Osteoarthritis of the hip joint is a progressive degenerative degenerative disease. Often, it develops in old age, when provoking factors arise - infectious diseases, non-inflammation of the joints, trauma, genetic disposal, curvature of the spine.
Coxarthrosis is another name for arthrosis of the hip joint, the treatment of which is very complex, long-term, conservative first, then surgery. The main symptoms of the disease are pain, restriction of movement; at a later stage, shortening of the diseased limb occurs, and femoral muscle atrophy.
However, recently the term arthrosis has been eliminated and now the disease is referred to as osteoarthritis of the joints. Previously, arthrosis was considered not an inflammatory process, but now inflammation is also recognized in arthrosis. As in the whole theory of aging, interleukin is secreted by different cartilage structures and triggers inflammation, which results in its degeneration, i. e. , cracking and decay. Therefore, there is no arthrosis now, there is only osteoarthritis.
Causes of hip joint arthrosis
The disease itself is not inherited, but these characteristics provoke its development due to weakness of cartilage tissue, various metabolic disorders, genetic features of the skeletal structure can be transmitted from parents to children. Therefore, the risk of developing joint arthrosis when there is this disease in the immediate family increases.
However, the leading cause of hip joint arthrosis is a related disease:
- Perthes disease is a violation of blood supply and nutrition to the head of the femur and joints in general, developing in childhood, more often in boys;
- Congenital hip dislocation, hip joint dysplasia;
- Injuries - hip fractures, dislocations, pelvic fractures;
- Femoral head necrosis;
- Inflammation, infectious processes - rheumatoid arthritis, purulent arthritis (read causes of pain in the hip joint).
As the disease progresses slowly, it can be unilateral and bilateral. Factors contributing to arthrosis:
- Presence of diseases equivalent to the spine - scoliosis, kyphosis, osteochondrosis, etc. , flat feet, knee joint arthrosis (see symptoms of knee joint arthrosis).
- Hormonal changes in the body, circulatory disorders.
- Excessive stress on the joints - sports, hard physical work, overweight
- An inactive lifestyle is combined with obesity.
- Age - in old age and old age, the risk of arthrosis increases significantly.
The main diagnostic methods are MRI and CT, radiography. MRI data provide a more accurate picture of soft tissue condition, and CT scans of bone tissue pathology, clinical signs and symptoms of hip joint arthrosis are also taken into account. It is important to prove not only the presence of pathology, but also the degree of arthrosis, and the causes of its occurrence.
For example, if a change in the picture with respect to the proximal femur, this is a result of Perthes disease, if the cervical-diaphyseal angle increases and the acetabulum feels flat, this is hip dysplasia. You can also find out about X-ray injuries.
Symptoms 1 2 3 degrees of arthrosis of the hip joint
The main symptoms of hip joint arthrosis are as follows:
- The most important and persistent are severe and persistent pain in the groin, hips, knee joints, sometimes radiating pain in the legs, in the groin area.
- Movement stiffness, joint movement limit.
- Restrictions on abduction of affected foot.
- In severe cases, lameness, walking disorders, leg shortening, femoral muscle atrophy.
1 degree arthrosis of the hip joint:
At this stage of the disease, a person experiences pain only during and after physical exercise, from running or long walks, while the joint itself is particularly painful, rarely pain radiating to the hips or knees. A person's gait is normal, lameness is not observed, thigh muscles do not develop atrophy. When diagnosed, bone growth is observed in the image, located around the inner and outer edges of the acetabulum, other pathological disorders in the neck and head of the femur are not observed.
2nd degree arthritis:
With stage 2 hip joint arthrosis, symptoms become noticeable and the pain becomes more persistent and intense, during rest and during movement, they radiate to the groin and thighs, with the patient's load already suffocated. There are also hip abduction restrictions, hip movement distance is reduced. In the picture, the narrowing of the gap becomes half of the norm, bone growth is found on the outer and inner edges, the head of the femoral bone begins to rise, deformed and shifted upwards, the edges become uneven.
3 degrees of hip joint arthrosis:
At this stage of the disease, the pain is painful and persistent, day and night, it is difficult for the patient to move freely, so that crutches or crutches are used, the distance of joint movement is very limited, the atrophy muscles of the lower leg, thighs and buttocks. The leg is shortened and the person has to tilt the body while walking towards the sore leg. Shifting in the center of gravity increases the load on the damaged joint. X-ray images show a lot of bone growth, femoral head expands and joint space is significantly reduced.
How to treat hip joint arthrosis?
To avoid surgery, it is very important to determine a timely diagnosis, to distinguish arthrosis from other diseases of the musculoskeletal system - reactive arthritis, trochanteric bursitis, etc. with the help of manual therapy, massage therapy, therapeutic gymnastics, but only under the supervision of a qualified orthopedist.
- First week - simple paracetamol.
- If there is no effect, then NSAIDs (preferably diclofenac or ketorol in small doses) under the proton pump inhibitor cover (but not omeprazole, as it enhances bone destruction with prolonged use).
- Plus chondroprotectors at any level.
The combination of all treatment steps should solve several problems at once:
To this day there are many options of various NSAIDs - non-steroidal anti-inflammatory drugs, which although they relieve pain, but do not affect the development of the disease, they can not stop the process of destruction of cartilage tissue. They have a number of serious side effects, long-term use of which is also unacceptable due to the fact that these agents affect the synthesis of proteoglycans, contributing to dehydration of cartilage tissue, which only exacerbates the condition. Of course, can not withstand the pain, but painkillers should be used with caution, under the supervision of a doctor, only during periods of deteriorating disease.
NSAIDs include: celecoxib, etoricoxib, texamen, nimesulide, naproxen sodium, meloxicam, ketorolac tromethamine, ketoprofen lysine, ketoprofen, ibuprofen, diclofenac.
Topical solutions to lower arthrosis such as warming ointments are not very therapeutic, but reduce pain by acting as a distraction and partially relieving muscle cramps.
Provides better nutrition for cartilage tissue and improves blood circulation
Condroprotective agents such as glucosamine and chondroitin sulfate are important drugs that can improve the condition of cartilage tissue, but only in the early stages of the disease. A complete description of these drugs in the form of tablets, injections, creams, with average prices and courses of treatment in the article osteoarthritis of the knee joint. To improve blood circulation, to reduce spasms of small ducts, it is usually recommended vasodilators - cinnarizine, pentoxifylline, xanthinol nicotinate.
Muscle relaxants, such as tizanidine and tolperisone hydrochloride, may be prescribed only for strict indications. Its use can have both positive and negative effects, muscle relaxation on the one hand reduces pain, improves blood circulation, but on the other hand, muscle spasms and tension - there is a protective reaction of the body and removing it can only accelerate the destruction of joint tissue.
Hormone injections are performed only with synovitis, which is the accumulation of fluid in the joint cavity. Once, and not more than 3 times a year (methylprednisolone, hydrocortisone acetate). Hormonal agents relieve pain and inflammation, but have significant immunosuppressive effects, and their use is not always permitted. It is better to inject into the thigh with chondroprotectors - Chondroitin sulfate, 5-15 procedures 2-3 times a year. Also shown is an intra-articular injection of hyaluronic acid - this is an artificial lubricant for the joints.
Doctors' opinions on the effectiveness of this procedure are divided into advocates and opponents, some consider its implementation justified, others useless. Perhaps laser therapy, magnetic laser therapy and sensible for arthrosis of the hip joint, many doctors do not consider other procedures necessary for the treatment of this disease, because the hip joint is a deep joint and many such procedures can not achieve the goal and waste time, effort and possiblyfunds for patients.
Professional massage, hip joint traction (hardware traction), manual therapy, physiotherapy training All of these therapeutic measures are very useful in complex disease therapy, they help strengthen the muscles around the joint, improve movement and, when combinedwith drug treatment, can help increase the distance from the head to the cavity and reduce the pressure on the femoral head. This is especially true for physiotherapy training, without its competent selection and regular implementation outside of exacerbations, it is impossible to achieve a real improvement in the patient’s condition.
If the patient is overweight, of course, diet can help reduce the load on a sore joint, but has no independent therapeutic effect. Doctors also recommend using a cane or crutch, depending on the degree of joint dysfunction.
For class 3 arthrosis, doctors always insist on surgical intervention, as a broken joint can only be restored by replacing it with an endoprosthesis. According to indications, a bipolar prosthesis is used, which replaces the head and socket, or a unipolar prosthesis, which simply transforms the femoral head without the acetabulum.
Today such operations are performed frequently, only after a thorough examination, in a planned manner under general anesthesia. They provide complete restoration of hip function with competent and comprehensive implementation of all postoperative measures - antimicrobial antibiotic therapy and a recovery period of about six months. Such prosthesis for hip joints lasts up to 20 years, after which they need to be replaced.