Coxarthrosis of the hip joint, a complex pathology of arthrosis, leads to serious changes in the joint.Unfortunately, the disability of mature people with loss of ability to work is common.In fact, statistics on diseases of the hip joint account for almost half of all pathologies of the musculoskeletal system.I will give an example from the life of a case after surgical treatment and a rare complication during rehabilitation.
Coxarthrosis of the hip joint: a little about the disease
Osteoarthritis 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 is the same osteoarthritis.
In terms of mechanism, the hip-pelvis articulation is similar to door hinges.The head of the femur is connected to the ischium like a hinge.Which has a special anatomical formation - the acetabulum.This structure guarantees maximum joint mobility.Which performs a complete cycle of movements, or rather, flexion, extension, rotation, etc.
Normally, the articular surfaces are smooth, there is enough liquid inside them, which ensures unhindered sliding.As the disease progresses, the lubricant becomes thicker and more viscous, which immediately affects the condition of the cartilage.The synovial fluid no longer performs its functions completely.Because of this, shock-absorbing pads dry out, crack and become rough.
- Firstly.As a result of the lack of necessary sliding, the friction of the bones increases, damaging them.
- Secondly.As it progresses, the deformation of the bone surfaces also joins the altered cartilaginous 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 a person's physical activity.Ultimately leading to disability.And completely disrupting the usual way of life.The disease and its treatment are extremely significant not only from a medical point of view, but also a major social problem.
Causes of the development of coxarthrosis and its types
At least there is no exact cause for coxarthrosis, which destroys the hip joint.There are only guesses.Most cases of development of hip joint pathology are associated with congenital dislocation of the hip and dysplasia (inferiority) of the joint.
Therefore, there are 2 types of coxarthrosis;
- primary (arising from unknown etiology);
- secondary (associated with injuries, illnesses).
Primary osteoarthritis is characterized by a combination of factors:
- heredity;
- influence of biological and mechanical processes;
- overweight;
- metabolic disorders;
- There is also a theory about pathological tissue restoration in response to damaging agents (inflammation, friction, infection).
Often this type of coxarthrosis is associated with damage to the spine and inflammatory phenomena in the knee joints (arthritis, arthrosis).
In the minor version, the reasons for the development are clearer.These include:
- Dysplastic disorders.In half of all cases of congenital pathology, grade 1 dysplastic coxarthrosis of the hip joint occurs.
- Hip dislocation (congenital).
- Life traumas.Fractures of the pelvis, femoral neck, dislocations, subluxations.
- Legg-Calvé-Perthes disease.Osteochondropathy of the femoral head with the development of its necrosis.This disease occurs in children when the blood supply and nutrition of the joint are impaired.
In addition, the pathology can affect both formations at the same time or be unilateral.In addition to the direct causes of occurrence, 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.Excess weight significantly increases the likelihood of osteoarthritis.
Provoking factors also include:
- Disturbance of metabolic processes, joint nutrition, hormonal imbalances.
- Adynamia.
- Bad posture.Mainly scoliosis, kyphosis, which lead to misalignment of the pelvic bones.
- Age after 40 years.It is estimated that after this date, every 10 patients will be diagnosed with coxarthrosis of the hip joint, grade 1, 2. After the age of 60, one in every three people is already observed.And when they reach the age of 70 or more, almost 80% of those who apply suffer from this pathology.
There is no specific gene responsible for the transmission of pathological changes in joints.However, the hereditary factor can still be traced.A person can receive structural features of cartilaginous tissue, altered metabolism and skeletal pathology from relatives.It is the combination of these genetic information that can cause the appearance of hip osteoarthritis.
Classification
The main division of the disease is based on severity.There are 3 stages, which differ not only in symptoms, but also in changes on the radiograph.It is these indicators that serve as the basis for diagnosis.
Degree |
Signs |
|---|---|
I |
|
II |
|
III |
|
This division is the most common.There are also types of Kellgren classifications.Includes 4 stages, plus grade zero – the equivalent of a healthy joint.
Symptoms
The basis of all diseases of the musculoskeletal system is pain.Coxarthrosis of the hip joint of 1-2 degrees has less pronounced symptoms than in the terminal stage 3. Initially, pain manifests itself during exercise.Especially after long walks or climbing stairs.Subsequently, pain becomes a constant companion, significantly worsening quality of life.
Coxarthrosis 1st degree
The unpleasant sensations are concentrated only in the joint region (groin and buttocks are practically unaffected), rarely affecting the hip or knee.The pain is relieved with rest.
At this stage, no other manifestations are detected - the gait remains unchanged, there are no disturbances in movements.In the dysplastic variant, on the contrary, there is increased mobility due to changes in the connective tissue;Often in the early stages of the disease, due to increased flexibility, patients become interested in gymnastics and yoga.Problems with movement only occur in stage 3.
For symptoms of stage 1 coxarthrosis of the hip joint, treatment can be carried out without surgery.Rational therapy allows you to eliminate unpleasant symptoms, stopping their progression.
2nd degree of the disease
The pain, although not constant, appears at rest.Irradiation becomes noticeable - hip, groin, knee.Stiffness is observed - movements are limited when lifting, an attempt to abduct to the side, difficulty in circular movements of the leg (the pain increases especially frequently).Lameness becomes noticeable, which appears after intense walking or running.
When moving, a crunch characteristic of arthrosis is heard - rough, dry.
3 degree osteoarthritis
The pain becomes constant and does not disappear after rest and sleep.Unpleasant sensations do not leave the patient even at night.There are problems with walking;To facilitate movement it is necessary to use a cane.The lameness is constant.
At this stage, atrophy of the limb muscles occurs and the leg itself shortens.These changes force the patient to bend towards the affected side, further increasing the load on the joint.Limitation of mobility is observed in almost all directions.
Changes in bilateral hip arthrosis of the hip joint change the patient's gait, which is why all formations involved in the walking process suffer.Lower back pain appears, posture is disturbed and the axial position of the pelvis changes.
Diagnosis
An important role in determining the disease is played by the orthopedic surgeon's examination, as well as a thorough analysis of complaints.It is worth assessing the patient's activity - ability to climb stairs, comfort when wearing boots and socks, walking activity, use of a cane.
It is recommended to check the general condition - blood test, urine test, biochemistry, ECG, determination of HIV and syphilis markers.
Coxarthrosis of the hip joint of the 1st degree has the most subtle symptoms.Therefore, it is worth carrying out an X-ray examination to visualize changes in the joint space.This method allows not only to identify the disease.And we also often find out the cause of the occurrence - dysplasia, Perthes disease.
Often, knee pain is much more pronounced in grade 1 deforming coxarthrosis of the hip joint, so it must be differentiated from gonarthrosis.Differential diagnosis also includes an examination of the spine to exclude radicular syndrome (which causes radiating pain in the hip and knee).
In doubtful cases, magnetic resonance imaging (allows you to examine soft tissues in detail) and computed tomography (to review bone formations) are used.
Treatment
The disease cannot be completely cured, but modern medicine can restore the lost ability to move, allowing you to live a full life.
The use of physiotherapy and medications is effective for grades 1-2 of the disease.In the terminal phase, only surgery helps.In another case, surgery is performed if the conservative therapy methods used do not bring relief.
1st degree treatment
Unfortunately, it is impossible to completely eliminate the pathology.In grade 1, treatment aims to stabilize the condition.
During therapy, a series of general recommendations must be followed:
- Normalization of physical activity - it is recommended to reduce excessive stress (long walks, runs, jumps).
- Wear shoes with good shock-absorbing soles and special insoles.
- Weight loss.
- Mandatory physiotherapy.
Important: many patients completely refuse gymnastics and any exercise due to pain.This is often associated with fear of increased pain and the possibility of the situation worsening.Practice proves this opinion wrong - regular exercise therapy helps to strengthen muscles, protect them from atrophy, reduce pain and improve joint function.
No diet is prescribed for grade 1 coxarthrosis of the hip joint;Moderate nutrition is prescribed for weight loss.It is also useful to add products with gelatin, canned fish with bones and dairy products to your diet.
Conservative
Nonsteroidal anti-inflammatory drugs are used as a medicinal method.Due to the large number of side effects, it is recommended to take medications for severe pain.You can combine its use with gastroprotectors.
Persistent pain is relieved with intra-articular steroid injections, and analgesic blocks are also possible.
For support the following is prescribed:
- Muscle relaxants – relieve tension, reduce leg pain.
- Chondroprotectors – improve the restoration of cartilaginous tissue.
- Vasodilators (nicotinic acid) - help relieve vascular spasm and also increase tissue microcirculation.
Warming compresses are also used in combination (you can also use traditional treatment methods).They do not provide a therapeutic effect, but help relieve muscle spasms.
Be sure to use physiotherapy - UHF, magnetotherapy, induction currents, massage.
Hip replacement surgery
To restore freedom of movement in stage 3 and relieve severe pain, the patient is prepared for planned endoprosthetic surgery.This is a special operation to replace a destroyed formation with an artificial one.The interventions completely restore the patient's motor skills.Helps you fully return to your normal lifestyle.
Depending on the extent of the process, the prosthesis can be unipolar (only the worn head of the femur is replaced) or bipolar (the surface of the acetabulum is also altered).After the operation, rehabilitation is mandatory so that the patient returns to active life as quickly as possible.
For patients over 60 years of age, the rehabilitation period is established even before surgical treatment, so that the recovery process takes place in less time.The service life of an artificial joint is about 20 years, but it is important to follow the recommendations:
- Exclusion of running, long walking, jumping.
- Avoiding heavy work.
- Avoid excessive exposure to a forced static position (this is especially true for people who work standing).
Life incident
My friend's husband needed surgical treatment for an endoprosthesis.He was not diagnosed with coxarthrosis, but had a lumbar hernia successfully removed.The condition did not improve, the examination continued and, finally, discovering what was wrong, they referred me for surgery under quota.
After the replacement, everything grew back safely, but the second hip joint also required surgical intervention.A year later, the quota for the operation was again met, and it was successful.And then, from the first minutes after anesthesia, rehabilitation and strict adherence to the doctor's recommendations are necessary.
And our friend?Already returning home from the hospital, I began to put pressure on the prosthetic joint (sitting for a long time, stepping on my foot).I forgot how careful I was the first time.As a result, the ligaments and muscles that did not have time to adapt to the implant were unable to hold it and it bounced.
Of course, they inserted it, plastered it, and then everything seemed to work out.But he complains that he cannot move his leg to the side, it hurts and he feels discomfort when walking.Although you do exercises and different exercises to develop both joints, it is also work and the desire to move independently.
Prevention
We discuss the symptoms and treatment of coxarthrosis in the hip joints, as well as its stages.
- Only daily physical exercise will help you avoid serious complications and live to a ripe old age without crutches.In Soviet times, serious work was carried out to prevent diseases of the musculoskeletal system and strengthen the immune system.Nowadays it is difficult to restore the lost experience, it is clear with the mind, but it is too lazy to do it.
- Excess weight wears out joints to the point of disgrace;the endoprosthesis is better, but it does not lose extra pounds.My friend is sure of this, even without trying to eat less sweets and starchy foods.Proper nutrition is a very important point.
- I consider that lifting weights is no less harmful to the entire skeleton.
- 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!