Coxarthrosis of the hip joint, a complex pathology of arthrosis, leads to serious changes in the joints. Unfortunately, the disability of mature people with a disability is a common occurrence. In fact, the statistics of the disease of the hip joint is almost half of all pathologies of the musculoskeletal system. I will give an example from the life of a case after surgical treatment and a rare complication during rehabilitation.
Coxarthrosis of the hip joint: a little about the disease
Osteoarthritis is a degenerative-dystrophic change that contributes to the complete destruction of cartilage with loss of joint function.
Coxarthrosis - here the hip joints are destroyed, in practice this is the same arthrosis.
In its mechanism, the joint of the hip with the pelvis is similar to the hinges of a door. The head of the femur is connected to the ischium as a hinge. Which has a special anatomical formation - the acetabulum. This structure provides maximum mobility of the joint. Which makes a full cycle of motion, or rather flexion, extension, rotation, etc.
Usually, the joint surfaces are smooth, there is enough fluid inside, which ensures unhindered sliding. As the disease progresses, the lubricant becomes thicker, more viscous, which is reflected in the condition of the cartilage. The synovial fluid no longer performs its functions completely. Because of what, shock absorbers dry out, become covered with cracks, become rough.
- First. As a result of the lack of the necessary sliding, the friction of the bones increases, which injures them.
- Second. As the progression progresses, the deformation of the bony surfaces is added to the altered cartilaginous tissue. In this way, the body tries to compensate for the increased load.
- in third place. The increased load leads to complete atrophy of the thigh muscles and weakness of the ligaments.
Important: arthrosis of the hip joint is a progressive disease. The changes can lead to a complete loss of physical activity by a person. It eventually leads to disability. And it completely disrupts the usual way of life. The disease and its treatment are extremely significant not only in the medical aspect, but are also a major social problem.
Reasons for the development of coxarthrosis and its types
At least the exact reason for the appearance of coxarthrosis, which destroys the hip joint, is not. There are only assumptions. Most cases of developing hip pathology are associated with congenital dislocation of the hip joint and dysplasia (insufficiency) of the joint.
Therefore, there are 2 types of coxarthrosis;
- primary (arising from an unknown etiology);
- secondary (related to injuries, diseases).
Primary osteoarthritis is characterized by a combination of factors:
- influence of biological, mechanical processes;
- metabolic disorders;
- there is also a theory of pathological tissue repair in response to damaging agents (inflammation, friction, infection).
Often this type of coxarthrosis is combined with damage to the spine and inflammation of the knee joints (arthritis, arthrosis).
In the case of the secondary variant, the reasons for development are clearer. They include:
- dysplastic disorders. Dysplastic coxarthrosis of the hip joint of the 1st degree occurs in half of all cases of congenital pathology.
- Hip dislocation (congenital).
- Life trauma. Fractures of the pelvis, neck of the femur, luxations, subluxations.
- Legg-Calve-Perthes disease. Osteochondropathy of the femoral head with the development of its necrosis. This disease occurs in children with impaired blood supply and nutrition to the joint.
In addition, the pathology can affect both formations at once or be unilateral. In addition to the direct causes of the occurrence, there are predisposing factors that provoke the development of the disease. Often the disease occurs with increased loads on the limbs of athletes. As well as people with difficult physical working conditions. Significantly increases the likelihood of arthrosis with excess weight.
Also, provoking factors include:
- Disturbance of metabolic processes, joint nutrition, hormonal disturbances.
- Postural disorder. Especially scoliosis, kyphosis, which lead to distortion of the pelvic bones.
- Age after 40 years. It is estimated that after this date, the diagnosis of "coxarthrosis of the hip joint 1, 2 degree" is made in every 10 patients. After 60, every third is observed. And when reaching 70 years or more, almost 80% of candidates suffer from thispathology.
There is no specific gene that is responsible for the transmission of pathological changes in the joints. However, the hereditary factor is still traceable. A person can inherit structural features of cartilage tissue, altered metabolism and skeletal pathology from relatives. It is the combination of such genetic information that can provoke the appearance of hip arthrosis.
The main division of the disease is according to severity. There are 3 stages that differ not only in symptoms but also in X-ray changes. It is these indicators that are taken as the basis of the diagnosis.
This division is the most common. There are also types of classification according to Kellgren. It includes 4 stages, plus zero stage - the equivalent of a healthy joint.
The basis of all diseases of the musculoskeletal system is pain. Coxarthrosis of the hip joint of the 1-2 degrees has symptoms less pronounced than in the terminal stage 3. Initially, the soreness appears during exertion. Especially after long walks, climbing stairs. Later, pain becomes a constant companion, which significantly worsens the quality of life.
Coxarthrosis 1 degree
Unpleasant sensations are concentrated only in the joint area (the groin, buttocks are practically not affected), they are rarely reflected in the hip or knee. Pain is relieved by rest.
At this stage, no further manifestations are detected - the gait remains unchanged, there are no movement disorders. In the dysplastic variant, on the contrary, there is an increase in mobility due to changes in the connective tissue, often in the initial stages of the disease, due to increased flexibility, patients like to do gymnastics and yoga. Traffic problems come in only 3 stages.
With symptoms of coxarthrosis of the 1st degree of the hip joint, the treatment can be carried out without surgical intervention. Rational therapy allows you to eliminate unpleasant symptoms by stopping the progression.
2 degree of disease
The pain, although not constant, occurs at rest. Irradiation becomes noticeable - thigh, groin, knee. Stiffness is observed - movements are limited when lifting, an attempt to abduct to the side, difficulty in circular movements of the leg (especially often the pain increases). A lameness that appears after intense walking or running becomes noticeable.
When moving, a characteristic arthritic crunch is heard - rough, dry.
3 degree osteoarthritis
The pain becomes constant, does not go away after rest and sleep. Unpleasant sensations do not leave the patient even at night. There are problems with walking, to facilitate movement, you must use a cane. The limp is constant.
At this stage, atrophy of the muscles of the limb occurs, the leg itself is shortened. These changes cause the patient to lean towards the affected side, which further increases the load on the joint. There is a limitation of mobility in almost all directions.
Changes in bilateral coxarthrosis of the hip joint change the patient's gait, due to which all formations involved in the walking process suffer. There is pain in the lower back, the posture is disturbed, the axial position of the pelvis changes.
An important role in determining the disease is played by an examination by an orthopedist, as well as a thorough analysis of complaints. It is worth assessing the patient's activity - the ability to climb stairs, comfort with shoes and socks, activity when walking, use of a cane.
It is recommended to check the general condition - blood, urine, biochemistry, ECG, determination of HIV markers and syphilis.
Coxarthrosis of the hip joint of the 1st degree has the vaguest symptoms. That is why it is worthwhile to carry out an X-ray examination to visualize the changes in the joint space. This method allows not only to establish the disease. And they also often find the cause of the appearance - dysplasia, Perthes disease.
Often, knee pain is much more pronounced with deforming coxarthrosis of the hip joint of the 1st degree, so it must be distinguished from gonarthrosis. Also, the differential diagnosis includes examination of the spine to rule out radicular syndrome (it gives radiating pain in the hip, knee).
In doubtful cases, MRI (allows you to examine soft tissues in detail) and CT (to examine bone formations) is used.
The disease cannot be completely cured, but modern medicine is able to restore the lost ability to move, allowing you to live a full life.
The use of physiotherapy, drugs is effective at 1-2 degree of disease. In the terminal stage, only surgery helps. In another case, they act if the methods of conservative therapy used do not bring relief.
1st degree treatment
Unfortunately, it is impossible to completely eliminate the pathology. At 1 degree, the treatment is aimed at stabilizing the condition.
During therapy, it is necessary to follow a number of general recommendations:
- Normalization of physical activity - it is recommended to reduce excessive loads (long hikes, running, jumping).
- The use of shoes with good shock-absorbing soles, special insoles.
- Losing weight.
- Mandatory exercise therapy.
Important: many patients completely refuse gymnastics and any exercise due to pain. Often this is related to the fear of increased pain, the possibility of worsening the situation. Practice proves that this opinion is wrong - regular exercise therapy helps strengthen muscles, protects them from atrophy, reduces pain and improves joint function.
A diet for coxarthrosis of the hip joint of the 1st degree is not prescribed, a moderate weight loss diet is prescribed. It is also useful to add foods with gelatin, canned fish with bones and dairy products to the diet.
As a medical method, nonsteroidal anti-inflammatory drugs are used. Due to the large number of side effects, it is recommended to drink drugs with severe pain. You can combine their intake with gastroprotectors.
Constant pain is relieved by intra-articular injections of steroid drugs, it is also possible to perform pain blocks.
For support appoint:
- Muscle relaxants - relieve tension, reduce leg pain.
- Chondroprotectors - improve the recovery of cartilage tissue.
- Vasodilators (nicotinic acid) - help relieve vasospasm, and also increase tissue microcirculation.
Warming compresses are also used in the complex (folk methods of treatment can also be used). They do not give a therapeutic effect, but help to relieve muscle spasm.
Do not forget to use physiotherapy - UHF, magnetotherapy, induction currents, massage.
Hip replacement surgery
To restore freedom of movement in stage 3, to relieve severe pain, the patient is prepared for a planned endoprosthetic surgery. This is a special operation to replace a destroyed entity with an artificial one. Interventions fully restore the patient's motor abilities. It helps to fully return to the usual way of life.
Depending on the spread of the process, the prosthesis can be unipolar (only the worn head of the femur is replaced) or bipolar (the surface of the acetabulum is also replaced). After the operation, rehabilitation is mandatory so that the patient can return to an active life as quickly as possible.
For patients over 60 years of age, the rehabilitation period is determined even before the surgical treatment, so the recovery process takes place in a shorter time. The service life of an artificial joint is about 20 years, but it is important to follow the recommendations:
- Excluding running, long walking, jumping.
- Avoiding heavy lifting.
- Avoid excessive stay in a forced static position (especially for people with a standing job).
Surgical treatment for endoprosthesis was required by my friend's husband. In the diagnosis, he was not given coxarthrosis, but a hernia of the lumbar spine was successfully removed. His condition did not improve, examinations continued, and finally, after it was understood what it was, he was sent for a quota operation.
After the replacement, everything grew successfully, but the second hip also required surgery. A year later, again the quota for the operation, which ended successfully. And then, from the first minutes after anesthesia, rehabilitation and exact implementation of the doctor's recommendations is necessary.
And what about our friend? Already on the way to the house after the hospital, he began to load the prosthetic joint (he sat for a long time, stepped on his leg). I forgot how careful I was the first time. As a result, the ligaments and muscles, which did not have time to get used to the implant, could not withstand it, and it popped out.
Of course, they put him in, put a cast on him, and then supposedly everything was fine. But he complains that he cannot move his leg to the side, it hurts, he feels discomfort when walking. Although he does exercises and various exercises for the development of both joints, it is also work and a desire for independent movement.
We analyzed the symptoms and treatment of coxarthrosis of the hip joints, as well as their stages.
- Only daily physical education will help you avoid serious complications and live to a ripe old age without crutches. In Soviet times, serious work was done to prevent diseases of the musculoskeletal system and strengthen the immune system. Now the lost experience is difficult to renew, it is clear with the mind, but it is too lazy to do it.
- Extra pounds wear out the joints to shame, arthroplasty is better, but not losing extra pounds. My friend is sure of it, even without trying to eat less sugary and starchy foods. Proper nutrition is very important.
- I consider lifting weights no less evil for the entire skeleton.
- Bad habits (alcohol, smoking) remove calcium, magnesium and other useful substances from the body.
Just dig, it's all interconnected.
Take care of yourself and your joints by exercising every day!