Coxarthrosis of the hip joint, a complex pathology of arthrosis, leads to severe articulation changes.Unfortunately, mature disability with loss of working capacity is common.In fact, statistics on diseases of the hip joint account for almost half of all pathologies of the musculoskeletal system.I will give an example from the life of a 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 the loss of joint functions.
Coxarthrosis - here the hip joints are destroyed, practically this is the same arthrosis.
In terms of mechanism, the articulation of the hip with the pelvis is similar to door hinges.The head of the femur is hinged to the ischium.Which has a special anatomical formation - the acetabulum.This structure ensures maximum joint mobility.Which performs a full cycle of motion, or rather bending, stretching, rotating, etc.
Normally, the joint surfaces are smooth, and there is enough fluid inside to ensure unhindered gliding.With the development of the disease, the lubricant becomes thicker and more viscous, which immediately affects the condition of the cartilage.The synovial fluid no longer fully performs its functions.This causes the shock absorber pads to dry out, crack and become rough.
- First.Due to the lack of the necessary sliding, the friction of the bones increases, causing damage.
- Second time.As this progresses, the deformation of the bone surfaces also joins the changed cartilage tissue.This is how the body tries to compensate for the increased load.
- Third time.The increased load leads to complete atrophy of the thigh muscles and weakness of the ligaments.
Important: arthrosis of the hip joint is a progressive disease.The changes can lead to a person's complete loss of physical activity.It ultimately leads to disability.And completely disrupting the usual way of life.The disease and its treatment are not only extremely significant from a medical point of view, but also a major social problem.
Causes and types of coxarthrosis
At least there is no exact cause of coxarthrosis, which destroys the hip joint.There are only assumptions.Most cases of the development of pathology of the hip joint are related to congenital dislocation of the hip and dysplasia (inferiority) of the joint.
Therefore, coxarthrosis has 2 types;
- primary (arising from unknown etiology);
- secondary (related to injuries, diseases).
Primary osteoarthritis is characterized by a combination of the following factors:
- heredity;
- effect of biological and mechanical processes;
- overweight;
- metabolic disorders;
- There is also a theory of abnormal tissue repair that responds to damaging agents (inflammation, friction, infection).
This type of coxarthrosis is often 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.These are:
- Dysplastic disorders.Dysplastic coxarthrosis of the 1st degree of the hip joint occurs in half of the cases of congenital pathology.
- Hip dislocation (congenital).
- Life traumas.Pelvic fracture, femoral neck, dislocations, subluxations.
- Legg-Calvé-Perthes disease.Osteochondropathy of the femoral head with the development of necrosis.This disease occurs in children when the blood supply and nutrition of the joint is damaged.
In addition, the pathology can affect both formations at the same time or be unilateral.In addition to the direct causes of the occurrence, there are predisposing factors that provoke the development of the disease.Often, the disease occurs with an increased load on the limbs of athletes.As well as people with difficult physical working conditions.Being overweight significantly increases the likelihood of arthrosis.
Provocative factors also include:
- Disruption of metabolic processes, joint nutrition, hormonal imbalance.
- Lack of vitality.
- Bad posture.Especially scoliosis, kyphosis, which lead to displacement of the pelvic bones.
- Age after 40 years.According to estimates, after this date, every 10th patient will be diagnosed with grade 1, 2 coxarthrosis of the hip joint.After the age of 60, it can be observed in every third person.And when they reach the age of 70, nearly 80% of applicants suffer from this pathology.
There is no specific gene that is responsible for the transmission of pathological changes in the joints.However, the hereditary factor can still be traced.A person can get structural features of cartilage tissue, altered metabolism and skeletal pathology from relatives.The combination of such genetic information can trigger the appearance of hip arthrosis.
Classification
The main division of the disease is based on severity.It has 3 stages, which differ not only in the symptoms, but also in the changes visible on the X-ray.These indicators are used as a basis for making a diagnosis.
Degree |
Signs |
|---|---|
I |
|
II |
|
III |
|
This division is the most common.There are also Kellgren classifications.It consists of 4 stages, plus zero degrees - which corresponds to a healthy joint.
Symptoms
The basis of all diseases of the musculoskeletal system is pain.The symptoms of 1-2 degree coxarthrosis of the hip joint are less pronounced than in the 3rd terminal stage.Initially, the pain occurs during exercise.Especially after long walks or climbing stairs.Later, the pain becomes a constant companion, significantly impairing the quality of life.
Coxarthrosis 1st degree
Unpleasant sensations are concentrated only in the joint area (the groin and buttocks are practically not affected), they are rarely reflected in the hips or knees.The pain eases with 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, mobility increases due to changes in the connective tissue;often in the early stages of the disease, due to increased flexibility, patients become interested in gymnastics and yoga.Movement problems only appear in stage 3.
In case of symptoms of stage 1 coxarthrosis of the hip joint, the treatment can be performed without surgery.Rational therapy makes it possible to eliminate unpleasant symptoms and stop the progression.
2nd degree disease
The pain, although not constant, manifests itself at rest.Irradiation becomes noticeable - hips, groin, knees.Stiffness is observed - movements are limited when lifting, attempts to pull to the side, difficulty in circular movements of the leg (the pain is especially often increased).Lameness becomes noticeable, which occurs after intensive walking or running.
During movement, a typical arthrosis crunch can be heard - rough, dry.
3 degree osteoarthritis
The pain becomes constant and does not go away after rest and sleep.Unpleasant sensations do not leave the patient even at night.There are problems with walking;a stick must be used to facilitate movement.The lameness is permanent.
At this stage, the muscles of the limb atrophy and the leg itself is shortened.These changes force the patient to bend to the affected side, further increasing the load on the joint.Restriction of mobility can be observed in almost all directions.
Changes in bilateral coxarthrosis of the hip joint change the patient's gait, therefore all formations involved in the gait process suffer.Lower back pain occurs, posture is disturbed, the axial position of the pelvis changes.
Diagnostics
An orthopedic surgeon's examination and a thorough analysis of complaints play an important role in diagnosing the disease.It is worth assessing the patient's activity - his ability to climb stairs, comfort when putting on boots and socks, walking activity, use of a cane.
We recommend checking the general condition - blood test, urinalysis, biochemistry, EKG, HIV markers and determination of syphilis.
1st degree coxarthrosis of the hip joint has the most subtle symptoms.That is why it is worth performing an X-ray examination in order to illustrate the changes that have occurred in the joint space.This method allows not only to identify the disease.And often find out the reason for its occurrence - dysplasia, Perthes disease.
Knee pain is often much more pronounced with deforming coxarthrosis of the 1st degree of the hip joint, so it must be distinguished from gonarthrosis.Differential diagnosis includes examination of the spine to rule out radicular syndrome (causes radiating pain in the hip and knee).
In doubtful cases, MRI (allows a detailed examination of soft tissues) and CT (to review bone formations) are used.
Treatment
The disease cannot be completely cured, but modern medicine can restore the lost mobility, allowing a full life.
Physiotherapy and the use of drugs are effective in stages 1-2 of the disease.In the terminal stage, only surgery helps.In another case, surgery is performed if the applied conservative therapeutic methods do not bring relief.
Treatment 1st degree
Unfortunately, the complete elimination of pathology is impossible.In stage 1, the treatment is aimed at stabilizing the condition.
Several general recommendations should be followed during therapy:
- Normalization of physical activity - it is recommended to reduce excessive stress (long hikes, running, jumping).
- Use shoes with good shock-absorbing soles and special insoles.
- Weight loss.
- Mandatory physical therapy.
Important: many patients completely refuse gymnastics and any exercise because of the pain.This is often related to the fear of increased pain and the possibility of worsening the situation.Practice proves that this opinion is wrong - regular exercise strengthens muscles, protects them from atrophy, reduces pain and improves joint function.
The diet for coxarthrosis of the 1st degree of the hip joint is not prescribed;a moderate diet is prescribed for weight loss.It is also useful to add products containing gelatin, canned fish with bones and dairy products to the diet.
conservative
Nonsteroidal anti-inflammatory drugs are used as a medical method.Due to the large number of side effects, it is recommended to take medicines in case of severe pain.Their use can be combined with gastroprotectors.
Persistent pain is alleviated with intra-articular steroid injections, and pain-relieving blockades are also available.
The following are required for support:
- Muscle relaxants - relieve tension, reduce pain in the legs.
- Chondroprotectors - improve cartilage tissue repair.
- Vasodilators (nicotinic acid) - help relieve vasospasm and increase tissue microcirculation.
Warming 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
In stage 3, in order to restore freedom of movement and relieve intense pain, the patient must be prepared for a planned endoprosthetic surgery.This is a special operation to replace a dead formation with an artificial one.The interventions fully restore the patient's motor skills.It helps you fully return to your normal lifestyle.
Depending on the extent 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 in order for the patient to return to active life as quickly as possible.
For patients over 60 years of age, the rehabilitation period is determined before the surgical treatment, so the recovery process takes place in a shorter 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.
- Avoid heavy lifting.
- Avoid excessive exposure to static strain (this is especially true for those who do standing work).
Life event
My friend's husband required surgical treatment for an endoprosthesis.He was not diagnosed with coxarthrosis, but the lumbar hernia was successfully removed.The condition did not improve, the examination continued, and finally, after it became clear what was wrong, he was sent for surgery within the quota.
After the replacement, everything grew back intact, but the second hip joint also required surgery.A year later, the quota for the operation was again available, which was successful.Then, from the first minutes after anesthesia, rehabilitation and strict adherence to the doctor's recommendations are required.
And what about our friend?Already after the hospital, I started to use the joint of the prosthesis (sitting for a long time, stepping on my feet) on the way home.I forgot how careful I was at first.Because of this, 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, plastered it, and then everything seemed to be fine.But he complains that he cannot move his leg to the side, it hurts, and he feels discomfort when walking.Although he performs exercises and various exercises to develop both joints, it is also a desire to work and move independently.
Prevention
We discussed the symptoms and treatment of coxarthrosis of the hip joint, as well as their stages.
- Only daily exercise will help you avoid serious complications and live to a ripe old age without crutches.In Soviet times, serious work was done to prevent musculoskeletal diseases and strengthen the immune system.Today it is difficult to restore the lost experience, it is clear with the mind, but lazy to do it.
- Being overweight wears out the joints to shame;the endoprosthesis is better, but it does not lose extra pounds.My friend is sure of this, without trying to eat less sweets and starchy foods.Proper nutrition is a very important aspect.
- I consider weight lifting no less bad for the entire skeleton.
- Bad habits (alcohol, smoking) remove calcium, magnesium and other useful substances from the body.
Just dig, it's all connected.
Take care of yourself and your joints with daily exercises!