Coxarthrosis is a widespread degenerative-dystrophic disease of the hip joint, in which, due to age-related changes or other factors, the articular joint of the femoral head and pelvic acetabulum is gradually destroyed.It is accompanied by pain and a limited range of motion of varying severity, depending on the stage of development.And if in the initial stage it is possible to deal with coxarthrosis with conservative methods, then in the 3rd stage it is possible to save the situation and preserve the functionality of the hip joint, that is, to prevent disability only through surgery.
It is classified as 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 be used only to describe the degenerative-dystrophic changes of the hip joint.
What is coxarthrosis?
Coxarthrosis is a complex pathology of one or both hip joints, during which the cartilage layers covering the femur and acetabulum are destroyed, which leads to a decrease in the size of the joint space.As the disease progresses, bone surfaces are deformed and bony growths, called osteophytes, occur on them.
Coxarthrosis is the second most common disease of the musculoskeletal system.More often, only gonarthrosis is diagnosed, i.e. degenerative-dystrophic change of the knee joint.However, the probability of disability with coxarthrosis is significantly higher.
The entire hip joint is enclosed in a special case called the joint capsule.It has a so-called synovial membrane, which produces synovial fluid.This fluid is very important for the proper functioning of the joint, as it not only moisturizes the hyaline cartilage, but also provides it with a source of nutrients.
Normally, the cartilage is constantly worn out and immediately restored due to the continuous process of regeneration, which is carried out with the help of substances included in it from the synovial fluid.But with injuries or age-related changes, the speed of regeneration processes decreases, which leads to the gradual wear of hyaline cartilage and the development of coxarthrosis.
This is explained by changes in the amount and composition of the produced synovial fluid.Under the influence of unfavorable factors, it becomes thicker and is formed in less volume.As a result, the synovial fluid can no longer provide the hyaline cartilage with all the necessary substances in the required amount, which leads to its rapid dehydration and thinning.Gradually, the strength and elasticity of the cartilage decreases, the areas of separation of the fibers formed in it, cracks appear in it, and the thickness also decreases.These changes are observed 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 pressure on the already degrading hyaline cartilage.This causes further damage, affecting joint function and posture, as the deformed areas prevent the femoral head from sliding easily into the acetabulum.As a result, symptoms of coxarthrosis appear.
In the absence of treatment, the pathological changes worsen and the hyaline cartilage wears out more and more.Subsequently, in some areas it disappears completely, which leads to the exposure of bones and a sharp increase in the load on the joint.As the femoral head comes into direct contact with the bone when moving inside the acetabulum, it causes severe pain and severe limitation of mobility.In this case, the pressure of bone structures on each other leads to the formation of bony formations on their surface.
Formed osteophytes can have sharp parts that can damage the muscles and ligaments surrounding the hip joint.This causes severe pain both directly in the joint area, as well as in the groin, buttocks and thighs.As a result, the patient saves the injured leg, puts less load on it and tries to avoid excessive movements with it.This leads to the development of muscle atrophy, which further aggravates the impaired mobility and eventually leads to lameness.
reasons
There are many reasons for the development of coxarthrosis, although in rare cases it occurs in the absence of any prerequisites.In this case, they talk about the presence of primary or idiopathic coxarthrosis.In the vast majority of cases, secondary coxarthrosis is diagnosed, which is a logical result of a number of diseases or changes in the state of the musculoskeletal system.Its development can be provoked by:
- Various types of injuries to the hip joint, including fractures, dislocations, bruises, sprains or torn ligaments;
- hard physical work, professional sports, especially weightlifting, parachuting, jumping sports;
- lifeless lifestyle;
- Excess weight, which significantly increases the load on the hip joints;
- foci of chronic infection in the body;
- congenital anomalies of the hip joints, such as dysplasia or dislocation;
- Metabolic pathologies and endocrine disorders, in particular gout, diabetes mellitus, especially in decompensated form;
- aseptic necrosis of the femoral head, which may be the result of a fracture of the femoral neck, especially during conservative treatment;
- inflammatory joint diseases, including rheumatoid arthritis, bursitis, tendonitis;
- spine diseases;
- genetic predisposition;
- Having bad habits, especially smoking.
Nevertheless, the main cause of coxarthrosis is inevitable age-related changes, and the presence of the above-mentioned factors only increases the likelihood and speed of its development.
Symptoms of coxarthrosis
The disease is characterized by a gradual progression with a systematic increase in the intensity of symptoms.Therefore, at the initial stage, 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 in the severity of the symptoms of coxarthrosis to unbearable pain and a significant limitation of mobility.
Thus, degenerative-dystrophic changes of the hip joint are accompanied by:
- Pain of varying intensity that initially appears after physical activity or walking and disappears after rest.The severity of the pain syndrome gradually increases, it appears more often, lasts longer, and the periods between the moment of loading on the joint and the onset of pain decrease.Later, pain appears almost constantly, including at rest, and becomes unbearable.Intensification of pain is characteristic at any stage of the disease with hypothermia and lifting heavy objects.
- Limitations of the mobility of the hip joint, which initially manifest as small difficulties when performing rotational movements of the leg.Over time, morning stiffness appears, which disappears after the patient "breaks down".This may be accompanied by the appearance of swelling of the hip joint.As the disease progresses, mobility limitations become more pronounced and permanent, that is, they do not disappear after warming up.Patients notice a decrease in the amplitude of leg movement and subsequently completely lose the ability to move.
- A cramp in the hip joint that occurs when walking or doing physical work, especially when prolonged.It occurs as a result of bone structures rubbing against each other, which is accompanied by a sharp increase in pain.
- Spasm of the thigh muscles, which causes diffuse pain in the thigh area.This can be the result of the addition 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 the accumulation of inflammatory discharge in the hip joint cavity.
- Lameness is initially caused by the unconscious desire of the patient to reduce the load on the diseased joint and transfer the weight to the healthy leg in order to prevent the appearance or intensification of pain, and then muscle contracture.The latter phenomenon appears already in the later stages of coxarthrosis and leads to the fact that the patient cannot fully straighten the leg and, moreover, maintain it in this position.Thus, the lower limb of the damaged hip joint is constantly in a slightly bent position, which provokes lameness.
- A decrease in leg length, which is mainly manifested by severe degenerative-dystrophic changes of the hip joint, which is accompanied not only by narrowing of the joint space, but also by flattening of the femoral head and muscle atrophy.As a result, the affected leg becomes 1 or more centimeters shorter than the healthy leg.
Coxarthrosis can affect one hip joint or both at the same time.But if in the first case the symptoms of the disease are observed only on one side, then in the second they will not be only bilateral, but differ in intensity.It depends on the degree of destruction of each hip joint.
Degree of coxarthrosis
The nature of the manifestation 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 mildest.In the initial stages of detection of degenerative-dystrophic changes in the hip joint, only occasional pain can be observed.As a rule, this happens after intense physical activity, sports or a long walk.Therefore, patients usually do not pay attention to them, attribute them to fatigue and consider them a normal age change.In this regard, coxarthrosis of the 1st degree is diagnosed only in individual cases, which usually occurs during examination for another reason.
As the disease progresses, his symptoms become stronger and he already feels like he has coxarthrosis of the 2nd degree.This stage of the development of the pathology is characterized by the narrowing of the joint space by 50%, as well as the appearance of signs of deformation of the femoral head due to its displacement.
As the pathology progresses further, the joint space becomes even narrower, and in the 3rd degree of coxarthrosis, it is almost completely absent.This is already accompanied by the formation of many osteophytes.At this stage of the development of the disease, the pain becomes not only strong, but also unbearable and often occurs even at complete rest, including at night.Since the hip joint is severely deformed, its elements can disrupt the nerves passing through it, which causes pain that radiates to the armpit, buttocks, as well as the thigh and lower limb.It also leads to the inability to move independently without the use of assistive devices, such as crutches or a cane.
3rd degree coxarthrosis is a direct indication for surgical treatment.If the operation is not performed in time, the femoral head will be firmly fused to the surface of the acetabulum by osteophytes.This will lead to shortening of the leg, a complete lack of ability to move independently, since the joint will completely lose mobility, that is, disability.
diagnosis
In case of symptoms of coxarthrosis, it is recommended to consult an orthopedist as soon as possible.First, the doctor will interview the patient and find out the nature of the complaints, and then he will continue to examine and perform functional tests, comparing the length of the legs.As a rule, the obtained data are enough to speak with high confidence about the presence of coxarthrosis.
But since a similar clinical picture can be accompanied by a number of other diseases of the hip joints, both inflammatory and non-inflammatory, instrumental diagnostic methods are definitely prescribed.With their help, the specialist will be able not only to confirm the presence of coxarthrosis, to distinguish it from radicular syndrome caused by spinal pathologies, but also to correctly assess the degree of its development and, accordingly, to select the most effective treatment tactics.
Today, the following are used to diagnose coxarthrosis:
- X-ray of the hip joints - the obtained images allow you to detect signs of destructive changes, the presence of osteophytes, the nature of deformation of bone structures and measure the thickness of the joint space.
- CT is a more modern method of diagnosing bone pathologies, which provides clearer data than X-ray, but 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 for studying joints, which provides maximum information about the state of the joint and all its structures, especially the hyaline cartilage, ligaments and blood supply characteristics.
Patients are prescribed a number of laboratory tests, including OAC, OAM, rheumatic tests, biochemical blood test and others.
Conservative treatment of coxarthrosis
When diagnosing coxarthrosis of the 1st or 2nd degree, treatment is carried out with conservative methods.For each patient, they are selected individually, taking into account the accompanying pathologies.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 accompanying diseases.
Within the treatment of coxarthrosis, patients are prescribed:
- drug therapy;
- exercise therapy;
- Physiotherapy.
It is necessary 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 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 exercise if the load is caused by sports.In some cases, it is recommended to use special bandages and orthoses, which will fix the hip joint during physical exertion and remove it.
drug therapy
Within the scope of drug treatment, drugs are selected individually for patients, taking into account existing concomitant diseases.As a rule, drugs from the following pharmacological groups are indicated for coxarthrosis:
- Nonsteroidal anti-inflammatory drugs are a wide group of drugs that have analgesic and anti-inflammatory effects (available in various dosage forms, including tablets, capsules, gels, creams, injectable solutions, which allows you to choose the most effective and convenient form of use);
- Corticosteroids are 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 in short courses by injection;
- Muscle relaxants - drugs that help reduce muscle tone, which allows you to effectively fight muscle spasms, which are often observed in coxarthrosis;
- Chondroprotectors – a group of drugs that contain components that the body uses to regenerate cartilage tissue;
- Medicines that improve microcirculation - help improve nutrition of soft tissues and activate metabolic processes in the damaged area;
- B vitamins - indicated for nerve conduction disorders caused by compression of nerves by the changed components of the hip joint.
If coxarthrosis causes an attack of acute pain, which cannot be alleviated with the help of prescribed non-steroidal anti-inflammatory drugs, patients are advised to undergo intra-articular or peri-articular blockade.Its essence is to inject an anesthetic solution together with corticosteroids directly into the hip joint cavity.This will relieve your pain in the shortest time and reduce the inflammatory process.But the blockade can be carried out only by a qualified medical specialist in a specially prepared room.It is not recommended to carry out such procedures at home.
Exercise therapy
When diagnosing coxarthrosis, regular physical therapy exercises are required.Like drug therapy, a set of exercises for exercise therapy is selected for each patient individually, taking into account the degree of destruction of the hip joint, the level of physical development of the patient and the nature of accompanying diseases (special attention is paid to cardiovascular pathologies).
Thanks to daily exercise therapy classes, it is possible to:
- reduce the severity of pain;
- increase the mobility of the hip joint;
- reduces the risk of developing muscle atrophy;
- elimination of thigh muscle spasms;
- Activates blood circulation and thereby improves nutrition of the damaged joint.
All exercises should be performed smoothly, avoiding sudden movements and tricks.But if pain occurs during exercise therapy, you should definitely consult a doctor to correct the selected complex or conduct repeated diagnostics to rule out the progression of the disease and the need for surgery.
Physiotherapy
Complex treatment of coxarthrosis includes courses of physiotherapeutic 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 is increasingly used as part of the conservative treatment of coxarthrosis, which can significantly increase the regeneration of hyaline cartilage.The essence of the procedure is the introduction of purified blood plasma into the hip joint cavity, obtained by centrifugation from the patient's own blood.
Surgery for coxarthrosis
If the patient is diagnosed with coxarthrosis of the 3rd degree, he is prescribed surgical intervention, since conservative methods are no longer effective in such cases.Unfortunately, such situations are very common today, as a large number of patients seek medical care when they can no longer tolerate pain or have severe mobility limitations that deprive them of the 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.Indications for its implementation are:
- Significant reduction of joint space by more than 80%;
- the presence of severe pain in the hip joint that cannot be eliminated;
- severe mobility disorders;
- Femoral neck fracture.
The gold standard for the treatment of severe coxarthrosis, including in the elderly, is hip replacement.This operation involves replacing the destroyed hip joint with an artificial endoprosthesis made of durable and at the same time biologically compatible materials.Endoprosthesis allows you to fully restore the functionality of the hip joint, eliminate pain and return a person to a fully active life.
The essence of this type of surgical intervention is the resection of the femoral head and a small fragment of its neck.The surgeon will also need to prepare the surface of the acetabulum for the placement of the endoprosthesis, that is, remove all the formed osteophytes and achieve the maximum restoration of its normal shape.After that, a selected type of endoprosthesis is installed, which is fixed using special cement (preferred for the treatment of the elderly) or without cement.In the latter case, the endoprosthesis has a special spongy part that is in contact with bone structures.Its fixation in the acetabulum is provided by the growth of bone tissue through the sponge.
The type of endoprosthesis is selected individually for each patient.The most effective is 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 has preservation of normal hyaline cartilage on the surface of the acetabulum, he can undergo a partial arthroplasty with replacement of the femoral head and/or neck only.Endoprostheses of different designs are used for this purpose: monopolar and bipolar.
The only disadvantage of endoprosthesis replacement is the need to replace the installed endoprosthesis after 15-30 years.
After endoprosthesis, patients undergo rehabilitation, the duration of which depends on the speed of tissue recovery.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, because they have a number of disadvantages.Thus, arthrodesis refers to the fixation of 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 cannot walk independently due to the lack of movement in the hip joint.Therefore, today arthrodesis is practically not performed.
Osteotomy involves performing an artificial femur fracture with a combination of bone fragments that will reduce the load on the affected femur joint.But the operation gives only a short-term effect, and endoprosthesis is still needed in the future.
Thus, coxarthrosis of the hip joint is a very dangerous disease that can lead to disability.This seriously reduces the quality of life and deprives a person of his ability to work.But if you pay attention to the early signs of pathology and get a timely consultation with an orthopedist, you can slow down its progression and achieve a significant improvement in your well-being.But in the case of already advanced coxarthrosis, there can be only one solution - endoprosthesis.Fortunately, this method can be used even in severe degenerative changes and fully restores the normal functioning of the hip joint.