Coxarthrosis affects the hip joints of middle-aged and elderly people. The causes of its development are previous injuries, congenital and acquired diseases of an inflammatory or non-inflammatory nature. The main symptoms of coxarthrosis are pain in the hip joint, morning swelling and stiffness of movement. In the initial phase of the pathology, treatment is conservative. If it is ineffective against the background of rapid progression of coxarthrosis or its late detection, surgical intervention, usually endoprosthetics, is indicated.
Description of the pathology
Coxarthrosis (osteoarthrosis, deforming arthrosis) is a degenerative dystrophic pathology of the hip joint. At the initial stage of development, the structure of synovial fluid changes. It becomes viscous, thick and therefore loses the ability to nourish the hyaline cartilage. Due to dehydration, its surface dries out and becomes covered with multiple radial cracks. In this condition, hyaline cartilage does not cushion shocks well when the bones that form the joint come into contact.
To adapt to the increased pressure that occurs on them, bone structures are deformed with the formation of growths (osteophytes). The metabolism in the hip joint deteriorates, which negatively affects the muscles and the ligamentous-tendon apparatus of the joint.
Degrees
Each stage is characterized by its own symptoms, the severity of which depends on the degree of narrowing of the joint space and the number of bone growths formed.
| Severity of coxarthrosis | Characteristic symptoms and radiographic signs |
|---|---|
| First | The joint space is unevenly narrowed and single osteophytes form around the acetabulum. Slight discomfort occurs, but more often the disease does not manifest itself clinically |
| Second | The joint space is narrowed almost 2 times, the head of the femur is displaced, deformed, enlarged, and bone growths are found even outside the cartilaginous lip. Hip pain becomes constant and is accompanied by significant limitation of mobility |
| Third | Complete or partial fusion of the joint space, multiple bone growths, expansion of the femoral head. The pain occurs day and night and spreads to the thighs and legs. Movement is only possible with the help of a cane or crutches |
Causes of the disease
Primary Coxarthrosis is a destructive-degenerative lesion of the hip joint, the causes of which have not been established. This means that no prerequisites for the premature destruction of hyaline cartilage have been identified. The following pathological conditions can provoke secondary coxarthrosis:
- previous injuries - fracture of the femoral neck or pelvic bones, dislocation;
- hip dysplasia;
- aseptic necrosis of the femoral head;
- congenital hip dislocation;
- inflammatory diseases, including infectious joint diseases (rheumatoid, reactive arthritis, gout, tendonitis, bursitis, synovitis).
The prerequisites for the development of coxarthrosis are obesity, increased physical activity, a sedentary lifestyle, metabolic disorders, hormonal disorders, kyphosis, scoliosis and flat feet.
Symptoms of the disease
At the initial stage of development, coxarthrosis may only manifest itself as mild pain. They usually occur after intense physical exertion or a hard day at work. The person attributes the deterioration in health to muscle "fatigue" and does not seek medical help. This explains the frequent diagnosis of coxarthrosis in stages 2 or 3, when conservative therapy is ineffective.
Limitation of joint mobility
The range of motion of the hip joint is reduced due to compensatory growth of bone tissue, damage to the synovial membrane and replacement of areas of the joint capsule with fibrous tissues devoid of any functional activity. Mobility can be somewhat limited even with grade 1 coxarthrosis. Difficulties arise when performing rotational movements with the leg.
As the disease progresses, morning stiffness and joint swelling become common. To regain mobility, a person needs to warm up for several minutes. By lunchtime, range of motion is restored, including as a result of the production of hormone-like substances in the body.
Crushing
When walking, flexing and (or) extending the hip joint, clicks, clicks and pops are clearly heard. The reason for this sound accompaniment to each step is the friction of the bone surfaces, including the osteophytes, against each other. Crunching may also appear in normal health due to the collapse of carbon dioxide bubbles in the joint cavity. Coxarthrosis is indicated by its combination with dull or sharp pain.
Pain
Painful sensations become constant already in stage 2 of coxarthrosis. Its severity decreases somewhat after a long rest. The pain intensifies during the next relapse or the development of synovitis (inflammation of the synovial membrane) that often accompanies osteoarthritis. During the remission phase, the discomfort subsides somewhat. But as soon as a person becomes hypothermic or lifts a heavy object, severe pain reappears.
Muscle spasm
Increased tension in the skeletal muscles of the thigh occurs in coxarthrosis for several reasons. First, the ligaments weaken. The muscles contract to hold the head of the femur in the acetabulum. Second, increased tone often accompanies inflammation of the synovial membrane. Thirdly, when osteophytes are displaced, nerve endings are compressed and muscle spasm becomes a compensatory reaction to acute pain.
Lameness
In the later stages of the development of coxarthrosis, the patient begins to limp severely. Changes in gait are caused by flexion contractures and deformation of bone surfaces, making it impossible to maintain a straight leg position. The person also limps to reduce the intensity of pain by transferring body weight to the unaffected limb.
Leg shortening
Shortening of the leg by 1 cm or more is typical for grade 3 coxarthrosis. The reasons for the decrease in the length of the lower limb are severe muscle atrophy, thinning and flattening of the cartilage, narrowing of the joint space and deformation of the femoral head.
Diagnostic methods
The initial diagnosis is made based on the patient's complaints, external examination, medical history and the results of various functional tests. Many inflammatory and non-inflammatory pathologies are disguised as symptoms of coxarthrosis, which is why instrumental and biochemical studies are carried out.
X-ray examination
The stage of Coxarthrosis is determined by performing an X-ray examination. The resulting images clearly show destructive changes in the hip joint. This is a narrowing of the joint space, deformation of bone surfaces and the formation of osteophytes.
Computed tomography
Computed tomography is prescribed to patients to determine the degree of flattening and deformation of hyaline cartilage. The results of the study also make it possible to assess the state of the ligamentous-tendinous apparatus, nerve trunks, muscles, small and large blood vessels.
Magnetic resonance imaging
Magnetic resonance imaging is one of the most informative studies in the diagnosis of coxarthrosis. To identify circulatory disorders in the affected joint area, it is carried out using contrast. A routine study is prescribed to determine the degree of damage to the ligaments and deformation of the femoral head and to detect areas of fibrous degeneration of the joint capsule.
Leg length measurement
Before taking the measurement, the doctor asks the patient to stand up and stretch his legs as much as possible. To obtain more reliable data, the orthopedist uses two bone landmarks. Superior - the anterior axis of the pelvic bone, located on the anterolateral surface of the abdomen, on the outer edge of the inguinal ligament. The second reference point is any bony structure of the knee, ankle or heel. Measuring leg length may not be informative if the coxarthrosis affects two hip joints at the same time.
Laboratory research
Clinical blood and urine tests are performed to assess the patient's general health. And the results of biochemical studies often make it possible to detect pathologies that caused the development of coxarthrosis. Gouty arthritis is indicated by high levels of uric acid and its salts. An increase in the erythrocyte sedimentation rate and an increase in the number of leukocytes indicate the occurrence of an inflammatory process (bursitis, arthritis, synovitis). To exclude rheumatoid arthritis, rheumatoid factor, C-reactive protein and antinuclear antibodies are determined.
Hip puncture
Using a puncture, synovial fluid is collected to study its composition and detect changes in consistency. If an infectious-inflammatory process is suspected, an additional biochemical examination of a biological sample is indicated.
Treatment options
When determining treatment tactics, the orthopedist takes into account the severity of the coxarthrosis, the form of its course, the causes of development and the severity of symptoms. Patients are often recommended to use rigid rib bandages and orthoses from the first days of treatment. The use of orthopedic devices helps slow cartilage degradation and bone deformation.
Medication
In the treatment of deforming osteoarthritis, drugs from different clinical and pharmacological groups are used. These are non-steroidal anti-inflammatory drugs (NSAIDs), muscle relaxants, glucocorticosteroids, chondroprotectors, ointments and gels with a warming effect.
Block
To relieve acute pain that cannot be eliminated by NSAIDs, intra-articular or peri-articular drug blocks are prescribed. To carry them out, hormonal agents are used. The analgesic effect of glucocorticosteroids is enhanced by their combination with anesthetics.
Injections
Intramuscular injection of NSAID solutions allows you to eliminate severe pain in the hip joint. To relax skeletal muscles, a medication is usually used that, in addition to a muscle relaxant, includes an anesthetic. In the form of injections, therapeutic regimens include B vitamins, medications to improve blood circulation and chondroprotectors.
Diet therapy
Overweight patients are advised to lose weight to slow the spread of pathology to healthy joint structures. The calorie content of the daily menu should be limited to 2, 000 kilocalories, excluding foods high in fat and simple carbohydrates. Nutritionists recommend that all patients with coxarthrosis follow adequate nutrition. The diet should contain fresh vegetables, fruits, berries, cereal porridge, fatty sea fish and dairy products. Following a therapeutic diet stimulates the strengthening of the immune system and the improvement of general health.
Exercise therapy and massage
Classical massage, acupressure and vacuum are used to treat coxarthrosis. After several sessions, blood circulation in the hip joint improves and nutrient reserves are replenished. Carrying out massage procedures stimulates the strengthening of the ligamentous-tendinous apparatus and the restoration of soft tissues damaged by the displacement of osteophytes.
Regular exercise therapy is one of the most effective ways to treat osteoarthritis. A set of exercises is created by the physiotherapist individually for the patient, taking into account their physical fitness.
Physiotherapy
Coxarthrosis patients receive up to 10 sessions of magnetic therapy, laser therapy, UHF therapy, UV irradiation and shock wave therapy. The therapeutic effect of the procedures is due to the improvement of blood circulation, acceleration of metabolism and regeneration processes. To relieve acute pain, electrophoresis or ultraphonophoresis is performed with glucocorticosteroids, anesthetics and B vitamins. Applications with ozokerite or paraffin help eliminate discomfort.
Surgical intervention
If conservative treatment is ineffective, pain that cannot be eliminated with medication or constant progression of coxarthrosis, patients are advised to undergo surgical intervention. The operation is performed immediately in case of pathology of the 3rd degree of severity, since it is impossible to eliminate the resulting destructive changes in cartilage and bones with medication or exercise therapy.
Arthroplasty
The operation is performed under general anesthesia. The head of the femur is removed from the acetabulum. Visible destructive changes in tissue are corrected - bone growths are removed, articular surfaces are leveled, tissue that has undergone necrosis is excised. During surgery, cavities are formed and filled with ceramic implants.
Endoprostheses
Implant hip replacement is performed under general anesthesia. To prevent the development of an infectious process, a course of antibiotics is prescribed. After 10 days, the sutures are removed and the patient is discharged from the medical center. At the rehabilitation stage, patients receive physiotherapy and massage procedures, exercise therapy.
Possible consequences
In the final stage of the pathology, flexion and adduction contractures develop. The patient's leg is constantly flexed, so he uses a cane or crutches to move around. After complete fusion of the joint space, immobility occurs, the patient is unable to perform household tasks and becomes disabled. Coxarthrosis is often complicated by aseptic necrosis of the femoral head, arthrosis of the knee joints and arthritis.
Prevention and prognosis
Only grade 1 coxarthrosis responds well to conservative treatment. In other cases, endoprosthesis allows you to completely restore the functional activity of the hip joint. After installing the endoprosthesis, the patient quickly returns to an active lifestyle.
To prevent the disease, orthopedists recommend stopping smoking, abusing alcoholic beverages, doing physical therapy and gymnastics daily and losing excess weight, if necessary.