Coxarthrosis is a common degenerative-dystrophic disease of the hip joint, in which, due to age-related changes or other factors, gradual destruction of the articular joint of the head of the femur and the acetabulum of the pelvis occurs.It is accompanied by pain and limited range of motion of varying severity, which depends on the stage of development.And if in the initial stages it is possible to treat coxarthrosis using conservative methods, then in the 3rd stage it is possible to save the situation and maintain the functionality of the hip joint, that is, to avoid disability, only through surgery.
It is classified as an arthropathy 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 destruction of the cartilaginous layers covering the head of the femur and the acetabulum occurs, which leads to a reduction in the size of the joint space.As the disease progresses, deformation of the bone surfaces and the formation of bony growths on them, called osteophytes, occur.
Coxarthrosis is the second most common disease of the musculoskeletal system.Most often, only gonoarthrosis is diagnosed, that is, a degenerative-dystrophic change in the knee joint.However, the likelihood of disability with coxarthrosis is significantly higher.
The entire hip joint is enclosed in a specific case, which is 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, since it not only lubricates the hyaline cartilage, but also provides it with a source of nutrients.
Normally, the cartilage constantly wears out and is immediately restored due to the continuous process of regeneration, carried out with the help of substances that enter it from the synovial fluid.But with injuries or age-related changes, the rate of regeneration processes decreases, which leads to gradual wear of the hyaline cartilage and the development of coxarthrosis.
This is explained by changes in the amount of synovial fluid produced and its composition.Under the influence of adverse factors, it becomes thicker and is produced in a smaller volume.As a result, the synovial fluid is no longer able to provide the hyaline cartilage with all the substances it needs in the required quantity, which leads to its rapid dehydration and thinning.Gradually, the strength and elasticity of the cartilage decreases, areas of separation of the fibers that form it, cracks are formed in it, and the thickness also decreases.These changes can be observed during instrumental diagnostic methods, especially joint space narrowing.
The narrowing of the joint space leads to increased friction between the bony structures that make up the hip joint and increased pressure on the already degraded hyaline cartilage.This causes even more damage, which affects the function of the joint and the condition of the individual, since the deformed areas prevent the femoral head from sliding easily into the acetabulum.As a result, symptoms of coxarthrosis appear.
If left untreated, the pathological changes worsen and the hyaline cartilage wears down more and more.Then, in some areas, it disappears completely, which leads to exposed bones and a sharp increase in the load on the joint.Since, when moving within the acetabulum, the head of the femur rubs directly against the bone, this causes severe pain and a sharp limitation of mobility.In this case, the pressure of bone structures between them leads to the formation of bone growths on their surface.
The osteophytes that form may have sharp parts that can injure the muscles and ligaments surrounding the hip joint.This leads to severe pain both directly in the joint area and in the groin, buttocks and thigh.As a result, the patient spares the injured leg, loads it less and tries to avoid unnecessary movements with it.This causes muscle atrophy to develop, which further worsens mobility disability and eventually leads to lameness.
Reasons
There are many reasons for the development of coxarthrosis, although in rare cases it occurs in the absence of any prerequisites.In this case they speak of the presence of primary or idiopathic coxarthrosis.In the vast majority of cases, secondary coxarthrosis is diagnosed, which becomes a logical consequence of a number of diseases or changes in the state of the musculoskeletal system.Its development can be caused by:
- hip joint injuries of various types, including fractures, dislocations, bruises, sprains or torn ligaments.
- heavy physical work, professional sports, especially weight lifting, parachuting, jumping sports.
- sedentary lifestyle;
- excess weight, which significantly increases the load on the hip joints.
- foci of chronic infection in the body.
- congenital anomalies 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 a consequence of a fracture of the femoral neck, especially during conservative treatment.
- inflammatory diseases of the joints, including rheumatoid arthritis, bursitis, tendinitis;
- diseases of the spine;
- genetic predisposition;
- presence of bad habits, especially smoking.
However, 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 stages it can be asymptomatic or only occasionally cause anxiety to patients, but then the condition of the hip joint worsens, which leads to an increase in the severity of the signs of coxarthrosis up to unbearable pain and a significant limitation of mobility.
Thus, degenerative-dystrophic changes in the hip joint are accompanied by:
- Pain of varying intensity, which first appears after physical activity or walking and subsides after rest.Gradually, the severity of the pain syndrome increases, occurs more often, lasts longer, and the periods between the moment when the load is applied to the joint and the onset of pain decrease.Later, the pain is present almost constantly, including at rest, and becomes unbearable.Intensification of pain is characteristic at any stage of the disease with hypothermia and lifting heavy objects.
- Mobility limitations of the hip joint, which initially manifest as minor difficulties in performing rotational movements of the leg.Over time, morning stiffness appears, which disappears after the patient "disperses".This may be accompanied by the appearance of swelling in the hip joint.As the disease progresses, mobility limitations become more severe and persistent, i.e. they do not subside after warming up.Patients notice a decrease in the amplitude of leg movements, and then completely lose the ability to perform certain movements.
- A tingling sensation in the hip joint that occurs when walking or doing physical work, especially when performing an extension.It becomes the result of the friction of the exposed bone structures against each other, which is accompanied by a sharp increase in pain.
- Spasms of the muscles of the thigh, leading to the appearance of diffuse pain in the thigh.This can be the result of the addition of various intra-articular disorders, including compression of nerves, excessive stretching of the ligaments surrounding the joint, as well as the development of arthritis, that is, inflammation of the synovial membrane and the accumulation of inflammatory effusion in the cavity of the hip joint.
- Lameness, initially resulting from the patient's unconscious desire to reduce the load on the affected joint and transfer weight to the healthy leg to avoid the occurrence or intensification of pain and subsequently the development of muscle spasm.The latter phenomenon appears already in the last stages of coxarthrosis and leads to the fact that the patient is not able to fully straighten his leg and, moreover, keep it in this position.Thus, the lower limb with the affected hip joint is constantly in a slightly bent position, which causes lameness.
- Reduction of leg length, which occurs mainly with severe degenerative-dystrophic changes in the hip joint, accompanied not only by narrowing of the joint space, but also by flattening of the femoral head and muscle atrophy.As a result, the diseased leg becomes shorter than the healthy leg by 1 or more centimeters.
Coxarthrosis can affect either one hip joint or both at the same time.But if in the first case the symptoms of the disease will be observed only on one side, then in the second they will not just be bilateral, but will also differ in intensity.This depends on the degree of damage to each hip joint.
Grades of coxarthrosis
The nature of the manifestations of the disease depends on the stage of its development.In total, there are 3 degrees of coxarthrosis, of which the first is considered the mildest.In the initial stages of the onset of degenerative-dystrophic changes in the hip joint, only occasional pain can be observed.As a rule, this happens after intense physical activity, sports or a lot of walking.Therefore, patients usually ignore them, attributing them to fatigue and considering them a normal age-related change.In this regard, coxarthrosis of the 1st degree is diagnosed only in isolated cases, which usually appears during an examination for another reason.
As the disease progresses, its symptoms intensify and already with coxarthrosis of the 2nd degree they become noticeable.This stage of development of the pathology is characterized by a narrowing of the joint space by 50%, as well as the appearance of signs of deformation of the femoral head with its displacement.
With further progression of the pathology, the joint space narrows even more and in the 3rd degree the coxarthrosis is almost completely absent.This is already accompanied by the formation of multiple osteophytes.At this stage of the development of the disease, the pain becomes not only intense, but unbearable and often occurs even in a state of complete rest, including at night.Since the hip joint is severely deformed, its elements can impinge on the nerves that pass here, which leads to pain that radiates to the groin, buttocks, as well as the thigh and even the lower leg.This also causes the inability to move independently without the use of assistive devices, for example, crutches or a cane.
Grade 3 coxarthrosis is an immediate indication for surgical treatment.If the operation is not done in time, the femoral head will be firmly fused to the surface of the acetabulum by osteophytes.This will lead to a shortening of the leg, a complete lack of ability to move independently, since the joint will completely lose mobility, that is, disability.
Diagnostics
If signs of coxarthrosis appear, it is recommended to consult an orthopedist as soon as possible.First, the doctor will interview the patient and find out the nature of the complaints, and then proceed to the examination and perform functional tests, comparing the length of the legs.As a rule, 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 a number of other diseases of the hip joints, both inflammatory and non-inflammatory in nature, instrumental diagnostic methods are necessarily prescribed.With their help, a specialist will be able not only to confirm the presence of coxarthrosis, to differentiate it from the root syndrome caused by pathologies of the spine, but also to 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 resulting images allow you to detect signs of destructive changes, the presence of osteophytes, the nature of the deformation of bone structures and measure the thickness of the joint space.
- Computed tomography is a more modern method for diagnosing bone pathologies, providing clearer data than x-rays, but it is more expensive.Therefore, computed tomography is prescribed in controversial cases when it is necessary to clarify the diagnosis and the degree of destruction of the hip joint.
- Magnetic resonance imaging is a highly informative method for studying joints, providing the maximum amount of information about the condition of the joint and all its structures, especially the hyaline cartilage, ligaments and blood supply characteristics.
Patients are prescribed a number of laboratory tests, such as OAC, OAM, rheumatic tests, biochemical blood tests and others.
Conservative treatment of coxarthrosis
When diagnosing coxarthrosis of 1 or 2 degrees, treatment is carried out with conservative methods.For each patient they are selected individually, taking into account the detected accompanying pathologies.Therefore, it may often be necessary to consult not only an orthopedist, but also doctors of other specialties who will choose the necessary treatment to combat accompanying diseases.
As part of the treatment of coxarthrosis, patients are prescribed:
- drug therapy;
- exercise therapy;
- physiotherapy.
It is imperative that all patients take measures to eliminate the effects of factors that increase the load on the legs and contribute to the development of degenerative changes in the hip joint.This includes adjusting your diet and increasing your level of 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 braces that will stabilize the hip joint and relieve it during physical activity.
Pharmacotherapy
In the context of drug therapy, drugs are selected individually for patients, taking into account existing concomitant diseases.As a rule, drugs from the following pharmacological groups are indicated for coxarthrosis:
- NSAIDs are a broad group of drugs that exhibit analgesic and anti-inflammatory effects (available in various dosage forms, including tablets, capsules, gels, creams, injectable solutions, which allows you to choose the most effective and convenient form of use).
- Corticosteroids are drugs that have a strong anti-inflammatory effect, but due to the high risk of side effects, especially when oral forms are used, they are prescribed only in short doses by injection.
- muscle relaxants - drugs that help reduce muscle tone, which allows you to effectively fight muscle spasms, which are often observed with coxarthrosis.
- chondroprotectors - a group of drugs containing components used by the body to regenerate cartilage tissue.
- drugs that improve microcirculation - help to improve the nutrition of soft tissues and activate metabolic processes in the affected area.
- B vitamins - indicated for nerve conduction disorders caused by compression of nerves by altered elements of the hip joint.
If the coxarthrosis causes an attack of acute pain that cannot be relieved with the help of prescribed NSAIDs, patients are advised to undergo an intra-articular or peri-articular block.Its essence is the injection directly into the cavity of the hip joint of an anesthetic solution combined with corticosteroids.This will eliminate the pain in the shortest possible time and reduce the inflammatory process.But the blockade can only be carried out by a qualified doctor in a specially prepared room.It is not recommended to perform such procedures at home.
Exercise therapy
When diagnosed with coxarthrosis, regular physical therapy exercises are required.Just like drug therapy, a set of exercise therapy exercises for each patient is selected individually, taking into account the degree of destruction of the hip joint, the level of physical development of the patient and the nature of accompanying diseases (special attention is paid to cardiovascular pathologies).
Thanks to daily therapy exercise classes, it is possible to:
- reduce the severity of pain.
- increasing the mobility of the hip joint.
- reducing the risk of developing muscle atrophy.
- eliminate thigh muscle spasms.
- activates blood circulation and therefore 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, you should definitely contact your doctor to correct the selected complex or carry out repeated diagnoses to exclude the progression of the disease and the need for surgery.
Physiotherapy
The complex treatment of coxarthrosis includes courses of physiotherapeutic procedures that have anti-inflammatory, analgesic, decongestant and tonic effects on the body.Therefore, most often patients are prescribed 10-15 procedures:
- ultrasound therapy;
- electrophoresis?
- UVT?
- magnetic therapy;
- laser therapy etc.
Recently, plasmolifting is increasingly used as part of the conservative treatment of coxarthrosis, which can significantly increase the rate of regeneration of hyaline cartilage.The essence of the procedure is the introduction of pure blood plasma into the cavity of the hip joint, which is obtained by centrifugation from the patient's own blood.
Surgery for coxarthrosis
If a patient is diagnosed with grade 3 coxarthrosis, surgery is indicated, as conservative methods in such cases are no longer effective.Unfortunately, such situations are extremely common today, as a very large number of patients seek medical help when they can no longer tolerate pain or have severe motor limitations that deprive them of their ability to work and move independently.
Early surgery can completely eliminate these disorders and restore the patient's ability to move normally, significantly increasing his quality of life.Indications for its application are:
- significant reduction in joint spacing by more than 80%.
- the presence of severe pain in the hip joint that cannot be eliminated.
- severe motor impairments;
- femoral neck fracture.
The gold standard for treating 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 allow you to fully restore the functionality of the hip joint, eliminate pain and return a person to a full active life.
The essence of this type of surgery is the resection of the head of the femur and a small fragment of its neck.The surgeon will also need to prepare the surface of the acetabulum for the installation of the endoprosthesis, i.e. remove all the formed osteophytes and achieve the maximum restoration of its normal shape.After that, an endoprosthesis of the selected type is placed, 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 to the acetabulum is ensured by the growth of bone tissue through the sponge.
For each patient, the type of endoprosthesis is selected individually.The most effective is the total endoprosthetic, which involves a 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 preservation of normal hyaline cartilage on the surface of the acetabulum, he can undergo a partial arthroplasty with replacement of only the femoral head and/or neck.For this purpose, endoprostheses of different designs are used: unipolar and bipolar.
The only disadvantage of endoprosthesis replacement is the need to replace the installed endoprosthesis after 15–30 years.
After endoprosthetics, patients are given rehabilitation, the duration of which depends on the speed of tissue recovery.As part of rehabilitation, exercise therapy, physiotherapy and therapeutic massage are prescribed.
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 a number of disadvantages.Thus, arthrodesis involves fixing the bony structures of the hip joint with metal plates.As a result, the pain syndrome is completely eliminated, but the joint completely loses mobility.Thus, after arthrodesis, the patient can only stand up, but can no longer walk independently due to the lack of movement in the hip joint.Therefore, today arthrodesis is practically not performed.
Osteotomy involves performing an artificial fracture of the femur with such a combination of bone fragments that will reduce the load on the affected hip joint.But the operation gives only a short-term result and in the future there is still a need for an endoprosthesis.
Thus, coxarthrosis of the hip joint is quite a dangerous disease, which can lead to disability.It seriously reduces 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 get a timely consultation with an orthopedic surgeon, you can slow down its progression and achieve a significant improvement in your well-being.But with already advanced coxarthrosis, there can be only one solution - endoprosthetic.Fortunately, this method can be used even with severe degenerative changes and fully restore the normal function of the hip joint.