Coxarthrosis is a degenerative disease of the cartilage of the hip joint, leading to persistent joint dysfunction and disability. Usually, hip arthritis can be seen in elderly patients, men are more affected than women.
Classification of hip osteoarthritis
There are two main types of diseases:
- primary - the onset of the disease in a perfectly healthy setting;
- secondary - develops against the background of an arthritis, after a previous injury, as well as in the presence of congenital disorders of the development of the hip, dysplasia of the joint.
Cause of coxarthrosis
Based on the reasons for the development of hip disease, the following types are distinguished:
- idiopathic - coxarthrosis, which develops without a specific reason;
- involutive - joint disease associated with natural age-related changes of the body, manifested in old age;
- dysplasia (congenital) - joint disease that develops in the joint against the background of congenital malformations of its development;
- post-infectious - joint disease develops in the joints affected by rheumatoid arthritis, as well as from certain other infections;
- post-traumatic - arthrosis, which develops as a result of traumatic joint damage;
- pigmentation disorders - coxarthrosis, which develops against the background of metabolic disorders due to diseases of the endocrine system or hormonal therapy;
- vascular - the disease develops due to disorders of circulation in the joints;
- heredity - develops due to hereditary features of cartilage tissue growth (often in combination with degenerative deformities of other joints).
In addition, hip osteoarthritis can result from a violation of the biomechanics of body movement, often accompanied by curvature of the spine, herniated disc or defects in the skeleton of the lower extremities (for example, shorten one of them). Limping or poor posture puts undue stress on the hip joint, which can cause coxarthrosis. Another common cause of coxarthrosis is inactivity, however, excessive physical activity (sports or work) can also cause joint disease.
How does hip osteoarthritis present?
First of all, the patient with coxarthrosis complains of pain in the hip joint. Accompanied by a limp, over time, thigh and buttock muscles appear. Movement in the joint is accompanied by a characteristic crunching sound, with time, joint mobility decreases. The intensity of the symptoms directly depends on the extent of the disease.
Coxarthrosis 1 degree
The initial stage of the disease is manifested by mild pain, which may appear in the morning or after vigorous exercise on the joints. It is also possible to note an allergic phenomenon of the damaged joint, manifested by pain when the weather changes. The patient may feel stiffness in the morning, which disappears after a little exercise and warm-up.
Radiographic changes are minimal - there may be a slight narrowing of the joint space, thinning of the cartilage covering the head of the femur.
Coxarthrosis degree 2
The intensity of pain at this stage of the disease increases slightly, at the same time the pain spreads to the groin and knees. There are frequent cases of misdiagnosis of coxarthrosis involving pain that radiates to the knee and ankle ligaments. The pain begins not only after exertion, but also at rest. During limb movement, foreign sounds are emitted from the joint (clack, crunch). The range of motion in the joint is significantly reduced, especially rotational (circular) motion, the biomechanics of intra-articular movements are impaired and, accordingly, the joint function is reduced. Pain and decreased mobility of the joint result in a slightly limp presentation, which in turn leads to moderate gluteal atrophy from the affected joint.
On the positioning chart, one can see that the joint space is narrowed to one-third of its normal width, the cartilage is significantly thinned until it is absent in some areas, the appearance of osteoblastson the joint surface, deformation of the femoral head, and its upward displacement.
Coxarthrosis level 3
At this stage of the disease, the pain becomes constant, even at night, taking pain relievers can hardly be relieved. The range of motion of the joint is reduced to a minimum, the biomechanics of the joint is significantly impaired. The slightest movements are also accompanied by a creaking sound, a pronounced limp, significant deformity of the pelvis and shortening of the limb from the affected joint. The glutes and thighs on the same side are atrophied. Because of a significant limp, the patient is often unable to move independently without the use of a cane or assistive device.
X-ray showed clearly deformed femoral head, thickened femoral neck. The joint surfaces are covered with bony growths, the joint space is so much narrowed that it is practically nonexistent.
Diagnosis of hip arthritis
Diagnostic measures begin with interviewing the patient and examining the patient, performing some laboratory tests, and then special instrumental techniques are used to confirm the diagnosis. The following methods are considered the most informative today:
- X-ray exam -allows you to see the contour of the joint surfaces, the presence or absence of bony growths on them, to determine the presence of deformities of the femoral head and the width of the joint space;
- Joint ultrasoundallows not only to examine the joint surface, but also to identify dystrophic changes in the articular ligaments;
- computed tomography (CT) scan- makes it possible to obtain layer-by-layer images of the X-ray type, but clearer and more abundant;
- magnetic resonance imaging (MRI) -allows you to study the state of joint structures, joint surfaces, bones and ligaments with a high degree of visualization. At this time, it is considered the most advanced diagnostic method.
Treatment of coxarthrosis
The most effective is the complex treatment of the hip joint, taking into account the stage of the disease. It should be remembered: the sooner the treatment, the better the disease can be prevented from progressing, the patient is immobile, and unable to work. Therefore, even if there is the slightest discomfort in the joints, pain, stiffness, joint allergies seem insignificant, you need to see an orthopedic doctor to examine, diagnose and prescribe treatment. . Cartilage tissue is not restored, so it is better not to wait until it is significantly damaged, but to start treatment at a stage where the cartilage is malnourished, until irreversible changes have been made. develop in it.
The extent of treatment depends on the stage of the disease. So, with coxarthrosis of the first degree, non-narcotic analgesics and NSAIDs are used - they allow you to eliminate the pain syndrome, as well as eliminate inflammation in the tissues of the joints, preventing further damage. for the tissues of the joints. Because at this stage, the pain and inflammation syndrome is not severe, so there is no need to use long-term drugs. As a rule, it is enough to do with local means - ointments, gels containing NSAIDs. It is more important at this stage to ensure the normalization of metabolic processes in the cartilage tissue, to minimize its degeneration, for which drugs from the group of chondroprotectors are used. Their task is to restore metabolism in the cells of the cartilage tissue, as a result of which the nutritional properties of the joints are improved and the intensity of inflammation is reduced. For example, in the treatment of coxarthrosis, a well-proven chondroprotective drug, the active ingredient of which is a source of natural components of healthy cartilage tissue. It stimulates the production of the most important structural components in cartilage - proteoglycan and prevents the destruction of cartilage tissue.
The formal treatment of grade 2 and 3 coxarthrosis is much more difficult: the cartilage has been significantly damaged, the joint surfaces are exposed, bone-forming substances are formed on them in large quantities, preventingnormal joint movement. At this stage, only symptomatic treatment can relieve joint pain and slow cartilage destruction. Pain at this stage of the disease is very intense, analgesics and NSAIDs are used to relieve pain and the best solution would be a combination of the use of topical agents (ointments, creams) andDosage forms for systemic action (tablets, injections).
During exacerbations of the disease, whatever the stage, it is important to minimize the load on the joint to avoid further damage to the cartilage. During the period of remission, in addition to taking chondroprotectors to normalize metabolism in cartilage tissue, exercise therapies, massage and kinetic therapy are recommended. They provide a reasonable load to the joints, prevent fixation and deposition of mineral salts in joint tissues and ligaments, and stimulate microcirculation. Exercise therapy is also of great importance for the general state of the body: during exercise, biologically active substances are produced in it that increase mood and general well-being - endorphins and serotonin.
Proper nutrition plays an important role in the complex treatment of hip arthritis. The patient's diet should be adequate, rich in plant and animal protein, fiber, and vitamins. Proper nutrition is important not only to stimulate joint regeneration but also to maintain the patient's body weight within normal limits. Being overweight is an additional load on the diseased joint and is a factor in disease progression.
During the period of remission, physical therapy methods have been shown to be good - electrophoresis, mud therapy, ultrasound and magnetic therapy. In addition, the effectiveness of biological and mechanical methods in the treatment of coxarthrosis is noted. Among biological methods, the most popular is hirudotherapy, which thins the blood and stimulates microcirculation of capillaries both in the joint and the muscles surrounding it, helping to prevent atrophy in thethem. Mechanical methods include joint traction to relieve excess stress on the affected joint and acupuncture. However, it should be remembered: physiotherapeutic, mechanical and biological methods for the treatment of coxarthrosis can only be used during remission. With an exacerbation of the disease, their use leads to the progression of inflammation and destruction of cartilage tissue.
In cases where conservative treatments for coxarthrosis do not work, the patient can be treated surgically - arthroplasty and joint replacement. The first variant of the operation involves the restoration of mobility in the joint due to the plasticity of its own tissues, the second - the replacement of the joint surfaces with an endocrine - a mechanical joint. Surgical intervention allows you to restore joint mobility and the patient's ability to work.
Prevention of dry joints of the hip joint
Preventive measures for reduction are taking chondroprotectors, proper nutrition and proper stress reduction on joints, especially for people who play sports or do heavy work.
Coxarthrosis is a serious disease that can deprive a patient of the ability to move independently. Disability can be avoided by quickly seeking medical help at the first discomfort in the joints, subject to competent complex treatment of the pathology at the very first stage.