Coxarthrosis of the hip joint, a complex pathology of arthrosis, causes serious changes in articulation.Unfortunately, incapacitating adults are common.In fact, statistics on diseases of the hip joint account for almost half of all pathologies of the musculoskeletal system.I will give an example from the life of a case after surgical treatment and a rare complication during rehabilitation.
Coxarthrosis of the hip joint: a little about the disease
Osteoarthritis is a degenerative-dystrophic change that contributes to the complete destruction of cartilage with the loss of joint function.
Coxarthrosis - where the hip joints are destroyed, practically, this is the same arthrosis.
In terms of mechanism, the articulation of the hip with the pelvis is similar to door hinges.The head of the femur joins the ischium like a hinge.Having a special anatomical structure - acetabulum.This structure provides maximum joint mobility.Which complete cycle of movements, namely bending, extension, rotation, etc.
Normally, the articular surfaces are smooth, with enough fluid to ensure smooth gliding.As the disease progresses, the lubricant becomes thicker and more viscous, which immediately affects the condition of the cartilage.Synovial fluid no longer fully performs its functions.Because of this, shock absorbers dry out, crack and become rough.
- First.As a result of the lack of necessary sliding, the friction of the bones increases and injures them.
- Secondly.As it progresses, the deformation of the bone surfaces also joins the modified cartilage tissue.Thus, the body tries to compensate for the increased load.
- Thirdly.The increased load leads to complete atrophy of the femoral muscles and weakness of the ligaments.
Important: arthrosis of the hip joint is a progressive disease.Changes can cause a person to completely lose physical activity.It eventually leads to disability.And it completely disrupts the usual way of life.The disease and its treatment are not only extremely important from a medical point of view, but also a huge social problem.
Causes and types of coxarthrosis development
At least there is no exact cause of coxarthrosis, which destroys the hip joint.There are only assumptions.Most cases of the development of pathology of the hip joint are associated with congenital dislocation of the hip and dysplasia (lowness) of the joint.
Therefore, there are 2 types of coxarthrosis;
- primary (arising from an unknown etiology);
- secondary (related to injuries, diseases).
Primary osteoarthritis is characterized by a number of factors:
- heredity;
- influence of biological, mechanical processes;
- overweight;
- metabolic disorders;
- There is also a theory about the pathological regeneration of tissues in response to harmful agents (inflammation, friction, infection).
Often, this type of coxarthrosis is combined with spine damage and knee joint inflammation (arthritis, arthrosis).
The reasons for the development in the secondary version are more obvious.These include:
- Dysplastic disorders.Dysplastic coxarthrosis of the 1st degree of the hip joint occurs in half of all cases of congenital pathology.
- Hip dislocation (congenital).
- Life traumas.Pelvic, femoral neck fractures, dislocations, subluxations.
- Legg-Calve-Perthes disease.Osteochondropathy of the femoral head with the development of its necrosis.This disease occurs in children when the blood supply and nutrition of the joint is disturbed.
In addition, the pathology can affect both formations at once or be unilateral.In addition to the direct causes of the occurrence, there are predisposing factors that lead to the development of the disease.Often, the disease occurs with increased loads on the limbs of athletes.As well as people with hard physical work conditions.Excess weight significantly increases the likelihood of arthrosis.
Precipitating factors include:
- Disruption of metabolic processes, joint nutrition, hormonal imbalance.
- Adynamia.
- Poor posture.In particular, scoliosis, kyphosis, which causes misalignment of the pelvic bones.
- Age after 40 years.After this date, it is estimated that every 10 patients are diagnosed with coxarthrosis of the hip joint 1, 2. After 60, every third person is already observed.At the age of 70 and over, almost 80% of applicants suffer from this pathology.
There is no specific gene responsible for the transmission of pathological changes in the joints.However, the hereditary factor can still be traced.A person can inherit structural features of cartilage tissue, altered metabolism, and skeletal pathology from relatives.It is a combination of such genetic information that can provoke the appearance of hip arthrosis.
Classification
The main classification of the disease is based on severity.There are 3 stages that are distinguished not only by symptoms, but also by changes in X-rays.These indicators are the basis for making a diagnosis.
Degree |
Signs |
|---|---|
I |
|
II |
|
III |
|
This section is the most common.There are also types of Kellgren's classification.It involves 4 stages, plus a degree of zero - the equivalent of a healthy joint.
Symptoms
Pain is the basis of all diseases of the musculoskeletal system.Coxarthrosis of the hip joint of the 1-2 degrees has less pronounced symptoms compared to the terminal stage 3.First, the pain manifests itself during exercise.Especially after long walks or climbing stairs.Later, pain becomes a constant companion that significantly worsens the quality of life.
Coxarthrosis 1st degree
Unpleasant sensations are concentrated only in the joint area (the groin and hips are practically not affected), and are rarely reflected in the hips or knees.Pain is relieved by rest.
At this stage, no additional manifestations are detected - the gait remains unchanged, there is no disturbance in movements.In the dysplastic variant, on the contrary, increased mobility due to connective tissue changes;often in the early stages of the disease, due to increased flexibility, patients are interested in gymnastics and yoga.Movement problems occur only in stage 3.
Treatment for symptoms of stage 1 coxarthrosis of the hip joint can be performed without surgery.Rational therapy allows you to eliminate unpleasant symptoms and stop the development.
2nd degree of the disease
Pain, although not constant, manifests itself at rest.Radiation becomes noticeable - hip, groin, knee.Stiffness is observed - lifting movements are limited, he tries to run to the side, he has difficulty in circular movements of the leg (the pain increases especially often).Visible lameness is noticeable after strenuous walking or running.
When moving, a characteristic arthrosis is heard - rough, dry.
3 degree arthrosis
The pain is constant and does not go away after rest and sleep.Unpleasant feelings do not leave the patient even at night.There are problems with walking;you need to use a cane to facilitate movement.Rot is permanent.
At this stage, limb muscles atrophy and the leg itself is shortened.These changes force the patient to bend to the affected side, further increasing the load on the joint.Mobility is restricted in almost all directions.
Changes in bilateral coxarthrosis of the hip joint change the patient's gait, so all formations involved in the walking process suffer.Lower back pain appears, posture is disturbed, and the axial position of the pelvis changes.
Diagnostics
An important role in the diagnosis of the disease is the examination of the orthopedic surgeon, as well as a comprehensive analysis of complaints.It is worth assessing the patient's activity - the ability to climb stairs, comfort when wearing boots and socks, walking activity, use of a cane.
It is recommended to check the general condition - blood test, urine test, biochemistry, ECG, determination of HIV markers and syphilis.
Grade 1 coxarthrosis of the hip joint has the most subtle symptoms.Therefore, it is worthwhile to conduct an X-ray examination to visualize changes in the joint space.This method allows not only to identify the disease.Also, find out the reason for its frequent occurrence - dysplasia, Perthes disease.
Knee pain is often more pronounced with deforming coxarthrosis of the 1st degree of the hip joint, so it should be distinguished from gonarthrosis.Differential diagnosis also includes examination of the spine to rule out radicular syndrome (which causes pain that radiates to the hip and knee).
In suspicious cases, MRI (allows for a detailed examination of soft tissues) and CT (to review bone formations) are used.
Treatment
It is impossible to completely cure the disease, but modern medicine can restore lost mobility, allowing you to live a full life.
Physiotherapy and the use of drugs are effective for 1-2 degrees of the disease.At the terminal stage, only surgery helps.In another case, if conservative therapy methods used do not bring relief, surgery is performed.
Treatment 1st degree
Unfortunately, it is impossible to completely eliminate the pathology.In class 1, treatment is aimed at stabilizing the condition.
A number of general recommendations should be followed during therapy:
- Normalization of physical activity - it is recommended to reduce excessive stress (long walks, runs, jumps).
- Use shoes with good shock-absorbing soles and special insoles.
- Weight loss.
- Compulsory physical therapy.
Important: many patients completely refuse gymnastics and any exercise due to pain.This is often associated with increased fear of pain and the possibility of worsening the condition.Experience proves this idea wrong - regular exercise therapy helps to strengthen muscles, protect them from atrophy, reduce pain and improve joint functions.
No diet is prescribed for 1st degree coxarthrosis of the hip joint;moderate nutrition is prescribed for weight loss.It is also useful to add gelatin products, canned fish with bones, and dairy products to your diet.
conservative
Non-steroidal anti-inflammatory drugs are used as medicine.Due to the large number of side effects, it is recommended to take medication for severe pain.You can combine their use with gastroprotectors.
Persistent pain is relieved by intra-articular steroid injections, and pain-relieving blocks are also available.
The following are designated for support:
- Muscle relaxants - relieve tension, reduce leg pain.
- Chondroprotectors - improve cartilage tissue regeneration.
- Vasodilators (nicotinic acid) - help to eliminate vascular spasm and also increase tissue microcirculation.
Warming compresses are also used in combination (you can also use traditional treatment methods).They do not have a therapeutic effect, but they help to relieve muscle spasms.
Be sure to use physiotherapy - UHF, magnetotherapy, induction currents, massage.
Hip replacement surgery
In the 3rd stage, the patient is prepared for a planned endoprosthetic operation to restore freedom of movement and relieve intense pain.This is a special operation to replace the destroyed formation with an artificial one.Interventions completely restore the patient's motor abilities.It helps you fully return to your normal lifestyle.
Depending on the volume of the prosthesis, the prosthesis can be either unipolar (only the worn head of the femur is replaced) or bipolar (the surface of the acetabulum is also replaced).After surgery, rehabilitation is mandatory to return the patient to active life as soon as possible.
For patients over 60 years of age, the rehabilitation period is established even before surgical treatment, so that the healing process takes place in a shorter time.The lifespan of an artificial joint is about 20 years, but it is important to follow the recommendations:
- Exclusion of running, long walking, jumping.
- Avoid heavy loads.
- Avoid excessive exposure to a forced static position (this is especially true for people who work on their feet).
A life event
My friend's husband required surgical treatment for endoprosthesis.He was not diagnosed with coxarthrosis, but the lumbar hernia was successfully removed.The situation did not improve, the examination continued, and finally, they understood what was happening and sent me to surgery with a quota.
After the replacement, everything grew safely, but the second hip joint also required surgery.A year later, the quota for the operation was again, which was also successful.And then, from the first minutes after anesthesia, rehabilitation and strict adherence to the doctor's recommendations are required.
And our friend?Already after the hospital, on the way home, I began to strain the prosthetic joint (sitting for a long time and pressing on my foot).I forgot how careful I was the first time.As a result, the ligaments and muscles that did not have time to adapt to the implant could not hold it and came out.
Of course, they inserted it, put a cast, and then everything was fixed.But he complains that he cannot move his leg to the side, that it hurts, and that he feels discomfort when he walks.Although he does exercises and various exercises to develop both joints, it is also a desire to work and move independently.
Prevention
We discussed the symptoms and treatment of coxarthrosis in the hip joints, as well as their stages.
- Only daily physical exercises will help prevent serious complications and live a mature old age without crutches.During the Soviet period, serious work was carried out in the direction of prevention of diseases of the musculoskeletal system and strengthening of the immune system.Nowadays, it is difficult to recover the lost experience, it is clear with reason, but it is too lazy to do it.
- Excess weight wears the joints to shame;endoprosthetics are better, but do not lose extra pounds.My friend is convinced of this without even trying to eat less sweets and starchy foods.Proper nutrition is very important.
- I consider weight lifting to be no less bad for the entire skeleton.
- Bad habits (alcohol, smoking) remove calcium, magnesium and other useful substances from the body.
Just dig it, it's all connected.
Take care of yourself and your joints by exercising every day!