Osteoarthritis of the hip joint: symptoms, treatment and prevention

The hip joint is the largest joint in our body.It has a hinged 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 a visible limitation of the movements of the hip joint 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 visible effect.Meanwhile, the untreated disease progresses and leads to lameness, constant pain, shortening of the leg, and inability to bend and extend.And treatment at this stage is possible only surgically, i.e.the joint must be replaced with a prosthesis.

Causes of coxarthrosis

Primary arthrosis of the hip joint develops more often in people over 40 years of age.The reasons for it have not yet been studied.The hyaline cartilage that covers the joint surfaces and provides gliding begins to thin and break down.Due to the increased friction and pressure on the bones, bone spurs appear on them.The joint is deformed, the movements in it are limited.In primary coxarthrosis, both the knee joints and the spine are often affected.

Secondary arthrosis develops against the background of various diseases:

• Hip dysplasia.This term refers to 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 hip dysplasia: preluxation, subluxation, and dislocation of the hip joint.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.Bone tissue is focally resorbed, the head of the joint is deformed.Arthrosis develops secondarily.
• Legg-Calvé-Perthes disease.It is an osteochondropathy of the femoral head that occurs in children aged 3 to 14 years, mostly boys.It occurs, as a rule, as a result 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 develops, 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: contusions, fractures of the femur, acetabulum, dislocations of the hip joint, chronic trauma, i.e.microtraumas received systemically.
• 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 genetically relatives may have a certain structure of cartilage tissue, metabolic disorders that lead to the development of arthrosis.Therefore, it is worth considering whether the parents or more distant relatives have joint diseases.
• osteoporosis.The vulnerable area for this disease is the neck of the femur.Its structure becomes more rarefied, pathological fractures are possible.All this secondarily leads to arthrosis.
• Diabetes mellitus.In this case, arthrosis develops due to vascular disorders.
• Polyneuropathy with impaired 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 absorbers decrease, and as a result, the cartilage coating suffers.

Symptoms of coxarthrosis

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

• Pain that occurs periodically after physical activity.Specific pain sensations can be localized in the groin, side, thigh or knee.After a break, they go away, so no importance is attached to them.Meanwhile, this is a worrying sign.
• Slight limitation of hip rotation (inward and outward).This can be easily checked while lying on your back by rotating the entire leg clockwise and counterclockwise.
• An X-ray may reveal a slightly uneven narrowing of the joint space.

In stage 2 arthrosis, the signs are more pronounced:

• The pain appears in the projection of the joint, most often in the inguinal fold, and is also noted at rest.
• Limitations occur not only when rotating the leg, but also when abducting the hip to the side.Movements in the joint are slightly painful, especially in extreme positions (with maximum abduction of the hip, bending of the leg towards the abdomen).
• On an X-ray, you can see a moderate narrowing of the joint space and isolated bony processes along the edges of the acetabulum.Cysts can also form in the bony structure of the femoral head.

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

• Pain in the joint during exercise, at night.
• Lameness, patients often use a cane.
• Marked limitation of movements in the joint, as a result of which a person can hardly put on socks or shoes.
• The leg becomes thinner due to hypotrophy of the muscles of the thigh and lower leg.The muscles of the gluteal region also weaken.
• Shortening of the leg is possible due to its incomplete extension and deformation of the head of the femur.As a result, scoliosis of the lumbar region (lateral curvature) is formed and pain occurs in the lumbosacral region.
• Signs of the 3rd stage, revealed by X-rays, are pronounced narrowing of the joint gap to its complete absence, bony growths, deformation of the head and neck of the hip joint.

Diagnosis

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

Treatment

Coxarthrosis therapy depends on the stage of the process and in most cases includes a whole set of procedures.Of course, the earlier treatment begins, 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.Medicinal forms such as ointments, gels, creams are not effective enough due to the surrounding of the hip joint by large muscles and subcutaneous tissue.Long courses of nonsteroidal anti-inflammatory drugs are not recommended because of side effects on the cardiovascular system and the gastrointestinal tract.To help them, the doctor can prescribe drugs that relieve muscle spasm - a muscle relaxant.In cases of severe inflammation, intra-articular glucocorticoids may be necessary.Chondroprotectors are one of the main groups of drugs for the treatment of coxarthrosis.They are administered both intramuscularly and intra-articularly;in milder cases, tablet forms can be taken.These drugs are aimed at improving the recovery processes in cartilage tissue and slowing down its degeneration.The doctor may also prescribe vascular drugs to improve local blood circulation.
   • Physiotherapy.Her procedures improve blood circulation in the joint area and relax the muscles.These are UHF, magnetotherapy, laser treatment, diadynamic currents, electrophoresis.Purpose - according to individual indications.
   • Therapeutic massage.An irreplaceable method for the treatment of coxarthrosis: it relieves muscle spasms, has a beneficial effect on blood circulation, and when used systematically strengthens the muscles.
   • Therapeutic gymnastics.Improves blood flow and strengthens the muscle corset of the joint.Exercises recommended for coxarthrosis (performed on a firm support):
     • "bicycle" in a recumbent position;
     • lie 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 feet to the floor and raise your pelvis, hold in this position;
     • lying on your back, move your hip as far as possible to the side;
     • sitting in a chair, squeeze the ball between your thighs;
     • lying on your back, turn your legs in and out;
     • standing with your right leg on a slight rise and holding the support with your hands, swing your left leg back and forth and left and right, then do the same, changing your leg.
2. Surgical treatment.Endoprosthetics, i.e.the replacement of the joint with an artificial one is performed at 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 physical therapy are performed in a lying position, the patient can stand up, but for now without supporting his leg, and a few days later - with crutches.After 2-3 months, crutches will no longer be needed and full weight bearing on the leg will be allowed.Rehabilitation consisting of physiotherapy, massage and physiotherapy is recommended for patients who have undergone endoprosthetics.In most cases, limb function is restored.The service life of the prosthesis is from 10 to 20 years, after which 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.

• Avoid lifting weights and jumping (especially from heights).Try not to stand on your feet for a long time.
• Body weight control (reducing the consumption of flour, table salt, sweet, strong tea and coffee in the diet).Being overweight increases the risk of hip osteoarthritis.
• Dosed physical exercises aimed at strengthening the muscles of the thighs and buttocks (cycling or ergometer, swimming, therapeutic gymnastics).
• 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 keys to a positive prognosis for this disease.

Which doctor should I contact?

If you feel pain in your leg or hip joint, you should consult a doctor.He will prescribe primary diagnostic measures, specifically X-rays of the hip joint.After establishing the stage of the disease, the patient will be referred to a rheumatologist or orthopedist.A nutritionist and endocrinologist can provide additional help to reduce weight and slow the progression of the disease.It would be helpful for women to consult a gynecologist about prescribing hormone replacement therapy to prevent osteoporosis.