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 and limitation of the amplitude of movements of different severity depending on the stage of development. If it is possible to overcome coxarthrosis with conservative methods in the initial stages, in the 3rd stage it is possible to save the situation and preserve the working ability of the hip joint, that is, to avoid disability, by performing only one operation. operation.
It refers to the number of 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 in which the cartilaginous layers surrounding the femoral head and acetabulum are destroyed, which leads to a decrease in the size of the joint cavity. As the disease progresses, deformation of the bone surfaces and formation of bone growths called osteophytes are observed.
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. Nevertheless, the probability of disability in coxarthrosis is significantly higher.
The entire hip joint is closed in a special case called the articular capsule. It has a so-called synovial membrane that produces synovial fluid. This fluid is important for the proper functioning of the joint, as it not only lubricates the hyaline cartilage, but is also its source of nutrients.
Normally, cartilage is constantly worn out and regenerated immediately due to a continuous regeneration 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 due to changes in the amount of synovial fluid produced and its composition. Under the influence of negative factors, it thickens and is produced in smaller volumes. As a result, the synovial fluid can no longer supply the hyaline cartilage with all the necessary substances, which causes it to quickly become dehydrated and thin. Gradually, the strength and elasticity of the cartilage decreases, the areas of delamination of the fibers forming it, cracks are formed in it, and its thickness decreases. These changes can be observed during instrumental diagnostic methods, especially the narrowing of the joint space is noticeable.
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 more damage affecting the function of the joint and the position of the person, because the deformed areas prevent the femoral head from sliding easily in the acetabulum. As a result, there are symptoms of coxarthrosis.
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 the exposure of 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 leads to the appearance of 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 stress on it and tries not to make unnecessary movements with it. This leads to the development of muscle atrophy, which exacerbates mobility disorders and ultimately leads to lameness.
Reasons
There are many reasons for the development of coxarthrosis, although it rarely occurs against the background of the absence of any 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. This can be caused by:
- hip joint injuries of various nature, including fractures, dislocations, bruises, sprains or torn ligaments;
- heavy physical labor, professional sports, especially weightlifting, parachuting, jumping sports;
- sedentary lifestyle;
- being overweight, which significantly increases the load on the hip joints;
- centers of chronic infection in the body;
- congenital defects 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 diseases of the joints, including rheumatoid arthritis, bursitis, tendinitis;
- diseases of the spine;
- 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 significant limitation of mobility. .
Thus, degenerative-dystrophic changes in the hip joint are accompanied by:
- Pain of varying strength, first appears after physical exertion 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 moment of application of the load on the joint and the appearance of pain decrease. Later, the pain is almost constantly present, including at rest, and becomes unbearable. An increase in pain at any stage of the disease is characteristic during hypothermia and lifting heavy objects.
- Limitations in the mobility of the hip joint, which are initially manifested by small difficulties in performing rotational movements of the leg. Over time, morning stiffness appears, disappears after the patient "disintegrates". This may be accompanied by the appearance of edema in the hip joint. As the disease progresses, mobility limitations become more pronounced and persistent, that is, they do not disappear after warming up. Patients notice a decrease in the amplitude of leg movements and subsequently completely lose the ability to perform certain movements.
- Cracking in the hip joint that appears when walking or doing physical work, especially during extension. It is the result of the rubbing of bare bone structures against each other, which is accompanied by a sharp increase in pain.
- Spasm of the thigh muscles causes diffuse pain in the thigh. This can be the result of various intra-articular disorders, including nerve compression, overstretching of the ligaments surrounding the joint, and the development of synovitis, which is inflammation of the synovial membrane and accumulation of inflammation. effusion in the cavity of the hip joint.
- Lameness, which is primarily the result of 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 hip 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 one.
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 easiest. In the initial stages of degenerative-dystrophic changes in the hip joint, only episodic pain can be observed. As a rule, this happens after intense physical exertion, sports or a long walk. Therefore, patients usually ignore them, associate them with fatigue and consider them to be normal age-related changes. In this regard, grade 1 coxarthrosis is diagnosed only in isolated cases, which usually occurs during an 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 cavity, as well as the appearance of signs of deformation of the femoral head with its displacement.
With the further progression of the pathology, the joint space narrows even more, and with the 3rd degree of coxarthrosis, it is almost completely absent. This is accompanied by the formation of many osteophytes. At this stage of the development of the disease, the pain is not only strong, but unbearable and often occurs in a state of complete rest, including at night. Since the hip joint is severely deformed, its elements can disrupt the nerves passing through it, which causes pain that spreads to the groin, hip, as well as the thigh and even the lower leg. It also results in an 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 femoral head will be firmly attached to the surface of the acetabulum with osteophytes. This will lead to the shortening of the leg, the complete lack of independent movement, because it will completely lose joint mobility, that is, disability.
Diagnostics
If symptoms of coxarthrosis occur, it is recommended to contact 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 with the 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.
However, since such a clinical picture can accompany a number of other diseases of the hip joints, both inflammatory and non-inflammatory in nature, instrumental diagnostic methods are required. With their help, a specialist will not only confirm the presence of coxarthrosis, distinguish it from radicular syndrome caused by pathologies of the spine, but also correctly assess its degree of development, which means choosing the most effective treatment tactics. .
Today, it is 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, CT is prescribed in controversial cases, when it is necessary to clarify the diagnosis and the degree of destruction of the hip joint.
- MRI is a highly informative method for joint examination, which provides maximum information about the state of the joint and all its structures, especially the hyaline cartilage, ligaments, and blood supply characteristics.
Patients are given a number of laboratory tests, including KLA, OAM, rheumatic tests, biochemical blood tests, etc.
Conservative treatment of coxarthrosis
When 1 or 2 degree coxarthrosis is diagnosed, treatment is carried out by conservative methods. It is selected individually for each patient, taking into account the detected diseases. Therefore, it may be necessary to consult not only an orthopedist, but also 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 mandatory 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 exertion, if the load is related to sports, it is recommended to change the type of activity or reduce the intensity of exercise. In some cases, it is recommended to use special bandages and orthoses that will straighten and loosen the hip joint during physical exertion.
Medical therapy
As part of drug treatment, patients are selected drugs individually, taking into account existing concomitant diseases. As a rule, drugs of the following pharmacological groups are indicated for coxarthrosis:
- NSAIDs - 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 administration);
- corticosteroids - 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 for short courses in the form of injections;
- muscle relaxants - drugs that help reduce muscle tone, allow you to effectively deal with muscle spasms, often observed in coxarthrosis;
- chondroprotectors - a group of drugs containing components used by the body to restore cartilage tissue;
- preparations that improve microcirculation - help to improve the nutrition of soft tissues and activate the course of metabolic processes in the affected area;
- B vitamins - indicated for nerve conduction disorders caused by nerve compression by altered components of the hip joint.
If coxarthrosis causes an acute pain attack that cannot be stopped with the help of prescribed NSAIDs, patients are recommended intra-articular or peri-articular blockade. Its essence is that the anesthetic solution together with corticosteroids enters directly into the cavity of the hip joint. This will allow you to quickly relieve pain 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 indicated to carry out such procedures at home.
exercise therapy
When coxarthrosis is diagnosed, regular exercise therapy is mandatory. In the same way as 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, the nature of accompanying diseases (special attention). paid to cardiovascular pathologies).
Thanks to daily exercise therapy, you will:
- reduce the intensity of pain;
- increase the mobility of the hip joint;
- reduce the risk of 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 re-diagnose to rule out the progression of the disease and the need for surgery.
Physiotherapy
Comprehensive treatment of coxarthrosis includes courses of physiotherapy procedures that have an anti-inflammatory, analgesic, decongestant and tonic effect on the body. Therefore, patients are prescribed a maximum of 10-15 procedures:
- ultrasound therapy;
- electrophoresis;
- UVT;
- magnetotherapy;
- laser therapy, etc.
Recently, plasmolifting is used more and more as 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 powerful. Unfortunately, such cases are quite common today, as many patients turn to the doctor when they cannot 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;
- obvious movement disorders;
- femoral neck fracture.
The gold standard for the treatment of severe coxarthrosis, including in the elderly, is hip arthroplasty. 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 fully restore the functionality of the hip joint, relieve pain and return a person to a full-fledged active life.
The essence of this type of surgical intervention is the resection of a small piece of the femoral head and neck. Also, the surgeon must prepare the surface of the acetabulum for the installation of the endoprosthesis, that is, remove all the formed osteophytes and achieve maximum restoration of its normal form. After that, an endoprosthesis of the selected type is installed, which is fixed with special cement (better for the treatment of the elderly) or without cement. 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 sprouting of bone tissue through the sponge.
The type of arthroplasty is selected individually for each patient. The most effective is total arthroplasty, which involves a 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 partial arthroplasty with replacement of the femoral head and/or neck only. For this purpose, endoprostheses of different designs are used: monopolar and bipolar.
The only disadvantage of arthroplasty can be considered the need to change the installed endoprosthesis after 15-30 years.
After replacing the endoprosthesis, patients are given rehabilitation, the duration of which depends on the speed of tissue repair. Exercise therapy, physiotherapy and therapeutic massage are prescribed as part of 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, pain syndrome is completely eliminated, but joint mobility is completely lost. Thus, 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, arthrodesis is practically not performed today.
Osteotomy involves the execution of an artificial fracture of the femur with such a combination of bone fragments that will reduce the load on the affected hip joint. But the operation gives only a short-term effect, and the need for arthroplasty still arises in the future.
Thus, coxarthrosis of the hip joint is a very dangerous disease that can result in disability. It seriously lowers the quality of life and deprives a person of his ability to work. However, if you pay attention to the early signs of pathology and get timely advice from an orthopedist, you can slow down its development and achieve a significant improvement in well-being. But with coxarthrosis that is already working, there can be only one solution - arthroplasty. Fortunately, this method can be used even with serious degenerative-dystrophic changes and completely restores the normal functioning of the hip joint.