Osteoarthritis of the hip joint (distorting osteoarthritis, coxarthrosis, osteoarthrosis) is a slowly progressive degenerative dystrophic disease, leading over time to destroy the affected joint, persistent pain and limitation of mobility.
The disease affects people over 40, women fall sick several times more often than men.
In the global structure of osteoarthritis, osteoarthritis of hip joint belongs to the main role.This is due to the generalized congenital pathology of the hip joints (dysplasia), as well as a significant physical effort, to which these joints are sensitive.
Risk factors and causes of osteoarthritis of the hip joint
In the pathological mechanism of the development of osteoarthritis of the hip joint, the main role belongs to a change in the physicochemical characteristics of the synovial (intra-articular) fluid, following which it becomes more dense and viscous.This aggravates its lubricating qualities.During the movement, the surfaces of the joint cartilage begin to rub against each other, become rough, covered with cracks.Small hyalin cartilage particles are abandoned and fall into the joint cavity, causing the development of aseptic (non -infectious) inflammation.As the disease progresses in the inflammatory process, bone tissue is driven into the inflammatory process, which leads to aseptic necrosis of the sections of the femoral head and the surface of acetabulum, the formation of osteophytes (bone growth), improving inflammation and causes severe pain during movement.
In the end of osteoarthritis of the hip joint, inflammation is also thrown into the surrounding joint of the tissues (blood vessels, nerves, ligaments, muscles), which leads to the appearance of signs of periarthritis.Consequently, the hip joint is completely destroyed, its functions are lost, the movement in it ceases.This condition is called ankylosis.
Causes of osteoarthritis of the hip joint:
- Congenital lip of the thighs;
- hip dysplasia;
- Aseptic necrosis of the femoral head;
- Peters' disease;
- wounds of the hip joint;
- infectious arthritis of the hip joint;
- gonarthrosis (deformation of osteoarthrosis of the knee joint);
- osteochondrosis;
- Excess weight;
- Professional sports;
- flat feet;
- curvature of the spine;
- A sedentary lifestyle.
The pathology is not inherited, but the child inherits the characteristics of the structure of the musculoskeletal system of his parents, which can cause osteoarthritis of the hip joint under these conditions.This explains the fact of the existence of families, the incidence of which is higher than in the general population.
Forms of the disease
According to etiology, osteoarthritis of the hip joint is divided into primary and secondary.Secondary osteoarthritis develops in the context of other diseases of the hip joint or its injuries.The main form is not linked to the previous pathology, the reason for its development is often not possible, in this case, they speak of idiopathic osteoarthritis.
Coksartrose is one or bilateral.
Steps
Three stages (degree) are distinguished during osteoarthritis of the hip joint:
- The initial pathological changes are slightly expressed, provided that the rapid and adequate treatment is reversible.
- Progressive coxarthrosis - characterized by a gradual increase in symptoms (pain in the joint and altered of its mobility), changes in joint tissues are already irreversible, but therapy can slow down degenerative processes.
- The final movement in the joint is lost, ankylosis is formed.Treatment is only surgically (by replacing the joint with artificial).
Endoprosthetic operations in 95% of cases provide full restoration of members' mobility, restore patient performance.
Symptoms of osteoarthritis of the hip joint
The main signs of osteoarthritis of the hip joint:
- Pain in the groin, hips and knee;
- a feeling of stiffness in the affected joint and the limitation of its mobility;
- lameness;
- Restriction of the removal;
- Atrophic changes in the thigh muscles.
The presence of certain symptoms of osteoarthritis of the hip joint, as well as their severity, depend on the degree of disease.
In the 1st degree of osteoarthritis of the hip joint, patients complain of pain in the affected joint that occur under the influence of physical activity (prolonged walking, race).In some cases, pain is located in the knee or thigh area.After a short rest, the pain alone passes.The volume of members' movements is completely preserved, the process is not broken.The following modifications are noted on radiography:
- A slight unequal decrease in the light of the joint deviation;
- Osteophytes located on the inside of the pivot.
Changes in the neck and femoral head are not detected.
With the degree of osteoarthritis II of the hip joint, the pain also appears at rest, including at night.After physical activity, the patient begins to box, a characteristic approach of "duck" is formed.Thus, the starting pain called appears - after a long period of immobility, the first steps cause pain and discomfort, which then pass and then return after a long load.In the affected joint, the volume of movements (abduction, internal rotation) is limited.The radiography shows that the joint gap is unevenly narrowed and its light is 50% of the standard.Osteophytes are located both along the internal and external edge of the joint cavity, going beyond the limits of cartilage.The contours of the femoral head become uneven due to the deformation.
With the degree of osteoarthritis III of the intense and constant hip pain joint, not stopping at night.Walking is considerably difficult, the patient is forced to count on the cane.The volume of movements in the affected joint is strongly limited, later, it stops completely.Due to the atrophy of the hip muscles, the basin deviates in the front plane and the member is shortened.Trying to compensate for this shortening, patients on the move are obliged to reject the body to the lesion, which further increases the load on the painful joint.On radiographs, several bone growths, a significant narrowing of the joint difference and a pronounced increase in the femur's head are detected.
Diagnosis
The diagnosis of osteoarthritis of the hip joint is based on clinical image data of the disease, the results of medical examinations and instrumental studies, among which the main value belongs to the visualization methods - radiography, imaging by Caltic or Magnetic resonance.They not only make it possible to determine the presence of osteoarthritis of the hip joint and to assess its degree, but also to identify the possible cause of the disease (trauma, juvenile epiphysiolysis, Peters disease).
The differential diagnosis of osteoarthritis of the hip joint with other diseases of the musculoskeletal system is quite complicated.On the degree of osteoarthritis II and III of hip joint, muscular atrophy develops, which can cause intensive pain in the knee joint characteristic of training or gonarthrosis (diseases of the knee joint).For the differential diagnosis of these states, the palpation of the knee and hip joints is palpate, the volume of movement in them is determined and they are also examined by radiologically.
In column diseases, in some cases, the nerve roots of the spinal cord with the development of pain syndrome are pressed.Pain can radiate to the hip joint area and imitate the clinical image of its defeat.However, the nature of pain with root syndrome is slightly different from that of osteoarthritis of the hip joint:
- The pain occurs following a movement of weight or a clumsy and clear movement, and not under the influence of physical effort;
- Pain is located in gludeal, not in the inguinal region.
With radicular syndrome, the patient can calmly take his leg on the side, while with osteoarthritis of the hip joint, abduction is limited.A characteristic sign of radicular syndrome is a positive symptom of tension - the appearance of acute pain when you try to raise a straight leg on the patient's back.
Hip joint osteoarthritis affects people over 40, women fall sick several times more often than men.
The osteoarthritis of the hip joint should also be differentiated by faithful scholarship (trochanterite).Viable bursitis is developing faster, in a few weeks.Usually, it is preceded by a significant physical effort or an injury.In this disease, pain is much more pronounced than with osteoarthritis of the hip joint.At the same time, the shortening of the member and the limitation of his mobility is not detected.
The clinical picture of atypical reactive arthritis and ankylosing spondylitis may resemble clinical manifestations of hip joint articulation.However, pain occurs in patients mainly at night or at rest, when walking does not intensify, but, on the contrary, weakens.In the morning, the patients note a stiffness in the joints, which spends after a few hours.
Treatment of hip joint osteoarthritis
Orthopedians are engaged in the treatment of osteoarthritis of the hip joints.With degree I and II of the disease, conservative therapy is indicated.With pronounced pain syndrome, patients are prescribed non-steroidal anti-inflammatory drugs in a short course.They should not be accepted for a long time, because they are not only capable of having a negative effect on the organs of the gastrointestinal tract, but also to remove the regenerative capacities of the hyalin cartilage.
In the osteoarthritis treatment regime of the hip joint, they include chondroprotectors and vasodilators, which creates optimal possibilities to restore damaged cartilage tissues.With pronounced muscle spasms, this may require the appointment of central muscle relaxants.
In cases where it is not possible to stop pain syndrome with non-steroidal anti-inflammatory drugs, resort to intra-articular corticosteroid injections.
The local treatment of osteoarthritis of the hip joint using warming ointments allows you to reduce muscle spasms and somewhat weaken pain due to distracting action.
In complex osteoarthritis therapy of hip joint, physiotherapeutic methods are also used:
- magnetotherapy;
- inductothermia;
- UHF;
- Laser therapy;
- ultrasound treatment;
- massage;
- Medical gymnastics;
- Manual therapy.
Food nutrition for osteoarthritis of the hip joint aims to correct body weight and the normalization of metabolic processes.The reduction in body weight reduces the load on the hip joints and thus slows down the progression of the disease.
To unload the affected joint, the doctor may recommend that patients go to crutches or cane.
With the degree of osteoarthritis III of the hip joint, conservative treatment is ineffective.In this case, it is possible to improve the condition of the patient, it is possible to return normal mobility only as a result of surgery - replacing the joint destroyed by an artificial (joint endoprosthetic).
Possible consequences and complications
The most serious complication of the progressive osteoarthritis of the hip joint is disability due to loss of movement in the joint.With bilateral coksartrosis, the patient loses his ability to move independently and needs constant foreign care.A long stay in bed in a position creates the prerequisites for the occurrence of stagnant (hypostatic) pneumonia, which is difficult to succumb and can lead to death.
Pathology is not inherited, but the child inherits the characteristics of the structure of the musculoskeletal system of his parents, which can cause osteoarthritis of the hip joint.
Forecast
Osteoarthritis of the hip joints is a gradual chronic disease, which cannot be completely cured only in the early stages, subject to the elimination of the cause of the disease.In other cases, therapy allows you to slow down its course, however, over time, there is a need to set up hip endoprotheses.These operations in 95% of cases provide complete restoration of members' mobility, restore patient performance.The lifespan of modern prostheses is 15 to 20 years, after which they are subject to a replacement.
Prevention
The prevention of osteoarthritis of the hip joint aims to eliminate the causes that can lead to the development of this disease and include:
- Detection and treatment in a timely time of diseases and injuries of the hip joint;
- rejection of a sedentary lifestyle, regular but not excessive physical activity;
- body weight control;
- rational nutrition;
- Refusal of bad habits.