Coxarthrosis is a common degenerative-dystrophic disease of the hip joint, in which, due to age changes or other factors, gradual destruction of the joint joint of the head of the femur and the acetabulum of the pelvis is observed. It is accompanied by pain and limitation of the amplitude of movements of varying severity, which depends on the stage of development. And if in the initial stages it is possible to deal with coxarthrosis by conservative methods, then in the third stage it is possible to save the situation and maintain the functionality of the hip joint, that is, to avoid damage, only by performing an operation.
It belongs to arthrosis and can be accompanied by the development of similar processes in other joints, and this pathology represents 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 cartilage layers covering the head of the femur and the acetabulum are destroyed, which leads to a decrease in the size of the joint gap. As the disease progresses, deformation of the bone surfaces and the formation of bone growths, called osteophytes, are observed.
Coxarthrosis is the second most frequent disease of the musculoskeletal system. More often, only gonarthrosis is diagnosed, that is, a degenerative-dystrophic change in the knee joint. However, the probability of damage in coxarthrosis is significantly higher.
The entire hip joint is enclosed in a special housing, which is called the joint capsule. There is a so-called synovial membrane that 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, cartilage is constantly worn out and immediately restored due to the continuous regeneration process, which is carried out with the help of substances that enter it from the synovial fluid. But with injuries or age-related changes, the rate of regeneration processes decreases, which leads to gradual wear of hyaline cartilage and the development of coxarthrosis.
This is due to changes in the amount of synovial fluid produced and its composition. Under the influence of unfavorable factors, it becomes thicker and is produced in a smaller volume. As a result, the synovial fluid is no longer able to provide the hyaline cartilage with all the necessary substances in the required quantity, which leads to its rapid dehydration and thinning. Gradually, the strength and elasticity of the cartilage decreases, it forms areas of delamination of the fibers that form it, cracks, and the thickness also decreases. These changes can be noticed during instrumental diagnostic methods, in particular, the narrowing of the joint gap draws attention to itself.
The narrowing of the joint space leads to increased friction between the bony structures that make up the hip joint and increased pressure on the already degrading hyaline cartilage. This provokes even more damage, which affects the functioning of the joint and the condition of the person, because the deformed areas prevent the head of the femur from sliding easily into the acetabulum. As a result, there are symptoms of coxarthrosis.
If left untreated, the pathological changes worsen, and the hyaline cartilage wears out more and more. Subsequently, in some areas, it completely disappears, which leads to bare bones and a sharp increase in the load on the joint. Since during movement inside the acetabulum, the head of the femur rubs directly against the bone, this provokes the appearance of severe pain and a sharp limitation of mobility. In this case, the pressure of bone structures on each other leads to the formation of bone growths on their surface.
The osteophytes that form can have sharp parts that can injure the muscles and ligaments around the hip joint. This leads to the appearance of severe pain both directly in the joint area and in the groin, buttock and thigh. As a result, the patient spares the injured leg, puts less strain on it and tries to avoid unnecessary movements with it. This leads to the development of muscle atrophy, which further worsens movement disorders and eventually leads to lameness.
reasons
There are many reasons for the development of coxarthrosis, although in rare cases it occurs against the background of the absence of prerequisites. In this case, they talk about the presence of primary or idiopathic coxarthrosis. In the majority of cases, secondary coxarthrosis is diagnosed, which becomes a logical consequence of a number of diseases or changes in the state of the musculoskeletal system. It can be provoked by:
- hip injuries of various nature, including fractures, sprains, bruises, sprains or torn ligaments;
- heavy physical labor, professional sports, especially weight lifting, parachuting, jumping;
- sedentary way of life;
- 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 result from a fracture of the femoral neck, especially with 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.
However, the main cause of coxarthrosis is still 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 symptoms. Therefore, in the initial stages, it can be asymptomatic or only sometimes cause anxiety to patients, but subsequently the condition of the hip joint worsens, which leads to an increase in the severity of the signs of coxarthrosis to unbearable pain and a significant limitation of mobility.
So, degenerative-dystrophic changes in the hip joint are accompanied by:
- Pain of varying strength, initially occurring after physical exertion or walking and subsiding after rest. Gradually, the severity of the pain syndrome increases, appears more often, lasts longer, and the periods between the moment of applying the load on the joint and the onset of pain decrease. Later, the pain is almost constant, 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.
- Limitations of the mobility of the hip joint, which initially manifest themselves with minor difficulties in the execution of rotational movements of the leg. Over time, morning stiffness appears, which disappears after the patient "disperses". This may be accompanied by the appearance of swelling in the hip joint. As the disease progresses, mobility limitations become more pronounced and permanent, that is, they do not disappear after warming up. Patients note a decrease in the amplitude of leg movements and subsequently completely lose the ability to perform certain movements.
- Cracking in the hip joint that occurs when walking or doing physical work, especially when doing extension. This happens as a result of rubbing exposed bone structures against each other, which is accompanied by a sharp increase in pain.
- Spasm of the thigh muscles, resulting in diffuse pain in the thigh. This can be the result of the attachment of various intra-articular disorders, including nerve compression, excessive stretching of the ligaments around the joint, as well as the development of synovitis, i. e. inflammation of the synovial membrane and the accumulation of inflammatory effusion in the cavity of the hip joint.
- Lameness, which is initially the result of the patient's unconscious desire 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 then the development of muscle contracture. The latter phenomenon appears already in the later stages of coxarthrosis and leads to the fact that the patient is unable to fully straighten the leg and, moreover, keep it in this position. In this way, the lower limb with the affected hip joint is constantly in a slightly contracted position, which provokes lameness.
- A decrease in the length of the leg, which is manifested mainly in severe degenerative-dystrophic changes in the hip joint, accompanied not only by the narrowing of the joint gap, but also by the flattening of the head of the femur, muscle atrophy. As a result, the diseased leg becomes shorter than the healthy one by 1 or more centimeters.
Coxarthrosis can affect one hip joint or both at the same time. But if in the first case the symptoms of the disease will be observed only on one side, then in the second they will not only be 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 its development. In total, there are 3 degrees of coxarthrosis, of which the first is considered the easiest. In the initial stages of occurrence of degenerative-dystrophic changes in the hip joint, only episodic pain can be observed. As a rule, this happens after intense physical exertion, sports or a long walk. Therefore, patients usually do not pay attention to them, attributing them to fatigue and considering them as normal age-related changes. In this regard, coxarthrosis of the 1st degree is diagnosed only in individual cases, which usually happens during an examination for another reason.
As the disease progresses, its symptoms intensify and already with coxarthrosis of the 2nd degree they are felt. This stage of development of the pathology is characterized by a narrowing of the joint gap by 50%, as well as the appearance of signs of deformation of the head of the femur with its displacement.
With further progression of the pathology, the joint space narrows even more, and in the 3rd degree of coxarthrosis, it is almost completely absent. This is already accompanied by the formation of numerous osteophytes. At this stage of the development of the disease, the pain becomes not just strong, but unbearable and often occurs even in a state of complete rest, including at night. Since the hip joint is severely deformed, its elements can affect the nerves passing through it, which leads to pain radiating to the groin, buttocks, as well as the thigh and even the lower leg. This also provokes the inability to move independently without the use of aids such as crutches or canes.
Coxarthrosis of the 3rd degree is a direct indication for surgical treatment. If the operation is not performed in time, the head of the femur will fuse firmly with the surface of the acetabulum with osteophytes. This will lead to shortening of the leg, a complete lack of the possibility of independent movement, since the joint will completely lose mobility, i. e. to damage.
Diagnosis
If signs of coxarthrosis appear, it is recommended to contact an orthopedist as soon as possible. Initially, the doctor will interview the patient and understand the nature of the complaints, after which he will proceed to research and perform functional tests, comparing the length of the legs. As a rule, 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 a number of other diseases of the hip joints, both inflammatory and non-inflammatory, instrumental diagnostic methods are needed. With their help, the specialist will be able not only to confirm the presence of coxarthrosis, to distinguish it from radicular syndrome caused by pathologies of the spine, but also to 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 you to detect signs of destructive changes, the presence of osteophytes, the nature of the deformation of bone structures and measure the thickness of the joint gap.
- CT is a more modern method of diagnosing bone pathologies, providing clearer data than X-rays, but 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 a highly informative method of joint research, providing the maximum amount of information about the state of the joint and all its structures, especially the hyaline cartilage, connections and characteristics of the blood supply.
Patients are prescribed a number of laboratory tests, including KLA, OAM, rheumatic tests, biochemical blood tests, etc.
Conservative treatment of coxarthrosis
When diagnosing coxarthrosis of 1 or 2 degrees, the treatment is carried out by conservative methods. For each patient, they are selected individually, taking into account the detected concomitant diseases. Therefore, it may often be necessary to consult not only an orthopedist, but also doctors from other specialties, who will select the necessary treatment to combat accompanying 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 contribute to the progression of degenerative changes in the hip joint. This includes adjusting your diet and increasing your level of physical activity if you are overweight. If the patient is regularly exposed to excessive physical exertion, it is recommended to change the type of activity or reduce the intensity of training if the exertion is due to sports. In some cases, it is recommended to use special bandages and orthoses that will fix the hip joint and relieve it during exercise.
Medical therapy
As part of drug treatment, patients are individually selected drugs, taking into account the existing concomitant diseases. As a rule, drugs from the following pharmacological groups are indicated for coxarthrosis:
- NSAIDs - an extensive group of drugs that exhibit analgesic and anti-inflammatory effects (available in various dosage forms, including tablets, capsules, gels, creams, injection solutions, which allows you to choose the most effective and convenient form of administration);
- corticosteroids - drugs that have a powerful 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 help reduce muscle tone, which allows you to effectively cope with 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;
- Vitamins of group B - are indicated for disorders of nerve conduction caused by compression of a nerve by changed components of the hip joint.
If coxarthrosis has caused an attack of acute pain that cannot be stopped with prescribed NSAIDs, patients are recommended intra-articular or peri-articular blockade. Its essence consists in the introduction directly into the cavity of the hip joint of an anesthetic solution in combination with corticosteroids. This will allow you to quickly remove the pain and reduce the inflammatory process. But the blockade can only be performed by a qualified health worker in a specially prepared room. Performing such procedures at home is not indicated.
exercise therapy
When diagnosed with coxarthrosis, regular exercise is mandatory. In the same way as drug therapy, a set of exercise exercises for each patient is selected individually, taking into account the degree of destruction of the hip joint, the level of physical development of the patient, the nature of concomitant diseases (special attention is paid to cardiovascularpathologies).
Thanks to daily exercise therapy you can:
- reducing the severity of pain;
- increasing the mobility of the hip joint;
- reducing the risk of muscle atrophy;
- elimination of thigh muscle spasms;
- activate blood circulation and thus improve the nutrition of the affected joint.
All exercises should be performed smoothly, avoiding sudden movements and sudden movements. But if pain occurs during exercise therapy, you should definitely contact your doctor to correct the selected complex or perform a re-diagnosis to rule out the progression of the disease and the need for surgery.
Physiotherapy
The comprehensive treatment of coxarthrosis includes courses of physiotherapy procedures that have an anti-inflammatory, analgesic, decongestant and toning effect on the body. That is why patients are most often prescribed 10-15 procedures:
- ultrasound therapy;
- electrophoresis;
- UVT;
- magnetic therapy;
- laser therapy, etc.
Recently, plasmolifting is increasingly used as part of the conservative treatment of coxarthrosis, which can significantly increase the rate of regeneration of hyaline cartilage. The essence of the procedure is the introduction into the cavity of the hip joint of purified blood plasma, which is obtained by centrifugation from the patient's own blood.
Surgery for coxarthrosis
If the patient is diagnosed with coxarthrosis of the 3rd degree, he is indicated for surgical intervention, since conservative methods in such cases are already powerless. Unfortunately, such situations are extremely common today, as a very large number of patients seek medical help when they can no longer withstand pain or have severe mobility limitations that deprive them of their ability to work and move independently.
Timely surgical intervention can completely eliminate these disorders and restore the patient's ability to move normally, significantly improving his quality of life. The indications for its application are:
- significant reduction of joint space by more than 80%;
- the presence of severe pain in the hip joint that cannot be eliminated;
- pronounced mobility disorders;
- fracture of the neck of the femur.
The gold standard for the treatment of a severe form of coxarthrosis, including in the elderly, is the endoprosthesis of the hip joint. This operation involves the replacement of a destroyed hip joint with an artificial endoprosthesis made of durable and at the same time biologically compatible materials. Arthroplasty allows you to fully restore the functionality of the hip joint, eliminate pain and return a person to a full active life.
The essence of this type of surgical intervention is resection of the head of the femur and a small fragment of its neck. Also, the surgeon will have to prepare the surface of the acetabulum for installation of the endoprosthesis, i. e. remove all formed osteophytes and achieve maximum restoration of its normal shape. After that, an endoprosthesis of the selected type is installed, which is fixed with special cement (preferably for the treatment of the elderly) or in a cementless way. In the latter case, the endoprosthesis has a special spongy part in contact with the bone structures. Its fixation in the acetabulum is ensured by the sprouting of bone tissue through the sponge.
For each patient, the type of arthroplasty is selected individually. The most effective is total arthroplasty, which involves a 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 a partial arthroplasty with replacement of only the femoral head and/or neck. Endoprostheses of different designs are used for this purpose: monopolar and bipolar.
The only disadvantage of arthroplasty can be considered the need to replace the installed endoprosthesis after 15-30 years.
After endoprosthesis replacement, patients are shown rehabilitation, the duration of which depends on the speed of tissue recovery. Exercise, physical therapy and therapeutic massage are prescribed as part of 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 a number of disadvantages. Thus, arthrodesis involves fixing the bony structures of the hip joint with metal plates. As a result, the pain syndrome is completely eliminated, 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.
Osteotomy involves making an artificial fracture of the femur with such a combination of bone fragments that will reduce the load on the affected hip joint. But the operation gives only a short-term effect, and in the future the need for arthroplasty still arises.
Thus, coxarthrosis of the hip joint is a rather dangerous disease that can lead to disability. This seriously reduces the quality of life and deprives a person of working capacity. But if you pay attention to the early signs of pathology and get advice from an orthopedist in time, you can slow down its progression and achieve a significant improvement in well-being. But with already ongoing coxarthrosis, there can be only one solution - endoprosthetics. Fortunately, this method can be used even with serious degenerative-dystrophic changes and completely restore the normal functioning of the hip joint.