Coxarthrosis of the hip joint, a complex pathology of arthrosis, leads to serious changes in the articulation.Unfortunately, the disability of mature people with loss of ability to work is common.In fact, statistics on hip joint disease 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, practically, this is the same arthrosis.
In terms of its mechanism, the articulation of the hip with the pelvis is similar to door hinges.The head of the femur is attached to the ischium as a hinge.Which has a special anatomical formation - acetabulum.This structure ensures maximum joint mobility.Which performs a complete cycle of movements, or rather bending, stretching, rotation, etc.
Normally, the articular surfaces are smooth, there is enough fluid inside, which ensures unimpeded gliding.As the disease progresses, the lubricant becomes thicker and more viscous, 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.Increased load leads to complete atrophy of the femoral muscles and weakness of the ligaments.
Important: osteoarthritis of the hip joint is a progressive disease.Changes can lead to the complete loss of a person's physical activity.Ultimately it leads to disability.And completely disrupting the usual way of life.The disease and its treatment are extremely important not only from the 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 hip joint pathology development are associated with congenital dislocation of the hip and dysplasia (inferiority) of the joint.
Therefore, there are 2 types of coxarthrosis;
- primary (stemming from an unknown etiology);
- secondary (associated with injuries, diseases).
Primary osteoarthritis is characterized by a combination of factors:
- inheritance;
- the impact of biological, mechanical processes;
- excess weight;
- metabolic disorders;
- There is also a theory of 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, arthrosis).
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).
- 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 appears in children when the blood supply and nutrition of the joint are damaged.
In addition, the pathology can affect both formations at once or be unilateral.In addition to the direct causes of the occurrence, there are predisposing factors that provoke the development of the disease.Often the disease appears with increased loads on the limbs of athletes.As well as people with difficult physical working conditions.Excess weight significantly increases the possibility of arthrosis.
Provocative factors also include:
- Disruption of metabolic processes, joint nutrition, hormonal imbalance.
- Adynamia.
- Bad attitude.Especially scoliosis, kyphosis, which lead to distortion 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, degree 1, 2. After 60, every third is already observed.And when they reach the age of 70 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 joint.However, the hereditary factor can still be traced.A person can get structural features of cartilage tissue, altered metabolism and skeletal pathology from relatives.It is the combination of such genetic information that can provoke the appearance of hip arthrosis.
Distribution
The main division of the disease is based on its severity.There are 3 stages, which differ not only in symptoms, but also in radiographic changes.It is these indicators that are taken as a basis for establishing a diagnosis.
diploma |
The signs |
|---|---|
The |
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of secondment |
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III |
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This division is the most common.There are also types of Kellgren classifications.It includes 4 stages, plus the zero degree - the equivalent of a healthy joint.
Symptoms
The basis of all diseases of the musculoskeletal system is pain.Coxarthrosis of the hip joint of degree 1-2 has less pronounced symptoms than with terminal stage 3. Initially, the pain appears during exercises.Especially after long walks or climbing stairs.Later, pain becomes a constant companion, significantly worsening the quality of life.
Coxarthrosis of the first degree
Unpleasant sensations are concentrated only in the joint area (hips and buttocks are practically not affected), rarely being reflected in the groin or knee.The pain eases with rest.
At this stage, no further manifestations are detected - the gait remains unchanged, there are no disturbances in movement.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.Movement problems occur only in stage 3.
For stage 1 symptoms of coxarthrosis of the hip joint, treatment can be performed without surgery.Rational therapy allows you to eliminate unpleasant symptoms, stopping the progression.
The second degree of the disease
Pain, although not constant, occurs at rest.Radiation becomes visible - groin, groin, knee.Stiffness is noted - movements are limited to lifting, attempts to grab to the side, difficulty in circular movements of the leg (pain especially often increases).Lameness becomes apparent, which appears after intense walking or running.
When you move, a characteristic crack of arthrosis is heard - harsh, dry.
Osteoarthritis 3 degrees
The pain becomes constant and does not go away after rest and sleep.Unpleasant sensations do not leave the patient even at night.Has problems with walking;to facilitate movement, you must use a cane.The lameness is constant.
At this stage, limb muscle atrophy occurs, and the leg itself is shortened.These changes force the patient to bend on the affected side, further increasing the load on the joint.Mobility restriction is 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.There is pain in the lower back, the posture is disturbed and the axial position of the pelvis changes.
Diagnosing
An important role in determining the disease is an examination by an orthopedic surgeon, as well as a complete 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 markers.
Coxarthrosis of the hip joint of the first degree has the most subtle symptoms.This is why it is worth performing an X-ray examination to visualize changes in the joint space.This method allows you not only to identify the disease.And also often find out the cause of the appearance - dysplasia, Perthes disease.
Often, knee pain is much more pronounced with deforming coxarthrosis of the 1st degree of the hip joint, so it must be distinguished from gonarthrosis.The differential diagnosis also includes an examination of the spine to rule out radicular syndrome (it gives radiating pain to the hip and knee).
In suspicious cases, MRI (allows you to examine soft tissues in detail) and CT (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 methods of conservative therapy used do not bring relief.
Grade 1 treatment
Unfortunately, it is impossible to completely eliminate the pathology.At level 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).
- 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 accompanied by the fear of increasing pain and the possibility of worsening the situation.Practice proves that this opinion is wrong - regular exercise therapy helps strengthen muscles, protect them from atrophy, reduce pain and improve joint function.
A diet for grade 1 coxarthrosis of the hip joint is not prescribed;moderate food 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-inflammatory drugs 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 their use with gastroprotectors.
Persistent pain is relieved with intra-articular steroid injections and sedative blocks are also possible.
For support is described:
- Muscle relaxants – relieve tension, reduce leg pain.
- Chondroprotectors - improve the restoration of cartilage tissue.
- 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 current, 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 destroyed formation with an artificial one.Interventions fully restore the patient's motor skills.It helps you fully return to your normal lifestyle.
Depending on the extent of the process, the prosthesis can be either unipolar (only the worn head of the femur is replaced) or bipolar (the surface of the acetabulum is also changed).After surgery, rehabilitation is mandatory so that the patient can return to an active life as soon as possible.
For patients over 60 years old, the rehabilitation period is set 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:
- Exclusion of running, long walking, jumping.
- Avoiding heavy lifting.
- Avoid excessive exposure to a forced static position (this is especially true for people with standing jobs).
Life event
My friend's husband sought surgical treatment for endoprosthetics.He was not diagnosed with coxarthrosis, but a lumbar hernia was successfully removed.The condition did not improve, the examination continued, and finally, after finding out what was wrong, they sent me for sub-quota surgery.
After the replacement, everything grew safely, but the second hip joint also required surgery.A year later, the quota for the operation was again, which was successful.And then, from the first minutes after anesthesia, rehabilitation and strict adherence to the doctor's recommendations are required.
What about our friend?Already on the way home after the hospital, I began to stress the prosthetic joint (sitting for a long time, stepping on my feet).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.
Sure enough, they got him in, put a cast on him, 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 he walks.Although he does various exercises and exercises to develop both joints, it is also work and the desire to move independently.
Preventing
We have discussed the symptoms and treatment of coxarthrosis in the hip joints, as well as their stages.
- Only daily physical exercise will help you avoid serious complications and live to a ripe old age without crutches.In 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, it is clear with the mind, but it is very lazy to do it.
- Excess weight tires the joints to shame;endoprosthetic is better, but not by losing 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 bad for the entire skeleton.
- Bad habits (alcohol, smoking) remove calcium, magnesium and other useful substances from the body.
Just dig in, it's all interconnected.
Take care of yourself and your joints by exercising every day!