coxarthrosis: arthropathy of the hip joint

Hip joint or coxarthrosis is a chronic, slow degenerative process of the femoral head and pelvic acetabular joint. In this disease, bone and cartilage tissue become deformed, leading to severe limitation of leg movement and disability as the condition progresses. All components of the joint are involved in this process: the bones, the joint capsule covering the bones, cartilage, ligaments, muscles. Symptoms and treatment of coxarthrosis (hip joint disease) vary from person to person; the condition usually occurs in middle-aged and older people, but the change can occur after 20 years.The main symptoms of hip joint (hip joint) are pain and stiffness of movement. Most often, its development is preceded by injury and joint pathologies of both inflammatory and non-inflammatory nature. Hip arthrosis is one of the most common joint diseases and is related to the large loads placed on the hip joint.During its development, the disease goes through several stages. In the early stages, the hip can be treated conservatively, but as the disease progresses, only surgical treatment is effective. Therefore, you should not delay visiting a specialist and signing up for a consultation. At the clinic, you can be examined and receive conservative treatment.

reason

Hip arthrosis of the hip joint can be primary or secondary, that is, occurring in the context of any disease or injury of the musculoskeletal system. Let's consider in more detail the factors that influence the development of the hip joint or cause hip arthropathy.

• exogenous- These are environmental factors: strenuous physical activity, consequences of major injuries - fractures, dislocations, torn ligaments, adverse working conditions associated with weightlifting, prolonged sitting.
• endogenous— These are chronic infectious inflammatory and autoimmune diseases: rheumatoid arthritis, reactive arthritis, psoriatic arthritis. There are also metabolic disorders: gout, diabetes.
• Congenital diseases.Dysplasia (impaired joint formation) and osteochondrosis (dystrophy of joint structures followed by necrosis and bone destruction) may also lead to hip arthropathy. For example, congenital hip dislocation and aseptic necrosis of the femoral head - Perthes disease.
• genetic susceptibilityOften causes coxarthrosis of the hip joint. This includes mutations in the type II procollagen gene.
• Getting older.More commonly, hip joint development is due to inevitable age-related changes.
• ground. Osteoarthritis is believed to be more common in women than men. This is due to the effects of the female sex hormone estrogen on mineral metabolism and bone density.
• Being overweight.Excess weight is directly related to the occurrence of joint disease. The more you weigh, the more likely you are to develop hip arthritis, because excess fat tissue increases the load on the joints, and fat tissue produces pro-inflammatory substances that damage cartilage tissue.
• professional sportsHip arthropathy may occur due to excessive stress on the joints and frequent injuries. Potentially dangerous sports include weightlifting, skydiving and acrobatics.

Under the influence of these factors, the joint cavity gradually undergoes changes at the cellular level: the decay process begins to exceed the synthesis process, metabolism changes, the amount of synovial fluid that nourishes the cartilage tissue decreases, and the cartilage becomes thinner. As a result, the seams "dry out" and lose volume. Along the edges of the joint surfaces of bones, bony growths - osteophytes - appear, which reduce the range of motion of the joint and thereby reduce the load on the joint.

symptom

How quickly does the hip joint (hip joint) develop? Symptoms gradually increase, and in the first stage, people may not pay them the attention they deserve and dismiss them as fatigue. This is dangerous because treatment has a greater effect at the beginning of the degenerative process.The first clinical symptoms of hip arthropathy are pain, muscle spasm and limited range of motion.The intensity and duration of pain may vary. At first, the unpleasant sensation is mild and short-lived. Predisposing factors for its occurrence are prolonged walking or strenuous physical activity.Joint movement is limited due to severe pain. The patient's gait changes: the hips protrude backward, the body leans forward when shifting weight to the injured side, and there is a limp.Swelling in the joint area may also occur, but is usually invisible due to the presence of layers of muscle and fat, causing the joint to creak during movement and shortening of lower limb function.The presence and severity of certain signs depend on the stage of hip joint disease. There are 4 clinical and diagnostic stages of hip arthrosis, determined by the degree of damage to the articular cartilage:

• Grade 1 hip arthrosisIt is characterized by asymptomatic or periodic pain that occurs only after strenuous physical activity, such as running or long walks. The pain is localized to the joint area and rarely spreads to the entire thigh or even the knee. Usually disappears after rest. X-ray examination of the hip joint shows no change or slight narrowing of the joint space. MRI shows signs of cartilage tissue heterogeneity.
• 2nd degree hip arthrosisThe pain becomes more severe, occurs with little physical activity and sometimes at rest, and may radiate to the thigh and groin area. Lameness may occur after strenuous physical activity. The range of motion of the joint is reduced: abduction and internal rotation of the hip are restricted. X-rays show marked uneven narrowing of the joint space and isolated osteophytes (growths of bone tissue) along the edge of the glenoid. MRI in stage 2 hip arthrosis shows significant erosion and cracking of the cartilage, with less than half the thickness reduced.
• For 3rd degree hip arthrosisThe pain becomes constant and often disrupts the patient's sleep. Walking is difficult, forcing the patient to adopt forced body positions while relying on the healthy leg or crutches. The range of motion of the joints is greatly restricted. On radiographs, the joint space is almost non-existent and multiple osteophytes are formed on the bone surface. MRI showed more than half of the cartilage tissue was destroyed. However, the third stage can still be treated conservatively.
• Stage IV Hip Arthropathy (Hiparthrosis)It is characterized by a significant loss of joint function. Pain throughout the leg: joints, groin, glutes, hips, knees, ankles. Flat feet develop, legs become shorter, and muscles atrophy. On X-rays: multiple large osteophytes, joint space missing or minimized. Stage IV is not suitable for conservative treatment; hip replacement is required. The surgery can reduce pain, improve leg function and the patient's quality of life.

Diagnosis of hip arthritis

The basis for diagnosing hip arthritis is an initial consultation with a specialist. The doctor will clarify the symptoms: where, when and why the pain occurs, where the pain goes, why the pain decreases and worsens, and what causes the pain. Visual inspection, palpation, gait assessment, and special testing to detect joint dysfunction are then required.The diagnosis of hip arthrosis is made on the basis of clinical signs and data from other instrumental studies, mainly radiographic examination of the joint. There are no characteristic laboratory signs for the diagnosis of arthrosis, but clinical blood tests may be needed to differentiate between coxarthrosis and arthritis. In this case, experts consider levels of white blood cells, ESR, C-reactive protein, and uric acid.Of the instrumental methods for diagnosing arthritis of the hip, radiography is usually sufficient. This is an easy-to-understand study that reveals the characteristic changes of hip arthropathy: joint space narrowing, osteophytes, cartilage surface erosions and ulcers, cysts. X-rays of people with hip arthritis may also show changes that indicate trauma.CT and MRI can be used as other instrumental diagnostic methods. Computed tomography allows a more detailed study of pathological changes in bone structures, while magnetic resonance imaging provides the opportunity to evaluate soft tissue diseases.

Which doctor should I contact?

This pathology is treated by an orthopedic traumatologist. However, depending on the nature and course of the disease, other specialists may need to be consulted:

• The surgeon excludes surgical pathology requiring surgical intervention;
• The tuberculosis physician rules out bone tuberculosis;
• The oncologist rules out malignancy;
• Endocrinologists with metabolic disorders;
• If you suspect a lumbosacral intervertebral hernia is compressing a spinal nerve root, see a neurologist.

treat

The choice of treatment depends on the stage of the disease. To treat grade 1 bilateral hip arthritis (coxarthrosis), lifestyle changes and increased physical activity are usually sufficient. In the second stage, conservative treatment is used, including medications and physical therapy procedures. Stage three is less difficult to treat but still avoids surgery, while the same cannot be said for stage four. The goals of conservative treatment are to improve quality of life and to halt or slow the progression of degenerative changes in the joints.Medical treatment for hip joint disease includes medications that reduce the symptoms of the disease. These are NSAIDs used short-term to relieve pain and inflammation. Corticosteroids and muscle relaxants are sometimes used to relieve severe pain and muscle tension.Non-drug treatments include:

• Reduce the load on the hip joint.Depending on the situation, patients may be advised to lose weight, provide additional support and transfer their weight to a cane or crutches.
• Therapeutic exercise.A properly chosen set of exercises can help improve joint mobility, reduce pain, and prevent muscle atrophy.
• Treatment with physical therapy methods. For hip joints, prescribed courses are: magnet therapy, laser therapy, shock wave therapy.
• PRP treatment.The method involves introducing your own plasma into the joint, which helps relieve pain, inflammation and promotes the recovery of damaged joint tissue.
• Intramuscular Theo Taping.This involves applying special tape to the skin to reduce the load on the joints.
• acupuncture.A method based on the introduction of a sterile needle into the biologically active site. Effectively relieves pain and relaxes muscles around joints.

For each patient, doctors develop an individual treatment plan that may include different approaches depending on the severity of symptoms, stage of the disease, age and health. A comprehensive treatment approach ensures efficient surgery and rapid recovery; medical treatment alone may not achieve the desired results.Hip replacement surgery is used when the condition is severe, the pain cannot be eliminated, and the range of motion of the joint is significantly limited.

result

Pathological changes in joints can lead to:

• Hip subluxation and dislocation. In this case, leg movement is severely limited and severe pain occurs, requiring hospitalization in a trauma unit and sometimes surgical intervention.
• Local inflammatory processes: bursitis and tenovaginitis.
• Large osteophytes compress the sciatic nerve and are accompanied by a sharp, stabbing pain in the back of the leg.
• Ankylosis is the complete inability to move a joint, significantly reducing the patient's quality of life.
• Decreased physical activity, persistent pain, and limited joint movement. In the future, this can lead to obesity and depression.
• Long-term and frequent use of NSAIDs may cause stomach and heart problems.

prevention

In order to enjoy a comfortable and high-quality life without a hip joint, you must adhere to the following recommendations:

• If you experience hip pain, seek medical attention immediately.
• Use caution when engaging in strenuous exercise, performing physical activities at home and work, and lifting heavy objects.
• Control your weight with a balanced diet and regular physical activity.
• Avoid heavy physical labor and overloading exercise. Moderate physical activity can improve the condition of joints, maintain their normal mobility, and reduce the load on other joints.

generalize

1. Hip arthrosis is one of the most common joint diseases and is caused by heavy loads on the hip joint.
2. The main symptoms of hip joint (hip joint) are pain and stiffness of movement.
3. There are 4 levels of hip arthritis, 1-2 can be treated conservatively, and 3-4 can be treated surgically. However, in stage three, surgery can still be avoided if you follow all of your doctor's recommendations.
4. Experts use a comprehensive approach to treating hip joint disease, including medications, physical therapy, manual therapy, nutritional correction and physical activity.