Arthrosis of the hip joint is a degenerative-dystrophic pathology, which is characterized by the destruction of hyaline cartilage.
The disease develops gradually, accompanied by pain and decreased range of motion. In the absence of medical intervention at the initial stage of arthrosis, 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, CT, arthroscopy. Treatment of pathology of 1 and 2 degrees of severity is conservative. If ankylosis is detected or drug therapy is ineffective, a surgical operation (arthrodesis, endoprosthetics) is performed.
The mechanism of development of pathology
The hip joint is formed by two bones - the ilium and the femur. The lower part of the ilium is represented by its body, which participates in articulation with the femur, forming the upper part of the acetabulum. During movement, the glenoid fossa is motionless, and the femoral head moves freely. Such a "hinge" device of the hip joint allows it to bend, unbend, rotate, promotes abduction, adduction of the hip. The smooth, resilient, resilient hyaline cartilage lining the acetabulum and femoral head provides smooth sliding of the articular structures. Its main functions are redistribution of loads during movement, prevention of rapid wear of bone tissues.
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 arthrosis, it thickens, becomes viscous.
The resulting deficiency of nutrients provokes drying of the surface of the hyaline cartilage. It becomes covered with cracks, which leads to permanent microtrauma of tissues during flexion or extension of the hip joint. Cartilage becomes thinner and loses its cushioning properties. Bones are deformed to "adapt" to the increase in pressure. And against the background of deterioration of metabolism in tissues, destructive and degenerative changes progress.
Causes and provoking factors
Idiopathic or primary arthrosis develops for no reason. It is believed that the destruction of cartilage tissue occurs due to the natural aging of the body, slowing down of recovery processes, a decrease in the production of collagen and other compounds necessary for the full regeneration of the structures of the hip joint. Secondary arthrosis occurs against the background of a pathological condition already present in the body. The most common causes of secondary disease include:
- previous injuries - damage to the ligamentous-tendon apparatus, muscle ruptures, their complete separation from the bone base, fractures, dislocations;
- violation of the development of the joint, congenital dysplastic disorders;
- autoimmune pathologies - rheumatoid, reactive, psoriatic arthritis, systemic lupus erythematosus;
- nonspecific 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 joints, due to the production of "super-extensible" collagen, provoking their excessive mobility, weakness of the ligaments.
Since the cause of the development of arthrosis can be hemarthrosis (hemorrhage in the cavity of the hip joint), the provoking factors include hematopoiesis disorders. The prerequisites for the onset of the disease are excess weight, excessive physical activity, a sedentary lifestyle. Its development is caused by improper organization of sports training, a deficiency in the diet of foods with a high content of microelements, fat- and water-soluble vitamins. Postoperative arthrosis 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 with frequent hypothermia, living in an environmentally unfavorable environment, and working with toxic substances.
Arthrosis of the hip joint cannot be inherited. But in the presence of certain congenital features (metabolic disorders, skeletal structure), the likelihood of its development increases significantly.
Symptoms
The leading symptoms of arthrosis of the hip joint are pain when walking in the hip region, radiating to the groin, 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 articulation, the limb is noticeably shortened. Another characteristic sign of pathology is limitation of hip abduction. For example, difficulties arise when trying to sit on a stool with legs apart.
For arthrosis of the first severity, periodic pain occurs after intense physical exertion. They are localized in the articulation area and disappear after a long rest.
With arthrosis of the second degree 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 begins to limp barely noticeably. Limitation of movement in the joint is noted, especially during abduction and internal rotation of the thigh.
Arthrosis of the third degree is characterized by constant severe pain that does not subside 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 a 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 provokes a strong shift in the center of gravity and an increase in stress on the joint. At this stage of arthrosis, pronounced ankylosis of the joint develops.
| Degrees | Radiographic signs |
| The first | The changes are not pronounced. The joint gaps are moderately, unevenly narrowed, there is no destruction of the surface of the femur. Minor bony growths are observed 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 upward, deformed, enlarged, its contours become uneven. Bony growths form on the surface of the inner and outer edges of the glenoid fossa |
| Third | There is a complete or partial fusion of the joint space. The femoral head is strongly expanded. Multiple bony growths are located on all surfaces of the acetabulum |
Diagnostics
When making a diagnosis, the doctor takes into account the clinical manifestations of pathology, anamnesis, the results of an external examination of the patient and instrumental studies. Radiography is the most informative. With its help, the condition of the hip joint is assessed, the stage of its course, the degree of damage to the cartilaginous tissues, and in some cases the cause of 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 articulation. Perthes disease or juvenile epiphysiolysis is indicated by the disturbed shape of the hip bone. Radiography can reveal post-traumatic arthrosis, despite the absence of a previous trauma in the anamnesis. Other diagnostic methods are also used:
- CT helps to detect the growth of the edges of the bone plates, formed osteophytes;
- MRI is performed to assess the condition of the connective tissue structures and the degree of their involvement in the pathological process.
If necessary, the inner surface of the joint is examined with arthroscopic instruments. Differential diagnosis is carried out to exclude gonarthrosis, lumbosacral or thoracic osteochondrosis. Pain in arthrosis can be disguised as clinical manifestations of radicular syndrome caused by nerve entrapment or inflammation. It is usually possible to exclude neurogenic pathology with the help of a series of tests. Arthrosis 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 treatment tactics
Medical treatment is aimed at improving the patient's well-being. For this, drugs of various clinical and pharmacological groups are used:
- non-steroidal 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 blockades in combination with anesthetics Procaine, Lidocaine;
- muscle relaxants - Baclofen, Tizanidine. They are included in treatment regimens for spasm 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 arthrosis.
Rubbing ointments with a warming effect helps to eliminate mild pain. The active ingredients of external agents are capsaicin, cinquefoil, camphor, menthol. These substances are characterized by a local irritating, distracting, analgesic effect. Compresses on the joints with Dimethylsulfoxide, medical bile will help to cope with puffiness, morning swelling of the thigh. Patients are recommended classical, acupressure or vacuum massage for coxarthrosis. Daily exercise therapy is an excellent prevention of further progression of arthrosis.
Surgical intervention
With the ineffectiveness of conservative therapy or diagnosing a pathology complicated by ankylosis, an operation is performed. It is impossible to restore the cartilaginous tissue in the joint damaged by arthrosis without prosthetics surgery, but with the right approach to treatment, adherence to all medical prescriptions, maintaining a correct lifestyle, doing therapeutic exercises, regular massage courses, taking vitamins and proper nutrition, you can stop the lesion process anddestruction of cartilage and hip joints.