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Osteoarthritis of the hip joint: symptoms, treatment and prevention

The hip joint is the largest joint in our body.It has a hinge configuration that allows movement in different planes.At the same time, the joint is surrounded by strong ligaments and muscles.The hip joints bear the main load when walking, running or carrying heavy loads.Coxarthrosis (another name for osteoarthritis of the hip joint) is quite common in people, both old and young.Once it starts, it can go undiagnosed for a long time, because visible limitation of hip movement does not occur immediately.

Often, patients, without being examined by a doctor or without presenting all their complaints, begin to treat lumbosacral osteochondrosis or arthrosis of the knee joints without a visible effect.Meanwhile, the untreated disease progresses and leads to lameness, constant pain, shortening of the leg, and the inability to bend and extend.And treatment at this stage is possible only surgically, that is, the joint must be replaced with a prosthetic.

Causes of coxarthrosis

healthy joint and arthrosis of the hip joint

Primary arthrosis of the hip joint develops more often in people older than 40 years.Its causes have not yet been studied.The hyaline cartilage that covers the joint surfaces and allows gliding starts to thin and collapse.Due to the increased friction and pressure on the bones, bone spurs appear on them.The joint is deformed, its movements are limited.In primary coxarthrosis, the knee joints and spine are often affected.

Secondary arthrosis develops against the background of various diseases:

  • Hip dysplasia.This term refers to the congenital underdevelopment of the components of this joint in a child.As a result, the femoral head is not centered as it should be in the acetabulum.There are three types of dysplasia: preluxation, subluxation and dislocation of the hip.In congenital dislocation, the head of the femur is located outside the socket and, if proper treatment is not carried out, arthrosis subsequently develops.
  • Aseptic necrosis.The bone tissue of the femoral head begins to dissolve due to impaired blood supply.The bone tissue is focally resorbed, the joint head is deformed.Arthrosis develops secondarily.
  • Legg-Calvé-Perthes disease.This is osteochondropathy of the femoral head, which occurs in children from 3 to 14 years old, mostly in boys.It occurs, as a rule, as a consequence of complications after infectious processes, as well as injuries, physical overload and metabolic diseases.The cartilaginous area of the head is not well supplied with blood, which leads to necrosis of this area and deformation of the joint.
  • Inflammation, infections.If arthritis of the hip joint has developed, the synovial fluid loses its lubricating properties, the mucous membrane of the joint thickens, the hyaline cartilage is subjected to mechanical stress, and at the same time metabolic disorders occur in the joint.
  • Injuries: bruises, fractures of the femur, acetabulum, hip dislocations, chronic trauma, or microtraumas that are systematically acquired.
  • Overloading of the hip joint associated with sports and professional activities.For example, long walking without rest, vibration effects, constant jumping and carrying heavy loads are undesirable for the joint.The muscle corset of a child or teenager cannot always compensate for such loads.
  • Increased body weight, especially at a young age, when the cartilage is not yet able to withstand large axial loads.In addition, such patients usually have metabolic problems.
  • Coxarthrosis itself is not inherited, but genetic relatives may have a certain structure of cartilage tissue, metabolic disorders that lead to the development of arthrosis.Therefore, it is worth considering whether parents or distant relatives have joint diseases.
  • Osteoporosis.The vulnerable area for this disease is the neck of the femur.Its structure is becoming rarer, pathological fractures are possible.All this leads secondarily to arthrosis.
  • diabetes mellitus.In this case, arthrosis develops due to vascular disorders.
  • Polyneuropathy with weakened sensation in the legs.
  • Diseases of other parts of the musculoskeletal system.These include: scoliosis, arthrosis and knee injuries, flat feet.The distribution of the load on the hip joints changes, the shock absorption properties decrease, and as a result, the cartilage coating suffers.

Symptoms of coxarthrosis

hip joint pain due to arthrosis

For disease prevention and early diagnosis, it is important to know the signs of initial arthrosis of the hip joint (stage 1 coxarthrosis):

  • Pain that occurs periodically after physical activity.Specific feelings of pain can be localized in the groin, side, hip or knee area.After rest they leave, so they are not given importance.Meanwhile, this is an alarming sign.
  • Slight restriction of hip rotation (internally and externally).This can easily be checked while lying on your back, rotating the entire leg clockwise and counterclockwise.
  • An X-ray can reveal a slight uneven narrowing of the joint space.

In stage 2 arthrosis, the signs are more pronounced:

  • The pain occurs in the projection of the joint, most often in the inguinal fold, and is also noted at rest.
  • Restrictions appear not only when turning the leg, but also when abducting the hip to the side.Movements in the joint are somewhat painful, especially in extreme positions (with maximum abduction of the hip, bending of the leg towards the stomach).
  • On the X-ray, you can see a moderate narrowing of the joint space and isolated bony growths on the edges of the acetabulum.Cysts can also form in the bony structure of the femoral head.

Arthrosis of the hip joint of the 3rd stage is easily diagnosed, its symptoms are severe:

  • Joint pain during exercise, at night.
  • When limping, patients often use a cane.
  • Pronounced limitation of movement in the joint, which makes it difficult for the person to put on socks or shoes.
  • The leg becomes thinner due to hypotrophy of the thigh and lower leg muscles.The muscles of the gluteal region also weaken.
  • It is possible to shorten the leg due to incomplete extension and deformation of the femoral head.As a result, scoliosis of the lumbar region (lateral curvature) occurs, and pain appears in the lumbosacral region.
  • Signs of the 3rd stage, revealed by X-ray, are pronounced narrowing of the joint space to its complete absence, bony growths, deformation of the head and neck of the hip joint.

Diagnostics

Clarification of subjective complaints, collection of anamnesis, assessment of symptoms, as well as clarification of stage - radiography, CT and MRI are of great importance in diagnostics.Computed tomography allows you to study the bone structure of the hip joint in detail, and the magnetic resonance method visualizes soft tissues, the state of the joint capsule and the presence of synovitis.

Treatment

Therapy of coxarthrosis depends on the stage of the process and in most cases includes a whole series of procedures.Of course, the earlier treatment is started, the greater its effectiveness.

  1. Conservative treatment
    • Drug therapy.Non-steroidal anti-inflammatory drugs in tablets, suppositories or intramuscular injections are used to relieve pain.Dosage forms such as ointments, gels, creams are not effective enough because the hip joint is surrounded by large muscles and subcutaneous tissue.Long courses of non-steroidal anti-inflammatory drugs are not recommended due to adverse effects on the cardiovascular system and gastrointestinal tract.To help them, the doctor can prescribe drugs that relieve muscle spasm - muscle relaxants.In cases of severe inflammation, intra-articular glucocorticoids may be required.Chondroprotectors are one of the main groups of drugs for the treatment of coxarthrosis.They are applied both intramuscularly and intra-articularly;in milder cases, tablets can be taken.These drugs are aimed at improving the cartilage tissue regeneration process and slowing down its degeneration.The doctor may also prescribe vascular drugs to improve local blood circulation.
    • Physiotherapy.Her procedures improve blood flow in the joint area and relax the muscles.These are UHF, magnetic therapy, laser treatment, diadynamic currents, electrophoresis.Purpose - according to individual indications.
    • Therapeutic massage.An essential way of treating coxarthrosis: relieves muscle spasms, has a beneficial effect on circulation, and when carried out systematically, strengthens muscles.
    • Therapeutic gymnastics.It improves blood flow and strengthens the muscle corset of the joint.Exercises recommended for coxarthrosis (performed on firm support):
      • "bicycle" in a recumbent position;
      • lying on your back, grab your knee with your hand and pull it towards your stomach, and do the same with the other leg;
      • while lying on your back, bend your knees, press your soles on the floor and raise your pelvis, keep in that position;
      • lying on your back, move your thigh as far as possible to the side;
      • sitting on a chair, squeeze the ball between your thighs;
      • lying on your back, turn your legs in and out;
      • standing with the right leg on a slight rise and holding the support with the hands, swing the left leg back and forth and left and right, then do the same, changing the leg.
  2. Surgical treatment.Endoprosthetics, i.e. replacement of the joint with an artificial one, is performed in the 3rd stage of coxarthrosis in the presence of limb shortening, constant pain and severe contracture.Endoprosthetics can be cemented (in the presence of osteoporosis) or cementless.The prosthesis itself can be unipolar (replacement of only the head) and total (replacement of both components).The very next day after the operation, some elements of therapy exercises are performed while lying in bed, the patient can stand up, but for now without leg support, and a few days later - on crutches.After 2-3 months, crutches will no longer be needed and full weight bearing on the leg will be allowed.Rehabilitation consisting of physical therapy, massage and physical therapy is recommended for patients who have undergone endoprosthetics.In most cases, limb function is restored.The lifetime of the prosthesis is from 10 to 20 years, and then it is replaced with a new one.

Prevention of coxarthrosis

Prevention measures are very important, especially if you have a history of hip dysplasia, fractures, severe bruising or purulent processes in this area.

  • Avoiding heavy lifting and jumping (especially from heights).Try not to be on your feet for long periods of time.
  • Weight control (reduce consumption of flour products, table salt, sweet, strong tea and coffee in your diet).Being overweight increases the risk of hip arthrosis.
  • Dosed physical exercises aimed at strengthening the muscles of the thighs and buttocks (cycling or exercise bike, swimming, therapeutic exercises).
  • If there are diseases related to metabolism (diabetes mellitus, atherosclerosis), they must be compensated.

Compliance with preventive measures, early detection of coxarthrosis and its adequate treatment are the key to a positive prognosis for this disease.

Which doctor should I contact?

If you feel pain in the leg or hip joint, consult a doctor.He will prescribe primary diagnostic measures, especially X-rays of the hip joint.After determining the stage of the disease, the patient will be referred to a rheumatologist or orthopedist.Additional help in losing weight and slowing down the progression of the disease can be provided by a nutritionist and an endocrinologist.For women, it would be beneficial to consult a gynecologist to prescribe hormone replacement therapy to prevent osteoporosis.