Coxarthrosis is a common degenerative-dystrophic disease of the hip joint, in which the articular joint of the femoral head and the acetabulum of the pelvis gradually die as a result of age-related changes or other factors. It is accompanied by pain and limitation of the amplitude of movements of different 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 an operation can save the situation and maintain the working capacity of the hip joint, i. e. avoid disability. operation.
It belongs to the number of 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 femoral head and acetabulum are destroyed, which leads to a decrease in the size of the joint space. As the disease progresses, deformation of the bone surface and the formation of bone growths, known as osteophytes, can be observed.
Coxarthrosis is the second most common disease of the musculoskeletal system. More often, only gonarthrosis is diagnosed, that is, degenerative-dystrophic changes in the knee joint. Despite this, 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 essential for the proper functioning of the joint, as it not only lubricates the hyaline cartilage, but is also a source of nutrients for it.
Normally, the cartilage is constantly worn out and immediately repaired thanks to the continuous regeneration process, which is carried out with the help of substances introduced 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.
The reason for this is a change in the amount and composition of the synovial fluid produced. Due to adverse factors, it becomes thicker and is produced in smaller quantities. Because of this, the synovial fluid is no longer able to supply the hyaline cartilage with all the necessary substances in sufficient quantities, which leads to rapid drying and thinning. The strength and flexibility of the cartilage gradually decreases, the areas of delamination of the fibers that make it up, cracks appear in it, and the thickness also decreases. These changes can be noticed during instrumental diagnostic procedures, especially the narrowing of the joint space attracts attention.
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 to it, which affects the function of the joint and the condition of the person, since the deformed areas prevent the femoral head from sliding easily in the acetabulum. As a result, there are symptoms of coxarthrosis.
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 the exposure of the bones and a sharp increase in the load on the joint. Since the femoral head 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 the appearance of severe pain both directly in the joint area 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 movement disorders and ultimately leads to lameness.
Cause
There are many reasons for the development of coxarthrosis, although in rare cases it occurs due to the lack 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. You can trigger:
- injuries of various nature 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 malformations 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 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;
- the presence of bad habits, especially smoking.
Nevertheless, the main cause of coxarthrosis remains the 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:
- Pain of varying intensity that initially occurs after physical exertion or walking and 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. It is characterized by increased pain at any stage of the development of the disease during hypothermia and lifting heavy objects.
- Restrictions on the mobility of the hip joint, which are initially manifested in minor difficulties in executing the rotational movement of the leg. Over time, morning stiffness appears, which disappears after the patient "falls apart". This may be accompanied by the appearance of edema in the hip joint. As the disease progresses, movement restrictions become more pronounced and permanent, i. e. they do not disappear even after warming up. Patients notice a decrease in the amplitude of leg movements, and subsequently completely lose the ability to perform certain movements.
- A crack in the hip joint that appears when walking or doing physical work, especially in extension. This is the result of the friction of bare bone structures against each other, accompanied by a sharp increase in pain.
- Spasm of the thigh muscles, leading to diffuse pain in the thigh. This can be caused by adhesions of various intra-articular disorders, including compression of nerves, excessive stretching of the ligaments surrounding the joint, and the development of synovitis, i. e. inflammation of the joint membrane and the accumulation of inflammation. effusion in the cavity of the hip joint.
- Lameness, which at first is the result of 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 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 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.
- The decrease in leg length, which occurs mainly in severe degenerative-dystrophic changes of the hip joint, not only with the narrowing of the joint gap, 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 one.
Coxarthrosis can affect both hip joints, and 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. In total, there are 3 degrees of coxarthrosis, the first of which is considered the simplest. In the initial stage of degenerative-dystrophic changes of the hip joint, only episodic pains can be observed. This usually occurs after intense physical exertion, sports or a long walk. Therefore, patients usually do not pay attention to them, attribute them to fatigue and see them as normal age-related changes. 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, as well as 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 with the 3rd degree of coxarthrosis, it is almost completely absent. This is accompanied by the formation of multiple osteophytes. At this stage of the development of the disease, the pain is not only strong, but becomes unbearable, and often occurs even at complete rest, including at night. Since the hip joint is severely deformed, its elements can damage the nerves passing through it, which leads to pain radiating to the groin, buttocks, thighs, and even legs. It also causes you to be unable to move independently without the use of assistive devices such as crutches or canes.
Grade 3 coxarthrosis is a direct indication for surgical treatment. If the operation is not performed in time, the femoral head is firmly fused with the surface of the acetabulum with osteophytes. This leads to the shortening of the leg, the complete absence of the possibility of independent movement, 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 continues the examination by comparing the leg length and performing functional tests. In general, the data obtained are sufficient to speak with a high degree of confidence about the presence of coxarthrosis.
But since such a clinical picture can accompany many other diseases of the hip joints, both inflammatory and non-inflammatory, instrumental diagnostic methods are needed. 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, which means choosing 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 of joint examination, 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 KLA, 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 co-morbidities. 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.
It is mandatory for all patients to take measures to eliminate the effects of factors that increase the load on the legs and promote the progression of degenerative changes in the hip joint. This includes changing your diet and increasing your level of physical activity if you are overweight. If the patient is regularly exposed to excessive physical strain, it is recommended to change the type of activity or reduce the intensity of the training if the strain 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 exertion.
Medical therapy
As part of drug treatment, patients are selected individually, taking into account existing accompanying diseases. Medicines from the following pharmacological groups are usually recommended for coxarthrosis:
- NSAIDs - a wide group of drugs with analgesic and anti-inflammatory effects (available in various dosage forms, including tablets, capsules, gels, creams, injection solutions, which allow you to choose the most effective and convenient form of administration);
- corticosteroids - 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 for short courses in the form of injections;
- muscle relaxants - drugs that reduce muscle tone, which allow effective treatment of muscle spasms often observed in coxarthrosis;
- chondroprotectors - a group of drugs containing components used by the body to regenerate cartilage tissue;
- preparations that improve microcirculation - help to improve the nutrition of soft tissues and activate the course of 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 has caused an acute pain attack that cannot be stopped with the help of prescribed NSAIDs, intra-articular or peri-articular blockade is recommended for patients. Its essence lies in the fact that the anesthetic solution is combined with corticosteroids and delivered directly into the cavity of the hip joint. This makes it possible to quickly eliminate pain and reduce the inflammatory process. But the blockade can only be performed by a qualified health worker in a room specially designed for this purpose. Performing such procedures at home is not visible.
exercise therapy
During the diagnosis of coxarthrosis, regular exercise is mandatory. Similar to drug therapy, exercise therapy exercises are selected individually for each patient, taking into account the degree of destruction of the hip joint, the patient's level of physical development, and the nature of concurrent diseases (special attention). paid for cardiovascular diseases).
Thanks to the daily practical therapy:
- reduces the severity of pain;
- increases the mobility of the hip joint;
- reduces the risk of muscle atrophy;
- eliminates thigh muscle 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 for correction of the selected complex or re-diagnosis in order to rule out the progression of the disease and the need for surgery.
Physiotherapy
The comprehensive 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;
- magnetotherapy;
- laser therapy etc.
Recently, as part of the conservative treatment of coxarthrosis, plasmolifting has been used more and more often, which can significantly increase the speed of hyaline cartilage regeneration. The essence of the procedure is to inject purified blood plasma into the cavity of the hip joint, which is obtained by centrifugation from the patient's own blood.
Coxarthrosis surgery
If a patient is diagnosed with coxarthrosis of the 3rd degree, surgical intervention is required, since conservative methods are powerless in such cases. Unfortunately, such situations are extremely common these days, as many patients go to the doctor when they can no longer bear the pain or have severe movement restrictions that deprive them of their ability to work and move independently.
Timely surgical intervention can completely eliminate these disorders and restore the patient's normal movement, thereby significantly improving his quality of life. Indications for execution are as follows:
- a significant reduction in joint space, by more than 80%;
- the presence of severe pain in the hip joint that cannot be eliminated;
- pronounced mobility disorders;
- femoral neck fracture.
The gold standard for the treatment of severe coxarthrosis, including in the elderly, is hip arthroplasty. 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 surgery is the resection of a small fragment of the femoral head and neck. In addition, the surgeon must 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 sprouting of bone tissue through the sponge.
The type of arthroplasty is selected individually for each patient. The most effective is total arthroplasty, 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 partial arthroplasty, replacing only the femoral head and/or neck. Endoprostheses of different designs are used for this purpose: monopolar and bipolar.
The only disadvantage of arthroplasty is the need to replace the implanted endoprosthesis after 15-30 years.
After endoprosthesis replacement, patients undergo rehabilitation, the duration of which depends on the extent of tissue repair. 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 performing an artificial fracture of the femur using a combination of bone fragments that reduce the load on the affected hip joint. But the surgery gives only a short-term effect, and the need for joint surgery will still arise 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 seek advice from an orthopedist in time, you can slow down its progression and achieve a significant improvement in well-being. But in the case of already running coxarthrosis, there is only one solution - arthroplasty. Fortunately, this method can also be used in severe degenerative-dystrophic changes and can completely restore the normal functioning of the hip joint.