Coxarthrosis of the hip joint, a complex pathology of osteoarthritis, leads to serious joint changes.Unfortunately, older people often become disabled and lose the ability to work.In fact, statistics on hip joint diseases account for almost half of all musculoskeletal diseases.I will give a real life example 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 leads to the complete destruction of cartilage with loss of joint function.
Coxarthrosis – here the hip joints are destroyed, it is practically the same osteoarthritis.
The articulation of the hip with the pelvis is similar in mechanics to door hinges.The femoral head is connected to the ischium like a hinge.Which has a special anatomical formation – the hip socket.This structure ensures maximum joint mobility.Which performs a complete cycle of movement, i.e. flexion, extension, rotation, etc.
Normally the joint surfaces are smooth and there is enough fluid inside to ensure unhindered sliding.As the disease progresses, the lubricant becomes thicker and more viscous, which directly affects the condition of the cartilage.The synovial fluid no longer fully fulfills its functions.This causes the shock-absorbing pads to dry out, crack and become rough.
- First.The lack of the necessary lubrication increases the friction on the bones and leads to injuries.
- Second.As the deformation of the bone surfaces progresses, the cartilage tissue also changes.The body tries to compensate for the increased stress.
- Third.Increased load leads to complete atrophy of the thigh muscles and weakness of the ligaments.
Important: Osteoarthritis of the hip joint is a progressive disease.Changes can lead to a complete loss of physical activity.Ultimately, this leads to disability.And completely disrupt the usual way of life.The disease and its treatment are not only of great importance from a medical perspective, but also represent a major social problem.
Causes of 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 development of hip joint pathology are associated with congenital hip dislocation and dysplasia (inferiority) of the joint.
Therefore, there are two types of coxarthrosis;
- primary (due to an unknown etiology);
- secondary (associated with injuries, diseases).
Primary osteoarthritis is characterized by a combination of factors:
- heredity;
- influence of biological, mechanical processes;
- obesity;
- metabolic disorders;
- There is also a theory of pathological tissue repair in response to harmful influences (inflammation, friction, infection).
This form of coxarthrosis is often accompanied by damage to the spine and inflammatory symptoms of the knee joints (arthritis, arthrosis).
In the secondary version, the reasons for the development are clearer.This includes:
- Dysplastic disorders.In half of all cases of congenital pathology, grade 1 dysplastic coxarthrosis of the hip joint occurs.
- Hip dislocation (congenital).
- Life traumas.Fractures of the pelvis, femoral neck, 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 to the joint is impaired.
In addition, the pathology can affect both formations at the same time or be unilateral.In addition to the direct causes of its occurrence, there are predisposing factors that trigger the development of the disease.The disease often occurs when athletes place increased strain on their limbs.As well as people with difficult physical working conditions.Being overweight significantly increases the likelihood of osteoarthritis.
The provoking factors also include:
- Disruption of metabolic processes, joint nutrition, hormonal imbalances.
- 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, one in 10 patients will be diagnosed with grade 1, 2 coxarthrosis of the hip joint.After 60 years, one in three people is already being observed.And by the time they reach age 70 or older, almost 80% of applicants suffer from this disease.
There is no specific gene responsible for transmitting pathological changes in the joints.However, the hereditary factor is still detectable.A person can receive from relatives the structural features of cartilage tissue, altered metabolism and skeletal pathology.It is the combination of this genetic information that can cause hip osteoarthritis to occur.
Classification
The main classification of the disease is based on severity.There are 3 stages that differ not only in the symptoms but also in the changes on the x-ray.It is these indicators that are used as the basis for diagnosis.
Diploma |
Sign |
|---|---|
I |
|
II |
|
III |
|
This division is the most common.There are also types of Kellgren classifications.It includes 4 levels plus degree zero – 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 less pronounced symptoms than in the final stage 3. At first, pain is noticeable during physical activity.Especially after long walks or climbing stairs.Later, pain becomes a constant companion and significantly worsens 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) and are rarely reflected in the hip or knee.The pain is relieved by rest.
At this stage, no further manifestations are noticeable - the gait remains unchanged and there are no movement disorders.In the dysplastic variant, on the other hand, there is an increase in mobility due to changes in the connective tissue;Due to increased flexibility, patients are often interested in gymnastics and yoga in the initial stages of the disease.Movement problems only appear in stage 3.
If there are symptoms of stage 1 coxarthrosis of the hip joint, treatment can be carried out without surgery.Rational therapy allows you to eliminate unpleasant symptoms and stop progression.
2. Degree of illness
Although the pain is not constant, it is noticeable at rest.The radiation is noticeable – hips, groin, knees.Stiffness is observed - movements are limited when lifting, when trying to abduct to the side, difficulty with circular movements of the leg (particularly often the pain increases).Lameness becomes noticeable after intensive walking or running.
When moving, a characteristic arthritic crunch can be heard - rough, dry.
3rd degree osteoarthritis
The pain becomes constant and does not go away even after rest and sleep.Unpleasant sensations do not leave the patient even at night.There are problems walking;To make movement easier you have to use a stick.The lameness is constant.
At this stage, atrophy of the limb muscles occurs and the leg itself shortens.These changes force the patient to bend over to the affected side, further increasing stress on the joint.A restriction of mobility can be observed in almost all directions.
Changes in bilateral coxarthrosis of the hip joint change the patient's gait, which is why all formations involved in the walking process suffer.Pain occurs in the lower back, posture is disturbed and the axial position of the pelvis changes.
diagnosis
An important role in determining the disease is an examination by an orthopedist and a thorough analysis of the symptoms.It is worth assessing the patient's activity - the ability to climb stairs, comfort in putting on boots and socks, walking activity, 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 most subtle symptoms.It is therefore worth carrying out an X-ray examination to make changes in the joint space visible.This method allows not only to identify the disease.And often you also find out the cause of its occurrence - dysplasia, Perthes disease.
Knee pain is often significantly more pronounced in grade 1 deforming coxarthrosis of the hip joint and should therefore be differentiated from gonarthrosis.The differential diagnosis also includes an examination of the spine to rule out radicular syndrome (radiating pain in the hip and knee).
In cases of doubt, MRI (allows a detailed examination of the soft tissue) and CT (to check the bone formations) are used.
Treatment
The disease cannot be completely cured, but modern medicine can restore lost mobility and allow you to live a full life.
The use of physiotherapy and medication is effective for disease levels 1-2.In the final stage, only surgery can help.In another case, surgery is performed if the conservative therapy methods used do not bring relief.
1st degree treatment
Unfortunately, it is impossible to completely eliminate the pathology.In grade 1, treatment aims to stabilize the condition.
During therapy, some general recommendations must be followed:
- 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 physiotherapy.
Important: Many patients completely reject gymnastics and any physical activity due to pain.This is often associated with fear of increased pain and the possibility of the situation worsening.Practice proves that this opinion is wrong - regular exercise therapy helps to strengthen muscles, protect them from atrophy, relieve pain and improve 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 also useful to include products with gelatin, canned fish with bones and dairy products in your diet.
Conservative
Non-steroidal anti-inflammatory drugs are used as a medical method.Due to the large number of side effects, it is recommended to take medication to combat severe pain.You can combine their use with gastroprotectors.
Persistent pain is relieved by intra-articular steroid injections, and pain-relieving blocks are also possible.
To provide support, the following is required:
- Muscle relaxants – relieve tension, relieve leg pain.
- Chondroprotectors – improve the restoration of cartilage tissue.
- Vasodilators (nicotinic acid) – help to relieve vascular spasms and also increase tissue microcirculation.
Warming compresses are also used in combination (you can also use conventional treatment methods).They do not have a therapeutic effect, but help relieve muscle spasms.
Be sure to use physiotherapy – UHF, magnetic field therapy, induction currents, massage.
Hip replacement surgery
To restore freedom of movement and relieve severe pain in stage 3, the patient is prepared for planned endoprosthetic surgery.This is a special operation to replace a destroyed formation with an artificial one.The procedures completely restore the patient's motor skills.Helps you fully return to your normal lifestyle.
Depending on the extent of the process, the prosthesis can be either unipolar (only the worn femoral head is replaced) or bipolar (the surface of the acetabulum is also changed).After the operation, rehabilitation is essential in order to return the patient to an active life as quickly as possible.
For patients over 60 years of age, the rehabilitation period is determined before 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 a forced static position (this is especially true for those with standing workstations).
Life incident
My friend's husband needed surgical treatment for arthroplasty.He was not diagnosed with coxarthrosis, but a lumbar hernia was successfully removed.The condition did not improve, the examination continued and finally, after I found out what was wrong, they sent me for surgery under a quota.
After the replacement everything grew back well, but the second hip joint also required surgical intervention.A year later, the quota for the operation was available again, which was successful.And then from the first minutes after anesthesia, rehabilitation and strict adherence to the doctor's recommendations are required.
And what about our friend?On the way home after the hospital, I started putting strain on the prosthetic joint (sitting for long periods of time, stepping on my 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.
Of course they inserted it, put a cast on it and then everything seemed to work.But he complains that he cannot move his leg to the side, it hurts and he feels uncomfortable when walking.Although he does exercises and various exercises to develop both joints, it is also work and the desire to move independently.
Prevention
We discussed the symptoms and treatment of coxarthrosis in the hip joints, as well as its stages.
- Only daily physical exercise will help you avoid serious complications and live into old age without crutches.During Soviet times, serious work was done to prevent diseases of the musculoskeletal system and strengthen the immune system.Nowadays it is difficult to restore the lost experience, this is clear to the mind, but one is too lazy to do it.
- Excess weight wears out joints to the point of disgrace;Endoprosthetics is better, but not to lose extra pounds.My friend is sure of this without even trying to eat less sweets and starchy foods.Proper nutrition is a very important point.
- I consider lifting weights to be no less damaging to the entire skeleton.
- Bad habits (alcohol, smoking) deprive the body of calcium, magnesium and other useful substances.
Just look, everything is connected.
Take care of yourself and your joints by exercising every day!