Coxarthrosis of the hip joint, a complex pathology of arthrosis, leads to serious changes in the joints.Unfortunately, disability of mature people with loss of ability to work is common.In fact, statistics on hip joint disease 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, this is the same arthrosis.
In terms of its mechanism, the articulation of the hip with the pelvis is similar to door hinges.The head of the femur is connected to the ischium like a hinge.Which has a special anatomical formation - the acetabulum.This structure provides maximum mobility of the joint.Which performs a full cycle of movements, or rather flexion, extension, rotation, etc.
Usually, the joint surfaces are smooth, there is enough fluid inside, which ensures unhindered sliding.As the disease progresses, the lubricant becomes thicker and more viscous, which immediately affects the condition of the cartilage.The synovial fluid no longer performs its functions completely.Because of this, shock-absorbing pads dry out, become cracked, and become rough.
- Firstly.As a result of the lack of necessary sliding, the friction of the bones increases, injuring them.
- Secondly.As it progresses, deformation of the bone surfaces also joins the altered cartilage tissue.The body thus tries to compensate for the increased load.
- Thirdly.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.Changes can lead to a person's complete loss of physical activity.It eventually leads to disability.And it completely disrupts the usual way of life.The disease and its treatment are extremely significant not only from a medical point of view, but are also a major social problem.
Reasons for 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 developing hip pathology are associated with congenital dislocation of the hip joint and dysplasia (insufficiency) of the joint.
Therefore, 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;
- overweight;
- metabolic disorders;
- There is also a theory of pathological tissue repair in response to damaging 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 variant, the reasons for development are clearer.These include:
- 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, luxations, 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 are disturbed.
In addition, the pathology can affect both formations at once 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 increased loads on the limbs of athletes.As well as people with difficult physical working conditions.Being overweight significantly increases the likelihood of osteoarthritis.
Provocative factors also include:
- Disruption of metabolic processes, joint nutrition, hormonal imbalance.
- adynamia.
- Bad posture.Especially scoliosis, kyphosis, which lead to displacement of the pelvic bones.
- Age after 40 years.It is estimated that after this date every 10 patients were diagnosed with coxarthrosis of the hip joint 1, 2 degree.After 60, every third person is already observed.And when they turn 70 and over, almost 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.One can acquire from relatives the structural characteristics of cartilage tissue, altered metabolism and skeletal pathology.It is the combination of such genetic information that can provoke the appearance of 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 - the equivalent of a healthy joint.
Symptoms
The basis of all diseases of the musculoskeletal system is pain.Coxarthrosis of the hip joint of 1-2 degrees has symptoms less pronounced than in terminal stage 3. Initially, the pain appears during exercise.Especially after long walks or climbing stairs.Later, pain becomes a constant companion, which significantly worsens the quality of life.
Coxarthrosis 1 degree
Unpleasant sensations are concentrated only in the area of the joint (groins and buttocks are practically not affected), they are rarely reflected in the thigh or knee.The pain is relieved by rest.
At this stage, no additional manifestations are detected - the gait remains unchanged, there are no movement disorders.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 are interested in gymnastics and yoga.Movement problems occur only in stage 3.
With symptoms of stage 1 coxarthrosis of the hip joint, treatment can be carried out without surgery.Rational therapy allows you to eliminate unpleasant symptoms, stopping the progression.
2nd degree of disease
The pain, although not constant, occurs at rest.Irradiation becomes noticeable - thigh, groin, knee.Stiffness is observed - movements are limited when lifting, attempts to abduct to the side, difficulty in circular movements of the leg (especially often the pain increases).A lameness that appears after intense walking or running becomes noticeable.
When moving, a characteristic arthritic crunch is 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.Has trouble walking;to facilitate movement, you must use a cane.The lameness is permanent.
At this stage, atrophy of the muscles of the limb occurs and the leg itself is shortened.These changes force the patient to bend to the affected side, which further increases the load on the joint.There is a limitation of mobility in almost all directions.
Changes in bilateral coxarthrosis of the hip joint change the patient's gait, due to which all formations involved in the walking process suffer.Pain appears in the lower back, the posture is disturbed, the axial position of the pelvis changes.
Diagnosis
An important role in determining the disease is played by an examination by an orthopedic surgeon, as well as a thorough analysis of complaints.It is worth assessing the patient's activity - the ability to climb stairs, comfort when wearing boots and socks, activity when walking, use of a cane.
It is recommended to check the general condition - blood test, urine test, biochemistry, ECG, determination of HIV markers and syphilis.
Coxarthrosis of the hip joint of the 1st degree has the weakest symptoms.That is why it is worthwhile to carry out an X-ray examination to visualize the changes in the joint space.This method allows not only to identify the disease.And they also often find the cause of the appearance - dysplasia, Perthes disease.
Often, knee pain is much more pronounced with deforming coxarthrosis of the hip joint of the 1st degree, so it must be distinguished from gonarthrosis.The differential diagnosis also includes examination of the spine to rule out radicular syndrome (it gives radiating pain in the hip and knee).
In doubtful cases, MRI (allows you to examine soft tissues in detail) and CT (to examine bone formations) are used.
Treatment
The disease cannot be cured completely, 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 degrees of the disease.In the terminal stage, only surgery helps.In another case, surgery is performed if the conservative therapeutic methods used do not bring relief.
Treatment 1st degree
Unfortunately, it is impossible to completely eliminate the pathology.At 1 degree, the treatment is aimed at stabilizing the condition.
A number of general recommendations should be followed during therapy:
- Normalization of physical activity - it is recommended to reduce excessive stress (long walks, running, jumping).
- Use shoes with good shock-absorbing soles and special insoles.
- Weight loss.
- Compulsory physiotherapy.
Important: many patients completely refuse gymnastics and any exercise due to pain.This is often associated with fear of increasing 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.
Diet for coxarthrosis of the hip joint 1 degree is not prescribed;for weight loss, a moderate diet is prescribed.It is also useful to add products with gelatin, canned fish with bones and dairy products to your diet.
Conservative
As a medicinal method, non-steroidal anti-inflammatory drugs are used.Due to the large number of side effects, it is recommended to take drugs for severe pain.You can combine their use with gastroprotectors.
Stubborn pain is alleviated with intra-articular steroid injections, pain-relieving blocks are also possible.
The following is prescribed for support:
- Muscle relaxants – relieve tension, reduce leg pain.
- Chondroprotectors – improve cartilage tissue recovery.
- Vasodilators (nicotinic acid) - help relieve vascular spasm and also increase tissue microcirculation.
Warming compresses are also used in combination (you can also use traditional methods of treatment).They do not provide a therapeutic effect, but help relieve muscle spasms.
Do not forget to use physiotherapy - UHF, magnetotherapy, induction currents, massage.
Hip replacement surgery
To restore freedom of movement in stage 3 and relieve severe pain, the patient is being prepared for a planned arthroplasty.This is a special operation to replace a destroyed entity with an artificial one.Interventions fully restore the patient's motor abilities.It helps you fully return to your normal lifestyle.
Depending on the degree 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 replaced).After the operation, rehabilitation is mandatory in order for the patient to return to an active life as quickly as possible.
For patients over 60 years of age, the rehabilitation period is established even before surgical treatment, so the recovery process takes place in a shorter period of time.The lifespan of the artificial joint is about 20 years, but it is important to follow the recommendations:
- Excluding running, long walking, jumping.
- Avoiding heavy lifting.
- Avoid excessive exposure to a forced static position (this is especially true for people who work in an upright position).
A life event
My friend's husband needed surgical treatment for an arthroplasty.He was not diagnosed with coxarthrosis, but with a successfully removed lumbar hernia.The condition did not improve, the examinations continued, and finally, when they realized what was wrong, they sent me for a quota operation.
After the replacement, everything grew successfully, but the second hip joint also required surgery.A year later it was again the quota for the operation, which was successful.And then, from the first minutes after anesthesia, rehabilitation and strict adherence to the doctor's recommendations are necessary.
And what about our friend?Already on the way home from the hospital, I began to stress the prosthetic joint (prolonged sitting, stepping on the foot).I forgot how careful I was the first time.As a result, the ligaments and muscles, which did not have time to adapt to the implant, could not hold it, and it popped out.
Sure enough, 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 does exercises and various exercises for the development of both joints, it is also work and a desire for independent movement.
Prevention
We discussed the symptoms and treatment of coxarthrosis of the hip joints, as well as their stages.
- Only daily physical 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 diseases of the musculoskeletal system and strengthen the immune system.Nowadays it is difficult to recover the lost experience, it is clear with the mind, but it is too lazy to do it.
- Excess weight wears out the joints to the point of obscenity;arthroplasty is better, but not weight loss.My friend is sure of it without even trying to eat less sweets and starchy foods.Proper nutrition is a very important point.
- I believe that lifting weights is no less evil for the entire skeleton.
- Bad habits (alcohol, smoking) remove calcium, magnesium and other useful substances from the body.
Just dig, it's all interconnected.
Take care of yourself and your joints by exercising every day!