels of uric acid and its salts. An increase in the sedimentation rate of erythrocytes and an increase in the number of leukocytes indicate the presence of an inflammatory process (bursitis, arthritis, synovitis). To rule out rheumatoid arthritis, rheumatoid factor, C-reactive protein and antinuclear antibodies are determined.
Thigh puncture
Using a puncture, synovial fluid is collected to study its composition and detect changes in consistency. If an infectious-inflammatory process is suspected, an additional biochemical examination of a biological sample is indicated.
Treatment options
When determining the tactics of treatment, the orthopedist takes into account the severity of the coxarthrosis, the form of its course, the causes of development and the severity of the symptoms. Patients are often advised to wear rigid rib casts and orthoses from the first days of treatment. The use of orthopedic devices helps to slow the breakdown of cartilage and bone deformation.
Medicines
In the treatment of deforming arthrosis, drugs from different clinical and pharmacological groups are used. These are nonsteroidal anti-inflammatory drugs (NSAIDs), muscle relaxants, glucocorticosteroids, chondroprotectors, ointments and gels with a warming effect.
Blockade
To relieve acute pain that cannot be eliminated by NSAIDs, intra-articular or peri-articular drug blockades are prescribed. Hormonal means are used to perform them. The analgesic effect of glucocorticosteroids is enhanced by combining them with anesthetics.
injections
Intramuscular injection of NSAID solutions allows you to eliminate severe pain in the hip joint. A drug is usually used to relax the skeletal muscles, which in addition to the muscle relaxant includes an anesthetic. In the form of injections, therapeutic regimens include vitamins of group B, drugs to improve blood circulation and chondroprotectors.
Diet therapy
Overweight patients are advised to lose weight to slow down the spread of pathology to healthy joint structures. The caloric content of the daily menu should be limited to 2000 kilocalories, excluding foods with a high fat content and simple carbohydrates. Nutritionists recommend that all patients with coxarthrosis adhere to proper nutrition. The diet should include fresh vegetables, fruits, berries, cereals, fatty sea fish and dairy products. Adherence to a therapeutic diet stimulates the strengthening of the immune system and improvement of overall health.
Exercise therapy and massage
Classical, acupressure and vacuum massage are used in the treatment of coxarthrosis. After a few sessions, blood circulation in the hip joint improves and nutrient reserves are replenished. Carrying out massage procedures stimulates the strengthening of the tendon-tendon apparatus and the restoration of soft tissues damaged by displacement of osteophytes.
Regular exercise therapy is one of the most effective ways to treat osteoarthritis. The set of exercises is compiled by a physiotherapist individually for the patient, taking into account his physical fitness.
Physiotherapy
Patients with coxarthrosis are prescribed up to 10 sessions of magnetic therapy, laser therapy, UHF therapy, UV radiation and shock wave therapy. The therapeutic effect of the procedures is due to the improvement of blood circulation, acceleration of metabolism and regeneration processes. To relieve acute pain, electrophoresis or ultraphonophoresis is performed with glucocorticosteroids, anesthetics and vitamins of group B. Applications with ozokerite or paraffin help to eliminate discomfort.
Surgical intervention
If conservative treatment is ineffective, the pain cannot be eliminated with drugs or the stable progression of coxarthrosis, patients are advised to undergo surgical intervention. The operation is performed immediately in the case of pathology of the 3rd degree of severity, since it is impossible to eliminate the resulting destructive changes in the cartilage and bones by taking drugs or exercises.
Arthroplasty
The operation is performed using general anesthesia. The head of the femur is removed from the acetabulum. Visible destructive changes in tissues are corrected - bone growths are removed, joint surfaces are leveled, tissue that has undergone necrosis is excised. During the operation, cavities are formed and filled with ceramic implants.
Endoprosthetics
Hip replacement with an implant is performed under general anesthesia. To prevent the development of an infectious process, a course of antibiotics is prescribed. After 10 days, the sutures are removed and the patient is discharged from the hospital. At the rehabilitation stage, patients are shown physiotherapy and massage procedures, exercises.
Possible consequences
In the final stage of the pathology, flexion and adduction contractures develop. The patient's leg is permanently bent, so he uses a cane or crutches to move. After complete fusion of the joint space, immobility occurs, the patient cannot do housework and becomes disabled. Coxarthrosis is often complicated by aseptic necrosis of the femoral head, arthrosis of the knee joints, and arthritis.
Prevention and prognosis
Only grade 1 coxarthrosis responds well to conservative treatment. In other cases, endoprosthesis allows you to completely restore the functional activity of the hip joint. After the installation of the endoprosthesis, the patient quickly returns to an active lifestyle.
To prevent the disease, orthopedists recommend quitting smoking, abusing alcoholic beverages, doing daily physical therapy and gymnastics and, if necessary, getting rid of excess weight.