Coxarthrosis is a common degenerative-dystrophic disease of the hip joint in which, due to age-related changes or other factors, progressive destruction of the articular joints of the femoral head and the acetabulum of the pelvis occurs.It is accompanied by pain and limited range of motion of varying severity, depending on the stage of development.And if at the first stage it is possible to cope with coxarthrosis with conservative methods, then at the 3rd stage you can save the situation and maintain the function of the hip joint, that is, avoid disability, only with surgery.
It is classified as a joint disease 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 destruction of the cartilage layers covering the head of the femur and the acetabulum occurs, leading to a decrease in the size of the joint space.As the disease progresses, the bone surface becomes deformed and bone growths form on it, called bone spurs.
Coxarthrosis is the second most common disease of the musculoskeletal system.Most often, only gonorrhea is diagnosed, that is, degenerative-dystrophic changes in the knee joint.However, the likelihood of disability with coxarthrosis is significantly higher.
The entire hip joint is enclosed in a special box called the joint capsule.It has what is called a synovial membrane, which produces synovial fluid.This fluid is extremely important for the normal functioning of the joints, as it not only lubricates the hyaline cartilage, but also provides the cartilage with a source of nutrients.
Normally, cartilage is constantly worn out and is immediately restored due to constant regeneration carried out with the help of substances that enter it from the synovial fluid.But with injuries or age-related changes, the speed of the regeneration process decreases, leading to gradual wear and tear of hyaline cartilage and the development of coxarthrosis.
This is explained by changes in the amount of synovial fluid produced and its composition.Under the influence of adverse factors, it becomes thicker and is produced in less quantity.As a result, the synovial fluid is no longer able to supply the hyaline cartilage with all the necessary substances in the necessary quantities, leading to dehydration and rapid thinning.Gradually, the strength and elasticity of cartilage decreases, the fibers that form it separate, cracks form in it, and the thickness also decreases.These changes can be noticed in instrumental diagnostic methods, especially when the joint space is narrowed.
Narrowing of the joint space leads to increased friction between the bony structures that form the hip joint and increased pressure on the already degenerated hyaline cartilage.This causes even greater damage, affecting joint function and the person's condition, as the deformed areas prevent the femoral head from sliding easily within the acetabulum.As a result, coxarthrosis symptoms occur.
If left untreated, the pathological changes will become more severe and the hyaline cartilage will gradually wear away.Then, in some areas, it completely disappears, leading to exposed bones and a sharp increase in the load on the joints.Because when moving inside the acetabulum, the head of the femur rubs directly against the bone, this causes severe pain and significantly limits mobility.In this case, the pressure of bone structures on each other leads to the formation of bone growths on their surface.
The bone spurs that form may have sharp parts that can damage the muscles and ligaments surrounding the hip joint.This leads to severe pain both directly in the joint area and in the groin, buttocks and thighs.As a result, the patient avoids the injured leg, reduces the load on the leg and tries to avoid making unnecessary movements with the injured leg.This causes muscle atrophy to develop, worsening mobility impairment and eventually leading to lameness.
reason
There are many reasons for the development of coxarthrosis, although in rare cases it occurs in the absence of any prerequisites.In this case, they talk about the presence of primary or idiopathic coxarthrosis.In the vast majority of cases, secondary coxarthrosis is diagnosed, becoming a logical consequence of some disease or changes in the condition of the musculoskeletal system.Its development can be stimulated by:
- Hip injuries of various types, including fractures, dislocations, bruises, sprains or torn ligaments;
- heavy manual labor, professional sports, especially weightlifting, skydiving, and diving;
- sedentary lifestyle;
- being overweight, which significantly increases the load on the hip joint;
- chronic infection in the body;
- congenital abnormalities of the hip joint, such as dysplasia or dislocation;
- metabolic diseases and endocrine disorders, especially gout, diabetes, especially in the decompensated form;
- Aseptic necrosis of the femoral head, which can result from femoral neck fractures, especially during conservative treatment;
- Arthritis, including rheumatoid arthritis, bursitis, tendinitis;
- diseases of the spine;
- genetic predisposition;
- the presence of bad habits, especially smoking.
However, the main cause of coxarthrosis remains 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 early stages, it may be asymptomatic or only occasionally cause concern for the patient, but then the condition of the hip joint worsens, as a result of which the severity of the signs of coxarthrosis increases to the point of unbearable pain and significant limitation of mobility.
So, degenerative-dystrophic changes in the hip joint are accompanied by:
- Pain of varying intensity, initially occurring after physical activity or walking and gradually decreasing after rest.Gradually, the severity of the pain syndrome increases, it appears more often, lasts longer, and the time interval from the moment the load is applied to the joint to the appearance of pain decreases.After that, the pain is almost constant, even at rest, and becomes unbearable.Intensification of pain is typical at any stage of the disease with hypothermia and heavy lifting.
- Limitations in hip joint mobility initially manifest as minor difficulties in performing rotational movements of the legs.Over time, morning stiffness appears and disappears after the patient "disperses".This may be accompanied by the appearance of swelling in the hip joint.As the disease progresses, limitations in mobility become more pronounced and persistent, that is, they do not disappear after onset.The patient notices a decrease in the range of motion of the legs and then a complete loss of the ability to perform certain movements.
- A crunching sound in the hip joint occurs when walking or performing physical activities, especially when performing stretching movements.It becomes the result of friction of exposed bone structures against each other, accompanied by a sharp increase in pain.
- Thigh muscle spasm, leading to radiating pain in the thigh.This can be the result of the addition of various intra-articular disorders, including nerve compression, excessive stretching of the ligaments around the joint, as well as the development of synovitis, that is, inflammation of the synovium and accumulation of inflammatory fluid in the cavity of the hip joint.
- Limping, which initially arises from the patient's unconscious desire to reduce the load on the diseased joint and transfer weight to the healthy leg to avoid the appearance or intensification of pain, is followed by the development of muscle contractures.The latter phenomenon already occurs in the later stages of coxarthrosis and leads to the patient's inability to fully straighten his legs and, moreover, to keep his legs in this position.Therefore, the lower limb with the affected hip joint is constantly in a slightly bent position, causing lameness.
- The decrease in leg length, which mainly occurs with severe degenerative-dystrophic changes in the hip joint, is accompanied not only by narrowing of the joint space, but also by collapse of the femoral head and muscle atrophy.As a result, the diseased leg becomes 1 cm or more shorter than the healthy leg.
Coxarthrosis can affect one hip joint or 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 case they will not only be bilateral, but will also have different intensity.This depends on the level of destruction of each hip joint.
Degree of coxarthrosis
The nature of the manifestations of the disease depends on the stage of its development.There are 3 degrees of coxarthrosis in total, of which the first degree is considered the mildest.At the initial stage of the appearance of degenerative-dystrophic changes in the hip joint, only occasional pain can be observed.As a rule, this happens after physical activity, intense sports or long walks.Therefore, patients often do not pay attention to them, thinking it is fatigue and considering it a normal change of age.In this regard, grade 1 coxarthrosis is diagnosed only in isolated cases, which often occur during examination for another reason.
As the disease progresses, its symptoms increase, and with grade 2 coxarthrosis, they make themselves felt.This stage of pathological development is characterized by an approximately 50% narrowing of the joint space, as well as the appearance of signs of deformation of the femoral head with its displacement.
With further progression of the pathology, the joint space narrows even more and at grade 3 coxarthrosis is almost absent.This was accompanied by the formation of many bone spurs.At the advanced stage of the disease, the pain becomes not only severe, but also unbearable and often occurs even at complete rest, including at night.Because the hip joint is severely deformed, its elements can impact the nerves that pass through here, leading to pain that radiates to the groin, buttocks, as well as the thighs and even lower legs.This also results in the inability to move independently without the use of auxiliary devices, such as crutches or a cane.
Grade 3 coxarthrosis is a direct indication for surgical treatment.If surgery is not performed on time, the femoral head will be firmly attached to the acetabular surface by bone spurs.This will lead to a shortening of the legs, a complete loss of the ability to move independently, because the joints will completely lose mobility, that is, become disabled.
Diagnose
If there are signs of coxarthrosis, an orthopedist should be consulted as soon as possible.Initially, the doctor will interview the patient and find out the nature of the complaint, then conduct an examination and perform functional tests, comparing the length of the leg.As a rule, the data obtained are sufficient to speak of the presence of coxarthrosis with a high degree of confidence.
But since a similar clinical picture can accompany a number of other diseases of the hip joint, both inflammatory and non-inflammatory in nature, instrumental diagnostic methods are necessarily indicated.With their help, the specialist can not only confirm the presence of coxarthrosis, distinguishing it from nerve root syndrome due to spinal pathologies, but also accurately assess the degree of its development and thereby choose the most effective treatment tactic.
Today, the following are used to diagnose coxarthrosis:
- X-ray of the hip joint - the image obtained allows you to detect signs of destructive changes, the presence of bone spurs, the deforming nature of the bone structure and measure the thickness of the joint space.
- CT is a more modern method of diagnosing bone diseases, providing clearer data than X-rays but is more expensive.Therefore, CT is indicated in controversial cases when it is necessary to clarify the diagnosis and extent of hip joint destruction.
- MRI is a highly informative method for studying joints, providing the maximum amount of information about the condition of the joint and all its structures, especially the hyaline cartilage, ligaments and blood supply characteristics.
The patient is prescribed a number of laboratory tests, including OAC, OAM, rheumatology tests, biochemical blood tests, and others.
Conservative treatment of coxarthrosis
When coxarthrosis is diagnosed at 1 or 2 degrees, treatment is carried out using conservative methods.For each patient, they are selected individually, taking into account the detected comorbidities.Therefore, it is often necessary to consult not only with an orthopedist, but also with other specialists who will select the necessary treatment to combat comorbidities.
As part of the treatment of coxarthrosis, patients are prescribed:
- drug treatment;
- exercise therapy;
- physical therapy.
It is imperative that all patients take measures to eliminate the impact of factors that increase the load on the legs and contribute to the progression of degenerative changes in the hip joint.This involves adjusting your diet and increasing your level of physical activity if you are overweight.If the patient is regularly exposed to excessive physical activity, the type of activity should be changed or the intensity of exercise should be reduced if the intensity of exercise is due to playing sports.In some cases, it is recommended to use special bandages and orthotics to immobilize the hip joint and reduce pain during physical activity.
Drug treatment
As part of drug treatment, drugs are selected individually for each patient, taking into account existing comorbidities.As a rule, drugs from the following pharmacological groups are prescribed for coxarthrosis:
- NSAIDs are a group of drugs with analgesic and anti-inflammatory effects (available in many different dosage forms, including tablets, capsules, gels, creams, injectable solutions, allowing you to choose the most effective and convenient form of use);
- Corticosteroids are drugs with strong anti-inflammatory effects, but due to the high risk of side effects, especially when taken orally, they are only prescribed for short periods of time by injection;
- muscle relaxants - drugs that help reduce muscle tone, allowing you to effectively fight muscle spasms, often seen in coxarthrosis;
- chondroprotectors – a group of drugs containing components used by the body to regenerate cartilage tissue;
- drugs that improve microcirculation - help improve the nutrition of soft tissues and activate metabolic processes in the affected area;
- Vitamin B - indicated for nerve conduction disorders due to nerve compression by altered components of the hip joint.
If coxarthrosis causes acute pain that is not relieved by prescribed NSAIDs, the patient is recommended to undergo intra-articular or peri-articular blockade.Its essence is to inject directly into the cavity of the hip joint an anesthetic solution combined with corticosteroids.This will eliminate pain in the shortest possible time and reduce the inflammatory process.But the blockade can only be carried out by a qualified medical specialist in a specially prepared room.Carrying out such procedures at home is not recommended.
Exercise therapy
When coxarthrosis is diagnosed, regular physical therapy is required.Just like drug treatment, a set of exercise therapy 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 and the nature of accompanying diseases (with special attention to cardiovascular pathologies).
Thanks to daily exercise therapy classes, it is possible to:
- reduces the severity of pain;
- increased mobility of the hip joint;
- reduces the risk of developing muscle atrophy;
- eliminates thigh muscle spasms;
- Activates blood circulation and thereby improves the nutrition of the affected joints.
All exercises should be performed smoothly, avoiding sudden movements and jerks.But if pain occurs during exercise, you should definitely contact your doctor to correct the selected complex or conduct a repeated diagnosis to exclude progression of the disease and the need for surgery.
Physical therapy
Complex treatment of coxarthrosis includes courses of physiotherapeutic procedures that have anti-inflammatory, analgesic, decongestant and tonic effects on the body.Therefore, most patients are usually prescribed 10–15 procedures:
- ultrasound therapy;
- electrophoresis;
- UVT;
- magnetic therapy;
- laser treatment, etc.
Recently, plasmolifting has been increasingly used as part of the conservative treatment of coxarthrosis, which can significantly increase the rate of hyaline cartilage regeneration.The essence of this procedure is the introduction of purified plasma into the cavity of the hip joint, obtained by centrifugation from the patient's own blood.
Surgical treatment of coxarthrosis
If a patient is diagnosed with grade 3 coxarthrosis, he will be prescribed surgical intervention because conservative methods in such cases are no longer effective.Unfortunately, such situations are extremely common today, since a very large number of patients seek medical help when they can no longer endure the pain or have severe mobility limitations that cause them to lose the ability to work and move independently.
Timely surgical intervention can completely eliminate these disorders and restore the patient's normal mobility, significantly improving quality of life.Indications for its implementation are:
- significantly reduce common space by more than 80%;
- the presence of severe pain in the hip joint that cannot be eliminated;
- severe mobility impairment;
- femoral neck fracture.
The gold standard for treating severe coxarthrosis, even in the elderly, is hip replacement.This operation involves replacing the destroyed hip joint with an artificial prosthesis made of durable and at the same time biologically compatible materials.Arthroscopy allows you to completely restore the function of the hip joint, eliminate pain and return a person to a full active life.
The essence of this type of surgical intervention is to remove the head of the femur and a small piece of the neck.The surgeon will also need to prepare the surface of the acetabulum for the installation of the prosthesis, that is, remove all formed bone spurs and achieve maximum restoration of its normal shape.Then a prosthesis of the selected type is inserted, fixed with special cement (suitable for the treatment of older people) or in a cementless way.In the latter case, the prosthesis has a special porous part that comes into contact with the bony structures.Its fixation in the acetabulum is ensured by the growth of bone tissue through the sponge.
For each patient, the type of endoscopy is selected individually.The most effective is total arthroscopy, which involves completely replacing the entire hip joint, that is, the neck and head of the femur, as well as the acetabulum.
If the patient has preserved normal hyaline cartilage on the acetabular surface, the patient can undergo partial arthroplasty by replacing only the femoral head and/or neck.For this purpose, prostheses of different designs are used: unipolar and bipolar.
The only disadvantage of endoscope replacement is the need to replace the installed endoscope after 15–30 years.
After endoscopy, the patient undergoes rehabilitation, recovery time depends on the speed of tissue recovery.As part of the recovery process, exercise therapy, physical therapy and massage therapy are prescribed.
Before the advent of modern endoscopic methods, patients with grade 3 coxarthrosis were referred for osteotomy or arthroplasty.Nowadays, these techniques are used less and less because they have a number of disadvantages.So, joint surgery involves fixing the bony structures of the hip joint with metal plates.As a result, the pain syndrome is completely eliminated, but the joint loses its mobility completely.Thus, after joint treatment, the patient can only stand but cannot walk independently because the hip joint cannot move anymore.Therefore, today joint treatment is practically not performed.
Osteotomy involves performing an artificial femur fracture with the incorporation of bone fragments that will reduce the load on the affected hip joint.But the surgery only brings short-term effects and in the future a prosthesis will still be needed.
Thus, hip coxarthrosis is a quite dangerous disease that can lead to disability.It seriously reduces the quality of life and takes away people's ability to work.But if you pay attention to the early signs of the pathology and consult a chiropractor promptly, you can slow its progression and achieve a significant improvement in your health.But with coxarthrosis, which is already advanced, there can be only one solution - endoscopy.Fortunately, this method can be used even in the presence of severe degenerative changes and completely restore the normal function of the hip joint.