Coxarthrosis is a common degenerative-dystrophic disease of the hip joint, in which, due to age changes or other factors, gradual destruction of the joint joint of the head of the femur and the acetabulum of the pelvis occurs.It is accompanied by pain and a limited range of motion of varying severity, which depends on the stage of development.And if in the initial stages it is possible to deal with coxarthrosis using conservative methods, then in the third stage it is possible to save the situation and maintain the functionality of the hip joint, i.e.to avoid damage, only by surgery.
It is classified as arthrosis and can be accompanied by the development of similar processes in other joints, and this pathology represents about 12% of all diseases of the musculoskeletal system.But the term "coxarthrosis" can only be used to describe degenerative-dystrophic changes in the hip joint.
What is coxarthrosis?
Coxarthrosis is a complex pathology of one or both hip joints, in which destruction of the cartilaginous layers covering the head of the femur and the acetabulum occurs, which leads to a decrease in the size of the joint gap.As the disease progresses, deformation of the bone surfaces occurs and the formation of bone growths on them, called osteophytes.
Coxarthrosis is the second most frequent disease of the musculoskeletal system.More often, only gonarthrosis is diagnosed, i.e.degenerative-dystrophic change in the knee joint.However, the probability of damage in coxarthrosis is significantly higher.
The entire hip joint is enclosed in a special box called the joint capsule.There is a so-called synovial membrane that produces synovial fluid.This fluid is extremely important for the proper functioning of the joint, as it not only lubricates the hyaline cartilage, but also supplies it with a source of nutrients.
Normally, the cartilage is constantly worn out and immediately restored due to the continuous regeneration process carried out with the help of substances entering it from the synovial fluid.But with injuries or age-related changes, the speed of regeneration processes decreases, which leads to gradual wear of hyaline cartilage and the development of coxarthrosis.
This is explained by changes in the amount of synovial fluid produced and its composition.Under the influence of unfavorable factors, it becomes thicker and is produced in a smaller volume.As a result, the synovial fluid is no longer able to provide the hyaline cartilage with all the necessary substances in the required quantity, which leads to its rapid dehydration and thinning.Gradually, the strength and elasticity of the cartilage decreases, there are areas of separation of the fibers that make it up, cracks and the thickness also decreases.These changes can be noticed with instrumental diagnostic methods, especially with narrowing of the joint space.
The narrowing of the joint space leads to increased friction between the bony structures that make up the hip joint and increased pressure on the already degrading hyaline cartilage.This provokes even greater damage that affects the functioning of the joint and the condition of the person, because the deformed areas prevent the head of the femur from sliding easily into the acetabulum.As a result, symptoms of coxarthrosis appear.
In the absence of treatment, the pathological changes worsen, and the hyaline cartilage wears out more and more.Subsequently, in some areas, it completely disappears, which leads to bare bones and a sharp increase in the load on the joint.Since the head of the femur rubs directly against the bone when moving inside the acetabulum, this provokes severe pain and a sharp limitation of mobility.In this case, the pressure of bone structures on each other leads to the formation of bone growths on their surface.
Formed osteophytes can have sharp parts that can injure the muscles and ligaments around the hip joint.This leads to severe pain both directly in the joint area and in the groin, buttock and thigh.As a result, the patient spares the injured leg, puts less strain on it and tries to avoid unnecessary movements with it.This leads to the development of muscle atrophy, which further worsens movement disorders and ultimately leads to lameness.
reasons
There are many reasons for the development of coxarthrosis, but in rare cases it happens in the absence of prerequisites.In this case, they talk about the presence of primary or idiopathic coxarthrosis.In the majority of cases, secondary coxarthrosis is diagnosed, which becomes a logical consequence of a number of diseases or changes in the state of the musculoskeletal system.Its development can be provoked by:
- hip injuries of various types, including fractures, sprains, bruises, sprains or torn ligaments;
- hard physical work, professional sports, especially weightlifting, parachuting, jumping;
- sedentary lifestyle;
- overweight, which significantly increases the load on the hip joints;
- foci of chronic infection in the body;
- congenital anomalies of the hip joints, such as dysplasia or dislocation;
- metabolic pathologies and endocrine disorders, especially gout, diabetes mellitus, especially in decompensated form;
- aseptic necrosis of the femoral head, which can be a consequence of a fracture of the femoral neck, especially with conservative treatment;
- inflammatory joint diseases, including rheumatoid arthritis, bursitis, tendinitis;
- diseases of the spine;
- genetic predisposition;
- presence of bad habits, especially smoking.
However, the main cause of coxarthrosis is still the inevitable age-related changes, and the presence of the above factors only increases the likelihood and speed of its development.
Symptoms of coxarthrosis
The disease is characterized by a gradual progression with a systematic increase in the intensity of symptoms.Therefore, in the initial stages it can be asymptomatic or only sometimes cause anxiety to patients, but subsequently the condition of the hip joint worsens, which leads to an increase in the severity of the signs of coxarthrosis to unbearable pain and significant limitation of mobility.
So, degenerative-dystrophic changes in the hip joint are accompanied by:
- Pain of varying strength, initially occurring after physical activity or walking and subsiding after rest.Gradually, the severity of the pain syndrome increases, appears more often, lasts longer, and the periods between the moment of applying the load on the joint and the onset of pain decrease.Later, the pain is almost constant, including at rest, and becomes unbearable.Intensification of pain is typical at any stage of the disease with hypothermia and lifting heavy objects.
- Limitations of the mobility of the hip joint, which initially manifest as slight difficulties in performing rotational movements of the leg.Over time, morning stiffness appears, which disappears after the patient "disperses".This may be accompanied by the appearance of swelling in the hip joint.As the disease progresses, mobility limitations become more pronounced and permanent, that is, they do not disappear after warming up.Patients note a decrease in the amplitude of leg movements and subsequently completely lose the ability to make certain movements.
- Creaking in the hip joint that occurs when walking or doing physical work, especially when doing extension.It occurs as a result of friction of exposed bone structures against each other, which is accompanied by a sharp increase in pain.
- Spasms of the thigh muscles, which leads to the appearance of diffuse pain in the thigh.This may be the result of the addition of various intra-articular disorders, including nerve compression, excessive stretching of the ligaments around the joint, as well as the development of synovitis, ie.inflammation of the synovial membrane and accumulation of inflammatory effusion in the cavity of the hip joint.
- Lameness, initially resulting from the unconscious desire of the patient to reduce the load on the diseased joint and transfer the weight to the healthy leg in order to avoid the appearance or intensification of pain, and then the development of muscle contracture.The latter phenomenon appears already in the later stages of coxarthrosis and leads to the fact that the patient is unable to fully straighten his leg and, moreover, keep it in this position.In this way, the lower limb with the affected hip joint is constantly in a slightly contracted position, which provokes lameness.
- Reduction in leg length, which occurs mainly in severe degenerative-dystrophic changes in the hip joint, accompanied not only by narrowing of the joint space, but also by flattening of the femoral head and muscle atrophy.As a result, the diseased leg becomes shorter than the healthy one by 1 or more centimeters.
Coxarthrosis can affect one hip joint or both at the same time.But if in the first case the symptoms of the disease will be observed only on one side, then in the second they will not only be bilateral, but also differ in intensity.This depends on the degree of destruction of each hip joint.
Degrees of coxarthrosis
The nature of the manifestations of the disease depends on the stage of its development.In total, there are 3 degrees of coxarthrosis, of which the first is considered the mildest.In the initial stages of occurrence of degenerative-dystrophic changes in the hip joint, only occasional pain can be observed.As a rule, this happens after intense physical exertion, sports or long walking.Because of this, patients usually ignore them, attributing them to fatigue and considering them a normal age-related change.In this regard, coxarthrosis of the 1st degree is diagnosed only in isolated cases, which usually happens during an examination for another reason.
As the disease progresses, its symptoms intensify, and already with coxarthrosis of the 2nd degree, they are felt.This stage of development of the pathology is characterized by a narrowing of the joint gap by 50%, as well as the appearance of signs of deformation of the head of the femur with its displacement.
With further progression of the pathology, the joint narrows even more, and in the 3rd degree of coxarthrosis, it is almost completely absent.This is already accompanied by the formation of numerous osteophytes.At this stage of the development of the disease, the pain becomes not just strong, but unbearable and often occurs even in a state of complete rest, including at night.Since the hip joint is highly deformed, its elements can affect the nerves passing here, which leads to pain radiating to the groin, buttocks, as well as the thigh and even the lower leg.This also provokes the inability to move independently without the use of aids, for example, crutches or a cane.
Coxarthrosis of the 3rd degree is a direct indication for surgical treatment.If the operation is not performed in time, the head of the femur will fuse firmly with the surface of the acetabulum through osteophytes.This will lead to a shortening of the leg, a complete lack of ability to move independently, as the joint will completely lose mobility, i.e.to damage.
Diagnosis
If signs of coxarthrosis appear, it is recommended to consult an orthopedist as soon as possible.Initially, the doctor will interview the patient and find out the nature of the complaints, after which he will proceed to an examination and perform functional tests, comparing the length of the legs.As a rule, the data obtained are sufficient to speak with a high degree of confidence about the presence of coxarthrosis.
But since such a clinical picture can accompany a number of other diseases of the hip joints, both inflammatory and non-inflammatory, instrumental diagnostic methods are necessarily prescribed.With their help, the specialist will be able not only to confirm the presence of coxarthrosis, to distinguish it from the radicular syndrome caused by pathologies of the spine, but also to correctly assess the degree of its development and therefore choose the most effective treatment tactics.
Today, the following are used to diagnose coxarthrosis:
- X-ray of the hip joints - the obtained images allow you to detect signs of destructive changes, the presence of osteophytes, the nature of the deformation of bone structures and measure the thickness of the joint gap.
- CT is a more modern method of diagnosing bone pathologies, providing clearer data than X-rays, but it is more expensive.Therefore, CT is prescribed in controversial cases when it is necessary to clarify the diagnosis and the degree of destruction of the hip joint.
- MRI is a highly informative method for studying joints, providing the maximum amount of information about the state of the joint and all its structures, especially hyaline cartilage, connections and characteristics of blood supply.
Patients are prescribed a number of laboratory tests, including OAC, OAM, rheumatic tests, biochemical blood test and others.
Conservative treatment of coxarthrosis
When diagnosing coxarthrosis of 1 or 2 degrees, treatment is carried out using conservative methods.For each patient, they are selected individually, taking into account the detected accompanying pathologies.Therefore, it may often be necessary to consult not only an orthopedist, but also doctors from other specialties, who will select the necessary treatment to combat concomitant diseases.
As part of the treatment of coxarthrosis, patients are prescribed:
- drug therapy;
- exercise therapy;
- physiotherapy.
It is imperative that all patients take measures to eliminate the effects of factors that increase the load on the legs and contribute to the progression of degenerative changes in the hip joint.This includes adjusting your diet and increasing your level of physical activity if you are overweight.If the patient is regularly exposed to excessive physical activity, it is recommended to change the type of activity or reduce the intensity of training if the load is due to sports.In some cases, it is recommended to use special bandages and orthoses that will fix the hip joint and relieve it during physical activity.
Drug therapy
As part of drug treatment, drugs are selected individually for patients, taking into account existing concomitant diseases.As a rule, drugs from the following pharmacological groups are indicated for coxarthrosis:
- NSAIDs are a wide group of drugs that exhibit analgesic and anti-inflammatory effects (available in various dosage forms, including tablets, capsules, gels, creams, injection solutions, which allows you to choose the most effective and convenient form of use);
- corticosteroids are drugs that have a powerful anti-inflammatory effect, but due to the high risk of side effects, especially when using oral forms, they are prescribed only for short courses by injection;
- muscle relaxants - drugs that help reduce muscle tone, which allows you to effectively fight muscle spasms, often observed in coxarthrosis;
- chondroprotectors - a group of drugs containing components used by the body to regenerate cartilage tissue;
- drugs that improve microcirculation - help to improve the nutrition of soft tissues and activate metabolic processes in the affected area;
- Vitamins of group B - indicated in disorders of nerve conduction caused by compression of nerves by changed components of the hip joint.
If coxarthrosis causes an attack of acute pain that cannot be relieved by prescribed NSAIDs, patients are advised to undergo intra-articular or peri-articular blockade.Its essence is to inject an anesthetic solution in combination with corticosteroids directly into the cavity of the hip joint.This will eliminate the pain in the shortest possible time and reduce the inflammatory process.But the blockade can only be performed by a qualified medical specialist in a specially prepared room.It is not recommended to perform such procedures at home.
Exercise therapy
When diagnosing coxarthrosis, regular physical therapy exercises are necessary.Like drug therapy, the complex of exercises for therapeutic gymnastics is selected individually for each patient, taking into account the degree of destruction of the hip joint, the level of physical development of the patient and the nature of concomitant diseases (special attention is paid to cardiovascular pathologies).
Thanks to daily therapy exercises, it is possible to:
- reducing the severity of pain;
- increasing the mobility of the hip joint;
- reducing the risk of developing muscle atrophy;
- elimination of thigh muscle spasms;
- activate blood circulation and thus improve the nutrition of the affected joint.
All exercises should be performed smoothly, avoiding sudden movements and sudden movements.But if pain occurs during exercise therapy, you should definitely contact your doctor to correct the selected complex or perform a re-diagnosis to rule out the progression of the disease and the need for surgery.
Physiotherapy
The complex treatment of coxarthrosis includes courses of physiotherapeutic procedures that have anti-inflammatory, analgesic, decongestant and toning effects on the body.That is why patients are most often prescribed 10-15 procedures:
- ultrasound therapy;
- electrophoresis;
- UVT;
- magnetic therapy;
- laser therapy, etc.
Recently, plasmolifting is increasingly used as part of the conservative treatment of coxarthrosis, which can significantly increase the rate of regeneration of hyaline cartilage.The essence of the procedure is the introduction of purified blood plasma into the cavity of the hip joint, which is obtained by centrifugation from the patient's own blood.
Surgery for coxarthrosis
If the patient is diagnosed with grade 3 coxarthrosis, he is indicated for surgical intervention, since conservative methods in such cases are no longer effective.Unfortunately, such situations are extremely common today, as a very large number of patients seek medical attention when they can no longer tolerate pain or have severe mobility limitations that deprive them of their ability to work and move independently.
Timely surgical intervention can completely eliminate these disorders and restore the patient's ability to move normally, significantly increasing his quality of life.Indications for its application are:
- significant reduction of joint space by more than 80%;
- the presence of severe pain in the hip joint that cannot be eliminated;
- severe mobility disorders;
- fracture of the neck of the femur.
The gold standard for the treatment of a severe form of coxarthrosis, including in the elderly, is hip replacement.This operation involves replacing the destroyed hip joint with an artificial endoprosthesis made of durable and at the same time biologically compatible materials.Arthroplasty allows you to fully restore the functionality of the hip joint, eliminate pain and return a person to a full active life.
The essence of this type of surgical intervention is resection of the head of the femur and a small fragment of its neck.The surgeon will also need to prepare the surface of the acetabulum for installation of the endoprosthesis, i.e.to remove all formed osteophytes and achieve maximum restoration of its normal shape.After that, an endoprosthesis of the selected type is installed, which is fixed with special cement (preferably when treating the elderly) or in a cementless way.In the latter case, the endoprosthesis has a special spongy part that is in contact with the bone structures.Its fixation in the acetabulum is provided by the growth of bone tissue through the sponge.
For each patient, the type of endoprosthesis is selected individually.The most effective is total endoprosthesis, which implies a complete replacement of the entire hip joint, i.e.on the neck and head of the femur, as well as on the acetabulum.
If the patient has preserved normal hyaline cartilage on the surface of the acetabulum, he can undergo a partial arthroplasty with replacement of only the femoral head and/or neck.Endoprostheses of different designs are used for this purpose: monopolar and bipolar.
The only disadvantage of the endoprosthesis is the need to replace the installed endoprosthesis after 15-30 years.
After endoprosthesis, patients receive rehabilitation, the duration of which depends on the speed of tissue recovery.Exercise, physical therapy and therapeutic massage are prescribed as part of recovery.
Before the advent of modern endoprostheses, patients with grade 3 coxarthrosis were prescribed osteotomy or arthrodesis.Today, these techniques are used less and less, as they have a number of disadvantages.Thus, arthrodesis involves fixing the bony structures of the hip joint with metal plates.As a result, the pain syndrome is completely eliminated, but the joint completely loses mobility.Thus, after arthrodesis, the patient can only stand, but can no longer walk independently due to the lack of movement in the hip joint.That is why arthrodesis is practically not performed today.
Osteotomy involves making an artificial fracture of the femur with such a combination of bone fragments that will reduce the load on the affected hip joint.But the operation gives only a short-term effect, and in the future there is still a need for endoprosthetics.
Thus, coxarthrosis of the hip joint is a rather dangerous disease that can lead to disability.This seriously reduces the quality of life and deprives a person of working capacity.But if you pay attention to the early signs of pathology and get a timely consultation with an orthopedist, you can slow down the progression and achieve a significant improvement in your well-being.But with already advanced coxarthrosis, there can be only one solution - endoprosthetics.Fortunately, this method can be used even with severe degenerative changes and completely restore the normal functioning of the hip joint.