Coxarthrosis of the hip joint, a complex pathology of osteoarthritis, leads to serious changes in the joint.Unfortunately, elderly disability with loss of work capacity is common.In fact, statistics on hip diseases 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: a little about the disease
Osteoarthritis is a degenerative-dystrophic change that contributes to the complete destruction of cartilage with loss of joint function.
Coxarthrosis - here the hip joints are destroyed, practically it is the same osteoarthritis.
In terms of its mechanism, the articulation 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 ensures maximum joint mobility.Which performs a complete cycle of movements, or rather flexion, extension, rotation, etc.
Normally, the joint surfaces are smooth, there is sufficient fluid inside, which 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 fulfills its functions.As a result, the shock absorber 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: hip osteoarthritis is a progressive disease.The changes can cause a person to lose their physical activity altogether.Ultimately leading to disability.And completely disrupting the usual way of life.The disease and its treatment are extremely important not only from a medical point of view, but also constitute a major social problem.
Causes of the development of coxarthrosis and its types
At least there is no exact cause of coxarthrosis, which destroys the hip joint.There are only hypotheses.Most cases of the development of hip joint pathology are associated with congenital hip dislocation and dysplasia (inferiority) of the joint.
So there are 2 types of coxarthrosis;
- primary (arising from an unknown etiology);
- secondary (associated with injuries, diseases).
Primary osteoarthritis is characterized by a combination of factors:
- heredity;
- influence of biological and mechanical processes;
- excess weight;
- metabolic disorders;
- There is also a theory about the restoration of pathological tissues in response to damaging agents (inflammation, friction, infection).
This type of coxarthrosis is often associated with lesions of the spine and inflammatory phenomena of the knee joints (arthritis, osteoarthritis).
In the secondary version, the reasons for the development are clearer.These include:
- Dysplastic disorders.In half of the 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 the development of its necrosis.This disease occurs in children when the blood supply and nutrition of the joint are impaired.
In addition, the pathology can affect both formations at once or be unilateral.In addition to the direct causes of occurrence, there are predisposing factors that provoke the development of the disease.The disease often occurs with increased load on the limbs of athletes.As well as people with difficult physical working conditions.Excess weight significantly increases the risk of osteoarthritis.
Provoking factors also include:
- Disruption of metabolic processes, joint nutrition, hormonal imbalances.
- Adynamia.
- Bad posture.Especially scoliosis, kyphosis, which causes misalignment of the pelvic bones.
- Age after 40 years.It is estimated that after this date, one in 10 patients is diagnosed with coxarthrosis of the hip joint, grade 1, 2. After 60 years, one in three people is already observed.And when they reach 70 years or older, almost 80% of candidates suffer from this pathology.
There is no specific gene responsible for transmitting pathological changes in the joints.However, the hereditary factor can still be traced.A person can receive structural features of cartilage tissue, impaired metabolism and skeletal pathology from loved ones.It is the combination of this genetic information that can cause the development of hip osteoarthritis.
Ranking
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 serve as the basis for the diagnosis.
Diploma |
Signs |
|---|---|
I |
|
II |
|
III |
|
This division is the most common.There are also types of Kellgren classifications.It includes 4 stages, plus degree zero – the equivalent of a healthy joint.
Symptoms
Pain is the basis of all diseases of the musculoskeletal system.Coxarthrosis of the hip joint of 1-2 degrees has less pronounced symptoms than at the end stage 3. Initially, pain manifests itself during exercise.Especially after long walks or climbing stairs.Later, pain becomes a constant companion, significantly deteriorating the quality of life.
Coxarthrosis 1st degree
Unpleasant sensations are concentrated only in the joints (the groin and buttocks are practically not affected), rarely being 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, on the contrary, there is an increase in mobility due to changes in the connective tissue;often in the early stages of the disease, due to increased flexibility, patients become interested in gymnastics and yoga.Movement problems 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 and stop progression.
2nd degree of illness
The pain, although not constant, occurs at rest.Irradiation becomes noticeable - hip, groin, knee.Stiffness is observed - movements are limited when lifting, attempts to abduct to the side, difficulty in circular movements of the leg (the pain especially often increases).Lameness becomes noticeable and appears after strenuous walking or running.
When moving, a crunch characteristic of osteoarthritis is heard - rough, dry.
3rd degree osteoarthritis
The pain becomes constant and does not disappear after rest and sleep.Unpleasant sensations do not leave the patient even at night.There are problems walking;To facilitate movement, you must use a cane.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 lean toward the affected side, thereby increasing the load on the joint.A limitation of mobility 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.
Diagnosis
An examination by an orthopedic surgeon, as well as a thorough analysis of complaints, play an important role in determining the disease.It is worth assessing the patient's activity - the ability to climb stairs, comfort when putting on boots and socks, walking activity, use of a cane.
It is recommended to check the general condition - blood test, urine analysis, biochemistry, ECG, determination of markers for HIV and syphilis.
1st degree coxarthrosis of the hip presents the most subtle symptoms.This 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 also often find out the cause of the appearance - dysplasia, Perthes disease.
Often, knee pain is much more pronounced in deforming coxarthrosis of the hip joint grade 1, therefore it should be distinguished from gonarthrosis.The differential diagnosis also includes an examination of the spine to exclude radicular syndrome (it gives radiating pain to the hip and knee).
In doubtful cases, MRI (allows you to examine soft tissues in detail) and CT scan (to examine bone formations) are used.
Treatment
The disease cannot be completely cured, but modern medicine can restore lost movement ability, allowing you to live life to the fullest.
The use of physiotherapy and medication is effective for grades 1-2 of the disease.In the terminal stage, only surgery is useful.In another case, surgical intervention is performed if the conservative therapeutic methods used do not bring relief.
1st degree treatment
Unfortunately, it is impossible to completely eliminate the pathology.In the first year, treatment is aimed at stabilizing the condition.
During treatment, a number of general recommendations should be followed:
- Normalization of physical activity - it is recommended to reduce excessive stress (long hikes, running, jumping).
- Use shoes with good shock-absorbing soles and special insoles.
- Weight loss.
- Mandatory physiotherapy.
Important: many patients completely refuse gymnastics and any exercises due to pain.This is often associated with fear of increased pain and the possibility of the situation getting worse.Practice proves that this opinion is wrong: regular exercise therapy helps to strengthen muscles, protect them from atrophy, reduce pain and improve joint function.
A diet for grade 1 coxarthrosis of the hip joint is not prescribed;a moderate diet is prescribed for weight loss.It is also useful to add products containing gelatin, canned fish with bones and dairy products to your 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 medication for severe pain.You can combine their use with gastroprotectors.
Persistent pain is relieved by intra-articular steroid injections and analgesic blocks are also possible.
For support, the following is prescribed:
- Muscle Relaxants – relieve tension, reduce leg pain.
- Chondroprotectors – improve the restoration of cartilage tissue.
- Vasodilators (nicotinic acid) - help relieve vascular spasms and also increase tissue microcirculation.
Heating compresses are also used in combination (you can also use traditional treatment methods).They do not provide a therapeutic effect, but they help relieve muscle spasms.
Be sure to use physiotherapy - UHF, magnetotherapy, induction currents, massage.
Hip replacement surgery
To restore freedom of movement at stage 3 and relieve severe pain, the patient is prepared for planned endoprosthetic surgery.This is a special operation aimed at replacing a destroyed formation with an artificial formation.The interventions completely restore the patient's motor skills.Helps you fully return to your normal lifestyle.
Depending on the extent of the process, the prosthesis can be either 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 in order to return the patient to an active life as quickly as possible.
For patients over 60 years old, the rehabilitation period is set even before surgical treatment, so that the recovery process takes place in a shorter time.The lifespan of an artificial joint is approximately 20 years, but it is important to follow the recommendations:
- Exclusion of running, long walks, jumping.
- Avoid lifting heavy objects.
- Avoid excessive exposure to a forced static position (this is especially true for people working while standing).
Life incident
My friend's husband had to undergo surgical treatment for stents.He was not diagnosed with hip osteoarthritis, but had a lumbar hernia successfully removed.The condition did not improve, the examination continued, and finally, after finding out what was wrong, they sent me for surgery according to a quota.
After the replacement, everything grew back safely, but the second hip joint also required surgery.A year later, the quota for the operation was reinstated, which was a success.And then, from the first minutes after anesthesia, rehabilitation and strict compliance with the doctor's recommendations are essential.
And what about our friend?Already on the way home from the hospital, I began to put pressure on the prosthetic joint (sitting for a long time, walking on my foot).I forgot how careful I had been the first time.Result: the ligaments and muscles which did not have time to adapt to the implant were not able to retain it and it came out.
Sure enough, they inserted it, put a cast on, and then everything seemed to be fine.But he complains that he can't move his leg sideways, it hurts and he feels discomfort when walking.Although he does exercises and various exercises to develop both joints, it 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 physical exercise will help you avoid serious complications and live to old age without crutches.In Soviet times, serious work was carried out to prevent diseases of the musculoskeletal system and strengthen the immune system.Nowadays, it is difficult to restore the lost experience. It is clear in the mind, but it is too lazy to do it.
- Excess weight wears out the joints to the point of dishonoring them;endoprostheses are better, but without losing extra pounds.My friend is sure of it, without even trying to eat fewer sweets and starchy foods.Good nutrition is a very important point.
- I consider that lifting weights is no less bad for the entire skeleton.
- Bad habits (alcohol, tobacco) remove calcium, magnesium and other beneficial substances from the body.
Just dig in, everything is interconnected.
Take care of yourself and your joints by doing sports every day!