Coxarthrosis: osteoarthritis of the hip joint

Osteoarthritis of the hip joint or coxarthrosis is a chronic and slow degenerative process of the joint of the head of the femur and the acetabulum of the pelvic bone. With this disease, bone and cartilage tissues are deformed, which, as it progresses, leads to significant limitation of leg movements and disability. All components of the joint are involved in the process: the bones, the joint capsules that cover them, the cartilage, the ligaments, the muscles. The symptoms and treatment of osteoarthritis of the hip (coxarthrosis) vary from person to person; the disease usually occurs in middle-aged and elderly people, although such changes can develop after 20 years.

The main signs of osteoarthritis of the hip (coxarthrosis) are pain and stiffness of movements. Most often, its development is preceded by injuries, as well as joint pathologies of an inflammatory and non-inflammatory nature. Coxarthrosis is one of the most common osteoarthritis, associated with significant load on the hip joint.

In its development, the disease goes through several stages. In the early stages, coxarthrosis can be treated conservatively, but as the process progresses, only surgical treatment is effective. Therefore, you should not delay in consulting a specialist and signing up for a consultation. In clinics you can undergo an examination and receive conservative treatment.

Causes

Coxarthrosis of the hip joint can be primary or secondary, that is, occur against the background of a disease or injury of the musculoskeletal system. Let's consider in more detail the factors influencing the development or leading to coxarthrosis of the hip joint.

• Exogenous- these are environmental factors: intense physical activity, consequences of serious injuries - fractures, dislocations, ligament tears, unfavorable working conditions linked to carrying heavy loads, prolonged sitting.
• Endogenous— these are chronic infectious-inflammatory and autoimmune diseases: rheumatoid, reactive rheumatism, psoriatic. As well as metabolic disorders: gout, diabetes.
• Congenital diseases.Dysplasia (impaired joint formation) and osteochondropathy (malnutrition of joint structures with subsequent necrosis, bone destruction) can also lead to coxarthrosis. For example, congenital hip dislocation, aseptic necrosis of the femoral head - Perthes disease.
• Genetic predispositionoften causes coxarthrosis of the hip joints. This includes a mutation in the type II procollagen gene.
• Elderly age.Most often, the development of coxarthrosis of the hip joint is due to inevitable age-related changes.
• Ground. Osteoarthritis is thought to occur more often in women than men. This is due to the influence of the female sex hormones, estrogen, on mineral metabolism and bone density.
• Excess body weight.There is a direct relationship between excess weight and the occurrence of osteoarthritis. The higher the body weight, the higher the risk of developing hip osteoarthritis, because excess fatty tissue increases the load on the joints and fatty tissue produces pro-inflammatory substances that damage cartilage tissue.
• Professional sportscan provoke the development of coxarthrosis due to excessive stress on the joints and frequent injuries. Potentially dangerous sports include weightlifting, skydiving and acrobatics.

Under the influence of these factors, changes gradually occur in the joint cavity at the cellular level: decomposition processes begin to prevail over synthesis processes, metabolism changes, the volume of joint fluid that nourishes the cartilaginous tissue decreases andthe cartilage becomes thinner. As a result, the joint "drys out" and decreases in volume. Along the edges of the articular surfaces of the bones, bony growths appear - osteophytes, which reduce the range of movement of the joint and thereby reduce the load on it.

Symptoms

How quickly does osteoarthritis of the hip (coxarthrosis) develop? The symptoms gradually increase, and in the early stages a person may not pay attention to them and dismiss them as fatigue. This is dangerous, because it is at the beginning of the degenerative process that the treatment has the most effect.

The first clinical symptoms of coxarthrosis are pain and limited range of motion caused by muscle spasms.

The pain can vary in intensity and duration. At first, the unpleasant sensations are mild and short-lived. The provoking factor for their appearance is prolonged walking or intense physical activity.

The limitation of joint mobility is due to severe pain. The patient's gait changes: the buttocks protrude backwards, the body leans forward when transferring weight to the injured side, and the person limps.

Swelling in the joints is also possible, which is usually invisible due to the muscle and fat layer, cracking of the joints during movements and functional shortening of the lower limb.

The presence of certain signs and their severity depend on the stage of coxarthrosis. There are 4 clinical and diagnostic stages of coxarthrosis, which are determined by the degree of damage to the articular cartilage:

• Coxarthrosis 1st degreecharacterized by asymptomatic or periodic pain that occurs only after strenuous physical activity, such as running or long walks. The pain is localized at the joint, less often extending to the entire thigh and even the knee. After rest, it usually disappears. There is no change on the hip joint x-ray or there is a slight narrowing of the joint space. MRI reveals signs of heterogeneity of the cartilaginous tissue.
• For coxarthrosis of 2 degreesthe pain becomes more intense, appears with little physical activity, and sometimes at rest, and can radiate to the thigh and groin. Lameness appears after significant physical effort. The range of movement of the joint decreases: abduction and inward rotation of the hip are limited. X-ray photographs reveal obvious, uneven narrowing of the joint space and isolated osteophytes (growths of bone tissue) along the edge of the glenoid fossa. An MRI at stage 2 of coxarthrosis reveals obvious erosions and cracks in the cartilage with thinning of less than half.
• For 3rd degree coxarthrosisthe pain becomes constant and often disturbs patients while they sleep. Walking is difficult, forcing the patient to adopt a forced body position, relying on a healthy leg or a cane. The range of movement of the joint is severely limited. On radiographs, the joint space is practically absent and multiple osteophytes have formed on the surface of the bones. MRI shows destruction of more than half of the volume of cartilage tissue. However, the third stage can still be treated conservatively.
• Stage 4 osteoarthritis of the hip joint (coxarthrosis)characterized by significant loss of joint function. The whole leg hurts: joint, groin, gluteal region, hip, knee, ankle. Flat feet develop, the leg shortens and its muscles atrophy. On the x-ray: multiple large osteophytes, the joint space is absent or narrowed to a minimum. Stage 4 is not amenable to conservative treatment; a hip replacement is performed. The operation reduces pain, improves leg function and the patient's quality of life.

Diagnosis of osteoarthritis of the hip joint

The basis for diagnosing hip osteoarthritis is an initial consultation with a specialist. The doctor clarifies the complaints: where the pain is localized, when and why it occurs, where it goes, what reduces and intensifies it, what is its cause. Then visual inspection, palpation, gait assessment are necessary, and special tests are carried out to detect joint dysfunction.

The diagnosis of coxarthrosis is made on the basis of clinical signs and data from additional instrumental studies, the main of which is radiography of the joint. There are no characteristic laboratory signs for the diagnosis of osteoarthritis, however, a clinical blood test may be necessary for the differential diagnosis of coxarthrosis and arthritis. In this case, the specialist will take into account the level of leukocytes, ESR, C-reactive protein and uric acid.

Among the instrumental methods for diagnosing osteoarthritis of the hip joints, radiography is usually sufficient. This is an accessible study that reveals changes characteristic of coxarthrosis: narrowing of the joint space, osteophytes, erosion and ulceration of the cartilage surface, cysts. X-rays of patients with hip osteoarthritis may also reveal changes indicating trauma.

CT and MRI can be used as other instrumental diagnostic methods. Computed tomography allows a more detailed study of pathological changes in bone structures, and magnetic resonance imaging provides the opportunity to assess soft tissue disorders.

Which doctor should I contact?

This pathology is treated by orthopedic traumatologists. But depending on the nature and progress of the disease, consultations with other specialists may be necessary:

• the surgeon must exclude surgical pathology requiring surgical intervention;
• phthisiatrician to exclude bone tuberculosis;
• oncologist to exclude malignant neoplasms;
• endocrinologist for concomitant metabolic disorders;
• a neurologist, in case of suspicion of compression of the spinal nerve roots by an intervertebral hernia of the lumbosacral spine.

Treatment

The choice of treatment method depends on the stage of the disease. To treat grade 1 bilateral hip osteoarthritis (coxarthrosis), it is often enough to change your lifestyle and increase physical activity. At stage 2, conservative treatment is used, which includes medications and physiotherapeutic procedures. Stage 3 is less treatable, but surgery can still be avoided, which is not the case with stage 4. The goal of conservative treatment is to improve quality of life, as well as to stop or slow downthe rate of development of degenerative changes in the joint.

Drug treatment for coxarthrosis includes medications that reduce the symptoms of the disease. These are nonsteroidal anti-inflammatory drugs used short term to relieve pain and inflammation. Corticosteroids and muscle relaxants are sometimes used to relieve severe pain and muscle tension.

Non-drug therapy includes:

• Reduce the load on the hip joint.Depending on the situation, the patient may be advised to reduce their weight, create additional support, and transfer their weight to a cane or crutches.
• Therapeutic exercise.A correctly selected set of exercises helps to improve joint mobility, reduce pain, and also prevent muscle atrophy.
• Physiotherapeutic treatment methods.For coxarthrosis of the hip joint, courses are prescribed: magnetotherapy, laser therapy, shock wave therapy.
• PRP therapy.The method involves introducing your own blood plasma into the joint, which helps relieve pain, inflammation and improve the restoration of damaged joint tissues.
• Kinesio recording.This involves the application of special adhesive tapes to the skin, which relieve the load on the joint.
• Acupuncture.A method based on the introduction of sterile needles into biologically active points. Effectively relieves pain and relaxes the muscles around the joint.

For each patient, doctors develop individual treatment, which may include different methods depending on the severity of symptoms, stage of the disease, age and health status. An integrated approach to treatment guarantees high efficiency of procedures and rapid recovery; drug treatment alone may not give the expected result.

Hip replacement is used in severe cases of the disease, when pain cannot be eliminated and joint mobility is significantly limited.

Consequences

Pathological changes in the joint can lead to:

• Subluxation and dislocation of the hip joint. In this case, leg movements are sharply limited, severe pain appears, hospitalization in the trauma department and sometimes surgical intervention is required.
• Local inflammatory processes: bursitis and tendovaginitis.
• Compression of the sciatic nerve by large osteophytes, accompanied by intense shooting pain in the back of the leg.
• Ankylosis is total immobility of the joint, considerably reducing the patient's quality of life.
• Decreased physical activity, constant pain and limited joint mobility. In the future, this leads to obesity and depression.
• Stomach and heart diseases if you take nonsteroidal anti-inflammatory drugs for a long time and often.

Prevention

For a comfortable and quality life without coxarthrosis, you must adhere to the following recommendations:

• See a doctor promptly if you experience pain in your hip joint.
• Use caution when playing strenuous sports, performing physical activities at home and at work, and when lifting heavy objects.
• Control your weight through a balanced diet and regular physical activity.
• Avoid heavy physical work and sports overload. It is moderate physical activity that improves the condition of the joint, maintains its normal mobility and reduces the load on other joints.

Summary

1. Coxarthrosis is one of the most common osteoarthritis, caused by a significant load on the hip joint.
2. The main signs of osteoarthritis of the hip (coxarthrosis) are pain and stiffness of movements.
3. There are 4 degrees of coxarthrosis, 1-2 are amenable to conservative treatment, 3-4 - surgically. However, at stage 3, surgery can still be avoided if you follow all the doctor's recommendations.
4. Specialists use an integrated approach to the treatment of coxarthrosis, which includes medications, physiotherapy, manual therapy, nutritional correction and physical activity.