Coxarthrosis of the hip joint, a complex pathology of arthrosis, leads to serious changes in the joint.Unfortunately, disability of mature people with loss of ability to work is common.In fact, statistics on diseases of the hip joint account for almost half of all pathologies of the musculoskeletal system.I will give an example from the life of a case after surgical treatment and a rare complication during rehabilitation.
Coxarthrosis of the hip joint: a little about the disease
Osteoarthritis is a degenerative-dystrophic alteration that contributes to the complete destruction of the cartilage with loss of joint function.
Coxarthrosis: Here the hip joints are destroyed, it is practically the same arthrosis.
In terms of mechanism, the joint of the hip with the pelvis is similar to door hinges.The head of the femur is connected to the ischium like a hinge.Which has a special anatomical formation - the acetabulum.This structure guarantees maximum joint mobility.Which performs a complete cycle of movements, i.e. flexion, extension, rotation, etc.
Normally the joint surfaces are smooth, inside there is enough fluid that ensures unhindered sliding.As the disease develops, the lubricant becomes thicker and more viscous, which immediately affects the condition of the cartilage.The synovial fluid no longer fully performs its functions.Because of this, the shock absorbing pads dry out, crack and become rough.
- First of all.Due to the lack of necessary sliding, the friction of the bones increases, injuring them.
- Secondly.As it progresses, the deformation of the bone surfaces also joins the altered cartilaginous tissue.The body thus tries to compensate for the increased load.
- Thirdly.Increased load leads to complete atrophy of the femoral muscles and weakness of the ligaments.
Important: Osteoarthritis of the hip joint is a progressive disease.The changes can lead to a person's complete loss of physical activity.It ultimately leads to disability.And completely upsetting the usual way of life.The disease and its treatment are extremely significant not only from a medical point of view, but also represent a major social problem.
Causes of development of coxarthrosis and its types
At least there is no exact cause of coxarthrosis, which destroys the hip joint.There are only guesses.Most cases of development of pathology of the hip joint are associated with congenital dislocation of the hip and dysplasia (inferiority) of the joint.
There are therefore 2 types of coxarthrosis;
- primary (resulting from an unknown etiology);
- secondary (associated with accidents, illnesses).
Primary arthrosis is characterized by a combination of factors:
- inheritance;
- influence of biological and mechanical processes;
- excess weight;
- metabolic disorders;
- There is also a theory about the pathological restoration of tissues in response to harmful agents (inflammation, friction, infection).
This type of coxarthrosis is often associated with damage to the spine and inflammatory phenomena of the knee joints (arthritis, arthrosis).
In the minor version, the reasons for the development are clearer.These include:
- Dysplastic disorders.In half of all cases of congenital pathology, grade 1 dysplastic coxarthrosis of the hip joint occurs.
- Hip dislocation (congenital).
- Traumas of life.Fractures of the pelvis, femoral neck, dislocations, subluxations.
- Legg-Calvé-Perthes disease.Osteochondropathy of the femoral head with development of its necrosis.This disease occurs in children when the blood supply and nutrition of the joint is impaired.
In addition, the pathology can affect both formations simultaneously or be unilateral.In addition to the direct causes of the onset, there are predisposing factors that provoke the development of the disease.Often the disease occurs with an increased load on the limbs of athletes.As well as people with difficult physical working conditions.Excess weight significantly increases the likelihood of osteoarthritis.
Provocative factors also include:
- Disruption of metabolic processes, joint nutrition, hormonal imbalances.
- Adynamia.
- Bad posture.Especially scoliosis, kyphosis, which lead to misalignment of the pelvic bones.
- Age after 40 years.It is estimated that after this date every 10 patients are diagnosed with coxarthrosis of the hip joint, grade 1, 2. After the age of 60, one in three people is already observed.And by the time they reach age 70 or older, nearly 80% of those who apply suffer from this condition.
There is no specific gene responsible for the transmission of pathological changes in the joints.However, the hereditary factor can still be traced.A person can receive from relatives the structural characteristics of cartilaginous tissue, impaired metabolism and skeletal pathology.It is the combination of this genetic information that can cause the onset of hip arthritis.
Classification
The main division of the disease is based on severity.There are 3 stages, which differ not only in symptoms, but also in changes on the x-ray.It is these indicators that are taken as the basis for making a diagnosis.
Degree |
Signs |
|---|---|
I |
|
II |
|
III |
|
This division is the most common.There are also types of Kellgren classifications.It includes 4 phases, plus grade zero, the equivalent of a healthy joint.
Symptoms
The basis of all diseases of the musculoskeletal system is pain.Coxarthrosis of the hip joint of 1-2 degrees has less pronounced symptoms than terminal stage 3. Initially, pain occurs during exercise.Especially after long walks or climbing stairs.Subsequently, pain becomes a constant companion, significantly worsening the quality of life.
Coxarthrosis 1st degree
Unpleasant sensations are concentrated only in the joint area (the groin and buttocks are practically not affected), rarely reflected in the hip or knee.The pain is relieved by rest.
At this stage, no further manifestations are detected: the gait remains unchanged, there are no disturbances in movements.In the dysplastic variant, however, there is an increase in mobility due to alterations in the connective tissue;often in the initial stages of the disease, due to increased flexibility, patients become interested in gymnastics and yoga.Problems with movement only occur in stage 3.
For symptoms of stage 1 coxarthrosis of the hip joint, treatment can be carried out without surgery.Rational therapy allows you to eliminate unpleasant symptoms, stopping the progression.
2nd degree of disease
The pain, although not constant, occurs at rest.Irradiation becomes noticeable: hip, groin, knee.Rigidity is observed: movements are limited in lifting, in attempting to abduct laterally, difficulty in circular movements of the leg (pain especially often increases).Lameness becomes noticeable, appearing after intense walking or running.
When moving, the characteristic creak of arthrosis is heard: rough, dry.
3 degree arthrosis
The pain becomes constant and does not disappear after rest and sleep.The unpleasant sensations do not leave the patient even at night.There are problems walking;to facilitate the movement you need to use a stick.The lameness is constant.
At this stage, atrophy of the muscles of the limb occurs and the leg itself shortens.These changes force the patient to bend towards the affected side, further increasing the load on the joint.Mobility limitation is observed in almost all directions.
Changes in bilateral coxarthrosis of the hip joint change the patient's gait, which is why all formations involved in the walking process suffer.Lower back pain appears, posture is disturbed and the axial position of the pelvis changes.
Diagnostics
An important role in determining the disease is examination by an orthopedic surgeon, as well as a thorough analysis of complaints.It is worth evaluating the patient's activity: the ability to climb stairs, comfort in wearing boots and socks, motor activity, the use of a cane.
It is recommended to check the general condition: blood test, urinalysis, biochemistry, ECG, determination of HIV and syphilis markers.
1st degree coxarthrosis of the hip joint presents the most subtle symptoms.That is why it is worth carrying out an x-ray examination to visualize changes in the joint space.This method allows not only to identify the disease.And often you also find out the cause of the event: dysplasia, Perthes disease.
Often, knee pain is much more pronounced with coxarthrosis deformans of the hip joint grade 1, so it should be distinguished from gonarthrosis.The differential diagnosis also includes examination of the spine to exclude radicular syndrome (causes pain radiating to the hip and knee).
In doubtful cases, MRI (allows you to examine soft tissues in detail) and CT (to review bone formations) are used.
Treatment
The disease cannot be cured completely, but modern medicine can restore your lost ability to move, allowing you to live a full life.
The use of physiotherapy and medications is effective for grades 1-2 of the disease.In the terminal stage, only surgery helps.In another case, surgical intervention is performed if the used conservative therapeutic methods do not bring relief.
1st degree treatment
Unfortunately, it is impossible to completely eliminate the pathology.In grade 1, treatment aims to stabilize the condition.
During therapy it is necessary to follow a number of general recommendations:
- Normalization of physical activity: it is recommended to reduce excessive stress (long walks, running, jumping).
- Use shoes with good shock-absorbing soles and special insoles.
- Weight loss.
- Mandatory physical therapy.
Important: Many patients completely refuse gymnastics and any exercise due to pain.This is often associated with the fear of increased pain and the possibility of making the situation worse.Practice proves that this opinion is wrong: regular physical therapy helps to strengthen muscles, protect them from atrophy, reduce pain and improve joint function.
A diet is not prescribed for grade 1 coxarthrosis of the hip joint;for weight loss, moderate nutrition is prescribed.It is also useful to add products with gelatin, canned fish with bones and dairy products to the diet.
Conservative
Nonsteroidal anti-inflammatory drugs are used as a medicinal method.Due to the large number of side effects, it is recommended to take medications for severe pain.You can combine their use with gastroprotectors.
Persistent pain is relieved with intra-articular steroid injections, and pain-relieving blocks are also possible.
For support it is prescribed:
- Muscle relaxants – relieve tension, reduce leg pain.
- Chondroprotectors – improve the restoration of cartilaginous tissue.
- Vasodilators (nicotinic acid): help relieve vascular spasm and also increase tissue microcirculation.
Heating compresses are also used in combination (traditional treatment methods can also be used).They do not provide a therapeutic effect, but help relieve muscle spasms.
Be sure to use physiotherapy: UHF, magnetotherapy, induction currents, massage.
Hip replacement surgery
To restore range of motion in stage 3 and relieve severe pain, the patient is prepared for a planned endoprosthetic surgery.This is a special operation to replace a destroyed formation with an artificial one.The interventions completely restore the patient's motor skills.It helps you completely return to your normal lifestyle.
Depending on the extent of the process, the prosthesis can be unipolar (only the worn head of the femur is replaced) or bipolar (the surface of the acetabulum is also modified).After the operation, rehabilitation is mandatory to return the patient to an active life as quickly as possible.
For patients over the age of 60, the rehabilitation period is established even before surgical treatment, so that the recovery process occurs in a shorter period of time.The lifespan of an artificial joint is about 20 years, but it is important to follow the recommendations:
- Exclusion of running, long walks, jumping.
- Avoid heavy lifting.
- Avoid excessive exposure to a forced static position (this is especially true for people with standing jobs).
Life accident
My friend's husband needed surgical treatment for endoprosthesis.He was not diagnosed with coxarthrosis, but a lumbar hernia was successfully removed.The condition did not improve, the examination continued and finally, having found out what was wrong, they sent me to the operating room under altitude.
After the replacement everything grew back safely, but the second hip joint also required surgery.A year later the quota for the operation was reached again, and it was successful.And then, from the first minutes after anesthesia, rehabilitation and strict compliance with the doctor's recommendations are necessary.
And what about our friend?Already on the way home after the hospital, I started to put stress on the prosthetic joint (sitting for a long time, stepping on my foot).I had forgotten how careful I had been the first time.As a result, the ligaments and muscles that did not have time to adapt to the implant could not hold it and it popped off.
Of course they put him in, put a cast on him and then everything seemed to work.But he complains that he cannot move his leg to the side, it hurts and he feels uncomfortable when walking.Although he does exercises and various exercises to develop both joints, there is also work and the desire to move independently.
Prevention
We discussed the symptoms and treatment of coxarthrosis of the hip joints, as well as their stages.
- Only daily exercise will help you avoid serious complications and live to a ripe old age without crutches.In Soviet times, serious work was done to prevent diseases of the musculoskeletal system and strengthen the immune system.Nowadays it is difficult to restore the lost experience, it is clear with the mind, but it is too lazy to do it.
- Excessive weight wears down joints to the point of disgrace;endoprosthesis is better, but don't lose the extra pounds.My friend is sure of this, without even trying to eat less sweets and starchy foods.Proper nutrition is a very important point.
- I consider weight lifting no less harmful to the entire skeleton.
- Bad habits (alcohol, smoking) remove calcium, magnesium and other beneficial substances from the body.
Just dig, everything is interconnected.
Take care of yourself and your joints by exercising every day!