Coxarthrosis of the hip joint is a degenerative-dystrophic process that occurs in the articular joint of the femoral head and pelvic acetabulum. The disease is more typical of the middle-aged and elderly, although it can also occur in young people, including children. Most often, its development is preceded by injuries and numerous pathologies of an inflammatory and non-inflammatory nature, and pain and stiffness of movements become the main signs of the degenerative-dystrophic process of the hip joint. During its development, the disease goes through several stages, and if it can be treated conservatively in the initial stage, then in the last stages, the treatment of coxarthrosis of the hip joints is effective only with surgery. Otherwise, the pathology leads to serious disorders or even complete immobilization.
What is coxarthrosis of the hip joint and the mechanism of its formation
Coxarthrosis, also known as osteoarthritis and deforming arthrosis, is a complex disease of the hip joints (HJ) accompanied by progressive cartilage destruction. Over time, this leads to deformation of the surface of adjacent bones and the formation of bone growths, so-called osteophytes.
The two hip joints are the largest joints in the body. Each is formed by the acetabulum of the femur and pelvis. The head of the femur is located in the cup-shaped recess of the pelvis and is free to move in different directions. This structure of the joint allows the thigh to flex and flex, adduct and abduct, and rotate the thigh.
So that movement does not cause discomfort, the surfaces of the bones in contact with each other are covered by an elastic layer called hyaline cartilage. It allows the femoral head to slide easily in the acetabulum. In addition, hyaline cartilage stabilizes and cushions the hip joint during movement.
The entire joint is immersed in a kind of capsule called a joint capsule. It contains the synovial membrane, which synthesizes synovial fluid. He is the one who lubricates the surface of the cartilage, ensures the inflow of water and nutrients, i. e. is responsible for maintaining the normal structure of the cartilage tissue.
Above the joint capsule is a group of thigh and pelvic muscles that move the joint. The hip joint is also surrounded by a group of ligaments that ensure the stability of its position within physiological limits.
Because the hip joint is exposed to a lot of stress every day, it is prone to rapid wear and tear and injury. The risk of such changes significantly increases the impact of a number of unfavorable factors that are practically unavoidable in the modern world, but these will be discussed below. This explains the high prevalence of coxarthrosis.
As a result of the influence of negative factors, the production of synovial fluid is impaired. Its quantity gradually decreases, and its qualitative composition also changes: it becomes viscous, dense, and is no longer able to fully nourish the cartilage. This leads to acute nutritional deficiencies and gradual drying of the hyaline cartilage. As a result of such changes, the strength and elasticity of the cartilage tissue decreases, it peels, cracks, and its volume decreases. All this prevents the smooth sliding of the femoral head in the acetabulum of the pelvis, which leads to the appearance of signs of coxarthrosis of the hip joint.
The inter-articular space gradually narrows, increased friction occurs between the articulating bone surfaces, and the pressure of the bones on the hyaline cartilage increases. This leads to even more damage and wear, which only affects the biomechanics of the hip joint and the well-being of the person.
As the pathological changes progress, the hyaline layer gradually disappears completely, which leads to the exposure of the bone surfaces and a critical increase in the load on the bone joint. During movement, the femoral head is no longer covered by anything and rubs directly against the surface of the pelvic acetabulum. In addition to severely limiting mobility and causing unbearable pain, the bones are pressed together and flattened.
As the articulating bones deform, bone growths (osteophytes) form on their surface. They can have sharp edges and can seriously injure the surrounding muscles. This causes severe pain in the groin, legs and buttocks. Therefore, the patient unconsciously tries to protect the affected hip joint and avoid movement. The lack of proper loading of the muscles leads to gradual atrophy, further exacerbating mobility problems. This results in lameness.
Reasons for development
Coxarthrosis of the hip joint can be primary or secondary. In the first case, the causes of its development cannot be found, that is, the disease develops on its own without an obvious reason. Secondary coxarthrosis is the result of a number of changes in the state of the musculoskeletal system or lifestyle, in particular:
- hip joint injuries, including bone fractures, dislocations, contusions, sprains or tears of surrounding ligaments, chronic microdamages, etc. ;
- exhausting physical work;
- sedentary lifestyle;
- obesity;
- chronic infectious processes in the body;
- rheumatoid arthritis, gout, tendinitis, bursitis;
- endocrine diseases, metabolic and hormonal disorders, including diabetes;
- congenital malformations of the hip joint (dislocation, dysplasia);
- aseptic necrosis of the femoral head;
- various pathologies of the spine;
- genetic predisposition;
- addiction to smoking.
In the vast majority of cases, the development of coxarthrosis of the hip joint is due to the inevitable changes associated with age, and the presence of other factors from the above only increases the risk of its occurrence and increases the rate of progression.
Symptoms and grades
During coxarthrosis, 4 stages of development are distinguished, of which 1 is the lightest. Initially, the disease may be asymptomatic or manifest as mild pain. They occur more often after strong physical exertion, a long walk or at the end of a busy day. In the first stage of the development of the disease, discomfort is usually attributed to fatigue, and this is considered the norm. Therefore, coxarthrosis of the hip joint is extremely rarely diagnosed in the first stage of development.
Noticeable signs of coxarthrosis begin to appear in the 2nd stage of progression, when the joint space narrows to almost half, and the femoral head is displaced and deformed. With the transition to the 3rd stage, the pains become unbearable, they can bother you even at night, and they tend to radiate to the hips, shins, groin, and buttocks. Since the joint gap is practically absent and more osteophytes are formed on the bone surfaces, independent movement is impossible in such situations. Therefore, patients are forced to use canes or crutches.
So, the main symptoms of coxarthrosis of the hip joint are:
- Mobility restrictions - initially, patients may notice difficulties in performing rotational movements of the leg, but over time they are joined by morning stiffness and swelling of the HJ. Because of this, a person needs several minutes to warm up and walk, so to speak, to restore their normal range of motion. It gradually becomes more and more difficult for the patient to perform leg movements.
- Characteristic cracking - occurs when walking and when bending or extending the hip joint. This is the result of bone surfaces rubbing against each other and is accompanied by sharp or dull pain in coxarthrosis.
- Pain syndrome - pains initially appear after physical exertion and subside somewhat after prolonged rest. An acute attack can be triggered by weight lifting or hypothermia, since coxarthrosis is often complicated by inflammation of the joint membrane. As the disease progresses, the pain becomes more frequent, lasts longer and worsens.
- Spasm of the thigh muscles - the result of pinching of nerves and weakening of the ligamentous apparatus, so the muscles spasm compensatory to keep the head of the femur in the acetabulum. Muscle spasm can also be triggered by the addition of synovitis.
- Lameness - occurs at the last stage of the development of the disease, as the deformation of the bone surfaces causes the appearance of contracture of the flexor muscles. Therefore, a person cannot fully straighten his leg and keep it in this position. In addition, the patient may involuntarily limp to transfer his weight to the healthy side of the body, as this helps reduce the intensity of the pain.
- Shortening of the leg - can be observed in 3rd degree coxarthrosis. The leg on the side of the affected hip joint may be shortened by 1 cm or more due to narrowing of the joint space, decreased muscle tone, and flattening of the femoral head.
At the same time, degenerative-dystrophic changes can be observed in one or both hip joints. Accordingly, the characteristic symptoms can be observed either on one side or on both at the same time, but in the latter case, their severity may be different on the left and right sides.
Diagnostics
The doctor may suspect the presence of coxarthrosis of the hip joint based on the patient's complaints, external examination and the results of functional tests. During the visual inspection, be sure to measure the length of the legs. To do this, the patient is asked to stand up and straighten his legs as much as possible. The measurement is made between the anterior axis of the pelvic bones and any bony structure of the knee, ankle or heel. But if both hip joints are simultaneously affected by coxarthrosis, the data obtained are not informative.
But since the symptoms characteristic of coxarthrosis can accompany many other inflammatory and non-inflammatory diseases, instrumental examination methods are mandatory for the patient to accurately diagnose the pathology. Maybe:
- CT or X-ray of the hip joint - the images show destructive changes in it, narrowing of the joint space, formation of osteophytes and deformation of the bone surfaces;
- MRI is the most informative examination method, which enables accurate assessment of changes in cartilage structures, ligaments and the nature of blood circulation in the hip area.
Patients are also assigned to laboratory tests to assess their general health and detect diseases that may cause coxarthrosis. That:
- UAC and OAM;
- blood chemistry;
- rheumatic studies;
- hip joint puncture with biochemical examination.
The task of the diagnosis is to distinguish hip coxarthrosis and gonarthrosis (damage to the knee joint), as well as radicular syndrome in osteochondrosis, as well as protrusions and herniations of the intervertebral discs. In addition, the symptoms of coxarthrosis may resemble the manifestations of trochanteric bursitis and the atypical course of ankylosing spondylitis, which requires a full examination to reveal the true causes of pain and movement limitations.
Conservative treatment
Conservative treatment of coxarthrosis of the hip joint is effective only in the initial stages of the disease. It is selected individually for each patient and may include a whole range of different methods, each of which complements the others. Therefore, as part of the treatment of coxarthrosis of the hip joint, patients may be prescribed:
- drug therapy;
- exercise therapy;
- physiotherapy;
- plasmolifting.
In order for conservative treatment to be effective, patients must eliminate the influence of many factors that contribute to the development of coxarthrosis of the hip joint. If you are overweight, it is very important to lose as much as possible. This reduces the load on the affected joint and the risk of progression of the degenerative-dystrophic process.
You need to quit smoking and normalize your physical activity, avoid overexertion, but don't sit all the time. In order to prevent further destruction of the hip joint, it is recommended to wear special bandages and orthoses. They secure the joint and support it during movement.
Medical treatment
The nature of drug therapy is chosen strictly individually. In most cases, patients are prescribed:
- NSAIDs - drugs that simultaneously have an analgesic and anti-inflammatory effect (available in the form of tablets, injections and topical agents);
- corticosteroids - drugs with a strong anti-inflammatory effect, which are prescribed when NSAIDs do not give a pronounced effect;
- chondroprotectors - contribute to the activation of cartilage tissue regeneration processes, but their effectiveness has not been proven;
- muscle relaxants - drugs that reduce muscle tone and eliminate spasms, which are necessary to spasm certain muscles or groups against the background of severe pain;
- preparations that improve blood circulation - they are most often used in the form of injection solutions and help to improve the trophism of the tissues surrounding the joint;
- Group B vitamins - have been shown to normalize the transmission of nerve impulses, which is especially important when nerves are compressed by deformed bone structures.
Intra-articular or peri-articular blocks can be performed on patients in case of acute pain that cannot be eliminated with the help of tablets. They are only performed by trained healthcare professionals in a healthcare facility and involve injecting corticosteroid anesthetic solutions into the joint cavity or the area immediately around it.
exercise therapy
Therapeutic exercise is an effective method for treating decreased muscle tone and limited mobility. The range of motion can be increased and the severity of pain can be reduced thanks to a properly selected exercise sequence. They prevent muscle atrophy and help eliminate spasms if coxarthrosis is accompanied by pinching of nerve fibers, which reflexively leads to spasms of individual muscles.
Exercise therapy classes can improve blood circulation in the area of the degenerative-dystrophic process. Thanks to this, the quality of the trophism of the diseased joint improves and the regeneration processes are accelerated.
A specialist must individually develop a series of exercises for each patient. At the same time, not only the degree of destruction of the hip joint is taken into account, but also the patient's level of physical development.
Physiotherapy
Physiotherapy procedures and massage have an anti-inflammatory, pain-relieving, toning and edema-reducing effect. They also contribute to the maintenance of normal leg muscle tone, preventing atony and atrophy.
With coxarthrosis of the hip joint, 10-15 procedures are prescribed:
- ultrasound therapy;
- magnetotherapy;
- laser therapy;
- electrophoresis;
- ultraphonophoresis;
- UHF;
- paraffin treatment.
In addition, many patients are offered mud therapy. Such procedures have a positive effect only in the first stage of the development of coxarthrosis of the hip joint or during rehabilitation after surgical treatment. Thanks to the medicinal mud, the quality of blood circulation can be improved and the restoration of the motor skills of the affected joint can be accelerated.
Plasmolifting
Plasmolifting or PRP therapy is a procedure during which platelet-rich plasma from the patient's own blood is injected into the cavity of the hip joint. This allows the activation of hyaline cartilage restoration processes.
However, according to some scientists, such a procedure can cause the development of malignant tumors. This point of view is based on the fact that plasmolifting promotes the formation of a large number of stem cells, the effect of which on the body has not yet been fully investigated.
Surgical treatment of coxarthrosis of the hip joint
Despite significant discomfort in the hip joint, many people seek medical help too late, when pathological changes in the joint reach 3 or even 4 degrees of severity and functionality is irreversibly exhausted.
With advanced pathology, surgery is a necessary measure. Only timely surgical intervention will help restore normal mobility and save the patient from excruciating pain, that is, a significant improvement in the quality of human life. No medication or physiotherapy can restore severely damaged cartilage. At best, painful intra-articular injections and medications can reduce the pain. But this will be a temporary phenomenon, after which the pain will return again with the same or even greater force.
Indications for hip surgery are:
- disappearance of the interarticular space;
- persistent pain in the hip joint that cannot be relieved;
- critical mobility disorders;
- hip fracture.
Depending on the severity of joint destruction and bone deformity, patients may be offered different types of surgical treatment, namely:
- arthrodesis;
- endoprosthesis;
- osteotomy.
Arthrodesis
Arthrodesis is an affordable surgery that involves firmly fixing the joint bones with metal plates. The result is complete immobilization of the joint. Therefore, with the help of arthrodesis, it is only possible to correct the supporting function of the leg and eliminate the pain, but there is no need to talk about the restoration of mobility or a significant improvement in the quality of life.
Endoprosthesis
Endoprosthesis with arthroplasty is the only way to radically solve the problem of coxarthrosis of the hip joint, restoring all its functions and motor skills. This is a high-tech method of solving the problem of coxarthrosis, which allows you to completely forget about pain and movement restrictions for 15-30 years. Thanks to the use of modern endoprostheses, it is possible to fully restore motor support functions and ensure the patient's normal life.
The surgery involves resection of the head and part of the neck of the femur. Surgical preparation of the acetabular bed is also performed, which includes removal of osteophytes, alignment of its surface, and resection of tissues that have undergone necrosis. Endoprostheses can even be used to treat elderly patients with coxarthrosis of the hip joint.
The operation is performed under general anesthesia and takes about an hour. Depending on the severity of the degenerative-dystrophic process, the operation can be performed using one of the following methods:
- superficial - includes grinding of the acetabulum and the head of the femur, with additional coating with smooth implants that replace the destroyed hyaline cartilage (the method is rarely used due to the possibility of inflammation of the periarticular tissues);
- unipolar - removing the femoral head and replacing it with an endoprosthesis (if the cartilage remains on the surface of the acetabulum and only the femoral head has died);
- bipolar - similar to the previous technique, differing only in the design of the used endoprosthesis, which has a lower coefficient of friction and provides smoother movements in the joint bed;
- Total is the most effective and safest method of solving the problem of coxarthrosis of the hip joint, which includes the complete resection of the femoral head with the capture of a part of the neck and the acetabular cavity and its replacement with a full-fledged artificial one. articular joint.
Thus, patients can be recommended to have various types of endoprostheses installed. Most hip replacements are made in the United States and the United Kingdom. For their production, chemically and biologically inert metals are used: cobalt, chromium, titanium alloys. Ceramics are also often used. In addition, most modern models use polymer inserts that enable the natural shock-absorbing, stabilizing and sliding properties of synthetic TBS.
After the operation, antibiotics are prescribed to prevent the development of infectious complications, and the sutures are removed after 10 days. The size of the scar after the operation is approximately 8 cm, at the same time the patient is discharged from the clinic. Rehabilitation after endoprosthesis is simple, but still requires physiotherapy, massage and movement therapy.
osteotomy
An osteotomy is a surgical intervention that is a temporary measure before the cardinal replacement of the hip joint with an artificial endoprosthesis. The essence of the operation is to align the axis of the femur due to its intentional fracture. The resulting fragments are placed in the most suitable position, thus relieving the diseased joint a little. As a result, it is possible to temporarily reduce the severity of pain and improve mobility.
Thus, coxarthrosis of the hip joint is a rather terrifying disease that completely deprives a person of the possibility of independent movement. It progresses for a long time, and its symptoms, especially in the early stages, are often seen by patients as a normal state after physical exertion. But this is precisely where the insidiousness of the disease lies, because it can only be treated non-surgically in the initial stages of its development. But if the degenerative-dystrophic process has already completely destroyed the hyaline cartilage and led to the exposure and flattening of the bone surface, only surgery can help the patient. Fortunately, the modern level of medicine and surgery in particular makes it possible to completely restore the normal state of the hip joint and its functions.