Coxarthrosis

Osteoarthritis of the hip joint (coxarthrosis) is a chronic pathology, accompanied by the gradual destruction of cartilage tissue of the affected area, followed by the involvement of adjacent structures in the process. The disease requires long-term treatment and in severe cases, the only way to regain movement is joint replacement.

General information

Coxarthrosis belongs to the group of degenerative diseases. It begins gradually with microscopic changes in cartilage structure. Increased stress, inflammatory diseases, disorders of blood supply lead to structural transformations and thinning of cartilage tissue, and they, in turn, deform the contours of the articular area. As a result, the load distribution on the contact surfaces of the bones changes, and areas with maximum pressure begin to be consumed more quickly. This causes a whole cascade of pathological reactions:

• the appearance of microcracks and compression areas in cartilage tissue;
• decrease in the softness of articular surfaces;
• excessive growth of cartilage at the site of thinning and its replacement with bone tissue;
• the appearance of osteophytes (bone growths) along the edges of the articular site;
• thickening and decreased elasticity of the wrist capsule;
• strengthening and reduced strength of ligaments;
• changes in the composition of synovial fluid (natural lubrication within the joint);
• narrowing of the joint space;
• union of all node elements (ankylosis).

Without treatment, coxarthrosis inevitably becomes the cause of immobility and disability.

Causes

Depending on the causes of the disease, primary and secondary coxarthrosis are distinguished. In the first case, it occurs itself, for example, against the background of an inherited predisposition, in the second, it is provoked by disease or other damage. In most cases, the process of cartilage tissue degeneration occurs due to a combination of several factors. The reason could be:

• congenital hip dislocation;
• flat feet, scoliosis and other orthopedic problems;
• Legg-Calve-Perthes disease;
• inflammation of the joints (arthritis), regardless of origin;
• injuries and microtraumas of the hip joint against the background of overweight, professional sports, etc . ;
• hip joint dysplasia;
• metabolic disorders;
• endocrine diseases (especially diabetes mellitus);
• violation of blood supply to the lower extremities;
• frequent stress;
• heredity (coxarthrosis in parents or other close relatives significantly increases the risks of its development in a child);
• congenital pathologies and autoimmune diseases of connective tissue (hypermobility of the joints, rheumatoid arthritis, systemic lupus erythematosus, etc. );
• underwent joint operations.

Age is an important predisposing factor. According to statistics, after 45 years, the chance of developing coxarthrosis increases significantly.

Symptoms

The main symptoms of coxarthrosis of the hip joint do not depend on the cause of development. Most patients notice:

• restriction of movement: one of the earliest symptoms due to thinning of the cartilage layer and increased friction of the articular surfaces of the bones; in the future, the appearance of cartilage growths further exacerbates the problem;
• pain: rubbing the bones deprived of a cartilaginous layer against each other, the gradual involvement of all common elements in the degenerative process, a decrease in the blood supply to the tissues cause sensations of pain that increase with the progression of the disease; the pain is shot in nature and often worsens by the end of the day;
• muscle spasm, which leads to increased pain symptoms and limited range of motion in the joints;
• reduction in leg length: this symptom appears in the later stages of the disease due to narrowing of the joint space and gradual grinding of the bone heads due to constant rubbing; the difference between the legs can be up to 2 cm;
• lameness: accompanied by severe pain and restriction of movement, as well as shortening of the leg; is an unfavorable sign indicating serious damage to the articular apparatus.

stages

In the developmental process, coxarthrosis goes through several stages, which depend on the degree of tissue damage.

• 1 degree At this time, the patient notices mild joint pain that appears after intense or prolonged physical activity and quickly passes after rest. As a rule, the discomfort occurs exactly in the area of the hip joints, but in some cases extends to the hip or knee. The gait does not change, the movements of the legs are fully preserved. On the roentgenogram, specific changes are observed: subchondral sclerosis.
• 2nd degree. The pain becomes more severe, arises after straining, spreads throughout the thigh and hip. After straining, a slight lameness may appear. Difficulties in foot abduction are found. X-ray shows a significant decrease in the distance between the bones (by 50% or more), deformity of the femoral head, and marked bone growth.
• 3 degrees The pain becomes permanent, walking without a stick becomes impossible. When moving, the patient tilts significantly towards the painful side, which further increases the load on the joint. The range of motion decreases, the muscles of the leg and buttocks atrophy. There is a shortening of the affected limbs. X-rays reveal a significant deformity of the wrist, a change in the contour of the femoral head, and a large number of osteophytes.
• 4 degrees The pain becomes stronger and does not stop for a minute, the patient loses the ability to move independently. X-ray shows complete destruction of articular cartilage as well as signs of bone fusion with each other (ankylosis). To cope with the disease at this stage is possible only with surgery.

Diagnosing

An orthopedic traumatologist is responsible for identifying symptoms and selecting treatment. To diagnose and determine the extent of the disease, he uses:

• survey: listening to patient complaints, identifying risk factors (trauma, illness, heredity, etc. );
• examination: assessment of limb mobility, determination of areas of greatest pain;
• X-rays: an X-ray image makes it possible to assess the condition of the bone and cartilage, the size of the joint space, the presence and location of bone growths; to see in more detail the necessary details, the study is completed with CT (computed tomography);
• laboratory diagnosis: a general blood test allows you to identify the signs of an inflammatory, biochemical process - to notice some risk factors, for example, uric acid level;
• MRI (magnetic resonance imaging): allows you to assess the condition not only of bones and cartilage, but also of soft tissues: bones, ligaments, muscles, joint capsule, etc. ;
• joint puncture.

If it is necessary to make a differential diagnosis with other diseases, as well as to assess the accompanying pathologies, additional tests, instrumental examinations and close specialist consultations are prescribed.

Treatment of coxarthrosis

Treatment of coxarthrosis of the hip joint depends on its stage and the severity of the symptoms. Pathology requires an integrated approach using different methods:

• drug treatment;
• non-drug treatment (physiotherapy, exercise therapy);
• surgery;
• lifestyle correction and diet.

Medication treatment

The medications prescribed for hip arthrosis are aimed at:

• removal of pain syndrome;
• restoration or at least slowing down the destruction of cartilage tissue;
• improving blood supply and nutrition in the affected area;
• treatment of concomitant pathologies.

Pain relievers are used in the form of tablets, intramuscular and intra-articular injections and local agents: creams, oils, patches. In the early stages of disease development, non-steroidal anti-inflammatory drugs are sufficient for most patients. With severe pain syndrome, hormonal agents are used. The introduction of analgesics directly into the joint capsule has a good effect.

If the course of the disease is accompanied by muscle spasms, muscle relaxants are used. They are used in combination with other analgesics.

Taking painkillers should be limited in time and dose, so as not to cause further damage to cartilage tissue and other side effects (in particular, the development of gastritis and stomach ulcers).

Chondroprotectors are drugs that help restore cartilage tissue. They are effective only with regular long-term use, which is combined with other methods of treatment, lifestyle and dietary adjustments. Medicines to improve blood microcirculation help increase their effect. For a similar purpose, heating ointments are prescribed. Only one doctor is involved in choosing the dose and regimen.

Medication-free treatment

This category includes various physiotherapy and manual techniques, as well as physiotherapy exercises. They help improve microcirculation and restore movement to the damaged joint. Depending on the situation, the doctor prescribes:

• shock wave therapy;
• magnetotherapy;
• electromostimulation;
• various types of electrophoresis and phonophoresis (associated with the administration of anesthetic drugs);
• mechanotherapy;
• massage and exercise therapy.

Surgery

If the disease has reached stage 3-4 of development, medication and physiotherapy will only alleviate the patient’s condition, but will not restore the ability to move fully. In this case, arthroplasty is indicated, d. m. th. complete or partial replacement of the damaged joint with a titanium prosthesis.

If there are indications, an easier version of the intervention is performed: grinding the contact areas of the bones and covering them with a special smooth implant that facilitates sliding.

prevention

Lifestyle can significantly reduce the risk of developing coxarthrosis, as well as the degree of its progression. Importers it is important to strictly adhere to the rules:

• leads an active lifestyle: swimming in the pool, walking, cycling - physical activity on an amateur level without racing for records helps to improve the blood supply and prevents the processes of degeneration of the joints;
• normalize body weight to reduce leg load;
• eliminate injuries, hypothermia and risk factors at work (tremor, weight lifting, walking);
• timely treatment of all diseases, including those not directly related to the musculoskeletal system;
• correct behavioral disorders in time, wear comfortable shoes.

diets

With the help of nutritional correction, the patient can not only reduce body weight, but also reduce inflammatory reactions, tissue salt deposits and metabolic disorders. It is recommended to stay on a balanced menu with sufficient but not excessive amounts of carbohydrates, proteins and fats, as well as vitamins and minerals. Particular attention should be paid to unsaturated fats (olive oil and flaxseed), omega-3 acids (found in excess in fish), collagen (dried meat, aspic). It is recommended to minimize fast carbohydrates, alcohol, strong coffee, artificial flavored products, preservatives and flavor enhancers.

Consequences and complications

Coxarthrosis is one of the most common causes of disability in older people. Without proper treatment, the pathology inevitably leads to complete disability, especially in bilateral lesions. Pain and limited mobility do not allow you to work and take care of yourself, so it is important to get treatment on time.