Arthrosis of the hip joint is a degenerative-dystrophic pathology, which is characterized by the destruction of hyaline cartilage.
The disease develops gradually, accompanied by pain and decreased freedom of movement. If there is no medical intervention in the initial stages of osteoarthritis, atrophy of the thigh muscles will appear after a few years.
The injured limb is shortened and the fusion of the joint space leads to partial or complete immobilization of the hip joint. The causes of the pathology are previous injuries, curvature of the spine, systemic diseases of the musculoskeletal system.
Osteoarthritis is usually found in middle-aged and elderly people. The diagnosis is made on the basis of the results of instrumental studies - radiography, MRI, CT, arthroscopy. Treatment of pathologies of 1 and 2 degrees of severity is conservative. If ankylosis is detected or drug therapy is ineffective, surgical operation (arthrodesis, endoprosthetics) is performed.
The mechanism of development of pathology
The hip joint is made up of two bones - the ilium and the femur. The lower part of the ilium is represented by its body, which participates in articulation with the femur and forms the upper part of the acetabulum. During movement, the glenoid fossa is motionless and the femoral head moves freely. Such a "hinge" device of the hip joint enables it to flex, loosen, rotate, promote abduction and adduction of the hip. The smooth, elastic, elastic hyaline cartilage that lines the acetabulum and the femoral head ensures that the joint structures slide freely. Its main functions are to redistribute loads during movement and to prevent rapid wear and tear of the bone tissue.
Under the influence of external or internal factors, the trophism of the cartilage is disturbed. It does not have its own circulatory system - the synovial fluid supplies the tissue with nutrients. With osteoarthritis, it thickens and becomes viscous.
The resulting lack of nutrients leads to the drying out of the surface of the hyaline cartilage. It becomes covered with cracks, resulting in permanent microtrauma of the tissues during flexion or extension of the hip joint. Cartilage becomes thinner and loses its cushioning properties. Bones are deformed to adapt to the rise in pressure. And against the background of a deterioration in metabolism in tissues, destructive and degenerative changes progress.
Causes and provoking factors
Idiopathic or primary osteoarthritis develops for no reason. It is believed that the destruction of cartilage tissue is due to the natural aging of the body, the slowing down of recovery processes, a decrease in the production of collagen and other compounds necessary for the complete regeneration of the structures of the hip joint. Secondary osteoarthritis occurs against the background of a pathological condition already present in the body. The most common causes of secondary diseases are:
- previous injuries - damage to the ligament-tendon apparatus, muscle tears, their complete separation from the base of the bone, fractures, dislocations;
- Violation of the development of the joint, congenital dysplastic disorders;
- Autoimmune diseases - rheumatoid, reactive, psoriatic arthritis, systemic lupus erythematosus;
- non-specific inflammatory diseases such as purulent arthritis;
- specific infections - gonorrhea, syphilis, brucellosis, ureaplasmosis, trichomoniasis, tuberculosis, osteomyelitis, encephalitis;
- Dysfunction of the endocrine system;
- degenerative-dystrophic pathologies - osteochondropathy of the femoral head, osteochondritis dissecans;
- Hypermobility of the joints due to the production of "super-stretchable" collagen, which leads to excessive mobility and weakness of the ligaments.
Since the cause of the development of osteoarthritis can be hemarthrosis (bleeding in the hip joint cavity), hematopoiesis disorders are one of the provoking factors. The prerequisites for the onset of the disease are obesity, excessive physical activity, a sedentary lifestyle. Its development is due to improper organization of sports training, a deficiency in the diet of foods with a high content of microelements, fat and water-soluble vitamins. Postoperative osteoarthritis occurs a few years after surgery, especially if it was accompanied by the removal of a large amount of tissue. The trophism of hyaline cartilage is disturbed by frequent hypothermia, living in an environmentally harmful environment and working with toxic substances.
Arthrosis of the hip joint cannot be inherited. However, in the presence of certain innate features (metabolic disorders, skeletal structure), the likelihood of its development increases significantly.
Symptoms
The main symptoms of osteoarthritis of the hip joint are pain when walking in the hip region, which radiates to the groin and knee joint. A person suffers from stiffness of movements, stiffness, especially in the morning. To stabilize the joint, the patient begins to limp, his gait changes. Over time, the limb becomes noticeably shortened due to muscle atrophy and deformation of the joint. Another characteristic sign of the pathology is the limitation of hip abduction. For example, difficulties arise when attempting to sit on a stool with your legs apart.
With osteoarthritis of the first severity, periodic pain occurs after intense physical exertion. They are localized in the area of articulation and disappear after a long pause.
With osteoarthritis of the second degree of the hip joint, the severity of the pain syndrome increases. Complaints also appear at rest, extending to the thigh and groin, increasing with weightlifting or increased motor activity. To get rid of pain in the hip joint, a person begins to limp barely noticeably. In particular, during abduction and internal rotation of the thigh, a restriction of movement in the joint is found.
Third-degree osteoarthritis is characterized by constant severe pain that does not go away during the day or night. Difficulty moving occurs, so a person is forced to use a stick or crutches when walking. The hip joint is stiff, there is significant atrophy of the muscles of the buttocks, thighs and legs. Due to the weakness of the thigh muscles of the abductor, the pelvic bones are displaced in the frontal plane. To compensate for the shortening of the leg, the patient bends as he moves toward the injured limb. This leads to a sharp shift in the center of gravity and an increase in the load on the joint. At this stage of osteoarthritis, pronounced ankylosis of the joint develops.
| Degree | X-ray sign |
| The first | The changes are not pronounced. The joint gaps are moderately, unevenly narrowed, there is no destruction of the surface of the femur. Minor bone growth is observed on the outer or inner edge of the acetabulum |
| The second | The height of the joint space is significantly reduced due to its uneven merging. The bony head of the femur is shifted upwards, deformed, enlarged, its contours become uneven. Bony growths form on the surface of the inner and outer edges of the glenoid fossa |
| third | There is a complete or partial fusion of the joint space. The femoral head is greatly expanded. There are several bony growths on all surfaces of the acetabulum |
diagnosis
When making a diagnosis, the doctor takes into account the clinical manifestations of pathology, anamnesis, the results of an external examination of the patient and instrumental studies. Radiography is the most informative. With its help, the state of the hip joint, the stage of its course, the degree of damage to the cartilage tissue and, in some cases, the cause of its development is established. If the cervico-diphyseal node is enlarged and the acetabulum is oblique and flattened, there is a high probability that it is possible to assume dysplastic congenital changes in articulation. Perthes disease or juvenile epiphysiolysis is indicated by the abnormal shape of the hip bone. Radiography can reveal post-traumatic osteoarthritis despite the lack of a history of trauma. Other diagnostic methods are also used:
- CT helps to detect the growth of the edges of the bone plates, formed osteophytes;
- MRI is performed to assess the condition of connective tissue structures and the degree of their involvement in the pathological process.
If necessary, the inner surface of the joint is examined with arthroscopic instruments. Differential diagnosis is performed to rule out gonarthrosis, lumbosacral, or thoracic osteochondrosis. Osteoarthritis pain can be disguised as clinical manifestations of radicular syndrome caused by nerve entrapment or inflammation. It is usually possible to rule out neurogenic pathology with the help of a series of tests. Arthrosis of the hip joint is necessarily different from trochanteric bursitis of the hip joint, ankylosing spondylitis, and reactive arthritis. To rule out autoimmune diseases, biochemical examinations of blood and synovial fluid are carried out.
Drug treatment tactics
Medical treatment aims to improve the patient's well-being. For this purpose, drugs from various clinical and pharmacological groups are used:
- Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) - Nimesulide, Ketoprofen, Diclofenac, Ibuprofen, Meloxicam, Indomethacin, Ketorolac. Injectable solutions are used to relieve acute pain, and pills, pills, ointments, and gels help relieve pain of mild or moderate severity.
- Glucocorticosteroids - triamcinolone, dexamethasone, hydrocortisone. They are in the form of intra-articular blockages in combination with the anesthetics procaine, lidocaine;
- Muscle relaxants - baclofen, tizanidine. They are included in treatment regimens for skeletal muscle spasms, entrapment of delicate nerve endings;
- Drugs that improve blood circulation in the joint - nicotinic acid, aminophylline, pentoxifylline. Are prescribed to patients to improve tissue trophism and prevent disease progression;
- Chondroprotectors. Only effective in stages 1 and 2 of osteoarthritis.
Rubbing ointments with a warming effect will help get rid of mild pain. The active ingredients of external active ingredients are capsaicin, cinquefoil, camphor, menthol. These substances are characterized by a local irritating, distracting, analgesic effect. Compresses the joints with dimethyl sulfoxide, medicinal bile helps with swelling and morning swelling of the thigh. A classic acupressure or vacuum massage is recommended for patients with coxarthrosis. Daily exercise therapy is an excellent way of preventing the further progression of osteoarthritis.
Surgical intervention
With the ineffectiveness of conservative therapy or the diagnosis of a pathology complicated by ankylosis, an operation is performed. It is impossible to restore cartilage tissue damaged by osteoarthritis in the joint without prosthetic surgery, but with the right approach to treatment, compliance with all medical regulations, maintaining a correct lifestyle, therapeutic exercises, regular massage classes, taking vitamins and eating right, you canstop the lesion process and the destruction of cartilage and hip joints.