Coxarthrosis is a common degenerative-dystrophic disease of the hip joint, in which age-related changes or other factors gradually destroy the femoral head joint and the pelvic acetabulum.It is accompanied by pain of varying severity depending on the stage of development and limited range of motion.If it is possible to overcome coxarthrosis using conservative methods in the initial stages, in the 3rd stage it is possible to save the condition and preserve the functionality of the hip joint, that is, to avoid disability, only with 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.However, 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, destruction of cartilaginous layers covering the head of the femur and acetabulum occurs, which leads to a decrease in the size of the joint cavity.As the disease progresses, deformation of the bone surfaces and the formation of bone growths called osteophytes occur on them.
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 probability of disability with coxarthrosis is significantly higher.
The entire hip joint is enclosed in a special joint called the joint capsule.It has a so-called synovial membrane that produces synovial fluid.This fluid is extremely important for the proper functioning of the joint, as it not only lubricates the hyaline cartilage, but also provides it with a source of nutrients.
Normally, cartilage is constantly worn out and regenerated immediately thanks to a continuous repair process carried out with the help of substances from the synovial fluid.However, 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 of synovial fluid produced and its composition.Under the influence of adverse factors, it thickens and is produced in less volume.As a result, the synovial fluid can no longer supply 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, the areas of separation of the fibers forming it, cracks are formed in it, and its thickness decreases.These changes can be observed during instrumental diagnostic methods, especially during 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 deteriorating hyaline cartilage.This leads to greater damage affecting the function of the joint and the condition of the person, because the deformed areas prevent the femoral head from sliding easily in the acetabulum.As a result, symptoms of coxarthrosis appear.
If left untreated, the pathological changes worsen and the hyaline cartilage wears out more and more.Later, it completely disappears in some areas, which leads to exposed bones and a sharp increase in the load on the joint.When moving inside the acetabulum, the head of the femur rubs directly against the bone, which causes severe pain and a sharp limitation of mobility.In this case, the pressure of bone structures on each other causes the formation of bone growths 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 and in the groin, hip and thigh.As a result, the patient keeps the injured leg, puts less load on it and tries not to make unnecessary movements with it.This leads to the development of muscle atrophy, which aggravates the impairment of mobility and ultimately leads to lameness.
Reasons
There are many reasons for the development of coxarthrosis, although it rarely occurs in the absence of any other condition.In this case, they talk about the presence of primary or idiopathic coxarthrosis.In most cases, secondary coxarthrosis is diagnosed, which is a logical result of a number of diseases or changes in the state of the musculoskeletal system.It can cause its development:
- various types of hip joint injuries, including fractures, sprains, bruises, sprains, or torn ligaments;
- hard physical labor, professional sports, especially weightlifting, parachuting, jumping sports;
- sedentary lifestyle;
- excess weight, which significantly increases the load on the hip joints;
- centers of chronic infection in the body;
- congenital anomalies of the hip joints, such as dysplasia or dislocation;
- metabolic pathologies and endocrine diseases, especially 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;
- spinal diseases;
- genetic predisposition;
- the presence of bad habits, especially smoking.
Nevertheless, the main cause of coxarthrosis is still 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 a gradual progression with a systematic increase in the intensity of symptoms.Therefore, it can be asymptomatic in the initial stages or only occasionally cause discomfort to patients, but later the condition of the hip joint worsens, which causes the severity of coxarthrosis symptoms to increase to unbearable pain and significantly limit mobility.
Thus, degenerative-dystrophic changes in the hip joint are accompanied by:
- Pain of varying intensity, which first appears after physical activity or walking and decreases after rest.Gradually, the severity of the pain syndrome increases, it appears more often, it lasts longer, and the periods between the appearance of pain from the moment the load is applied to the joint decrease.Later, the pain is almost constantly present, including at rest, and becomes unbearable.Intensification of pain is characteristic of hypothermia and lifting heavy objects at any stage of the disease.
- Limitations of the mobility of the hip joint, which initially manifest as minor difficulties in performing leg rotation movements.Over time, morning stiffness appears, disappears after the patient "disintegrates".This can be accompanied by the appearance of swelling in the hip joint.As the disease progresses, mobility limitations become more pronounced and persistent, that is, they do not go away after warming up.Patients notice a decrease in the amplitude of leg movements and subsequently completely lose the ability to perform certain movements.
- A crisis in the hip joint that appears when walking or doing physical work, especially when doing stretches.It is the result of friction between open bone structures, which is accompanied by a sharp increase in pain.
- Spasms of the thigh muscles cause the appearance of diffuse pain in the thigh.This can be the result 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 effusion in the hip joint cavity.
- Lameness caused by the unconscious desire of the patient to reduce the load on the diseased joint and transfer his weight to the healthy leg in order to avoid the appearance or intensification of pain, and then the development of muscle contracture.The latter phenomenon already occurs in the later stages of coxarthrosis and causes the patient to be unable to fully straighten the leg and, moreover, keep it in this position.Thus, with an affected hip joint, the lower limb is constantly slightly bent, which causes lameness.
- The decrease in leg length, which mainly occurs with severe degenerative-dystrophic changes in the femoral joint, is accompanied not only by the narrowing of the joint space, but also by flattening of the femoral head and muscle atrophy.As a result, the diseased leg is 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, 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.
Degrees of coxarthrosis
The nature of the manifestations of the disease depends on the stage of its development.In general, there are 3 degrees of coxarthrosis, the first of which is considered the lightest.In the initial stages 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, associate them with fatigue and consider them a normal age-related change.In this regard, coxarthrosis of the 1st degree is diagnosed only in isolated cases, which usually occurs during examination for another reason.
As the disease progresses, its symptoms intensify and they already feel themselves with 2nd degree coxarthrosis.This stage of the development of the pathology is characterized by a 50% narrowing of the joint space, as well as the appearance of signs of deformation of the femoral head with its displacement.
As the pathology progresses further, the joint space narrows and is almost completely absent in the 3rd degree of coxarthrosis.This is accompanied by the formation of many osteophytes.At this stage of the development of the disease, the pain is not only severe, but unbearable and often occurs in a state of complete rest, including at night.Since the hip joint is severely deformed, its elements can affect the nerves that pass through it, which causes pain that spreads to the groin, hips, and even the thigh and even the lower leg.It also leads to the inability to move independently without the use of assistive devices, such as crutches or a cane.
Grade 3 coxarthrosis is a direct indication for surgical treatment.If the operation is not performed in time, the head of the femur will be firmly attached to the surface of the acetabulum by osteophytes.This will lead to the shortening of the leg, the complete lack of ability to move independently, as it will completely lose joint mobility, that is, to disability.
Diagnostics
If symptoms of coxarthrosis occur, it is recommended to consult an orthopedist as soon as possible.First, the doctor will conduct an interview with the patient and find out the nature of the complaints, then he will continue to conduct an examination and functional tests, comparing the length of the legs.As a rule, the obtained information is enough to speak with a high degree of confidence about the presence of coxarthrosis.
Since a similar clinical picture can accompany a number of other diseases of the hip joints of both inflammatory and non-inflammatory nature, instrumental diagnostic methods are definitely prescribed.With their help, a specialist will be able to not only confirm the presence of coxarthrosis, distinguish it from radicular syndrome caused by spinal pathologies, but also correctly assess its degree of development and therefore choose the most effective treatment tactics.
Today, the following are used to diagnose coxarthrosis:
- X-ray of the hip joints - the obtained images allow to detect the signs of destructive changes, the presence of osteophytes, the nature of the deformation of the bone structures, and to measure the thickness of the joint space.
- CT is a more modern method for diagnosing bone pathologies, it provides clearer information than X-rays, but it is more expensive.Therefore, it is prescribed in controversial cases when it is necessary to clarify the CT diagnosis and the degree of destruction of the hip joint.
- MRI is a highly informative method for studying the joints, which provides maximum information about the condition of the joints and all its structures, especially the hyaline cartilage, ligaments and blood supply characteristics.
Patients are given a number of laboratory tests, including OAC, OAM, rheumatic tests, biochemical blood test, etc.
Conservative treatment of coxarthrosis
When 1 or 2 degree coxarthrosis is diagnosed, treatment is carried out by conservative methods.They are selected individually for each patient, taking into account the detected accompanying pathologies.Therefore, it may be necessary to refer not only to an orthopedist, but also to doctors of other specialties who will choose the necessary treatment to combat accompanying diseases.
As part of the treatment of coxarthrosis, patients are prescribed:
- drug treatment;
- exercise therapy;
- physiotherapy.
It is important for all patients to take measures to eliminate the influence 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 physical activity level if you are overweight.If the patient is regularly exposed to excessive physical activity, if the load is related to sports, it is recommended to change the type of activity or reduce the intensity of exercises.In some cases, it is recommended to use special bandages and orthoses that will straighten the hip joint and make it comfortable during physical activity.
Drug therapy
As part of drug treatment, drugs are selected individually for patients, taking into account existing concomitant diseases.As a rule, drugs of the following pharmacological groups are indicated for coxarthrosis:
- NSAIDs are a wide group of drugs with analgesic and anti-inflammatory effects (available in various dosage forms, including tablets, capsules, gels, creams, injection solutions, which allows choosing the most effective and convenient form of use);
- corticosteroids are drugs with 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, allow you to effectively fight muscle spasms, often observed with coxarthrosis;
- chondroprotectors - a group of drugs containing components used by the body to regenerate cartilage tissue;
- drugs that improve microcirculation - help to improve nutrition of soft tissues and activate metabolic processes in the affected area;
- B vitamins - indicated for nerve conduction disorders caused by compression of nerves by altered components of the hip joint.
If coxarthrosis causes an acute pain attack that cannot be relieved with prescribed NSAIDs, patients are recommended to undergo intra-articular or peri-articular blockade.Its essence is the injection of an anesthetic solution together with corticosteroids directly into the cavity of the hip joint.This will relieve pain in the shortest possible time and reduce the inflammatory process.But the blockade can be performed only by a qualified medical worker in a specially prepared room.It is not recommended to carry out such procedures at home.
Exercise therapy
When coxarthrosis is diagnosed, regular physical therapy exercises are required.Like drug therapy, it is selected individually for each patient, 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 intensity of pain;
- increase the mobility of the hip joint;
- reduce the risk of developing muscle atrophy;
- eliminate spasms of thigh muscles;
- activate blood circulation and thereby improve the nutrition of the affected joint.
All exercises should be performed smoothly, avoiding sudden movements and jerks.However, if pain occurs during exercise therapy, you should definitely contact your doctor to correct the selected complex or conduct a repeat diagnosis 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 an anti-inflammatory, analgesic, decongestant and tonic effect on the body.Therefore, patients are prescribed 10-15 procedures:
- ultrasound therapy;
- electrophoresis;
- UVT;
- magnetic therapy;
- laser therapy, etc.
Recently, plasmolifting is increasingly used as a part of conservative treatment of coxarthrosis, which can significantly increase the speed of recovery of hyaline cartilage.The essence of the procedure is the introduction of purified blood plasma obtained by centrifugation from the patient's own blood into the cavity of the hip joint.
Surgery for coxarthrosis
If a patient is diagnosed with coxarthrosis of the 3rd degree, he is indicated for surgical intervention, because in such cases conservative methods are no longer effective.Unfortunately, such cases are quite common today, as many patients turn to the doctor 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 ability to move normally, significantly improving the patient's quality of life.Here are the instructions for its implementation:
- a significant reduction in joint space of 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 treating 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.Endoprosthetics allow to completely restore the functionality of the hip joint, relieve pain and return a person to a fully active life.
The essence of such surgical intervention is the resection of the head of the femur and a small piece 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 that, an endoprosthesis of the selected type, which is fixed in a special cement (preferred for the treatment of elderly people) or without cement, is installed.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 endoprosthetic is selected individually for each patient.The most effective is the total endoprosthetic, 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 preserved normal hyaline cartilage on the surface of the acetabulum, he can undergo a partial arthroplasty by replacing only the femoral head and/or neck.For this purpose, endoprostheses of different designs are used: monopolar and bipolar.
The only disadvantage of endoprosthesis replacement is the need to replace the installed endoprosthesis after 15-30 years.
After endoprosthetics, patients are given rehabilitation, the duration of which depends on the speed of tissue regeneration.Exercise therapy, physiotherapy and therapeutic massage are prescribed as part of the recovery.
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 involves the fixation of bone structures of the hip joint with metal plates.As a result, the pain syndrome is completely eliminated, but the joint mobility is completely lost.So, after arthrodesis, the patient can only stand, but due to the lack of movement in the hip joint, he can no longer walk independently.Therefore, today arthrodesis is practically not performed.
Osteotomy consists of performing an artificial fracture of the femur with such a combination of bone fragments that will reduce the load on the affected femoral joint.But the operation gives only a short-term effect, and in the future there is still a need for endoprosthetics.
Thus, coxarthrosis of the hip joint is a very dangerous disease that can result in 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 consult an orthopedist in time, you can slow down its development and achieve a significant improvement in your well-being.But with already developed coxarthrosis, there can be only one solution - endoprosthetic.Fortunately, this method can be used even with severe degenerative changes and can completely restore the normal functioning of the hip joint.