Coxarthrosis of the hip joint, a complex pathology of osteoarthritis, causes serious changes in the joint.Unfortunately, disability of mature people with loss of ability to work is common.In fact, statistics on diseases of the hip joint account for almost half of all pathologies of the musculoskeletal system.I will give an example from the life 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 contributes to the complete destruction of cartilage with loss of joint function.
Coxarthrosis: here the hip joints are destroyed, it is practically the same osteoarthritis.
In terms of its mechanism, the hip joint with the pelvis is similar to the hinges of a door.The head of the femur is connected to the ischium like a hinge.Which has a special anatomical formation: the acetabulum.This structure guarantees maximum joint mobility.Which performs a complete cycle of movements, or rather flexion, extension, rotation, etc.
Normally, the joint surfaces are smooth and there is sufficient fluid inside, which ensures unhindered gliding.As the disease progresses, the lubricant becomes thicker and more viscous, which immediately affects the condition of the cartilage.The synovial fluid no longer fulfills its functions completely.Because of this, the cushioning pads dry out, crack and become rough.
- First of all.As a consequence of the lack of necessary sliding, the friction of the bones increases, injuring them.
- In second place.As it progresses, the deformation of the bone surfaces also joins the altered cartilage tissue.In this way, the body tries to compensate for the increased load.
- Third.The increased load causes complete atrophy of the femoral muscles and weakness of the ligaments.
Important: Osteoarthritis of the hip joint is a progressive disease.The changes can cause a person to completely lose physical activity.Ultimately it leads to disability.And completely altering the usual way of life.The disease and its treatment are very important not only from a medical point of view, but also a great social problem.
Causes of 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 the development of pathology of the hip joint are associated with congenital dislocation of the hip and dysplasia (inferiority) of the joint.
Therefore, there are 2 types of coxarthrosis;
- primary (arising from an unknown etiology);
- secondary (associated with injuries, diseases).
Primary osteoarthritis is characterized by a combination of factors:
- inheritance;
- influence of biological and mechanical processes;
- overweight;
- metabolic disorders;
- There is also a theory about pathological tissue restoration 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, osteoarthritis).
In the secondary version, the reasons for the development are clearer.These include:
- Dysplastic disorders.In half of all cases of congenital pathology, grade 1 dysplastic coxarthrosis of the hip joint occurs.
- Hip dislocation (congenital).
- Traumas of life.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 of the joint is disturbed.
Furthermore, the pathology can affect both formations at the same time or be unilateral.In addition to the direct causes of its appearance, there are predisposing factors that cause the development of the disease.Often the disease occurs with increased load on the limbs of athletes.As well as people with difficult physical working conditions.Excess weight significantly increases the likelihood of osteoarthritis.
Provoking factors also include:
- Alteration of metabolic processes, joint nutrition, hormonal imbalances.
- Prostration.
- Bad posture.Especially scoliosis, kyphosis, which cause misalignment of the pelvic bones.
- Age from 40 years.It is estimated that after this date, every 10 patients are diagnosed with coxarthrosis of the hip joint, degrees 1, 2. After 60, it is already observed in every third person.And when they reach 70 years of age or older, almost 80% of those who apply 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.A person can receive from relatives the structural features of cartilage tissue, disturbed metabolism and skeletal pathology.It is the combination of said genetic information that can cause the appearance of hip osteoarthritis.
Classification
The main division of the disease is based on severity.There are 3 stages, which differ not only in symptoms, but also in changes on the x-ray.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 grade 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 terminal stage 3. Initially, pain manifests itself during exercise.Especially after long walks or climbing stairs.Subsequently, pain becomes a constant companion, significantly worsening quality of life.
Coxarthrosis 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 with rest.
At this stage, no further manifestations are detected: the gait remains unchanged, there are no disturbances in movements.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 become interested in gymnastics and yoga.Problems with movement occur only in stage 3.
For symptoms of stage 1 coxarthrosis of the hip joint, treatment can be performed without surgery.Rational therapy allows you to eliminate unpleasant symptoms and stop progression.
2nd degree of disease
The pain, although not constant, manifests itself at rest.Irradiation becomes noticeable: hip, groin, knee.Stiffness is observed: movements are limited when lifting, trying to abduct to the side, difficulty in circular movements of the leg (pain increases especially often).The limp is noticeable, which appears after walking or running intensely.
When moving, a crunch characteristic of osteoarthritis is heard: rough, dry.
third 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.There are problems walking;To facilitate movement you must use a cane.The lameness is constant.
At this stage, atrophy of the muscles of the limb occurs and the leg itself becomes shorter.These changes force the patient to lean toward the affected side, further increasing the load on the joint.The limitation of mobility is observed in almost all directions.
Changes in bilateral coxarthrosis of the hip joint modify the patient's gait, so all formations involved in the walking process suffer.Lumbar pain appears, posture is altered and 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 the complaints.It is worth evaluating the patient's activity: the ability to climb stairs, comfort when putting on boots and socks, walking activity, and use of a cane.
It is recommended to check the general condition: blood test, urine analysis, biochemistry, ECG, determination of HIV and syphilis markers.
Coxarthrosis of the hip joint of the first degree has the most subtle symptoms.That is why it is worth performing an X-ray examination to visualize changes in the joint space.This method allows not only to identify the disease.And also often they find out the cause of the appearance: dysplasia, Perthes disease.
Often, knee pain is much more pronounced with grade 1 deforming coxarthrosis of the hip joint, therefore it must be distinguished from gonarthrosis.The differential diagnosis also includes an examination of the spine to exclude radicular syndrome (which causes pain that radiates to the hip and knee).
In doubtful cases, magnetic resonance imaging (allows soft tissues to be examined in detail) and computed tomography (to review bone formations) are used.
Treatment
The disease cannot be completely cured, but modern medicine can restore the lost ability to move, allowing you to live a full life.
The use of physiotherapy and medications is effective for degrees 1-2 of the disease.In the terminal stage, only surgery helps.In another case, surgery is performed if the conservative therapy methods used do not provide relief.
1st degree treatment
Unfortunately, it is impossible to completely eliminate the pathology.In grade 1, treatment aims to stabilize the condition.
During therapy, a number of general recommendations should be followed:
- Normalization of physical activity: it is recommended to reduce excessive stress (long walks, running, jumping).
- Wear shoes with well-absorbing soles and special insoles.
- Weight loss.
- Mandatory physiotherapy.
Important: many patients completely abandon gymnastics and any exercises due to pain.This is usually associated with the fear of increasing pain and the possibility of worsening the situation.Practice shows that this opinion is erroneous: regular exercise therapy helps to strengthen muscles, protect them from atrophy, reduce pain and improve joint function.
A diet is not prescribed for grade 1 coxarthrosis of the hip joint;Moderate nutrition is prescribed for weight loss.It is also useful to add gelatin products, canned fish with bones and dairy products to your diet.
conservative
Non-steroidal anti-inflammatories are used as a medicinal method.Due to the large number of side effects, it is recommended to take medications for severe pain.You can combine its use with gastroprotectors.
Persistent pain is relieved by intra-articular steroid injections, and analgesic blocks are also possible.
For support the following is prescribed:
- Muscle relaxants: relieve tension and reduce leg pain.
- Chondroprotectors: improve the restoration of cartilage tissue.
- Vasodilators (nicotinic acid) - help relieve vascular spasms and also increase tissue microcirculation.
Hot compresses are also used in combination (traditional treatment methods can also be used).They do not provide a therapeutic effect, but help relieve muscle spasms.
Be sure 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 prepared for planned endoprosthetic surgery.This is a special operation to replace a destroyed formation with an artificial one.The interventions completely restore the patient's motor abilities.It helps you fully return to your normal lifestyle.
Depending on the extent 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 changed).After the operation, rehabilitation is mandatory so that the patient returns to an active life as soon as possible.
For patients over 60 years of age, the rehabilitation period is established even before surgical treatment, so that the recovery process takes place in a shorter period of time.The useful life of an artificial joint is about 20 years, but it is important to follow the recommendations:
- Exclusion of running, walking a lot, jumping.
- Avoid lifting heavy objects.
- Avoid excessive exposure to a forced static position (this is especially true for people who work standing).
life incident
My friend's husband required surgical treatment for a stent.He was not diagnosed with coxarthrosis, but a lumbar hernia was successfully removed.The condition did not improve, the examination continued and finally, upon discovering what was wrong, I was sent for surgery on a fee basis.
After the replacement, everything grew back safely, but the second hip joint also required surgical intervention.A year later, space was again obtained for the operation, which was successful.And then, from the first minutes after anesthesia, rehabilitation and strict compliance with the doctor's recommendations are required.
And our friend?Already on the way home from the hospital, I started putting pressure on the prosthesis (sitting for a long time, stepping on my foot).I forgot how careful I was the first time.As a result, the ligaments and muscles that did not have time to adapt to the implant could not hold it and it came 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 discomfort when walking.Although you perform various exercises and exercises to develop both joints, it is also work and the desire to move independently.
Prevention
We have 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 to an old age without crutches.In Soviet times, serious work was carried out to prevent diseases of the musculoskeletal system and strengthen the immune system.Nowadays it is difficult to recover the lost experience, the mind is clear about it, but it is too lazy to do so.
- Excess weight wears down the joints to the point of disgrace;The endoprosthesis is better, but not to lose extra kilos.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 that lifting weights is no less harmful to the entire skeleton.
- Bad habits (alcohol, smoking) eliminate calcium, magnesium and other beneficial substances from the body.
Just dig in, everything is interconnected.
Take care of yourself and your joints by exercising every day!