Coxarthrosis is a common degenerative-dystrophic disease of the hip joint, in which the articular joint of the head of the femur and the acetabulum of the pelvis gradually die as a result of age-related changes or other factors.It is associated with pain and limited mobility of varying severity, which depends on the stage of development.And if in the initial stage it is possible to cope with coxarthrosis with conservative methods, then in the 3rd stage only surgery can save the situation and maintain the functionality of the hip joint, i.e. avoid disability.
It is classified as arthrosis and can be accompanied by the development of similar processes in other joints, and this pathology accounts for about 12% of all diseases of the musculoskeletal system.But the term "coxarthrosis" can only be used to describe degenerative-dystrophic changes in the hip joint.
What is coxarthrosis
Coxarthrosis is a complex pathology of one or both hip joints, in which the cartilaginous layers covering the head of the femur and acetabulum are destroyed, which leads to a decrease in the size of the joint space.As the disease progresses, bone surfaces are deformed and bone growths, so-called osteophytes, form on them.
Coxarthrosis is the second most common disease of the musculoskeletal system.More often, only gonarthrosis is diagnosed, i.e. a degenerative-dystrophic change of the knee joint.However, the probability of disability from coxarthrosis is significantly higher.
The entire hip joint is enclosed in a case called the joint capsule.It has a so-called synovial membrane, which produces synovial fluid.This fluid is extremely important for the proper functioning of the joint, as it not only lubricates the hyaline cartilage, but also provides a source of nutrients.
Normally, the cartilage is constantly worn down and immediately repaired thanks to the continuous regeneration process, which is carried out with the help of substances entering from the synovial fluid.But with injuries or age-related changes, the speed of regeneration processes decreases, which leads to gradual wear of hyaline cartilage and the development of coxarthrosis.
This is explained by changes in the amount and composition of the synovial fluid produced.As a result of adverse factors, it becomes thicker and is produced in smaller quantities.Because of this, the synovial fluid can no longer supply the hyaline cartilage with all the necessary substances, which leads to rapid drying and thinning.The strength and elasticity of the cartilage gradually decreases, the areas of separation of the fibers that make it up, cracks appear in it, and the thickness also decreases.These changes can be detected during instrumental diagnostic procedures, especially during the narrowing of the joint space.
The narrowing of the joint space leads to an increase in friction between the bony structures that make up the hip joint and an increase in pressure on the already degrading hyaline cartilage.This causes even more damage, which affects the function of the joint and the condition of the person, because the deformed areas prevent the femoral head from sliding easily in the acetabulum.As a result, symptoms of coxarthrosis appear.
If it is not treated, the pathological changes worsen, and the hyaline cartilage wears out more and more.After that, it disappears completely in some areas, which leads to a sharp increase in the load on the bones and the joint.Since the head of the femur rubs directly against the bone during movement inside the acetabulum, this causes severe pain and a sharp limitation of mobility.In this case, the pressure of the bone structures on each other leads to the formation of bone growths on their surface.
Formed osteophytes may have sharp parts that can injure the muscles and ligaments surrounding the hip joint.This leads to severe pain both directly in the area of the joint and in the groin, buttocks and thighs.As a result, the patient spares the injured leg, puts less strain on it, and tries to avoid unnecessary movements with it.This causes muscle atrophy, which further worsens the limitation of movement and ultimately leads to lameness.
Reasons
There are many reasons for the development of coxarthrosis, although in rare cases it occurs in the absence of prerequisites.In this case, they talk about the presence of primary or idiopathic coxarthrosis.In the vast majority of cases, secondary coxarthrosis is diagnosed, which is a logical consequence of many diseases or changes in the state of the musculoskeletal system.Its development can be provoked by:
- various types of injuries to the hip joint, including fractures, dislocations, contusions, sprains, or torn ligaments;
- heavy physical work, professional sports, especially weightlifting, parachuting, jumping sports;
- sedentary lifestyle;
- overweight, which significantly increases the load on the hip joints;
- foci of chronic infection in the body;
- congenital disorders of the hip joints, such as dysplasia or dislocation;
- metabolic pathologies and endocrine disorders, especially gout, diabetes mellitus, especially in decompensated form;
- aseptic necrosis of the femoral head, which may be the result of a femoral neck fracture, especially during conservative treatment;
- inflammatory joint diseases, including rheumatoid arthritis, bursitis, tendinitis;
- diseases of the spine;
- genetic predisposition;
- the presence of bad habits, especially smoking.
Nevertheless, the main cause of coxarthrosis is still inevitable age-related changes, and the presence of the above factors only increases the likelihood and speed of its development.
Symptoms of coxarthrosis
The disease is characterized by a gradual progression, with a systematic increase in the intensity of the symptoms.Therefore, in the initial stage it may be asymptomatic or only occasionally cause anxiety in patients, but later the condition of the hip joint deteriorates, which leads to the worsening of the symptoms of coxarthrosis to unbearable pain and significant limitation of mobility.
So, degenerative-dystrophic changes in the hip joint are accompanied by the following:
- Pain of varying intensity, which initially occurs after physical activity or walking, and then subsides after rest.The severity of the pain syndrome gradually increases, it appears more often, it lasts longer, and the period between the load on the joint and the onset of pain decreases.Later, the pain is almost constantly present, including at rest, and becomes unbearable.An increase in pain with hypothermia and lifting heavy objects is characteristic at any stage of the disease.
- Mobility limitations of the hip joint, which initially appear as minor difficulties in performing rotational movements of the leg.Over time, morning stiffness appears, which disappears after the patient "falls apart".This may be accompanied by the appearance of swelling in the hip joint.As the disease progresses, movement restrictions become more pronounced and permanent, i.e. they do not go away even after warming up.Patients notice a decrease in the amplitude of leg movements, and subsequently completely lose the ability to perform certain movements.
- Crackling in the hip joint, which appears when walking or doing physical work, especially when stretching.This is the result of the exposed bone structures rubbing against each other, accompanied by a sharp increase in pain.
- Spasms of the thigh muscles, which lead to the appearance of diffuse pain in the thigh.This can be caused by various intra-articular abnormalities, including nerve compression, excessive stretching of the ligaments surrounding the joint, and synovitis, i.e., inflammation of the joint membrane and the accumulation of inflammatory fluid in the hip joint cavity.
- Lameness, which initially arises from the unconscious desire of the patient to reduce the load on the diseased joint and transfer the weight to the healthy leg in order to avoid the appearance or intensification of pain and the subsequent development of muscle contracture.This latter phenomenon already occurs in the later stages of coxarthrosis, and leads to the fact that the patient cannot straighten his leg completely, or even keep it in this position.Thus, the lower limb with the affected hip joint is constantly in a slightly bent position, which causes lameness.
- The decrease in leg length, which is mainly associated with severe degenerative-dystrophic changes of the hip joint, not only with the narrowing of the joint space, but also with the flattening of the femoral head and muscle atrophy.As a result, the diseased leg will be 1 or more centimeters shorter than the healthy leg.
Coxarthrosis can affect one hip joint or both at the same time.But if in the first case the symptoms of the disease are observed only on one side, then in the second they are not only bilateral, but also differ in intensity.It depends on the degree of destruction of each hip joint.
Degrees of coxarthrosis
The nature of the manifestations of the disease depends on the stage of development.Overall, there are 3 degrees of coxarthrosis, the first of which is considered the mildest.In the initial stages of degenerative-dystrophic changes of the hip joint, only occasional pain is observed.This usually occurs after intense physical activity, sports or a long walk.Therefore, patients usually do not pay attention to them, attribute them to fatigue and see them as a normal age-related change.In this regard, coxarthrosis of the 1st degree is diagnosed only in isolated cases, which usually occurs during examination for other reasons.
As the disease progresses, its symptoms intensify, and they make themselves felt already at the 2nd degree of coxarthrosis.This stage of development of the pathology is characterized by a 50% narrowing of the joint space and the appearance of signs of deformation of the femoral head with its displacement.
With the further progression of the pathology, the joint space narrows even more and is almost completely absent in the 3rd degree of coxarthrosis.This is accompanied by the formation of multiple osteophytes.At this stage of the development of the disease, the pain becomes not only severe, but unbearable, and often occurs even at complete rest, including at night.Since the hip joint is severely deformed, its elements can impinge on the nerves that pass through it, which leads to pain radiating to the lumbar region, buttocks, thigh, and even the lower leg.It also causes you to be unable to move independently without the use of assistive devices such as crutches or a cane.
Grade 3 coxarthrosis is a direct indication for surgical treatment.If the operation is not performed in time, the head of the femur is firmly fused with the surface of the acetabulum by osteophytes.This leads to the shortening of the leg, the complete absence of the ability to move independently, as the joint completely loses mobility, i.e. disability.
Diagnostics
If signs of coxarthrosis appear, we recommend that you consult an orthopedist as soon as possible.Initially, the doctor questions the patient and finds out the nature of the complaints, then examines and performs functional tests, comparing the length of the legs.In general, the data obtained are sufficient to speak with a high degree of confidence about the presence of coxarthrosis.
But since a similar clinical picture can accompany many other diseases of the hip joints, both inflammatory and non-inflammatory, instrumental diagnostic methods are necessarily prescribed.With their help, the specialist can not only confirm the presence of coxarthrosis, distinguish it from radicular syndrome caused by spinal pathologies, but also correctly assess the degree of its development and therefore choose the most effective treatment tactics.
Today, the following are used to diagnose coxarthrosis:
- X-ray of the hip joints - the obtained images allow the detection of signs of destructive changes, the presence of osteophytes, the nature of the deformation of the bone structures and the measurement of the thickness of the joint space.
- CT is a more modern method for diagnosing bone pathologies, it provides clearer data than X-ray, but it is more expensive.Therefore, CT is prescribed in controversial cases when it is necessary to clarify the diagnosis and the degree of destruction of the hip joint.
- MRI is an extremely informative method for studying joints, which provides as much information as possible about the state of the joint and all its structures, especially the hyaline cartilage, ligaments and blood supply characteristics.
Patients are prescribed a number of laboratory tests, including OAC, OAM, rheumatic tests, biochemical blood tests and others.
Conservative treatment of coxarthrosis
When diagnosing grade 1 or 2 coxarthrosis, treatment is carried out with conservative methods.They are selected individually for each patient, taking into account the detected concomitant pathologies.Therefore, you often need to consult not only an orthopedic doctor, but also doctors of other specialties, who will select the necessary treatment to combat the concomitant diseases.
As part of the treatment of coxarthrosis, patients are prescribed:
- drug therapy;
- exercise therapy;
- physiotherapy.
All patients must be exposed to factors that increase the load on the legs and contribute to the progression of degenerative changes in the hip joint.This includes changing your diet and increasing your physical activity if you are overweight.If the patient is regularly exposed to excessive physical activity, it is recommended to change the type of activity or reduce the intensity of training if the load is due to sports.In some cases, it is recommended to use special bandages and orthoses that fix the hip joint and relieve it during physical activity.
Drug therapy
As part of drug treatment, drugs are selected individually for patients, taking into account existing accompanying diseases.Medicines belonging to the following pharmacological groups are usually prescribed for coxarthrosis:
- NSAIDs are a wide group of drugs that have an analgesic and anti-inflammatory effect (they are available in various dosage forms, including tablets, capsules, gels, creams, injection solutions, which allow you to choose the most effective and convenient way of use);
- corticosteroids are drugs that have a strong anti-inflammatory effect, but due to the high risk of side effects, especially when using oral forms, they are prescribed only in short courses in the form of injections;
- muscle relaxants - drugs that help reduce muscle tone, which allows you to effectively combat muscle spasms, which are often observed in coxarthrosis;
- chondroprotectors – a group of drugs containing components used by the body to regenerate cartilage tissue;
- drugs that improve microcirculation - they improve the nutrition of soft tissues and activate metabolic processes in the affected area;
- B vitamins – indicated for the treatment of nerve conduction disorders caused by nerve compression caused by altered components of the hip joint.
If coxarthrosis causes an attack of acute pain that cannot be relieved with the help of prescribed NSAIDs, patients should use intra-articular or peri-articular blockade.Its essence is to inject the anesthetic solution in combination with corticosteroids directly into the cavity of the hip joint.This eliminates the pain and reduces the inflammatory process in the shortest possible time.But the blockade can only be performed by a qualified medical professional in a specially prepared room.Performing such procedures at home is not recommended.
Exercise therapy
During the diagnosis of coxarthrosis, regular physical therapy exercises are necessary.Just like drug therapy, exercise therapy exercises are selected individually for each patient, taking into account the degree of damage to the hip joint, the patient's level of physical development and the nature of concomitant diseases (special attention is paid to cardiovascular pathologies).
Thanks to the daily gymnastics therapy classes, it is possible to:
- reduces the severity of pain;
- increases the mobility of the hip joint;
- reduces the risk of muscle atrophy;
- eliminates hamstring spasms;
- activates blood circulation and thus improves the nutrition of the affected joint.
All exercises must be performed smoothly, avoiding sudden movements and jerks.But if pain occurs during exercise therapy, be sure to consult your doctor in order to correct the selected complex or carry out repeated diagnostics in order to exclude the progression of the disease and the need for surgery.
Physiotherapy
The complex treatment of coxarthrosis consists of physiotherapy procedures that have an anti-inflammatory, pain-relieving, decongestant and toning effect on the body.Therefore, patients are most often prescribed 10-15 procedures:
- ultrasound therapy;
- electrophoresis;
- UVT;
- magnet therapy;
- laser therapy etc.
Recently, plasmolifting has been used more and more often as part of the conservative treatment of coxarthrosis, which can significantly increase the speed of hyaline cartilage regeneration.The essence of the procedure is the introduction of purified blood plasma into the cavity of the hip joint, which is obtained by centrifugation from the patient's own blood.
Coxarthrosis surgery
If the patient is diagnosed with grade 3 coxarthrosis, surgical intervention is required, as conservative methods are no longer effective in such cases.Unfortunately, such situations are extremely common nowadays, as many patients consult a doctor when they can no longer tolerate pain or have severe mobility limitations, which deprives them of their ability to work and move independently.
Timely surgical intervention can completely eliminate these abnormalities and restore the patient's normal movement, significantly improving his quality of life.The indications of its implementation are as follows:
- a significant reduction in joint space of more than 80%;
- the presence of severe pain in the hip joint that cannot be eliminated;
- severe mobility impairment;
- femoral neck fracture.
The gold standard for the treatment of severe coxarthrosis, including in the elderly, is hip replacement.This operation involves replacing the damaged hip joint with an artificial endoprosthesis made of durable and at the same time biologically compatible materials.Endoprosthetics enables the complete restoration of the functionality of the hip joint, the elimination of pain and the return of a person to a full active life.
The essence of this type of surgical intervention is the resection of the head of the femur and a small fragment of the neck.The surgeon must also prepare the surface of the acetabulum for the installation of the endoprosthesis, that is, he must remove all the osteophytes that have formed and achieve the maximum restoration of its normal shape.After that, a selected type of endoprosthesis is installed, which is fixed with special cement (preferably for the treatment of the elderly) or without cement.In the latter case, the endoprosthesis has a special spongy part that contacts the bone structures.Its fixation in the acetabulum is ensured by the growth of bone tissue through the sponge.
The type of endoprosthesis is selected individually for each patient.The most effective is the total endoprosthesis, which means the complete replacement of the entire hip joint, i.e. the neck and head of the femur, as well as the acetabulum.
If the patient has preserved normal hyaline cartilage on the surface of the acetabulum, he can undergo a partial arthroplasty, replacing only the femoral head and/or the neck.Endoprostheses of different designs are used for this purpose: monopolar and bipolar.
The only disadvantage of replacing the endoprosthesis is that the installed endoprosthesis must be replaced after 15-30 years.
After endoprosthesis, patients receive rehabilitation, the duration of which depends on the speed of tissue recovery.Exercise therapy, physiotherapy and therapeutic massage are prescribed as part of the recovery.
Before the advent of modern endoprostheses, patients with grade 3 coxarthrosis were prescribed osteotomy or arthrodesis.Today, these techniques are used less and less, as they have many disadvantages.Thus, arthrodesis involves fixing the bony structures of the hip joint with metal plates.As a result, the pain syndrome completely disappears, but the joint completely loses its mobility.Thus, after arthrodesis, the patient can only stand, but can no longer walk independently due to the lack of movement in the hip joint.Therefore, arthrodesis is practically not performed today.
An osteotomy involves artificially breaking the femur using a combination of bone fragments that reduce the load on the affected hip joint.But surgery gives only a short-term effect, and endoprosthesis is still needed in the future.
Thus, coxarthrosis of the hip joint is a rather dangerous disease that can result in disability.It seriously impairs the quality of life and deprives a person of the ability to work.But if you pay attention to the early signs of pathology and consult an orthopedist in time, you can slow down its progression and achieve a significant improvement in your well-being.But in the case of already advanced coxarthrosis, there is only one solution - endoprosthesis.Fortunately, this method can also be used in severe degenerative changes and can completely restore the normal functioning of the hip joint.