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Coxarthrosis

Hip arthritis (coxarthrosis) is a chronic pathology, accompanied by the gradual destruction of cartilage tissue of the affected area, followed by the involvement of neighboring structures in the process. The disease requires long-term treatment, and in severe cases, the only way to regain mobility is to replace the joints.

Joint of the hip joint

General information

Coxarthrosis belongs to the group of degenerative diseases. It starts gradually with tiny changes in the structure of the cartilage. Increased stress, inflammatory diseases, disorders of blood supply lead to structural transformations and thinning of cartilage tissue and, in turn, deform the contours of the joint area. As a result, the load distribution on the bone contact surfaces changes and the zones with the maximum pressure begin to wear faster. This causes a whole cascade of pathological reactions:

  • the appearance of microcracks and areas of condensation in the cartilage tissue;
  • reducing the softness of the articular surfaces.
  • overgrowth of cartilage at the point of thinning and its replacement with bone tissue.
  • the appearance of osteophytes (bone growth) along the edges of the joint area
  • thickening and reduced elasticity of the joint capsule.
  • hardening and reduced strength of the joints.
  • changes in the composition of synovial fluid (natural lubrication within the joint).
  • narrowing of the joint space.
  • fusion of all elements of the joint (anchorage).

Without treatment, the joint inevitably becomes the cause of immobility and disability.

Causes

Depending on the causes of the development of the disease, primary and secondary joint dislocation are distinguished. In the first case, it occurs on its own, for example, in the context of an inherited predisposition, in the second, it is caused by other diseases or injuries. In most cases, the process of cartilage tissue degeneration occurs due to a combination of different factors. The reason may be:

  • congenital dislocation of the hip.
  • flat feet, scoliosis and other orthopedic problems.
  • Legg-Calve-Perthes disease?
  • Inflammation of the joints (arthritis), regardless of the origin.
  • injuries and minor injuries of the hip joint with a background of overweight, professional sports, etc.
  • dysplasia of the hip joint.
  • metabolic disorders.
  • endocrine diseases (especially diabetes mellitus)
  • violations of the blood supply to the lower extremities;
  • frequent stress
  • heredity (cochlear disease in parents or other close relatives significantly increases the risks of its occurrence in a child).
  • congenital pathologies and autoimmune diseases of the connective tissue (hyperactivity of the joints, rheumatoid arthritis, systemic lupus erythematosus, etc. ).
  • submitted to joint ventures.

Age is an important predisposing factor. According to statistics, after 45 years, the probability of coxarthrosis increases significantly.

Symptoms

The main symptoms of hip arthroplasty do not depend on the cause of the development. Most patients note:

  • Restriction of movement: one of the first symptoms due to the thinning of the cartilage layer and the increased friction of the articular surfaces of the bones. In the future, the appearance of cartilage growths will further aggravate the problem.
  • pain: friction of the bones that lack cartilage between them, the gradual involvement of all elements of the joint in the degenerative process, the reduction of blood supply to the tissues causes a feeling of pain that increases as the disease progresses. the pain erupts in nature and often worsens by the end of the day.
  • muscle spasm, leading to increased pain symptoms and limited range of motion in the joint.
  • reduction in the length of the legs: this symptom occurs in the later stages of the disease due to the reduction of the joint space and the gradual grinding of the bone heads due to the constant friction. the difference between the legs can be up to 2 cm.
  • lameness: is associated with severe pain and limited movement, as well as reduced leg. is an unfavorable sign indicating severe damage to the joint device.

Stages

In the developmental process, coxarthrosis goes through various stages, which depend on the degree of tissue damage.

  • 1 point. At this time, the patient notices slight joint pain that occurs after intense or prolonged physical activity and passes quickly after rest. As a rule, the discomfort occurs exactly in the area of the hip joint, but in some cases it extends to the hip or knee. The gait does not change, the movements of the legs are fully maintained. On the roentgenogram, there are specific changes: subchronic sclerosis.
  • 2nd degree. The pain becomes more intense, occurs after exercise, spreads throughout the thigh and groin. After exercise, a slight lameness may occur. There are difficulties in abducting the foot. X-ray shows a significant reduction in the distance between the bones (by 50% or more), deformity of the femoral head and strong bone growths.
  • 3 points. The pains become permanent, walking without a cane becomes impossible. When moving, the patient leans noticeably to the painful side, which further increases the load on the joint. Range of motion decreases, leg muscles and buttocks atrophy. There is a shortening of the affected limb. X-ray reveals significant joint deformity, change in the contour of the femoral head and a large number of osteophytes.
  • 4 points. The pain becomes stronger and does not stop for a minute, the patient loses the ability to move independently. X-ray shows complete destruction of the articular cartilage, as well as signs of bone fusion between them (anchorage). The treatment of the disease at this stage is possible only with surgery.

Diagnostics

An orthopedic traumatologist is responsible for locating the symptoms and choosing treatment. To diagnose and determine the extent of the disease, it uses:

  • research: listening to patients' complaints, identifying risk factors (trauma, illness, heredity, etc. ).
  • examination: assessment of limb mobility, identification of areas with greater pain.
  • X-ray: an X-ray image makes it possible to assess the condition of the bones and cartilage, the size of the joint space, the presence and location of bone growths. To see the necessary details in more detail, the study is completed with CT (computed tomography).
  • Laboratory diagnostics: a general blood test allows you to identify signs of an inflammatory process, biochemical - to observe certain risk factors, for example, uric acid level.
  • MRI (magnetic resonance imaging): allows you to assess the condition not only of bones and cartilage, but also of soft tissues: bones, ligaments, muscles, joint capsule, etc.
  • joint puncture.

If it is necessary to make a differential diagnosis with other diseases, as well as to evaluate concomitant pathologies, additional examinations, instrumental examinations and consultation of close specialists are prescribed.

Treatment of coxarthritis

Treatment of hip joint coxarthrosis depends on the stage and severity of the symptoms. Pathology requires an integrated approach using various methods:

  • Medication?
  • non-medication (physiotherapy, exercise therapy);
  • surgery;
  • lifestyle correction and diet.

Drug treatment

Medications prescribed for hip arthropathy target:

  • removal of the pain syndrome.
  • restoring or at least slowing down the destruction of cartilage tissue;
  • improving blood supply and nutrition in the affected area;
  • treatment of concomitant pathologies.

Analgesics are used in the form of tablets, intramuscular and intra-articular injections and topical agents: creams, ointments, patches. In the early stages of the disease, non-steroidal anti-inflammatory drugs are sufficient for most patients. With severe pain syndrome, hormonal agents are used. Injecting analgesics directly into the joint capsule has a good effect.

If the course of the disease is accompanied by muscle spasm, muscle relaxants are used. Used in combination with other analgesics.

Painkillers should be limited in time and dose so as not to cause further damage to the cartilage tissue and other side effects (in particular, the development of gastritis and stomach ulcers).

Chondroprotectors are drugs that help repair cartilage tissue. They are effective only with long-term regular use, which is combined with other treatments, lifestyles and dietary adjustments. Drugs to improve blood microcirculation help to enhance their effect. For a similar purpose, heating ointments are prescribed. Only one doctor is involved in the choice of dosage and regimen.

Drug-free treatment

This category includes various physiotherapy and manual techniques, as well as physiotherapy exercises. They help to improve microcirculation and restore movement to the damaged joint. Depending on the condition, the doctor will prescribe:

  • shock wave therapy
  • magnetotherapy
  • electromusculation?
  • various types of electrophoresis and phonophoresis (accompanied by the administration of anesthetic drugs).
  • mechanotherapy
  • massage therapy and exercise.

Surgery

If the disease has reached stage 3-4 of development, medication and physiotherapy will only alleviate the patient's condition, but will not restore his ability to move fully. In this case, arthroplasty, ie complete or partial replacement of the damaged joint with titanium addition, is indicated.

If there are indications, a lighter version of the intervention is performed: sanding the contact areas of the bones and covering them with special smooth implants that facilitate sliding.

Prevention

Lifestyle can significantly reduce the risk of developing coxarthritis, as well as its rate of progression. It is important to follow the rules strictly:

  • Follow an active lifestyle: swimming in the pool, walking, cycling - physical activity on an amateur level without racing for a record helps to improve the blood supply and inhibits the processes of joint degeneration.
  • normalize body weight to reduce the load on the legs.
  • elimination of injuries, hypothermia and occupational risk factors (vibrations, weight lifting, upright work).
  • timely treatment of all diseases, including those not directly related to the musculoskeletal system.
  • correct posture disorders in time, wear comfortable shoes.

Diet

With the help of dietary correction, the patient can not only reduce body weight, but also reduce inflammatory reactions, tissue salt deposits and metabolic disorders. It is recommended to follow a balanced menu with sufficient but not excessive amounts of carbohydrates, proteins and fats, as well as vitamins and minerals. Particular attention should be paid to unsaturated fats (olive oil and flaxseed), omega-3 acids (found in excess in fish), collagen (gelatinized meat, lime). It is recommended to minimize fast carbohydrates, alcohol, strong coffee, products with artificial flavors, preservatives and flavor enhancers.

Consequences and complications

Coxarthrosis is one of the most common causes of disability in the elderly. Without proper treatment, the pathology inevitably leads to complete disability, especially bilateral damage. Pain and limited mobility do not allow you to work and take care of yourself, so it is important to receive timely treatment.