Osteoarthritis of the hip joint is a degenerative-dystrophic pathology, characterized by the destruction of hyaline cartilage.
The disease develops gradually, accompanied by pain and a decrease in range of motion. In the absence of medical intervention at the initial stage of osteoarthritis, after a few years, atrophy of the femoral muscles occurs.
The injured limb is shortened and the fusion of the joint space leads to partial or complete immobilization of the hip joint. The causes of pathology are previous injuries, curvature of the spine, systemic diseases of the musculoskeletal system.
Osteoarthritis is usually detected in middle-aged patients and the elderly. The diagnosis is made on the basis of the results of instrumental studies - radiography, MRI, computed tomography, arthroscopy. The treatment of pathology of 1 and 2 degrees of severity is conservative. If ankylosis is detected or if drug treatment is ineffective, surgery (arthrodesis, endoprosthesis) is performed.
The mechanism of development of pathology
The hip joint is made up of two bones - the ilium and the femur. The lower part of the ilium is represented by its body, which participates in the articulation with the femur, forming the upper part of the acetabulum. During movement, the glenoid fossa is stationary and the femoral head moves freely. Such a "hinge" device of the hip joint allows it to bend, unfold, turn, promotes abduction and adduction of the hip. The smooth, elastic and elastic hyaline cartilage that lines the acetabulum and the femoral head allows unhindered sliding of the joint structures. Its main functions are the redistribution of loads during movement, the prevention of rapid wear and tear of bone tissue.
Under the influence of external or internal factors, the trophism of the cartilage is disturbed. It does not have its own circulatory system - the synovial fluid supplies the tissue with nutrients. With osteoarthritis, it thickens, becomes viscous.
The resulting nutrient deficiency causes the surface of the hyaline cartilage to dry out. It becomes covered with cracks, which causes permanent microtrauma to the tissues when flexing or extending the hip joint. Cartilage thins and loses its cushioning properties. The bones are deformed to "adapt" to the increased pressure. And against the background of the deterioration of metabolism in tissues, destructive and degenerative changes progress.
Causes and provoking factors
Idiopathic or primary osteoarthritis develops for no reason. It is believed that the destruction of cartilage tissue occurs due to the natural aging of the body, slowing recovery processes, decreased production of collagen and other compounds necessary for the complete regeneration of joint structures. of the hip. Secondary osteoarthritis occurs against the background of a pathological condition already present in the body. The most common causes of secondary illness include:
- previous injuries - lesions of the ligamentous tendon apparatus, muscle ruptures, complete separation of the bone base, fractures, dislocations;
- violation of joint development, congenital dysplastic disorders;
- autoimmune pathologies - rheumatoid arthritis, reactive, psoriatic, systemic lupus erythematosus;
- non-specific inflammatory diseases such as purulent arthritis;
- specific infections - gonorrhea, syphilis, brucellosis, ureaplasmosis, trichomoniasis, tuberculosis, osteomyelitis, encephalitis;
- disruption of the functioning of the endocrine system;
- degenerative-dystrophic pathologies - osteochondropathy of the femoral head, osteochondritis dissecans;
- hypermobility of the joints, due to the production of "super-stretch" collagen, causing their excessive mobility, weakness of the ligaments.
Since the cause of the development of osteoarthritis may be hemarthrosis (hemorrhage into the cavity of the hip joint), provoking factors include disorders of hematopoiesis. Prerequisites for the onset of the disease are excess weight, excessive physical activity, a sedentary lifestyle. Its development is due to a poor organization of sports training, a deficiency in the diet of foods rich in microelements, fat-soluble and water-soluble vitamins. Postoperative osteoarthritis occurs several years after surgery, especially if it was accompanied by excision of a large amount of tissue. The trophism of hyaline cartilage is upset by frequent hypothermia, living in an environmentally unfavorable environment and working with toxic substances.
Osteoarthritis of the hip joint cannot be inherited. But in the presence of certain congenital characteristics (metabolic disorders, skeletal structure), the probability of its development increases significantly.
Symptoms
The main symptoms of osteoarthritis of the hip joint are pain when walking in the hip area, radiating to the groin, the knee joint. A person suffers from stiffness of movements, stiffness, especially in the morning. To stabilize the joint, the patient begins to limp, his gait changes. Over time, due to muscle atrophy and deformation of the joint, the limb is noticeably shortened. Another characteristic sign of the pathology is the limitation of hip abduction. For example, difficulties arise when trying to sit on a stool with the legs apart.
For osteoarthritis of first severity, periodic pain occurs after intense physical exertion. They are localized in the joint area and disappear after a long rest.
With second-degree osteoarthritis of the hip joint, the severity of the pain syndrome increases. Discomfort occurs even at rest, extends to the thigh and groin, increases with weight lifting or increased motor activity. To eliminate pain in the hip joint, a person barely begins to limp. Limitation of movement of the joint is noted, especially during abduction and internal rotation of the thigh.
Third-degree osteoarthritis is characterized by constant severe pain that does not go away during the day and night. Difficulties arise when moving. Therefore, when walking, a person is forced to use a cane or crutches. The hip joint is stiff, there is significant atrophy of the muscles of the buttocks, thighs and legs. Due to the weakness of the abductor femoral muscles, the pelvic bones are displaced in the frontal plane. To compensate for the shortening of the leg, the patient leans towards the injured limb when moving. This causes a strong shift in the center of gravity and an increase in stress on the joint. At this stage of osteoarthritis, pronounced ankylosis of the joint develops.
| Degrees | X-ray signs |
| The first one | The changes are not pronounced. Joint spaces are moderately, unevenly narrowed, there is no destruction of the surface of the femur. Minor bony growths are seen on the outer or inner edge of the acetabulum |
| The second | The height of the joint space is significantly reduced due to its uneven fusion. The bony head of the femur is displaced upwards, deformed, enlarged, its contours become uneven. Bone growths form on the surface of the inner and outer edges of the glenoid fossa |
| The third | There is a complete or partial fusion of the joint space. The femoral head is greatly enlarged. Multiple bony growths are located on all surfaces of the acetabulum |
Diagnostic
When diagnosing, the doctor takes into account the clinical manifestations of the pathology, anamnesis, the results of an external examination of the patient and instrumental studies. The x-ray is the most informative. With its help, the condition of the hip joint is assessed, the stage of its development, the degree of damage to cartilage tissue, and in some cases the cause of the development is established. If the cervico-diphyseal node is enlarged, and the acetabulum is oblique and flattened, then with a high degree of probability it is possible to assume dysplastic congenital changes in the joint. Perthes disease or juvenile epiphysis is indicated by the disturbed shape of the hip bone. The x-ray may reveal post-traumatic osteoarthritis, despite the absence of trauma prior to the history. Other diagnostic methods are also used:
- Computed tomography can detect the growth of the edges of the bone plates, formed by osteophytes;
- MRI is performed to assess the condition of connective tissue structures and the degree of their involvement in the pathological process.
If necessary, the internal surface of the joint is examined with arthroscopic instruments. Differential diagnosis is performed to exclude knee osteoarthritis, lumbosacral or thoracic osteochondrosis. Pain in osteoarthritis can be disguised as clinical manifestations of radicular syndrome caused by nerve entrapment or inflammation. It is usually possible to rule out neurogenic pathology with the help of a series of tests. Osteoarthritis of the hip joint is necessarily differentiated from trochanteric bursitis of the hip joint, ankylosing spondylitis, reactive arthritis. To exclude autoimmune pathologies, biochemical studies of blood and synovial fluid are carried out.
Drug addiction treatment tactics
Medical treatment is aimed at improving the well-being of the patient. For this, drugs of various clinical and pharmacological groups are used:
- nonsteroidal anti-inflammatory drugs (NSAIDs) - nimesulide, ketoprofen, diclofenac, ibuprofen, meloxicam, indomethacin, ketorolac. To relieve acute pain, injection solutions are used, and pills, pills, ointments, gels help to eliminate pain of mild or moderate severity;
- glucocorticosteroids - triamcinolone, dexamethasone, hydrocortisone. They are used in the form of intra-articular blockages in combination with anesthetics Procaine, Lidocaine;
- muscle relaxants - Baclofen, Tizanidine. They are included in treatment regimens for spasms of skeletal muscles, pinching of sensitive nerve endings;
- drugs that improve blood circulation in the joint - nicotinic acid, aminophylline, pentoxifylline. Are prescribed to patients to improve tissue trophism, prevent the progression of the disease;
- chondroprotectors. Effective only in stages 1 and 2 of osteoarthritis.
Rubbing ointments with a warming effect help to eliminate mild pain. The active ingredients of external agents are capsaicin, cinquefoil, camphor, menthol. These substances are characterized by an irritating, distracting local analgesic effect. Compresses on the joints with dimethyl sulfoxide, medical bile will help to cope with puffiness, swelling of the thigh in the morning. Patients are recommended classical massage, acupressure or vacuum for coxarthrosis. Daily physical therapy is an excellent prevention of further progression of osteoarthritis.
Surgical intervention
With the ineffectiveness of conservative therapy or the diagnosis of a pathology complicated by ankylosis, an operation is performed. It is impossible to restore cartilage tissue in the joint damaged by osteoarthritis without prosthetic surgery, but with the right approach to treatment, compliance with all medical prescriptions, maintenance of a correct lifestyle, the practice of'therapeutic exercises, regular massage courses, taking vitamins and proper nutrition, you can stop the process of injury and destruction of cartilage and hip joints.