Coxarthrosis of the hip joint, a complex pathology of arthropathy, leads to serious changes in the joint.Unfortunately, the disability of mature people with loss of capacity for work is common.In fact, statistics on the disease 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 recovery.
Coxarthrosis of the hip joint: 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, practically, this is the same arthropathy.
In terms of its mechanism, the hip joint with the pelvis is similar to door hinges.The head of the femur connects to the hip joint as a joint.Which has a special anatomical formation - the acetabulum.This structure ensures maximum mobility of the joint.Which performs a full cycle of motion, or rather flexion, extension, rotation, etc.
Normally, the articular surfaces are smooth, there is enough fluid inside, which ensures unimpeded gliding.As the disease develops, the lubricant becomes thicker and thicker, which immediately affects the condition of the cartilage.Synovial fluid no longer fully performs its functions.Because of this, shock absorbing pads dry out, crack and become rough.
- First.As a result of the lack of the necessary sliding, the friction of the bones increases, injuring them.
- Secondly.As it progresses, the deformation of the bone surfaces also joins the altered cartilage tissue.The body thus tries to compensate for the increased load.
- Thirdly.The 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.The changes can lead to a person's complete loss of physical activity.It eventually leads to disability.And completely disrupting the usual way of life.The disease and its treatment is extremely important not only from a medical point of view, but also a great social problem.
Causes of coxarthrosis development 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 related to congenital hip dislocation and dysplasia (inferiority) of the joint.
Therefore, there are 2 types of coxarthrosis.
- primary (arising from unknown etiology).
- secondary (related to injuries, diseases);
Primary osteoarthritis is characterized by a combination of factors:
- heredity?
- influence of biological, mechanical processes.
- overweight;
- metabolic disorders;
- There is also a theory about pathological tissue repair in response to harmful factors (inflammation, friction, infection).
Often this type of coxarthrosis is combined with damage to the spine and inflammatory phenomena of the knee joints (arthritis, joints).
In the secondary version, the reasons for development are clearer.These include:
- Dysplastic disorders.In half of cases of congenital pathology, grade 1 dysplastic coxarthrosis of the hip joint occurs.
- Hip dislocation (congenital).
- Life traumas.Pelvic, femoral neck fractures, dislocations, subluxations.
- Legg-Calvé-Perthes disease.Osteochondropathy of the femoral head with development of its necrosis.This disease occurs in children when the blood supply and nutrition of 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 occurrence, there are predisposing factors that cause the development of the disease.Often the disease occurs with increased loads on the limbs of athletes.As well as people with difficult physical working conditions.Being overweight significantly increases the likelihood of arthritis.
Precipitating factors also include:
- Disorder of metabolic processes, joint nutrition, hormonal imbalances.
- Weakness.
- Bad posture.Especially scoliosis, kyphosis, which lead to misalignment of the pelvic bones.
- Age after 40 years.It is estimated that after this date, every 10th patient is diagnosed with coxarthrosis of the hip joint, grade 1, 2. After 60, every third person is already observed.And when they reach the age of 70 and above, 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 identified.A person can inherit structural features of cartilage tissue, altered metabolism, and skeletal pathology from relatives.It is the combination of such genetic information that can cause hip arthropathy to occur.
Classification
The main division of the disease is based on severity.There are 3 stages, which differ not only in symptoms, but also in X-ray changes.These indicators are taken as a basis for 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 degrees 1-2 has less severe symptoms than with the final stage 3. Initially, the pain manifests itself during exercise.Especially after long walks or climbing stairs.Later, pain becomes a constant companion, significantly worsening the quality of life.
1st degree coxarthrosis
Unpleasant sensations are concentrated only in the area of the joint (the groin and buttocks are practically not affected), they are rarely reflected in the hip or knee.The pain is relieved by 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 are interested in gymnastics and yoga.Movement problems appear only in stage 3.
For symptoms of stage 1 coxarthrosis of the hip joint, treatment can be performed without surgery.Rational treatment allows you to eliminate unpleasant symptoms, stopping the progression.
2nd degree disease
The pain, although not constant, manifests itself in a state of rest.Radiation is felt - hip, groin, knee.Stiffness is observed - movements are limited in lifting, effort to abduct to the side, difficulty in circular movements of the leg (pain especially often increases).Lameness is felt, which appears after vigorous walking or running.
When moving, a characteristic arthrosis crunch is heard - rough, dry.
Osteoarthritis grade 3
The pain becomes constant and does not subside after rest and sleep.The unpleasant sensations do not leave the patient even at night.There are problems with walking.to facilitate movement, you must use a cane.The lameness is continuous.
At this stage, limb muscle atrophy occurs and the leg itself is shortened.These changes cause the patient to bend toward the affected side, further increasing the load on the joint.Mobility restriction is observed in almost all directions.
Changes in the bilateral coxarthrosis of the hip joint alter the patient's gait, so all formations involved in the gait process suffer.Lower back pain occurs, body posture is disturbed and the axial position of the pelvis changes.
Diagnostics
An important role in determining the disease is the examination by an orthopedic surgeon, as well as the thorough analysis of complaints.It is worth assessing the patient's activity - the ability to climb stairs, comfort when wearing 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 and syphilis indicators.
1st degree coxarthrosis of the hip joint has the most distinctive symptoms.This is why it is worth taking an X-ray to visualize the changes in the joint space.This method allows not only to identify the disease.And you also often find out the cause of the appearance - dysplasia, Perthes disease.
Often, the knee pain is much more severe with 1 degree coxarthrosis of the hip joint, so it must be distinguished from gonoarthrosis.The differential diagnosis also includes examination of the spine to rule out radicular syndrome (gives radiating hip and knee pain).
In doubtful cases, magnetic resonance imaging (allows you to examine soft tissues in detail) and CT (to review bone formations) is 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 drugs is effective for degrees 1-2 of the disease.In the final stage, only surgery helps.In another case, surgery is performed if the conservative treatment methods used do not bring relief.
1st degree treatment
Unfortunately, it is impossible to completely eliminate the pathology.In grade 1, treatment is aimed at stabilizing the condition.
During treatment, some general recommendations should 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 physical therapy.
Important: many patients completely refuse gymnastics and any exercise due to pain.This is often associated with the fear of increased pain and the possibility of worsening the condition.Practice proves that this opinion is wrong - regular exercise therapy helps strengthen muscles, protects them from atrophy, reduces pain and improves joint function.
No diet is prescribed for grade 1 coxarthrosis of the hip joint.moderate diet is prescribed for weight loss.It is also useful to add products with gelatin, canned fish with bones and dairy products to your diet.
Conservative
As a pharmaceutical method, non-steroidal anti-inflammatory drugs are used.Due to the large number of side effects, it is recommended to take medication for severe pain.You can combine their use with gastroprotectors.
Persistent pain is relieved by intra-articular steroid injections and palliative blocks are also possible.
The following are prescribed for support:
- Muscle relaxants – relieve tension, reduce leg pain.
- Cartilage protectors – improve cartilage tissue repair.
- Vasodilators (nicotinic acid) - help relieve vascular spasm and also increase tissue microcirculation.
Heating compresses are also used in combination (you can also use traditional treatment methods).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 a planned endoprosthetic surgery.This is a special operation to replace a damaged formation with an artificial one.The interventions fully restore the patient's motor skills.It helps you fully return to your normal lifestyle.
Depending on the extent of the procedure, the prosthesis can be either unipolar (only the worn head of the femur is replaced) or bipolar (the acetabular surface is also changed).After the operation, rehabilitation is mandatory so that the patient can return to active life as quickly as possible.
For patients over 60 years of age, the recovery period is established even before the surgical treatment, so that the recovery process takes place in a shorter period of time.The lifespan of an artificial joint is about 20 years, but it is important to follow the recommendations:
- Blocking running, long walking, jumping.
- Avoid heavy weights.
- Avoid excessive exposure to a forced static position (this is especially true for people with standing work).
Life event
My friend's husband needed surgical treatment for endoprosthesis.He was not diagnosed with a coxarthrosis, but a lumbar hernia was successfully removed.The condition did not improve, the examination continued and finally, after they found out what was wrong, they sent me for a quota operation.
After the replacement, all developed safely, but the second hip joint also required surgery.A year later, the quota for the business was again, which was successful.And then, from the first minutes after anesthesia, recovery and strict adherence to the doctor's recommendations are required.
And what about our friend?Already on the way home after the hospital, I began to put pressure on the prosthetic joint (I sit for a long time, stepping on my leg).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 popped out.
Of course, they put it in, plastered it, and then everything seemed to come out.But he complains that he cannot move his leg to the side, it hurts and he feels discomfort when he walks.Although he does exercises and various exercises to develop both joints, it is also work and a 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 in old age without crutches.In the Soviet era, serious work was carried out to prevent diseases of the musculoskeletal system and strengthen the immune system.Nowadays it is difficult to restore the lost experience, it is clear with the mind, but you are too lazy to do it.
- Excess weight wears out the joints to a point of shame.the endoprosthetic is better, but not to lose the extra pounds.My friend is sure of it, without even trying to eat less sweet and starchy foods.Proper nutrition is a very important point.
- I find that lifting weights is no less bad for the whole frame.
- Bad habits (alcohol, smoking) remove calcium, magnesium and other beneficial substances from the body.
Just dig, it's all interconnected.
Take care of yourself and your joints by exercising daily!