Coxarthrosis is a common degenerative-dystrophic disease of the hip joint, in which, due to age-related changes or other factors, there is a gradual destruction of the articular joint of the femoral headand the acetabulum of the pelvis. It is accompanied by pain and limitation of range of motion of varying severity, which depends on the stage of development. And if at the initial stages it is possible to cope with coxarthrosis by conservative methods, then at the 3rd stage it is possible to save the situation and maintain the working capacity of the hip joint, this isthat is, to avoid invalidity, only by carrying out an operation.
It belongs to the number of arthrosis and can be accompanied by the development of similar processes in other joints, and this pathology accounts for 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 the cartilage layers covering the femoral head and acetabulum are destroyed, which leads to a decrease in the size of the joint space. As the disease progresses, we observe the appearance of deformation of the surfaces of the bones and the formation of bony growths on them, called osteophytes.
Coxarthrosis is the second most common disease of the musculoskeletal system. Most often, only gonarthrosis is diagnosed, that is, a degenerative-dystrophic change in the knee joint. Nevertheless, the probability of disability in coxarthrosis is significantly higher.
The entire hip joint is enclosed in a specific casing, called the joint capsule. It has a so-called synovial membrane, which produces synovial fluid. This liquid is essential for the proper functioning of the joint, because it not only lubricates the hyaline cartilage, but it is also a source of nutrients for it.
Normally, the cartilage is constantly worn out and immediately restored due to the process of continuous regeneration, which is 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 due to changes in the amount of synovial fluid produced and its composition. Under the influence of adverse factors, it becomes thicker and produced in a smaller volume. As a result, the synovial fluid is no longer able to provide the hyaline cartilage with all the substances it needs in the right amount, which leads to its rapid dehydration and thinning. Gradually, the strength and elasticity of the cartilage decreases, areas of delamination of the fibers forming it, cracks form in it, and the thickness also decreases. These changes can be noticed during instrumental diagnostic methods, in particular, the narrowing of the joint space draws attention to itself.
The narrowing of the joint space leads to increased friction between the bony structures that form the hip joint and increased pressure on the already degraded hyaline cartilage. This causes even more damage to it, which affects the functioning of the joint and the condition of the person, since the deformed areas prevent the femoral head from sliding easily into the acetabulum. As a result, there are symptoms of coxarthrosis.
If left untreated, the pathological changes worsen and the hyaline cartilage wears out more and more. Subsequently, in some areas it completely disappears, which leads to exposure of the bones and a sharp increase in the load on the joint. Since when moving inside the acetabulum, the femoral head rubs directly against the bone, this causes the appearance of severe pain and a strong limitation of mobility. In this case, the pressure of bone structures on each other leads to the formation of bone growths on their surface.
The formed osteophytes can have sharp parts that can injure the muscles and ligaments surrounding the hip joint. This leads to the appearance of strong pains both directly in the joint area, and in the groin, buttocks and thigh. As a result, the patient spares the injured leg, exerts less pressure on it and tries to avoid making unnecessary movements with it. This causes the development of muscle atrophy, which further aggravates mobility disorders and ultimately leads to lameness.
causes
There are many reasons for the development of coxarthrosis, although in rare cases it occurs against the background of the absence of prerequisites. In this case, they 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. It can be caused by:
- hip joint injuries of various kinds, including fractures, dislocations, bruises, sprains or torn ligaments;
- heavy physical work, professional sports, in particular weightlifting, skydiving, show jumping;
- sedentary lifestyle;
- being overweight, which significantly increases the load on the hip joints;
- foci of chronic infection in the body;
- birth defects of the hip joints, such as dysplasia or dislocation;
- metabolic pathologies and endocrine disorders, in particular gout, diabetes mellitus, in particular 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 diseases of the joints, including rheumatoid arthritis, bursitis, tendonitis;
- spinal diseases;
- genetic predisposition;
- the presence of bad habits, in particular smoking.
Nevertheless, the main cause of coxarthrosis remains the inevitable age-related changes, and the presence of the above factors only increases the likelihood and speed of its development.
Coxarthrosis symptoms
The disease is characterized by a 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, which leads to an increase inseverity 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 varying intensity, initially appearing after physical exertion or walking and easing after rest. Gradually, the severity of the pain syndrome increases, it appears more often, lasts longer, and the periods between the moment of applying the load to the joint and the onset of pain are reduced. Later, the pain is present almost constantly, including at rest, and becomes unbearable. Increased pain at any stage of the development of the disease during hypothermia and lifting heavy objects is characteristic.
- Restrictions on the mobility of the hip joint, which initially manifests itself in minor difficulties in the implementation of rotational movements of the leg. Over time, morning stiffness appears, which disappears after the patient "disperses". This may be accompanied by the appearance of edema in the hip joint. As the disease progresses, mobility restrictions become more pronounced and persistent, that is, they do not disappear after warming up. Patients notice a decrease in the range of motion of the legs, and then completely lose the ability to perform certain movements.
- Crack in the hip joint, which appears when walking or performing physical labor, especially when extending. It becomes the result of the bare bone structures rubbing against each other, which is accompanied by a sharp increase in pain.
- Spasm of the thigh muscles, resulting in diffuse pain in the thigh. This can be the result of the attachment of various intra-articular disorders, including compression of the nerves, overstretching of the ligaments surrounding the joint, as well as the development of synovitis, that is, ainflammation of the synovial membrane and the accumulation of effusion in the cavity of the hip joint.
- Lameness, which arises first from the unconscious desire of the patient to reduce the load on the diseased joint and transfer weight to the healthy leg in order to avoid the appearance or intensification of pain, and then the development ofa muscle contracture. The latter phenomenon occurs already in the later stages of coxarthrosis and leads to the fact that the patient is not able to fully straighten the leg and, moreover, hold it in this position. Thus, 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 mainly occurs already 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, muscle atrophy. As a result, the diseased leg becomes shorter than the healthy leg by 1 centimeter or more.
Coxarthrosis can affect both one hip joint and 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. It depends on the degree of destruction of each hip joint.
Coxarthrosis degrees
The nature of the manifestations of the disease depends on the stage of its development. In total, there are 3 degrees of coxarthrosis, the first of which is considered the easiest. At the initial stages of the appearance of degenerative-dystrophic changes in the hip joint, only episodic pain can be observed. As a rule, this occurs after intense physical exertion, playing sports or a long walk. Therefore, patients usually do not pay attention to them, attributing them to fatigue and considering them normal age-related changes. In this regard, coxarthrosis of the 1st degree 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 coxarthrosis of the 2nd degree they make themselves felt. This stage of pathology development is characterized by a narrowing of the joint space by 50%, as well as the appearance of signs of deformation of the femoral head with its displacement.
With the progression of the pathology, the joint space narrows even more, and with the 3rd degree of coxarthrosis 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 strong, but unbearable and often occurs even in a state of complete rest, including at night. Since the hip joint is severely deformed, its elements can impinge on the nerves that pass through it, resulting in pain radiating to the groin, buttocks, as well as the thigh and even the lower leg. It also causes the inability to move independently without the use of assistive devices, such as crutches or canes.
Coxarthrosis of the 3rd degree is a direct indication for surgical treatment. If the operation is not performed in time, the femoral head will firmly fuse with the surface of the acetabulum with osteophytes. This will lead to a shortening of the leg, to the complete absence of the possibility of independent movement, since the joint will completely lose its mobility, that is, to disability.
Diagnostic
If signs of coxarthrosis appear, it is recommended to contact an orthopedist as soon as possible. Initially, the doctor will interview the patient and find out the nature of the complaints, then proceed to the examination and conduct 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 in nature, instrumental diagnostic methods are needed. With their help, a specialist will be able not only to confirm the presence of coxarthrosis, to differentiate it from the radicular syndrome caused by spinal pathologies, but also to correctly assess the degree of its development, which means choosing the most effective treatment tactics. .
Today, for the diagnosis of coxarthrosis, the following are used:
- X-ray of the hip joints - the images obtained allow you to detect signs of destructive changes, the presence of osteophytes, the nature of the deformation of bone structures, and to measure the thickness of the joint space.
- Computed tomography is a more modern method of diagnosing bone pathologies, providing clearer data than X-rays, but more expensive. Therefore, computed tomography 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 very informative method for examining joints, providing the maximum information about the condition of the joint and all its structures, especially hyaline cartilage, ligaments and blood supply characteristics.
Patients are prescribed a number of laboratory tests including KLA, OAM, rheumatic tests, biochemical blood tests and others.
Conservative treatment of coxarthrosis
When diagnosing coxarthrosis of 1 or 2 degrees, treatment is carried out by conservative methods. For each patient, they are selected individually, taking into account the detected comorbidities. 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 mandatory for all patients to 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 exertion, 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 braces that will fix the hip joint and unload it during physical exertion.
medical therapy
As part of drug treatment, patients are given individually selected drugs, taking into account existing concomitant diseases. As a rule, drugs of the following pharmacological groups are indicated for coxarthrosis:
- NSAIDs - a huge group of drugs with analgesic and anti-inflammatory effects (available in various dosage forms, including tablets, capsules, gels, creams, solutions for injection, which allows you to choose the form of applicationmost efficient and practical);
- corticosteroids - drugs that have a strong anti-inflammatory effect, but due to the high risk of side effects, especially when using oral forms, they are prescribed only for short-term treatment in the form of injections;
- muscle relaxants - drugs that help reduce muscle tone, which allows you to effectively treat muscle spasms, which are often observed in coxarthrosis;
- chondroprotectors - a group of drugs containing components used by the body for the regeneration of cartilage tissue;
- preparations that improve microcirculation - help improve soft tissue nutrition and activate the course of metabolic processes in the affected area;
- B vitamins - are indicated for nerve conduction disorders caused by nerve compression by altered components of the hip joint.
If coxarthrosis has caused an attack of acute pain, which cannot be stopped with the help of prescribed NSAIDs, intra-articular or peri-articular blockade is recommended for patients. Its essence lies in the introduction directly into the cavity of the hip joint of an anesthetic solution in combination with corticosteroids. This will allow you to quickly eliminate pain and reduce the inflammatory process. But the blockade can only be carried out by a trained health worker in a specially prepared room. Performing such procedures at home is not shown.
exercise therapy
When diagnosing coxarthrosis, regular exercise therapy is mandatory. Similar to drug therapy, a set of exercise therapy 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, from the nature of concomitant diseases (special attention is paid to cardiovascular pathologies).
With daily exercise therapy, you can:
- reduce the severity of pain;
- increase the mobility of the hip joint;
- reduce the risk of 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 smoothly, avoiding sudden movements and jerks. But if the pain occurs during exercise therapy, you should definitely contact your doctor in order to correct the selected complex or carry out a new diagnosis to exclude the progression of the disease and the need for an operation.
Physiotherapy
Comprehensive treatment of coxarthrosis involves courses of physiotherapy procedures that have anti-inflammatory, analgesic, decongestant and tonic effects on the body. Therefore, most often patients are 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 speed of regeneration of hyaline cartilage. The essence of the procedure is the introduction into the cavity of the hip joint of purified blood plasma, obtained by centrifugation from the patient's own blood.
Hip osteoarthritis surgery
If a patient is diagnosed with coxarthrosis of the 3rd degree, he is indicated for surgical intervention, since conservative methods in such cases are already powerless. Unfortunately, such situations are extremely common today, as so many patients seek medical attention when they can no longer bear the pain or have severe mobility restrictions that rob them of their ability to work and move around. in an autonomous way.
Timely surgical intervention can completely eliminate these disorders and restore the patient's ability to move normally, significantly improving their quality of life. The indications for its implementation are:
- a significant decrease in joint space by more than 80%;
- the presence of severe pain in the hip joint, which cannot be eliminated;
- pronounced mobility disorders;
- femoral neck fracture.
The gold standard for the treatment of severe coxarthrosis, including in the elderly, is hip arthroplasty. This operation consists of replacing a 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 a person to a full-fledged active life.
The essence of this type of surgical intervention is the resection of the femoral head and a small fragment of its neck. In addition, the surgeon will have to prepare the surface of the acetabulum for the installation of the endoprosthesis, that is, to remove all the osteophytes formed and obtain the maximum restoration of its normal shape. After that, a stent of the selected type is installed, which is fixed with a special cement (preferably for the treatment of the elderly) or without cement. In the latter case, the endoprosthesis has a particular spongy part in contact with the bone structures. Its fixation in the acetabulum is ensured by the germination of bone tissue through the sponge.
For each patient, the type of arthroplasty is selected individually. The most effective is total arthroplasty, which involves completely replacing the hip joint, that is, the neck and head of the femur, as well as the acetabulum.
If the patient has preservation of normal hyaline cartilage on the surface of the acetabulum, they can undergo partial arthroplasty with replacement of the femoral head and/or neck only. For this purpose, stents of different designs are used: monopolar and bipolar.
The only drawback of arthroplasty can be considered the need to replace the installed stent after 15-30 years.
After stent replacement, patients benefit from rehabilitation, the duration of which depends on the rate of tissue repair. As part of recovery, exercise therapy, physiotherapy and therapeutic massage are prescribed.
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 drawbacks. Thus, arthrodesis involves fixing the bone 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 is no longer able to walk independently due to the lack of movement of the hip joint. Therefore, today arthrodesis is practically not performed.
Osteotomy involves performing 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 the need for arthroplasty still arises.
So, coxarthrosis of the hip joint is a rather dangerous disease, which can lead to disability. This significantly reduces the quality of life and deprives a person of his ability to work. But if you pay attention to the first signs of pathology and get timely advice from an orthopedist, you can slow down its progression and achieve a significant improvement in well-being. But with an already ongoing coxarthrosis, there can be only one solution - arthroplasty. Fortunately, this method can be used even with severe degenerative-dystrophic changes and completely restore the normal functioning of the hip joint.