Coxarthrosis of the hip joint, a complex pathology of arthrosis, leads to serious changes in the articulation.Unfortunately, the disability of mature people with loss of working ability is common.In fact, statistics on diseases of the hip joints account for almost half of all pathologies of the musculoskeletal system.I will give an example from the life of one case after surgical treatment and a rare complication during rehabilitation.
Coxarthrosis of the hip joint: a little about the disease
Osteoarthritis is a degenerative-dystrophic change that contributes to the complete destruction of cartilage with loss of joint function.
Coxarthrosis - here the hip joints are destroyed, practically, it is the same arthrosis.
In its mechanism, the articulation of the hip with the pelvis is similar to the hinges of the neck.The head of the femur is connected to the ischium like a hinge.Which has a special anatomical formation - the acetabulum.This structure ensures maximum joint mobility.Which performs a full cycle of movement, i.e. flexion, extension, rotation, etc.
Normally, the joint surfaces are smooth, there is enough fluid inside, which ensures smooth gliding.As the disease develops, the lubricant becomes thicker and more viscous, which immediately affects the condition of the cartilage.The synovial fluid no longer performs its functions fully.This causes shock absorbing pads to dry out, crack and become rough.
- First.As a result of the lack of the necessary gliding, the friction of the bones increases, injuring them.
- Second.As it progresses, the changed cartilage tissue is joined by the deformation of the bone surfaces.In this way, the body tries to compensate for the increased load.
- Third.Increased load leads to complete atrophy of femoral muscles and weakness of ligaments.
Important: hip osteoarthritis is a progressive disease.The changes can lead to a complete loss of a person's physical activity.It eventually leads to disability.And they completely disrupt the usual way of life.The disease and its treatment are extremely significant not only from a medical point of view, but also a major social problem.
Causes of the development of coxarthrosis and its types
At least there is no exact cause of coxarthrosis, which destroys the hip joint.There are only assumptions.Most cases of the development of hip joint pathology are associated with congenital dislocation of the hip and dysplasia (inferiority) of the joint.
So, there are 2 types of coxarthrosis;
- primary (arising from an unknown etiology);
- secondary (related to injuries, diseases).
Primary osteoarthritis is characterized by a combination of factors:
- heredity;
- influence of biological, mechanical processes;
- excess weight;
- metabolic disorders;
- There is also a theory of pathological tissue restoration as a response to harmful agents (inflammation, friction, infection).
Often this type of coxarthrosis is combined with damage to the spine and inflammatory phenomena of the knee joints (arthritis, arthrosis).
In the secondary version, the reasons for the development are clearer.This includes:
- Dysplastic disorders.Dysplastic coxarthrosis of the hip joint of the 1st degree occurs in half of all cases of congenital pathology.
- Hip dislocation (congenital).
- Life traumas.Fractures of the pelvis, neck of the femur, dislocations, subluxations.
- Legg-Calvé-Perthes disease.Osteochondropathy of the femoral head with the development of its necrosis.This disease occurs in children when the blood supply and nutrition of the joint is disturbed.
In addition, the pathology can affect both formations at once or be unilateral.In addition to the direct causes, there are predisposing factors that provoke the development of the disease.Often the disease occurs with increased load on the limbs of athletes.As well as people with difficult physical working conditions.Being overweight significantly increases the likelihood of arthrosis.
Precipitating factors also include:
- Disorder of metabolic processes, joint nutrition, hormonal imbalance.
- Adynamia.
- Bad posture.Especially scoliosis, kyphosis, which lead to misalignment of the pelvic bones.
- Age after 40 years.It is estimated that after this date every 10th patient is diagnosed with coxarthrosis of the hip joint, grade 1, 2. After the age of 60, every third person is already under observation.And when they reach the age of 70 or more, almost 80% of those registered suffer from this pathology.
There is no specific gene that is responsible for the transmission of pathological changes in the joints.However, a hereditary factor can still be traced.A person can get structural characteristics of cartilage tissue, altered metabolism and skeletal pathology from relatives.The combination of such genetic information can cause hip arthrosis.
Classification
The main division of the disease is based on severity.There are 3 stages, which differ not only in symptoms, but also in X-ray changes.It is these indicators that are taken as the basis for making a diagnosis.
Degree |
Signs |
|---|---|
I |
|
II |
|
III |
|
This division is the most common.There are also types of Kellgren classifications.It includes 4 stages, plus zero stage - which is the equivalent of a healthy joint.
Symptoms
The basis of all diseases of the musculoskeletal system is pain.Coxarthrosis of the hip joint of degree 1-2 has less pronounced symptoms than in terminal stage 3. Initially, the pain manifests itself during exercise.Especially after long walks or climbing stairs.Later, pain becomes a constant companion, significantly worsening the quality of life.
Coxarthrosis of the 1st degree
Unpleasant sensations are concentrated only in the joint area (the groin and buttocks are practically not affected), they rarely affect the hip or knee.The pain is relieved by rest.
At this stage, no further manifestations are detected - the gait remains unchanged, there are no disturbances in movements.In the dysplastic variant, on the contrary, there is an increase in mobility due to changes in the connective tissue;often in the initial stages of the disease, due to increased flexibility, patients become interested in gymnastics and yoga.Movement problems occur only in the 3rd phase.
For symptoms of coxarthrosis of the hip joint in stage 1, treatment can be carried out without surgery.Rational therapy allows you to remove unpleasant symptoms, stop the progression.
2nd degree of the disease
The pain, although not constant, manifests itself at rest.Irradiation becomes noticeable - hip, groin, knee.Stiffness is noticed - movements are limited in lifting, attempting to abduct to the side, difficult circular movement of the leg (pain especially often increases).Lameness becomes noticeable, which occurs after intensive walking or running.
When moving, the characteristic creaking of arthrosis is heard - rough, dry.
Osteoarthritis 3 degrees
The pain becomes constant and does not disappear after rest and sleep.Unpleasant sensations do not leave the patient even at night.There are problems with walking;to facilitate movement, you must use a stick.The lameness is constant.
In this phase, limb muscle atrophy occurs, and the leg itself is shortened.These changes force the patient to bend to the affected side, further increasing the load on the joint.Limitation of mobility is observed in almost all directions.
Changes in bilateral coxarthrosis of the hip joint change the patient's gait, as a result of which all formations involved in the walking process suffer.Pain appears in the lower back, body posture is disturbed, the axial position of the pelvis changes.
Diagnostics
An important role in determining the disease is played by an orthopedist's examination, as well as a detailed analysis of complaints.It is worth assessing the patient's activity - ability to climb stairs, comfort when putting on boots and socks, walking activity, use of a cane.
It is recommended to check the general condition - analysis of blood, urine, biochemistry, EKG, determination of HIV markers and syphilis.
Coxarthrosis of the hip joint of the 1st degree has the most subtle symptoms.That's why it's worth doing an X-ray to visualize changes in the joint space.This method allows not only the identification of diseases.And often find out the cause of the appearance - dysplasia, Perthes disease.
Often, the pain in the knee is much more pronounced in deforming coxarthrosis of the hip joint of the 1st degree, so it should be distinguished from gonarthrosis.The differential diagnosis includes a spinal examination to rule out radicular syndrome (radiating pain to the hip and knee).
In suspicious cases, MRI (allows you to examine soft tissues in detail) and CT (to examine bone formations) are used.
Treatment
The disease cannot be completely cured, but modern medicine can restore the lost ability to move, allowing you to live a full life.
The use of physiotherapy and drugs is effective for 1-2 degree disease.In the terminal stage, only surgery helps.In the second case, surgery is performed if conservative methods of therapy do not bring relief.
1st degree treatment
Unfortunately, it is impossible to completely eliminate the pathology.In stage 1, treatment is aimed at stabilizing the condition.
During the therapy, it is necessary to adhere to a number of general recommendations:
- Normalization of physical activity - reduction of excessive stress (long walks, running, jumping) is recommended.
- Use shoes with good shock-absorbing soles and special insoles.
- Weight loss.
- Mandatory physical therapy.
Important: many patients completely refuse gymnastics and any exercise due to pain.This is often associated with the fear of increased pain and the possibility of worsening the situation.Practice proves that this opinion is wrong - regular exercise therapy helps strengthen muscles, protects them from atrophy, reduces pain and improves joint function.
A diet for coxarthrosis of the hip joint of the 1st degree is not prescribed;a moderate diet is prescribed for weight loss.It is useful to add products with gelatin, canned fish with bones and dairy products to the diet.
Conservative
As a medical method, non-steroidal anti-inflammatory drugs are used.Due to the large number of side effects, it is recommended to take medication for intense pain.You can combine their use with gastroprotectors.
Persistent pain is relieved by intra-articular steroid injections, and pain relief blocks are also possible.
The following is prescribed for support:
- Muscle relaxants – relieve tension, reduce pain in the leg.
- Chondroprotectors – improve cartilage tissue regeneration.
- Vasodilators (nicotinic acid) - help relieve vascular spasm and increase tissue microcirculation.
Heating compresses are also used in combination (you can also use traditional treatment methods).They do not provide a therapeutic effect, but they help relieve muscle spasms.
Be sure to use physiotherapy - UHF, magnetotherapy, induction currents, massage.
Hip replacement surgery
To restore freedom of movement in stage 3 and relieve intense pain, the patient is being prepared for a planned endoprosthetic operation.This is a special operation to replace a destroyed formation with an artificial one.Interventions fully restore the patient's motor skills.It helps you fully return to your normal lifestyle.
Depending on the scope of the process, the prosthesis can be unipolar (only the worn head of the femur is replaced) or bipolar (the surface of the acetabulum is also changed).After surgery, rehabilitation is mandatory so that the patient can return to an active life as soon as possible.
For patients older than 60 years, the rehabilitation period is established even before surgical treatment, so that the recovery process takes place in a shorter period of time.The lifespan of an artificial joint is about 20 years, but it is important to follow the recommendations:
- Exclusion of running, long walking, jumping.
- Avoiding heavy lifting.
- Avoid excessive exposure to a forced static position (this is especially true for people who work in a standing position).
A life incident
My friend's husband required surgical treatment of endoprosthetics.He was not diagnosed with coxarthrosis, but his lumbar hernia was successfully removed.The condition did not improve, the examination continued, and finally, after they discovered what was wrong, they sent me for the quota operation.
After the replacement, everything certainly grew, but the other hip joint also required surgical intervention.A year later the quota for the operation was successful again.And then, from the first minutes after anesthesia, rehabilitation and strict adherence to the doctor's recommendations are required.
And what about our friend?Already on the way home after the hospital, I began to stress the prosthetic joint (sitting for a long time, stepping on my foot).I forgot how careful I was the first time.As a result, the ligaments and muscles that did not have time to adapt to the implant could not hold it and it popped out.
Of course, they put it in, put a plaster on it, and then everything seemed to fall out.Ali complains that she cannot move her leg to the side, it hurts and she feels discomfort when walking.Although he does exercises and various exercises for the development of both joints, it is also work and a desire for independent movement.
Prevention
We talked about the symptoms and treatment of coxarthrosis in the hip joints, as well as their stages.
- Only daily physical activity will help you avoid serious complications and live to a very old age without crutches.In Soviet times, serious work was done to prevent diseases of the musculoskeletal system and strengthen the immune system.Today it is difficult to restore the lost experience, the mind is clear about it, but it is too lazy for that.
- Excess weight wears out the joints to shame;endoprosthetics is better, but does not lose excess weight.My friend is sure of it, she doesn't even try to eat less sweets and starchy foods.Proper nutrition is a very important point.
- I believe that lifting weights is no less bad for the entire skeleton.
- Bad habits (alcohol, smoking) remove calcium, magnesium and other useful substances from the body.
Dig it, everything is interconnected.
Take care of yourself and your joints by exercising every day!