Coxarthrosis is a common degenerative-dystrophic disease of the hip joint in which, due to age-related changes or other factors, a gradual destruction of the articular joint of the head of the femur and the acetabulum of the pelvis occurs.It is accompanied by pain and limited range of motion of varying severity, which depends on the stage of development.And if in the initial stages it is possible to cope with coxarthrosis using conservative methods, then at the third stage it is possible to save the situation and maintain the functionality of the hip joint, that is, to avoid disability, only by surgery.
It is classified as osteoarthritis and can be accompanied by the development of similar processes in other joints, and this pathology accounts for approximately 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 the destruction of the cartilage layers that cover the head of the femur and the acetabulum occurs, which leads to a decrease in the size of the joint space.As the disease progresses, deformation of bone surfaces occurs and the formation of bone growths on them, called osteophytes.
Coxarthrosis is the second most common disease of the musculoskeletal system.More often, only gonarthrosis is diagnosed, that is, a degenerative-dystrophic change in the knee joint.However, the likelihood of disability with coxarthrosis is significantly higher.
The entire hip joint is enclosed in a specific box, which is called the joint capsule.It has the so-called synovial membrane, which produces synovial fluid.This fluid is extremely important for the proper functioning of the joint, since it not only lubricates the hyaline cartilage, but also provides it with a source of nutrients.
Normally, cartilage is constantly worn out and immediately restored due to the continuous process of regeneration, which is carried out with the help of substances entering it from the synovial fluid.But with injuries or age-related changes, the rate 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 less volume.As a result, the synovial fluid can no longer provide the hyaline cartilage with all the substances it needs in the necessary quantity, which causes its rapid dehydration and thinning.Little by little, the resistance and elasticity of the cartilage decreases, areas of separation of the fibers that form it form, cracks form in it and the thickness also decreases.These changes can be noted during instrumental diagnostic methods, especially narrowing of the joint space.
The narrowing of the joint space causes increased friction between the bony structures that make up the hip joint and increased pressure on the already degrading hyaline cartilage.This causes even greater damage, affecting the functioning of the joint and the person's condition, as the deformed areas prevent the femoral head from sliding easily into the acetabulum.As a result, symptoms of coxarthrosis occur.
If left untreated, the pathological changes worsen and the hyaline cartilage becomes increasingly worn away.Subsequently, in some areas it disappears completely, which causes exposed bones and a sharp increase in the load on the joint.Since, when moving inside the acetabulum, the head of the femur directly rubs against the bone, this causes severe pain and severe limitation of mobility.In this case, the pressure of bone structures against each other leads to the formation of bone growths on their surface.
The osteophytes formed may have sharp parts that can damage the muscles and ligaments surrounding the hip joint.This causes intense pain both directly in the joint area and in the groin, buttocks and thighs.As a result, the patient protects the injured leg, applies less load to it and tries to avoid unnecessary movements with it.This causes muscle atrophy to develop, further aggravating the mobility disability and ultimately leading to lameness.
Causes
There are many reasons for the development of coxarthrosis, although in rare cases it occurs in the absence of prerequisites.In this case we speak of the presence of primary or idiopathic coxarthrosis.In the vast 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 caused by:
- hip joint injuries of various types, including fractures, dislocations, bruises, sprains or ligament tears;
- heavy physical work, professional sports, especially weightlifting, skydiving, jumping sports;
- sedentary lifestyle;
- excess weight, which significantly increases the load on the hip joints;
- foci of chronic infection in the body;
- congenital abnormalities of the hip joints, such as dysplasia or dislocation;
- metabolic pathologies and endocrine disorders, in particular gout, diabetes mellitus, especially in a decompensated form;
- aseptic necrosis of the femoral head, which may result from a fracture of the femoral neck, especially during conservative treatment;
- inflammatory joint diseases, including rheumatoid arthritis, bursitis, tendonitis;
- spinal diseases;
- genetic predisposition;
- Presence of bad habits, especially smoking.
However, the main cause of coxarthrosis remains 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 gradual progression with a systematic increase in the intensity of symptoms.Therefore, in the initial stages it may be asymptomatic or only occasionally cause anxiety to patients, but subsequently the condition of the hip joint worsens, leading to an increase in the severity of signs of coxarthrosis up to unbearable pain and significant limitation of mobility.
So, degenerative-dystrophic changes in the hip joint are accompanied by:
- Pain of variable intensity, which initially appears after physical activity or walking and subsides after rest.Gradually, the severity of the pain syndrome increases, it appears more frequently, lasts longer, and the periods between the moment of loading on the joint and the appearance of pain are reduced.Subsequently, the pain is present almost constantly, even at rest, and becomes unbearable.Intensification of pain is typical at any stage of the disease with hypothermia and heavy lifting.
- Mobility limitations of the hip joint, which initially manifest as small difficulties in performing rotational movements of the leg.Over time, morning stiffness appears, which disappears when the patient “disperses.”This may be accompanied by the appearance of swelling in the hip joint.As the disease progresses, mobility restrictions become more pronounced and persistent, that is, they do not disappear after warming.Patients notice a decrease in the range of leg movements and subsequently completely lose the ability to perform certain movements.
- Cracking in the hip joint that appears when walking or doing physical work, especially when doing extensions.It becomes the result of friction of the exposed bone structures against each other, which is accompanied by a sharp increase in pain.
- Spasms of the thigh muscles, causing diffuse pain in the thigh.This may be the result of a combination of various intra-articular disorders, including nerve compression, excessive stretching of the ligaments surrounding the joint, as well as the development of synovitis, that is, inflammation of the synovial membrane and accumulation of inflammatory effusion in the hip joint cavity.
- Lameness, initially resulting from the patient's unconscious desire to reduce the load on the diseased joint and transfer weight to the healthy leg to avoid the onset or intensification of pain, and then the development of muscle contracture.The latter phenomenon occurs already in the later stages of coxarthrosis and leads to the fact that the patient cannot fully straighten his leg and, moreover, maintain it in this position.Therefore, the lower limb with the affected hip joint is constantly in a slightly bent position, which causes lameness.
- A decrease in the length of the legs, which occurs mainly with severe degenerative-dystrophic changes in the hip joint, accompanied not only by a narrowing of the joint space, but also by a 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, in the second they will not only be bilateral, but will 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 the appearance of degenerative-dystrophic changes in the hip joint, only occasional pain can be observed.As a rule, this occurs after intense physical activity, sports or long walks.Therefore, patients usually do not pay attention to them, attributing them to fatigue and considering them a normal age-related change.In this sense, first degree coxarthrosis is diagnosed only in isolated cases, which usually occurs during an examination for another reason.
As the disease progresses, its symptoms intensify and already with second-degree coxarthrosis they make themselves felt.This stage of the development of pathology is characterized by a narrowing of the joint space by 50%, as well as the appearance of signs of deformation of the femoral head during its displacement.
With further progression of the pathology, the joint space narrows even more and in the third degree of coxarthrosis it is almost completely absent.This is already accompanied by the formation of multiple osteophytes.At this stage of the development of the disease, the pain becomes not only intense, but also unbearable and often appears even in a state of complete rest, even at night.Since the hip joint is severely deformed, its elements can affect the nerves passing through here, causing pain that radiates to the groin area, buttocks, as well as the thigh and even the lower leg.This also causes the inability to move independently without the use of assistive devices, for example, crutches or a cane.
Third degree coxarthrosis is a direct indication for surgical treatment.If the operation is not performed in time, the head of the femur will be firmly fused to the surface of the acetabulum by osteophytes.This will cause a shortening of the leg, a complete inability to move independently, since the joint will completely lose its mobility, that is, disability.
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 his discomfort, and then proceed to examine him 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 a similar clinical picture can accompany other diseases of the hip joints, both inflammatory and non-inflammatory in nature, instrumental diagnostic methods are necessarily prescribed.With its help, a specialist will be able not only to confirm the presence of coxarthrosis, differentiate it from radicular syndrome caused by pathologies of the spine, but also correctly assess the degree of its development and, therefore, select the most effective treatment tactics.
Today, the following are used to diagnose coxarthrosis:
- X-ray of the hip joints - the resulting images make it possible 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 space.
- CT is a more modern method for diagnosing bone pathologies, it provides 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 of studying joints, as it provides the maximum amount of information about the state of the joint and all its structures, especially hyaline cartilage, ligaments and features of the blood supply.
Patients are prescribed a series of laboratory tests, including OAC, OAM, rheumatic tests, biochemical blood tests and others.
Conservative treatment of coxarthrosis.
When coxarthrosis of 1 or 2 degrees is diagnosed, treatment is carried out using conservative methods.For each patient they are selected individually, taking into account the concomitant pathologies detected.Therefore, it may often be necessary to consult not only an orthopedist, but also doctors of 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 involves 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 practice.In some cases, it is recommended to use special bandages and orthoses that will fix the hip joint and provide relief during physical activity.
Drug therapy
As part of drug treatment, medications are selected individually for patients, taking into account existing concomitant diseases.As a general rule, medications from the following pharmacological groups are indicated for coxarthrosis:
- NSAIDs are a large group of drugs that exhibit analgesic and anti-inflammatory effects (available in various dosage forms, including tablets, capsules, gels, creams, injectable solutions, allowing 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 used orally, they are prescribed only in short courses by injection;
- muscle relaxants - drugs that help reduce muscle tone, allowing you to effectively combat muscle spasms, which are often observed with coxarthrosis;
- chondroprotectors - a group of drugs containing components used by the body for the regeneration of cartilage tissue;
- drugs that improve microcirculation: help improve soft tissue nutrition and activate metabolic processes in the affected area;
- B vitamins: indicated for nerve conduction disorders caused by compression of the nerves by altered components of the hip joint.
If coxarthrosis causes an attack of acute pain that cannot be relieved with the help of prescribed NSAIDs, patients are recommended to undergo an intra-articular or peri-articular block.Its essence is to inject directly into the hip joint cavity an anesthetic solution in combination with corticosteroids.This will eliminate pain in the shortest possible time and reduce the inflammatory process.But blocking can only be done by a qualified medical professional in a specially prepared room.It is not recommended to carry out such procedures at home.
exercise therapy
When diagnosing coxarthrosis, regular physiotherapy exercises are required.Like drug therapy, a set of physiotherapy exercises for each patient is selected individually, 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 physiotherapy classes, it is possible:
- reduce the severity of pain;
- increase the mobility of the hip joint;
- reduce the risk of developing muscle atrophy;
- eliminate spasms of the thigh muscles;
- Activate blood circulation and thus improve the nutrition of the affected joint.
All exercises should be performed gently, avoiding sudden movements and jerks.But if pain occurs during exercise therapy, you should definitely contact your doctor to correct the selected complex or carry out repeated diagnostics to exclude the progression of the disease and the need for surgery.
Physiotherapy
The complex treatment of coxarthrosis involves courses of physiotherapeutic procedures that have an anti-inflammatory, analgesic, decongestant and tonic effect on the body.Therefore, patients are most often prescribed 10-15 procedures:
- ultrasound therapy;
- electrophoresis;
- UVT;
- magnetic therapy;
- laser therapy, etc.
Recently, plasmolifting has been increasingly used as part of the conservative treatment of coxarthrosis, which can significantly increase the regeneration rate 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 of the patient's own blood.
Surgery for coxarthrosis
If a patient is diagnosed with grade 3 coxarthrosis, he is shown surgical intervention, since conservative methods in such cases are no longer effective.Unfortunately, these types of situations are extremely common today, as a large number of patients seek medical help 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.The indications for its implementation are:
- significant reduction in joint space by more than 80%;
- the presence of severe pain in the hip joint that cannot be eliminated;
- severe mobility problems;
- Fracture of the femoral neck.
The gold standard for the treatment of severe hip osteoarthritis, even in older people, is hip replacement.This operation involves the replacement of the destroyed hip joint with an artificial endoprosthesis made of durable and at the same time biologically compatible materials.The endoprosthesis allows you to completely restore the functionality of the hip joint, eliminate pain and return the person to a full active life.
The essence of this type of surgical intervention is the resection of the head of the femur and a small fragment of its neck.The surgeon must also prepare the surface of the acetabulum for the installation of the endoprosthesis, that is, remove all formed osteophytes and achieve maximum restoration of its normal shape.After this, an endoprosthesis of the selected type is installed, which is fixed with a special cement (preferable for the treatment of elderly people) or without cement.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 ensured by the growth of bone tissue through the sponge.
For each patient, the type of endoprosthesis is selected individually.The most effective is the total endoprosthesis, which involves the complete replacement of the entire hip joint, that is, the neck and head of the femur, as well as the acetabulum.
If the patient retains normal hyaline cartilage on the surface of the acetabulum, he or she may undergo partial arthroplasty with replacement of only the femoral head and/or neck.For this, endoprostheses of different designs are used: monopolar and bipolar.
The only disadvantage of stent replacement is the need to replace the installed stent after 15 to 30 years.
After endoprosthesis, patients receive rehabilitation, the duration of which depends on the speed of tissue restoration.As part of recovery, exercises, physiotherapy and therapeutic massages are prescribed.
Before the advent of modern stents, patients with grade 3 coxarthrosis were prescribed osteotomy or arthrodesis.Today, these techniques are used less and less, since they have a number of disadvantages.Therefore, 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 its mobility.Thus, after arthrodesis, the patient can only stand, but can no longer walk independently due to lack of movement in the hip joint.Therefore, arthrodesis is practically not performed today.
Osteotomy involves performing an artificial fracture of the femur with a combination of bone fragments that will reduce the load on the affected hip joint.But the operation only gives a short-term effect and endoprostheses will still be needed in the future.
Therefore, coxarthrosis of the hip joint is a rather dangerous disease that can lead to disability.It seriously reduces the quality of life and deprives a person of his or her ability to work.But if you pay attention to the first signs of pathology and timely consult with an orthopedist, you can slow down its progression and achieve a significant improvement in your well-being.But with the coxarthrosis already advanced, there can only be one solution: endoprostheses.Fortunately, this method can be used even with severe degenerative changes and completely restore normal function of the hip joint.