Coxarthrosis: arthrosis of the hip joint

Arthrosis of the hip joint or coxarthrosis is a chronic, slow degenerative process in the articulation of the head of the femur and the acetabulum of the pelvic bone. With this disease, the bone and cartilage tissues are deformed, which, as it progresses, leads to significant limitation of leg movement and disability. All components of the joint participate in the process: bones, joint capsules covering them, cartilage, ligaments, muscles. The symptoms and treatment of hip joint arthrosis (coxarthrosis) vary from person to person, the disease usually occurs in middle-aged and elderly people, although such changes can develop even after 20 years.

The main signs of arthrosis (coxarthrosis) of the hip joint are pain and stiffness of movement. Most often, its development is preceded by injuries and inflammatory and non-inflammatory joint pathologies. Coxarthrosis is one of the most common arthrosis, which is associated with a significant load on the hip joint.

During its development, the disease goes through several stages. In the early stages, coxarthrosis can be treated conservatively, but as the process progresses, only surgical treatment is effective. Therefore, do not delay visiting a specialist and sign up for a consultation. At the clinics, you can have an examination and receive conservative treatment.

Cause

Coxarthrosis of the hip joint can be primary or secondary, that is, in the background of any disease or injury of the skeletal and muscular system. Let's take a closer look at the factors influencing the development of the hip joint or leading to its coxarthrosis.

• Exogenous- these are environmental factors: heavy physical load, consequences of more serious injuries - fractures, dislocations, torn ligaments, unfavorable working conditions involving 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 joint structures, with subsequent necrosis and bone destruction) can also lead to coxarthrosis. For example, congenital dislocation of the hip, aseptic necrosis of the femoral head - Perthes disease.
• Genetic predispositionoften causes coxarthrosis of the hip joints. It involves a mutation in the type II procollagen gene.
• Old age.More often, the development of coxarthrosis of the hip joint is due to the inevitable changes associated with age.
• Floor. Osteoarthritis is thought to occur more often in women than men. This is due to the effect of the female sex hormone estrogen on mineral metabolism and bone density.
• Excess body weight.There is a direct connection between excess weight and the occurrence of arthrosis. The higher the body weight, the more likely it is to develop arthrosis of the hip joint, because the excess fat increases the load on the joints, and the fat produces inflammatory substances that damage the cartilage tissue.
• Professional sportcan cause the development of coxarthrosis due to excessive stress on the joints and frequent injuries. Potentially dangerous sports include weightlifting, skydiving and acrobatics.

As a result of these factors, changes gradually occur at the cellular level in the joint cavity: the processes of decomposition begin to prevail over the processes of synthesis, the metabolism changes, the volume of synovial fluid that nourishes the cartilage decreases, and the cartilage becomes thinner. As a result, the joint "dries out" and its volume decreases. Bone growth appears along the edges of the joint surface of the bones - osteophytes, which reduce the range of motion of the joint and thereby reduce the load.

Symptoms

How quickly does arthrosis of the hip joint (coxarthrosis) develop? The symptoms increase gradually, and in the first stages a person may not pay enough attention to them and describe them as fatigue. This is dangerous because the treatment has a greater effect at the beginning of the degenerative process.

The first clinical symptoms of coxarthrosis are pain and limited movement caused by muscle spasm.

The intensity and duration of the pain can vary. At first, the discomfort is mild and short-lived. The provoking factor for their appearance is prolonged walking or intense physical activity.

Limitation of joint mobility occurs due to severe pain. The patient's gait changes: the buttocks stretch back, the body bends forward when he shifts his weight to the injured side, the person limps.

Swelling may also occur in the joint area, which is usually invisible due to the layer of muscle and fat, cracking of the joints when moving, functional shortening of the lower limb.

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

• Coxarthrosis 1st degreecharacterized by asymptomatic or intermittent pain that occurs only after intense physical activity such as running or long walking. The pain is localized in the joint area, less often it extends to the entire thigh and even the knee. It usually disappears after resting. X-rays of the hip joint show no changes, or the joint space narrows slightly. MRI reveals signs of cartilage tissue heterogeneity.
• In case of 2 degree coxarthrosisthe pain becomes more intense, occurs with little physical activity, sometimes at rest, and may radiate to the thigh and groin area. Lameness occurs after significant physical exertion. The range of motion in the joint decreases: abduction and inward rotation of the hip is limited. X-rays clearly show uneven narrowing of the joint space and isolated osteophytes - growth of bone tissue - along the edge of the glenoid cavity. MRI in stage 2 coxarthrosis reveals obvious erosions and fissures in the cartilage, thinning to less than half.
• In case of 3rd degree coxarthrosisthe pain becomes constant and often disturbs patients during sleep. Walking is difficult, which forces the patient to assume a forced position, leaning on one healthy leg or a cane. The range of motion in the joint is sharply limited. On radiographs, the joint gap is practically absent, several osteophytes have formed on the bone surfaces. MRI shows the destruction of more than half of the volume of cartilage tissue. However, the third stage can still be managed conservatively.
• Stage 4 hip joint arthrosis (coxarthrosis)characterized by significant loss of joint function. The whole leg hurts: joint, groin, gluteal muscle, hip, knee, ankle. Flat feet develop, the leg shortens, and its muscles atrophy. On the X-ray: several large osteophytes, the joint space is absent or narrowed to a minimum. Stage 4 cannot be used for conservative treatment, hip replacement is performed. The operation reduces pain, improves leg function and the patient's quality of life.

Diagnosis of arthrosis of the hip joint

The basis for diagnosing arthrosis of the hip joint is the initial consultation with a specialist. The doctor clarifies the complaints: where the pain is localized, when and why it occurs, where it goes, what reduces it, increases it, what causes it. Visual inspection, palpation, gait assessment are then required, and special tests are performed to detect joint dysfunction.

The diagnosis of coxarthrosis is made on the basis of clinical symptoms and the data of additional instrumental tests, the main of which is radiography of the joint. There are no typical laboratory signs for the diagnosis of arthrosis, however, a clinical blood test may be required for the differential diagnosis of coxarthrosis and arthritis. In this case, the specialist takes into account the level of leukocytes, ESR, C-reactive protein and uric acid.

Of the instrumental methods for diagnosing arthrosis of the hip joints, radiography is usually sufficient. This is an accessible study that reveals the 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 reveal changes suggestive of trauma.

CT and MRI can be used as other instrumental diagnostic methods. Computed tomography enables a more detailed study of pathological changes in bone structures, and magnetic resonance imaging provides an opportunity to evaluate soft tissue abnormalities.

Which doctor should I see?

This pathology is treated by orthopedic traumatologists. But depending on the nature and course of the disease, consultation with other specialists may be necessary:

• surgeon to rule out surgical pathology requiring surgical intervention;
• phthisiatrics to rule out bone tuberculosis;
• an oncologist to rule out malignant tumors;
• endocrinologist in case of concurrent metabolic disorders;
• neurologist if there is a suspicion of compression of spinal nerve roots with intervertebral hernia of the lumbosacral spine.

Treatment

The choice of treatment method depends on the stage of the disease. A change in lifestyle and an increase in physical activity are often sufficient to treat grade 1 bilateral arthrosis (coxarthrosis) of the hip joint. In stage 2, conservative treatment is used, which includes medication and physiotherapy procedures. Stage 3 is less treatable, but surgery can still be avoided, which is not the case for stage 4. The aim of conservative treatment is to improve the quality of life and to stop or slow down the development of degenerative changes in the joints.

Drug therapy for coxarthrosis includes drugs that reduce the symptoms of the disease. These are nonsteroidal anti-inflammatory drugs that are used for a short time 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 their body weight, create additional support, and transfer their body weight to a cane or crutches.
• Therapeutic practice.A properly selected set of exercises improves the mobility of the joints, reduces pain and prevents muscle atrophy.
• Physiotherapy methods of treatment.Courses are prescribed for coxarthrosis of the hip joint: magnetic therapy, laser therapy, shock wave therapy.
• PRP therapy.During the method, one's own blood plasma is injected into the joint, which helps relieve pain and inflammation and improves the recovery of damaged joint tissues.
• Kinesio taping.This is the application of special adhesive tapes to the skin, which relieves the load on the joint.
• Acupuncture.A method based on introducing sterile needles into biologically active points. Effectively relieves pain and relaxes the muscles around the joint.

Doctors develop an individual treatment plan for each patient, which may include different methods depending on the severity of the symptoms, the stage of the disease, age and health. An integrated approach to treatment guarantees the high efficiency of the procedures and quick recovery, drug therapy alone does not necessarily bring the expected results.

The hip prosthesis can be used in severe cases of the disease, when the pain cannot be eliminated and the mobility of the joints is significantly limited.

Consequences

Pathological changes in the joint can lead to:

• Subluxation and dislocation of the hip joint. In this case, the movement of the leg is sharply limited, severe pain occurs, hospitalization in the trauma department, and sometimes surgical intervention is required.
• Local inflammatory processes: bursitis and tendovaginitis.
• Compression of the sciatic nerve by large osteophytes, accompanied by severe shooting pain in the back of the leg.
• Ankylosis is the complete immobility of the joint, which significantly reduces the patient's quality of life.
• Reduced physical activity, constant pain and limited joint mobility. In the future, this leads to obesity and depression.
• Stomach and heart diseases if you take NSAIDs for a long time and often.

Prevention

For a comfortable and quality life without coxarthrosis, you should follow the following recommendations:

• If you feel pain in the hip joint, see a doctor immediately.
• Be careful when playing strenuous sports, performing physical activities at home and at work, and lifting heavy objects.
• Control your weight with a balanced diet and regular physical activity.
• Avoid heavy physical work and sports overload. 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 arthrosis caused by a significant load on the hip joint.
2. The main signs of arthrosis (coxarthrosis) of the hip joint are pain and stiffness of movement.
3. There are 4 degrees of coxarthrosis, 1-2 are suitable for conservative treatment, 3-4 - surgically. However, in stage 3, surgery can still be avoided if you follow all the doctor's recommendations.
4. Specialists use an integrated approach to the treatment of coxarthrosis, which includes drugs, physiotherapy, manual therapy, nutritional correction and physical activity.