Coxarthrosis: arthrosis of the hip joint

Arthrosis of the hip joint or coxarthrosis is a chronic, slow degenerative process in the articulation 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 movements in the leg and disability. All components of the joint are involved in the process: bones, articular capsules covering them, cartilage, ligaments, muscles. Symptoms and treatment of arthrosis of the hip joint (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 arthrosis of the hip joint (coxarthrosis) are pain and stiffness of movement. Most often, its development is preceded by injuries, as well as joint pathologies of inflammatory and non-inflammatory nature. Coxarthrosis is one of the most common arthrosis, which is associated with a 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 visiting a specialist and sign up for a consultation. In clinics you can undergo examination and receive conservative treatment.

Causes

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

• Exogenous- these are environmental factors: heavy physical activity, the consequences of major injuries - fractures, dislocations, ligament tears, unfavorable working conditions associated with heavy lifting, prolonged sitting.
• Endogenous— these are chronic infectious-inflammatory and autoimmune diseases: rheumatoid, reactive, psoriatic arthritis. 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 dislocation of the hip, 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.More often, the development of coxarthrosis of the hip joint is due to inevitable age-related changes.
• Floor. It is believed that osteoarthritis occurs more often in women than in 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 body weight and the occurrence of arthrosis. The greater the body weight, the more likely it is to develop arthrosis of the hip joint, since excess adipose tissue increases the load on the joints, and adipose tissue produces pro-inflammatory substances that damage cartilage tissue.
• Professional sportscan cause the development of coxarthrosis due to excessive stress on the joints and frequent injuries. Potentially dangerous sports include weightlifting, parachuting, and acrobatics.

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

Symptoms

How quickly does arthrosis of the hip joint (coxarthrosis) develop? Symptoms increase gradually, and in the first stages a person may not pay due attention to them and write them off as fatigue. This is dangerous, because it is at the beginning of the degenerative process that treatment brings greater effect.

The first clinical symptoms of coxarthrosis are pain, limited range of motion caused by muscle spasm.

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.

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

Swelling in the joint area is also possible, which is usually invisible due to the muscle and fat layer, crunching in the joints when moving, functional shortening of the lower limb.

The presence of certain signs and their severity depends 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 intense physical activity, such as running or long walking. The pain is localized in the joint area, less often spreading to the entire thigh and even the knee. After rest it usually disappears. There are no changes on the x-ray of the hip joint or there is a slight narrowing of the joint space. MRI reveals signs of heterogeneity of cartilage 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 area. Lameness appears after significant physical exertion. The range of motion in the joint decreases: abduction and inward rotation of the hip are limited. X-ray photographs reveal a clear uneven narrowing of the joint space and isolated osteophytes—growths of bone tissue—along the edge of the glenoid cavity. An MRI at stage 2 of coxarthrosis reveals obvious erosions and cracks of the cartilage with its thinning by less than half.
• For coxarthrosis of the 3rd degreethe pain becomes constant and often disturbs patients during sleep. Walking is difficult, which forces the patient to take a forced position of the body, relying on a healthy leg or a cane. The range of motion in the joint is sharply limited. On radiographs, the joint space is practically absent, and multiple osteophytes have formed on the bone surfaces. MRI shows destruction of more than half the volume of cartilage tissue. However, the third stage can still be treated conservatively.
• Stage 4 arthrosis 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 radiograph: multiple large osteophytes, the joint space is absent or narrowed to a minimum. Stage 4 is not amenable to conservative treatment; hip replacement is performed. The operation reduces pain, improves the functioning of the leg and the patient’s quality of life.

Diagnosis of arthrosis of the hip joint

The basis for diagnosing arthrosis of the hip joint 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 causes it. Then a visual inspection, palpation, gait assessment is required, and special tests are carried out to detect dysfunction of the joint.

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 arthrosis, however, a clinical blood test may be needed 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.

Of the instrumental methods for diagnosing arthrosis of the hip joints, radiography is generally 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 coxarthrosis 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 evaluate disorders of soft tissues.

Which doctor should I contact?

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

• surgeon to exclude surgical pathology requiring surgical intervention;
• phthisiatrician to exclude bone tuberculosis;
• oncologist to exclude malignant neoplasms;
• endocrinologist for concomitant metabolic disorders;
• a neurologist, if there is a 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 arthrosis of the hip joint (coxarthrosis), it is often enough to change your lifestyle and increase physical activity. At stage 2, conservative treatment is used, which includes medication and physiotherapeutic procedures. Stage 3 is less treatable, but surgery can still be avoided, which cannot be said about stage 4. The goal of conservative treatment is to improve the quality of life, as well as stop or slow down the rate of development of degenerative changes in the joint.

Drug therapy for coxarthrosis includes drugs that reduce the symptoms of the disease. These are nonsteroidal anti-inflammatory drugs that are 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:

• Reducing the load on the hip joint.Depending on the situation, the patient may be advised to reduce body weight, create additional support and transfer body weight to a cane or crutches.
• Therapeutic exercise.A properly selected set of exercises helps improve joint mobility, reduce pain, and also prevent muscle atrophy.
• Physiotherapeutic methods of treatment.For coxarthrosis of the hip joint, courses are prescribed: magnetic therapy, 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 tissue.
• Kinesio taping.This is the application of special adhesive tapes to the skin, which relieves 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 an individual course of 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 effectiveness of procedures and quick recovery; drug therapy 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, movements in the leg 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, which is accompanied by severe, shooting pain along the back of the leg.
• Ankylosis is complete immobility of the joint, significantly 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.
• Diseases of the stomach and heart if you take non-steroidal anti-inflammatory drugs for a long time and often.

Prevention

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

• Visit a doctor promptly if you experience pain in the hip joint.
• Be careful when engaging in strenuous sports, performing household and work physical activities, and lifting heavy objects.
• Control body weight through a balanced diet and regular physical activity.
• Avoid heavy physical labor 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 arthrosis, which is caused by a significant load on the hip joint.
2. The main signs of arthrosis of the hip joint (coxarthrosis) are pain and stiffness of movement.
3. There are 4 degrees of coxarthrosis, 1-2 are amenable to conservative treatment, 3-4 - surgically. However, with 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.