Coxarthrosis: Osteoarthritis of the hip joint

Osteoarthritis of the hip joint or coxarthrosis is a chronic, slow degenerative process in the articulation of the femoral head and the hip socket of the pelvic bone. This disease causes deformation of the bone and cartilage tissue, which subsequently leads to significant limitations in movement in the leg and disability. All components of the joint are involved in the process: bones, surrounding joint capsules, cartilage, ligaments, muscles. Symptoms and treatment of osteoarthritis of the hip joint (coxarthrosis) vary from person to person; The disease usually occurs in middle-aged and older people, although such changes can also occur after 20 years.

The main signs of osteoarthritis of the hip joint (coxarthrosis) are pain and stiffness of movement. Most often, its development is preceded by injuries and joint diseases of an inflammatory and non-inflammatory nature. Coxarthrosis is one of the most common arthroses, which is associated with significant stress on the hip joint.

The disease goes through several stages in its development. In the early stages, coxarthrosis can be treated conservatively, but as it progresses, only surgical treatment is effective. Therefore, you should not delay visiting a specialist and register for a consultation. You can have yourself examined and treated conservatively in clinics.

causes

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

• Exogenous- These are environmental factors: heavy physical activity, the consequences of serious injuries – fractures, dislocations, ruptures of ligaments, unfavorable working conditions due to heavy lifting, prolonged sitting.
• Endogenous— These are chronic infectious, inflammatory and autoimmune diseases: rheumatoid, reactive, psoriatic arthritis. As well as metabolic disorders: gout, diabetes.
• Congenital diseases.Dysplasia (impaired joint formation) and osteochondropathy (malnutrition of the joint structures with subsequent necrosis, bone destruction) can also lead to coxarthrosis. For example, congenital hip dislocation, aseptic necrosis of the femoral head – Perthes disease.
• Genetic predispositionoften causes coxarthrosis of the hip joints. This includes a mutation in the type II procollagen gene.
• Older age.More often, the development of coxarthrosis of the hip joint is due to inevitable age-related changes.
• Floor. Osteoarthritis is thought to occur more frequently in women than in men. This is due to the influence of the female sex hormone estrogen on mineral metabolism and bone density.
• Overweight.There is a direct connection between being overweight and the occurrence of osteoarthritis. The higher the body weight, the more likely it is that osteoarthritis of the hip joint will develop, since excess fatty tissue increases the load on the joints and fatty tissue produces inflammatory substances that damage cartilage tissue.
• Professional sportscan lead to 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, changes gradually occur in the joint cavity at the cellular level: decay processes begin to prevail over synthesis processes, metabolism changes, the volume of synovial fluid that nourishes the cartilage tissue decreases, and the cartilage becomes thinner. As a result, the joint "dries out" and its volume decreases. Bone growths appear on the edges of the articular surfaces of the bones - osteophytes, which limit the range of motion in the joint and thereby reduce the load.

Symptoms

How quickly does osteoarthritis of the hip joint (coxarthrosis) develop? Symptoms gradually intensify, and in the early stages a person may not pay them due attention, writing them off as fatigue. This is dangerous because treatment has the greatest effect at the beginning of the degenerative process.

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

The pain can vary in intensity and duration. The unpleasant sensations are initially mild and short-lived. The provoking factor for their appearance is prolonged walking or intense physical activity.

Due to severe pain, joint mobility is restricted. The patient's gait changes: the buttocks protrude backwards, the body bends forward as the weight is shifted to the injured side, and the person limps.

Swelling in the joint area, which is usually invisible due to the muscle and fat layer, crunching in the joints during movement, and functional shortening of the lower extremities are also possible.

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

• Coxarthrosis of the 1st degreecharacterized by asymptomatic or periodic pain that occurs only after intense physical activity such as running or long walking. The pain is localized in the joint area and less often spreads to the entire thigh and even the knee. After rest it usually disappears. No changes can be seen on the x-ray of the hip joint; there is a slight narrowing of the joint space. MRI shows signs of heterogeneity of cartilage tissue.
• With coxarthrosis of the 2nd degreeThe pain becomes more severe, occurs with little physical activity and sometimes at rest, and can radiate to the thigh and groin area. Lameness occurs after significant physical exertion. The range of motion in the joint decreases: abduction and internal rotation of the hip are restricted. X-rays show a clear, uneven narrowing of the joint space and isolated osteophytes - growths of bone tissue - on the edge of the joint socket. An MRI in stage 2 coxarthrosis shows significant erosions and cracks of the cartilage with thinning of less than half.
• With coxarthrosis of the 3rd degreeThe pain becomes constant and often disturbs patients during sleep. Walking is difficult, forcing the patient to adopt a forced posture and rely on a sound leg or cane. The range of motion in the joint is severely limited. On x-ray images, the joint space is virtually non-existent and multiple osteophytes have formed on the bone surfaces. MRI shows destruction of more than half of the cartilage tissue volume. However, the third stage can still be treated conservatively.
• Osteoarthritis of the hip joint in stage 4 (coxarthrosis)characterized by a significant loss of joint function. The whole leg hurts: joint, groin, gluteal region, hip, knee, ankle. Flat feet develop, the leg shortens and its muscles atrophy. On the x-ray: several large osteophytes, the joint space is missing or narrowed to a minimum. In stage 4, conservative treatment is not possible; A hip joint replacement is performed. The operation relieves pain, improves the function of the leg and the patient's quality of life.

Diagnosis of osteoarthritis of the hip joint

The basis for diagnosing osteoarthritis of the hip joint is an initial consultation with a specialist. The doctor clarifies the symptoms: where the pain is located, when and why it occurs, where it goes, what relieves and increases it, what causes it. Then a visual inspection, palpation, gait assessment is required and special tests are carried out to identify dysfunctions of the joint.

The diagnosis of coxarthrosis is made on the basis of clinical signs and data from additional instrumental studies, of which radiography of the joint is the main focus. There are no characteristic laboratory findings for the diagnosis of osteoarthritis, but a clinical blood test may be required for the differential diagnosis of coxarthrosis and arthritis. In this case, the specialist takes into account the content of leukocytes, ESR, C-reactive protein and uric acid.

Of the instrumental methods for diagnosing arthrosis of the hip joints, x-rays are usually sufficient. This is an accessible study that reveals changes characteristic of coxarthrosis: narrowing of the joint space, osteophytes, erosion and ulceration of the cartilage surface, cysts. X-rays of patients with coxarthrosis may also show changes suggestive of trauma.

CT and MRI can be used as further instrumental diagnostic procedures. Computed tomography allows for a more detailed study of pathological changes in bone structures, and magnetic resonance imaging provides the opportunity to assess soft tissue diseases.

Which doctor should I contact?

This pathology is treated by orthopedic traumatologists. However, depending on the type and course of the disease, consultations with other specialists may be required:

• Surgeon to rule out surgical pathology requiring surgical intervention;
• Doctor to rule out bone tuberculosis;
• oncologist to rule out malignant neoplasms;
• Endocrinologist for accompanying metabolic disorders;
• a neurologist if there is suspicion of compression of the spinal nerve roots caused by an intervertebral fracture of the lumbosacral spine.

Treatment

The choice of treatment method depends on the stage of the disease. To treat grade 1 bilateral osteoarthritis of the hip joint (coxarthrosis), it is often enough to make lifestyle changes and increase physical activity. In stage 2, conservative treatment is used, which includes medication and physiotherapeutic procedures. Stage 3 is less treatable, but surgery can still be avoided, which is not the case for stage 4. The goal of conservative treatment is to improve quality of life and stop or slow the development of degenerative changes in the joint.

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

Non-drug therapy includes:

• Reducing the load on the hip joint.Depending on the situation, the patient may be advised to reduce body weight, provide additional support, and shift body weight to a cane or crutches.
• Therapeutic exercise.A properly selected set of exercises will help improve joint mobility, relieve pain and prevent muscle loss.
• Physiotherapeutic treatment methods.With coxarthrosis of the hip joint, courses are prescribed: magnetic therapy, laser therapy, shock wave therapy.
• PRP therapy.This method involves injecting your own blood plasma into the joint, which helps reduce pain and inflammation and improves the repair of damaged joint tissue.
• Kinesio taping.This involves applying special adhesive tapes to the skin, which relieves pressure on the joint.
• Acupuncture.A method based on inserting sterile needles into biologically active points. Effectively relieves pain and relaxes the muscles around the joint.

For each patient, doctors develop an individual course of treatment, which may include different methods depending on the severity of symptoms, stage of the disease, age and health status. An integrated treatment approach guarantees high effectiveness of procedures and quick recovery; drug therapy alone may not produce the expected result.

In severe cases of the disease, a hip replacement is used if the pain cannot be eliminated and joint mobility is significantly limited.

Follow

Pathological changes in the joint can lead to:

• Subluxation and dislocation of the hip joint. In this case, movements in the leg are severely limited, severe pain occurs, hospitalization in the trauma department and sometimes surgical intervention are required.
• Local inflammatory processes: bursitis and tendovaginitis.
• Compression of the sciatic nerve by large osteophytes, causing severe, stabbing pain along the back of the leg.
• Ankylosis is complete immobility of the joint, which significantly affects the patient's quality of life.
• Decreased physical activity, constant pain and limited joint mobility. This leads to obesity and depression in the future.
• Diseases of the stomach and heart if you take non-steroidal anti-inflammatory drugs for a long time and frequently.

prevention

For a comfortable and high-quality life without coxarthrosis, you must follow the following recommendations:

• See a doctor immediately if you experience pain in the hip joint.
• Use caution when participating in strenuous sports, performing physical activities around the home and at work, and lifting heavy objects.
• Control your body weight through a balanced diet and regular physical activity.
• Avoid heavy physical work and overexertion of sports. It is moderate physical activity that improves the condition of the joint, maintains its normal mobility and reduces the load on other joints.

Summary

1. Coxarthrosis is one of the most common osteoarthritis caused by significant stress on the hip joint.
2. The main signs of osteoarthritis of the hip joint (coxarthrosis) are pain and stiffness of movement.
3. There are 4 degrees of coxarthrosis, 1-2 can be treated conservatively, 3-4 - surgically. However, in stage 3, surgery can still be avoided if all doctor's recommendations are followed.
4. Specialists use an integrated approach to the treatment of coxarthrosis, which includes medication, physiotherapy, manual therapy, nutritional correction and physical activity.