Coxarthrosis: hip arthritis

Hip osteoarthritis or coxarthrosis is a slow, chronic degenerative process at the joint of the head of the femur and the acetabulum of the pelvis. With this disease, bone and cartilage tissues are deformed, and as the disease progresses, it will lead to significant limitation of leg mobility and disability. All components of the joints are involved in this process: bones, joint capsules that cover them, cartilage, ligaments, muscles. Symptoms and treatment of hip arthritis (coxarthrosis) vary from person to person; The disease usually occurs in middle-aged and elderly people, although such changes can develop after 20 years.

The main signs of hip arthritis (coxarthrosis) are pain and stiffness when moving. Usually, its development occurs before injuries, as well as joint pathologies of an inflammatory and non-inflammatory nature. Coxarthrosis is one of the most common joint diseases, which is associated with significant loads on the hip joint.

During development, the disease goes through many stages. In the early stages, coxarthrosis can be treated conservatively, but as the process progresses, only surgical treatment is effective. Therefore, you should not delay seeing a specialist and booking a consultation. At clinics, you can receive examination and conservative treatment.

reason

Coxarthrosis of the hip joint can be primary or secondary, that is, arise against the background of any disease of the musculoskeletal system or injury. Let's consider in more detail the factors that influence the development or lead to coxarthrosis of the hip joint.

• exogenous- these are environmental factors: heavy physical activity, consequences of severe injuries - fractures, dislocations, torn ligaments, unfavorable working conditions associated with lifting heavy objects, sitting for long periods of time.
• endogenous- these are chronic inflammatory and autoimmune diseases: rheumatoid arthritis, reactive, psoriasis. As well as metabolic disorders: gout, diabetes.
• Congenital diseases.Dysplasia (impaired joint formation) and osteoarthritis (malnutrition of joint structures leading to necrosis, subsequent bone destruction) can also lead to coxarthrosis. For example, congenital hip dislocation, aseptic necrosis of the femoral head - Perthes disease.
• Genetic predispositioncommonly causes coxarthrosis of the hip joint. This includes mutations in the type II procollagen gene.
• Old age.More commonly, the development of coxarthrosis in the hip joint is due to inevitable age-related changes.
• Floor. It is believed that osteoarthritis occurs more often in women than men. This is due to the influence of the female sex hormone estrogen on mineral metabolism and bone density.
• Excess body weight.There is a direct relationship between excess body weight and the occurrence of arthritis. The greater the body weight, the more likely it is to develop hip arthritis, since excess fatty tissue increases the load on the joints and fatty tissue produces inflammatory substances that damage cartilage tissue.
• Professional sportscan cause the development of coxarthrosis due to excessive stress on the joints and frequent injuries. Potentially dangerous sports include weightlifting, skydiving and acrobatics.

Under the influence of these factors, gradual changes occur in the joint cavity at the cellular level: decomposition processes begin to prevail over synthesis, metabolism changes, the amount ofThe synovial fluid that nourishes the cartilage tissue decreases and the cartilage becomes thinner. The result is a "dry" joint and reduced volume. Along the edges of the articular surfaces of bones, bone growths appear - osteophytes, which reduce the range of motion of the joint and thereby reduce the load on it.

Symptom

How quickly does hip arthritis (coxarthrosis) develop? Symptoms gradually increase and in the early stages a person may not pay enough attention to them and perceive them as fatigue. This is very dangerous because it is in the early stages of the degenerative process that treatment is more effective.

The first clinical symptoms of coxarthrosis are pain and limited movement due to muscle spasms.

The pain can vary in intensity and duration. At first, the discomfort is mild and short-lived. The trigger for their appearance is prolonged walking or intense physical activity.

Limited joint mobility occurs due to severe pain. The patient's gait changes: the buttocks protrude backwards, the body leans forward when shifting weight to the injured side, and the person walks with a limp.

There may also be swelling in the joint area, which is often invisible due to the layer of muscle and fat, joints that crackle when moving, and lower limb function is shortened.

The presence of certain signs and their severity depend on the stage of coxarthrosis. There are 4 clinical and diagnostic stages of coxarthrosis, determined based on the degree of articular cartilage damage:

• Grade 1 coxarthrosischaracterized by asymptomatic or episodic pain that occurs only after intense physical activity, such as running or long walks. The pain is localized in the joint area, rarely spreading to the entire thigh and even the knee. After rest it usually disappears. There were no changes in hip radiographs or mild narrowing of the joint space. MRI shows signs of cartilage tissue heterogeneity.
• For coxarthrosis 2 degreesThe pain becomes more intense, occurs with little physical activity, sometimes when resting, and can spread to the thigh and groin area. Lameness appears after significant exertion. Joint range of motion is reduced: the hip's ability to abduct and internally rotate is limited. X-rays showed obvious irregular narrowing of the joint space and isolated osteophytes—growths of bone tissue—along the rim of the glenoid cavity. An MRI scan in stage 2 coxarthrosis shows clear erosion and cracking of the cartilage at less than half the thickness.
• For grade 3 coxarthrosisThe pain becomes constant and often makes it difficult for the patient to sleep. Walking is very difficult, forcing the patient to be in a forced position, leaning on a strong leg or a stick. Joint range of motion is significantly limited. On X-ray, the joint cavity is practically absent and many bone spurs have formed on the bone surface. MRI shows destruction of more than half the volume of cartilage tissue. However, the third stage can still be treated conservatively.
• Stage 4 arthritis of the hip joint (coxarthrosis)Characterized by significant loss of joint function. Pain in the entire leg: joints, groin, buttocks, hips, knees, ankles. Flat feet develop, legs shorten and muscles atrophy. On X-ray: there are many large bone spurs, the joint space is absent or narrowed to a minimum. Stage 4 cannot be treated conservatively; Hip replacement is performed. Surgery reduces pain, improves leg function and the patient's quality of life.

Diagnosis of hip arthritis

The basis for diagnosing hip arthritis is an initial consultation with a specialist. The doctor clarifies the complaints: where the pain is localized, when and why it occurs, where it goes, what reduces and intensifies it, what causes it. Then it is necessary to visually inspect, palpate, evaluate gait, and special tests are performed to detect dysfunction of the joint.

Diagnosis of coxarthrosis is made on the basis of clinical signs and data from additional instrumental studies, the main of which are arthrography. There are no specific laboratory findings to diagnose arthrosis, however, clinical blood tests may be necessary to differentiate coxarthrosis and arthritis. In this case, the specialist will take into account the level of white blood cells, ESR, C-reactive protein and uric acid.

Among the methods of diagnosing hip disease, radiography is generally sufficient. This is an accessible study, showing the characteristic changes of coxarthrosis: narrowing of the joint space, bone spurs, erosion and ulceration of the cartilage surface, cysts. X-rays in coxarthrosis patients may also reveal changes that suggest injury.

CT and MRI can be used as other diagnostic tools. Computed tomography allows a more detailed study of pathological changes in the bone structure, and magnetic resonance imaging provides the opportunity to evaluate soft tissue disorders.

Which doctor should I contact?

This pathology is treated by orthopedic traumatologists. But depending on the nature and course of the disease, it may be necessary to consult other specialists:

• surgeon to rule out surgical pathology requiring surgical intervention;
• phthisiatrician to rule out bone tuberculosis;
• oncologist to rule out malignancies;
• endocrinologist for concomitant metabolic disorders;
• Neurologist, if there is any suspicion that the spinal nerve roots are compressed due to lumbosacral intervertebral herniation.

Treatment

The choice of treatment depends on the stage of the disease. To treat grade 1 bilateral arthritis of the hip joint (coxarthrosis), it is enough to change your lifestyle and increase physical activity. In stage 2, conservative treatment methods are used, including medication and physical therapy procedures. Stage 3 is more difficult to treat but surgery can still be avoided, which cannot be said for stage 4. The goal of conservative treatment is to improve quality of life as well as stop or slow the rate of progression. development of degenerative changes in the joints.

Drug treatment for coxarthrosis includes medications that relieve symptoms of the disease. These are nonsteroidal anti-inflammatory drugs used short-term to reduce pain and inflammation. Corticosteroids and muscle relaxants are sometimes used to relieve severe pain and muscle tension.

Non-pharmacological treatment includes:

• Reduces load on the hip joint.Depending on the situation, the patient may be advised to reduce body weight, provide additional support, and transfer body weight to a cane or crutches.
• Therapeutic exercises.A properly selected set of exercises will help improve joint mobility, reduce pain and prevent muscle atrophy.
• Physical therapy methods.For coxarthrosis of the hip joint, procedures are prescribed: magnetic therapy, laser therapy, shock wave therapy.
• PRP therapy.This method involves injecting your own plasma into the joint, which helps relieve pain, reduce inflammation and improve the recovery of damaged joint tissue.
• Kinesio recording.This is the application of special adhesive tape to the skin, which reduces the load on the joints.
• Acupuncture.One method is based on inserting sterile needles into biologically active points. Effectively relieves pain and relaxes muscles around joints.

For each patient, the doctor will develop an individual treatment course, which may include different methods depending on the severity of symptoms, stage of disease, age and health status. An integrated treatment method ensures high effectiveness of the procedure and quick recovery; Medical treatment alone may not produce the expected results.

Hip replacement is used in severe cases, when pain cannot be eliminated and joint mobility is significantly limited.

Consequence

Pathological changes in the joints can lead to:

• Subluxation and dislocation of the hip joint. In this case, movement in the legs is clearly limited, severe pain appears, hospitalization is required in the trauma department, and sometimes surgical intervention is required.
• Local inflammatory processes: bursitis and tendinitis.
• The sciatic nerve is compressed by large bone spurs, accompanied by severe pain along the back of the leg.
• Arthrosis is a condition in which the joints are completely immobilized, significantly reducing the patient's quality of life.
• Reduced physical activity, constant pain and limited joint mobility. In the future, this leads to obesity and depression.
• Stomach and heart diseases if taking non-steroidal anti-inflammatory drugs for a long time and regularly.

Prevent

To lead a comfortable and high-quality life without coxarthrosis, you must adhere to the following recommendations:

• See your doctor promptly if you feel pain in your hip joint.
• Be careful when participating in strenuous sports, performing physical activities at home and at work, and lifting heavy objects.
• Control your body weight through a balanced diet and regular physical activity.
• Avoid heavy labor and excessive sports. It is moderate physical activity that helps improve the condition of the joints, maintain normal mobility and reduce the load on other joints.

Summary

1. Coxarthrosis is one of the most common joint diseases, which is caused by the fact that the hip joint is subjected to significant loads.
2. The main signs of hip arthritis (coxarthrosis) are pain and stiffness when moving.
3. There are 4 degrees of coxarthrosis, 1-2 can be treated conservatively, 3-4 - surgically. However, in stage 3, you can still avoid surgery if you follow all your doctor's recommendations.
4. Specialists use a comprehensive approach to treating coxarthrosis, which includes medication, physical therapy, manual therapy, nutritional correction and physical activity.