Coxarthrosis affects the hip joints of middle-aged and elderly people. The causes of 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, swelling in the morning and stiffness of movement. In the initial stage of pathology, the treatment is conservative. If it is ineffective against the background of rapid development of coxarthrosis or late detection, surgical intervention, usually endoprosthetics, is indicated.
Description of pathology
Coxarthrosis (osteoarthrosis, arthrosis deformans) is a degenerative-dystrophic pathology of the hip joint. At the initial stage of development, the structure of the synovial fluid changes. It becomes viscous, thick, and therefore loses its ability to nourish hyaline cartilage. Due to dehydration, its surface dries up and is covered with numerous radial cracks. In this case, hyaline cartilage does not absorb shocks well when the bones that make up the joint come into contact.
In order to adapt to the increased pressure on them, bone structures are deformed by the formation of growths (osteophytes). The metabolism in the hip joint deteriorates, which negatively affects the muscles of the joint and the ligamentous-tendon apparatus.
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 space narrows unevenly, single osteophytes have formed around the acetabulum. Mild discomfort occurs, but more often the disease does not manifest itself clinically |
| Second | The articular space narrows almost 2 times, the head of the femur is displaced, deformed, enlarged, bone protrusions are found outside the cartilaginous lip. Hip pain is constant and is accompanied by significant limitation of mobility |
| the third | Complete or partial fusion of the joint cavity, multiple bone growth, femoral head enlargement. The pain occurs day and night and spreads to the thighs and legs. Movement is possible only with the help of a cane or crutches |
Causes of the disease
Primary coxarthrosis is a destructive-degenerative lesion of the hip joint of unknown cause. This means that no prerequisites for premature destruction of hyaline cartilage have been identified. The following pathological conditions can cause secondary coxarthrosis:
- previous injuries - fracture of the femoral neck or pelvis, dislocation;
- hip dysplasia;
- aseptic necrosis of the femoral head;
- congenital hip dislocation;
- inflammatory, including co-infectious 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 occur after intense physical exertion or a hard day's work. A person associates the deterioration of health with muscle "fatigue" and does not consult a doctor. This explains the frequent diagnosis of coxarthrosis in stages 2 or 3, when conservative therapy is ineffective.
Limitation of joint mobility
The range of motion of the hip joint decreases due to the 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. Even in grade 1 coxarthrosis, mobility may be somewhat limited. Difficulties arise when performing rotational movements with the leg.
As the disease progresses, morning stiffness and joint swelling become common. A person should warm up for a few minutes to regain mobility. Range of motion is restored by lunchtime, including as a result of the production of hormone-like substances in the body.
Crunch
When walking, bending and (or) extending the hip joint, clicks, crunches and cracking sounds are clearly heard. The reason that every step is accompanied by this sound is the friction of bone surfaces, including osteophytes. Crackling can also be seen in normal health due to the deposition of carbon dioxide bubbles in the joint cavity. Coxarthrosis is indicated by its combination with dull or sharp pain.
Pain
Painful sensations become stable already in the 2nd stage of coxarthrosis. Their severity decreases slightly after a long rest. The pain intensifies during the next relapse or the development of synovitis (inflammation of the synovial membrane), which is often accompanied by osteoarthritis. During the remission phase, the anxiety decreases slightly. 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 thigh occurs with coxarthrosis for several reasons. First, the bonds weaken. The muscles spasm to hold the head of the femur in the acetabulum. Secondly, increased tone is often accompanied by 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 the development of coxarthrosis, the patient begins to limp sharply. Changes in gait are provoked by flexion contractures and deformation of bone surfaces, which makes it impossible to maintain a straight leg position. The person also limps to reduce the severity of the pain by shifting body weight to the unaffected limb.
Shortening of the leg
A shortening of the leg by 1 cm or more is characteristic of 3rd degree coxarthrosis. The reasons for the decrease in the length of the lower limb are severe muscle atrophy, thinning and flattening of cartilages, narrowing of the joint space, and deformation of the femoral head.
Diagnostic methods
The initial diagnosis is 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 hidden as symptoms of coxarthrosis, so instrumental and biochemical studies are carried out.
X-ray examination
The stage of coxarthrosis is determined by X-ray examination. The obtained images clearly show destructive changes in the hip joint. This is the narrowing of the joint space, deformation of the bone surfaces and the formation of osteophytes.
CT scan
Patients are prescribed a CT scan to determine the degree of flattening and deformation of the hyaline cartilage. The results of the study also allow assessing the condition of the ligamentous-tendon apparatus, nerve trunks, muscles, small and large blood vessels.
Magnetic resonance imaging
MRI is one of the most informative studies in the diagnosis of coxarthrosis. It is done with contrast to identify blood circulation disorders in the affected joint area. A regular examination is prescribed to determine the degree of damage to the ligaments and deformation of the femoral head and to detect areas of fibrous degeneration of the articular capsule.
Measurement of leg length
Before the measurement, the doctor asks the patient to stand up and straighten his legs as much as possible. To get the most reliable information, the orthopedist uses two bone markers. Upper - the front axis of the pelvis is located on the outer edge of the inguinal ligament on the front side surface of the abdomen. The second reference point is any bony structure of the knee, ankle or heel. If coxarthrosis affects two hip joints at once, leg length measurements may not be informative.
Laboratory research
Clinical blood and urine tests are performed to assess the general health of the patient. And the results of biochemical studies often make it possible to detect pathologies that lead to the development of coxarthrosis. Gouty arthritis is indicated 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 occurrence of an inflammatory process (bursitis, arthritis, synovitis). Rheumatoid factor, C-reactive protein and antinuclear antibodies are prescribed to rule out rheumatoid arthritis.
Hip puncture
Using a puncture, synovial fluid is collected to study the composition and detect changes in consistency. If an infectious-inflammatory process is suspected, additional biochemical examination of the biological sample is indicated.
Treatment options
When determining treatment tactics, the orthopedist takes into account the severity of coxarthrosis, the form of its course, causes of development and severity of symptoms. Patients are often advised to wear bandages with rigid ribs and orthoses from the first days of treatment. The use of orthopedic devices slows down the breakdown of cartilage and bone deformation.
Medicines
Medicines of different clinical and pharmacological groups are used in the treatment of deforming arthrosis. These are non-steroidal anti-inflammatory drugs (NSAIDs), muscle relaxants, glucocorticosteroids, chondroprotectors, ointments and gels with a warming effect.
Blockade
Intra-articular or peri-articular drug blockades are prescribed to relieve acute pain that cannot be relieved by NSAIDs. Hormonal agents are used to implement them. The analgesic effect of glucocorticosteroids is enhanced by their combination with anesthetics.
Injections
Intramuscular injection of NSAID solutions can relieve severe pain in the hip joint. A drug containing an anesthetic is usually used along with a muscle relaxant to relax the skeletal muscles. Therapeutic regimens in the form of injections include B vitamins, 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 calorie content of the daily menu should be limited to 2000 kilocalories, excluding foods high in fat and simple carbohydrates. Nutritionists advise all patients with coxarthrosis to follow a proper diet. The diet should include fresh vegetables, fruits, berries, cereals, oily sea fish and dairy products. After a therapeutic diet, it is stimulated to strengthen the immune system and improve general 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 strengthens the ligamentous-tendon apparatus and stimulates the restoration of soft tissues damaged by the displacement of osteophytes.
Regular exercise therapy is one of the most effective methods of treating osteoarthritis. The complex of exercises is designed individually for the patient by the physical therapy doctor, 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 related to the improvement of blood circulation, acceleration of metabolism and regeneration processes. Electrophoresis or ultraphonophoresis is performed with glucocorticosteroids, anesthetics and B vitamins to relieve acute pain. Applications with ozokerite or paraffin help to relieve discomfort.
Surgical intervention
If conservative treatment is ineffective, in the case of pain that cannot be relieved by medication or the continuous development of coxarthrosis, surgical intervention is recommended to patients. Because it is impossible to eliminate the destructive changes in the cartilage and bones with drugs or exercise therapy, the operation is performed immediately in the case of pathology of the 3rd degree.
Arthroplasty
The operation is performed under general anesthesia. The femoral head is removed from the acetabulum. Visible destructive changes in the tissue are corrected - bone growths are removed, articular surfaces are straightened, necrotic tissue is removed. During the operation, cavities are formed and filled with ceramic implants.
Endoprostheses
Replacement of the hip with an implant is performed under general anesthesia. A course of antibiotics is prescribed to prevent the development of an infectious process. After 10 days, the sutures are removed and the patient is discharged from the hospital. Physiotherapy and massage procedures, exercise therapy are shown to patients during the rehabilitation phase.
Possible outcomes
In the last stage of pathology, flexion and adduction contractures develop. The patient's leg is constantly bent, so he uses a cane or a crutch to move. After the complete union of the joint cavity, immobility occurs, the patient cannot do household chores 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, endoprosthetics allow 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 giving up smoking, abusing alcohol, doing physical therapy and gymnastics every day, and losing excess weight if necessary.