Coxarthrosis affects the hip joints of middle-aged and older people. The causes of its development are previous injuries, congenital and acquired diseases of an inflammatory or non-inflammatory nature. The main symptoms of coxarthrosis are pain in the hip joint, morning swelling and stiffness in movement. At the initial stage of pathology, treatment is conservative. If it is ineffective against the background of rapid progression of coxarthrosis or late detection, surgical intervention, usually arthroplasty, is indicated.
Description of pathology
Coxarthrosis (osteoarthrosis, arthrosis deformans) is a degenerative-dystrophic pathology of the hip joint. In the early stages of development, the structure of the synovial fluid changes. It becomes viscous and thick and therefore loses its ability to nourish hyaline cartilage. Due to desiccation, its surface dries up and becomes covered with numerous radial cracks. In this condition, the hyaline cartilage does not absorb shock well when the bones that make up the joint come into contact.
To adapt to the increased pressure exerted on them, bone structures are deformed to form growths (osteophytes). The metabolism in the hip joint deteriorates, which has a negative effect on the muscles and the ligament-tendon system of the joint.
degrees
Each stage is characterized by its own symptoms, the severity of which depends on the degree of narrowing of the joint space and the number of bone growths formed.
| Severity of coxarthrosis | Characteristic symptoms and radiological signs |
|---|---|
| First | The joint space is narrowed unevenly and individual osteophytes have formed around the hip socket. Mild discomfort occurs, but more often the disease does not manifest itself clinically |
| Second | The joint space is narrowed almost twice, the femoral head is displaced, deformed, enlarged, and bone growths can also be found outside the cartilage lip. Hip pain becomes permanent and is accompanied by a significant limitation in mobility |
| Third | Complete or partial fusion of the joint space, multiple bone growths, expansion of the femoral head. The pain occurs day and night and spreads to the thighs and legs. Movement is only possible with the help of a cane or crutches |
Causes of the disease
Primary coxarthrosis is a destructive-degenerative damage to the hip joint, the causes of which are not clear. This means that no prerequisites for premature destruction of hyaline cartilage have been identified. The following pathological conditions can provoke secondary coxarthrosis:
- previous injuries – fracture of the femoral neck or pelvic bones, dislocation;
- hip dysplasia;
- aseptic necrosis of the femoral head;
- congenital hip dislocation;
- inflammatory, including infectious, diseases of the joint (rheumatoid, reactive arthritis, gout, tendinitis, bursitis, synovitis).
Prerequisites for the development of coxarthrosis are excess weight, increased physical activity, lack of exercise, metabolic disorders, hormonal disorders, kyphosis, scoliosis and flat feet.
Symptoms of the disease
In the early stages of development, coxarthrosis can only manifest itself with mild pain. They usually occur after intense physical exertion or a strenuous day at work. The person attributes the deterioration in health to muscle fatigue and does not seek medical help. This explains the frequent diagnosis of stage 2 or 3 coxarthrosis when conservative therapy is ineffective.
Restriction of joint mobility
The range of motion in the hip joint is limited due to the compensatory growth of bone tissue, damage to the synovial membrane, and replacement of areas of the joint capsule by fibrous tissue without any functional activity. Even with coxarthrosis grade 1, mobility can be somewhat limited. Difficulties arise when turning the leg.
As the disease progresses, morning stiffness and joint swelling often occur. To regain mobility, a person needs to warm up for several minutes. By lunchtime, the range of movement is restored, also through the production of hormone-like substances in the body.
Crunch
When walking, bending and (or) extending the hip joint, clicking, crunching and crackling sounds are clearly heard. The reason for this sound accompaniment of each step is the friction of bone surfaces, including osteophytes, against each other. Grinding can occur even in normal health due to the collapse of carbon dioxide bubbles in the joint cavity. Coxarthrosis is indicated by the combination with dull or stabbing pain.
pain
Already in stage 2 of coxarthrosis, the pain sensations become constant. Their severity decreases somewhat after a longer period of rest. The pain increases with the next relapse or the development of synovitis (inflammation of the lining of the joint), which is often accompanied by osteoarthritis. During the remission phase, the symptoms subside somewhat. But as soon as a person becomes hypothermic or lifts a heavy object, severe pain occurs again.
Muscle cramp
With coxarthrosis, there is increased tension in the skeletal muscles of the thigh for several reasons. First, the ligaments are weakened. The muscles spasm to hold the femoral head in the hip socket. Secondly, increased tone is often accompanied by inflammation of the synovial membrane. Thirdly, when osteophytes are displaced, nerve endings are compressed and muscle spasm becomes a compensatory response to acute pain.
Lameness
In the later stages of the development of coxarthrosis, the patient begins to limp severely. Gait changes are caused by flexion contractures and deformations of bone surfaces that make it impossible to maintain a straight leg position. The person also limps to reduce the severity of the pain by shifting their body weight to the unaffected limb.
Leg shortening
A shortening of the leg by 1 cm or more is typical for grade 3 coxarthrosis. The reasons for the shortening of the lower extremity are severe muscle loss, thinning and flattening of the cartilage, narrowing of the joint space and deformation of the femoral head.
Diagnostic methods
The initial diagnosis is made based on the patient's complaints, external examination, medical history and the results of a series of functional tests. Many inflammatory and non-inflammatory pathologies are disguised as symptoms of coxarthrosis, which is why instrumental and biochemical studies are carried out.
X-ray examination
The stage of coxarthrosis is determined by an X-ray examination. The resulting images clearly show destructive changes in the hip joint. This leads to a narrowing of the joint space, a deformation of the bone surfaces and the formation of osteophytes.
CT scan
Patients are prescribed a CT scan to determine the degree of flattening and deformation of the hyaline cartilage. The results of the study also make it possible to assess the condition of the ligament-tendon apparatus, nerve trunks, muscles, as well as small and large blood vessels.
Magnetic resonance imaging
MRI is one of the most informative examinations for diagnosing coxarthrosis. In order to detect circulatory disorders in the area of the affected joint, a contrast medium examination is carried out. A routine examination is prescribed to determine the degree of damage to the ligaments and deformation of the femoral head and to identify areas of fibrous degeneration of the joint capsule.
Leg length measurement
Before taking the measurement, the doctor asks the patient to stand up and stretch their legs as much as possible. To obtain the most reliable data, the orthopedist uses two bone landmarks. Above – the anterior axis of the pelvic bone, which is located on the anterior lateral surface of the abdomen at the outer edge of the inguinal ligament. The second reference point is any bone structure of the knee, ankle or heel. Leg length measurement may not be meaningful if coxarthrosis affects two hip joints at the same time.
Laboratory research
Clinical blood and urine tests are performed to assess the patient's general health. And the results of biochemical studies often make it possible to identify pathologies that caused the development of coxarthrosis. Gouty arthritis is indicated by high levels of uric acid and its salts. An increase in the erythrocyte sedimentation rate and an increase in the number of leukocytes indicate the occurrence of an inflammatory process (bursitis, arthritis, synovitis). To rule out rheumatoid arthritis, rheumatoid factor, C-reactive protein and antinuclear antibodies are determined.
Hip puncture
Joint fluid is collected through a puncture in order to examine its composition and determine changes in consistency. If an infectious-inflammatory process is suspected, further biochemical examination of a biological sample is indicated.
Treatment options
When determining the treatment tactics, the orthopedist takes into account the severity of the coxarthrosis, the form of its progression, the causes of its development and the severity of the symptoms. Patients are often recommended to wear bandages with rigid ribs and orthoses from the first days of treatment. The use of orthopedic devices helps slow down cartilage breakdown and bone deformation.
Medication
In the treatment of deforming arthrosis, drugs from various clinical and pharmacological groups are used. These are nonsteroidal anti-inflammatory drugs (NSAIDs), muscle relaxants, glucocorticosteroids, chondroprotectors, ointments and gels with a warming effect.
blockade
To relieve acute pain that cannot be eliminated by NSAIDs, intraarticular or periarticular drug blocks are prescribed. To carry it out, hormonal agents are used. The analgesic effect of glucocorticosteroids is enhanced when combined with anesthetics.
Injections
Intramuscular injection of NSAID solutions allows you to eliminate severe pain in the hip joint. To relax the skeletal muscles, a medication is usually used that contains both a muscle relaxant and an anesthetic. In the form of injections, therapy regimens include B vitamins, drugs to improve blood circulation and chondroprotectors.
Diet therapy
Obese patients are recommended to lose weight in order to slow down the spread of pathology to healthy joint structures. The calorie content of the daily menu should be limited to 2000 kilocalories by excluding high-fat foods and simple carbohydrates. Nutritionists recommend that all patients with coxarthrosis eat properly. The diet should contain fresh vegetables, fruits, berries, cereal porridge, fatty sea fish and dairy products. Following a therapeutic diet stimulates the strengthening of the immune system and improves overall health.
Movement therapy and massage
Classic massage, acupressure and vacuum massage are used in the treatment of coxarthrosis. After several sessions, blood circulation in the hip joint improves and nutrient reserves are replenished. Carrying out massage procedures stimulates the strengthening of the ligament-tendon apparatus and the restoration of soft tissues damaged by the displacement of osteophytes.
Regular exercise therapy is one of the most effective methods of treating osteoarthritis. An exercise complex is put together by a physiotherapist individually for the patient, taking into account their physical fitness.
physical therapy
Patients with coxarthrosis are prescribed up to 10 sessions of magnetic therapy, laser therapy, UHF therapy, UV irradiation and shock wave therapy. The therapeutic effect of the procedures is based on improved blood circulation, acceleration of metabolism and regeneration processes. To relieve acute pain, electrophoresis or ultraphonophoresis with glucocorticosteroids, anesthetics and B vitamins is performed. Applications with ozokerite or paraffin help eliminate discomfort.
Surgical intervention
If conservative treatment is ineffective, pain cannot be resolved with medication, or the coxarthrosis continues to progress, patients are recommended surgical intervention. For pathologies of the 3rd degree of severity, the operation is carried out immediately, since it is not possible to eliminate the resulting destructive changes in cartilage and bones by taking medications or exercise therapy.
Arthroplasty
The operation is performed under general anesthesia. The femoral head is removed from the hip socket. Visible destructive changes in the tissue are corrected - bone growths are removed, joint surfaces are leveled, dead tissue is excised. During the operation, cavities are created and filled with ceramic implants.
Endoprosthetics
Hip replacement with an implant is performed under general anesthesia. To prevent the development of an infectious process, a course of antibiotics is prescribed. After 10 days, the stitches are removed and the patient is discharged from the medical facility. During the rehabilitation period, patients are shown physiotherapeutic and massage procedures, as well as exercise therapy.
Possible consequences
In the final stage of pathology, flexion and adduction contractures develop. The patient's leg is constantly bent, so he uses a cane or crutches to move around. After the joint space has completely fused, immobility occurs, the patient can no longer do housework and becomes disabled. Coxarthrosis is often complicated by aseptic necrosis of the femoral head, arthrosis of the knee joints, and arthritis.
Prevention and prognosis
Only grade 1 coxarthrosis responds well to conservative treatment. In other cases, endoprosthetics allows full restoration of functional activity of the hip joint. After installing the endoprosthesis, the patient quickly returns to an active lifestyle.
To prevent the disease, orthopedists recommend quitting smoking, abusing alcoholic beverages, doing physical therapy and gymnastics daily, and losing excess weight if necessary.