Coxarthrosis is a common degenerative-dystrophic disease of the hip joint, in which, due to age-related changes or other factors, gradual destruction of the articular joint of the femoral head and acetabulum of the pelvis is observed. It is accompanied by pain and limitation of range of motion of varying severity, depending on the stage of development. And if in the initial stages it is possible to treat coxarthrosis with conservative methods, then in the 3rd stage it is possible to save the situation and preserve the working capacity of the hip joint, that is, to avoid disability, only by performing the operation.
It belongs to the number of joints and can be accompanied by the development of similar processes in other joints, and this pathology constitutes 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 cartilaginous layers covering the femoral head and acetabulum are destroyed, which leads to a reduction in the size of the joint space. As the disease progresses, the appearance of deformation of the bone surfaces and the formation of bony growths on them, called osteophytes, is observed.
Coxarthrosis is the second most common disease of the musculoskeletal system. Most often, only gonoarthrosis is diagnosed, i. e. degenerative-dystrophic change in the knee joint. However, the likelihood of disability in coxarthrosis is significantly greater.
The entire hip joint is enclosed in a specific case, which is called the joint capsule. It has a so-called synovial membrane, which 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, the cartilage constantly wears out and is immediately restored due to the continuous process of regeneration, 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 the 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 adverse 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 substances it needs in the right amount, which leads to its rapid dehydration and thinning. Gradually, the strength and elasticity of the cartilage decreases, the areas of detachment of the fibers that form it, cracks are formed in it, and the thickness also decreases. These changes can be observed during diagnostic methods of organs, in particular, the narrowing of the joint space draws attention.
The narrowing of the joint space leads to increased friction between the bony structures that make up the hip joint and an increase in pressure on the already degraded hyaline cartilage. This causes even more damage to it, which affects the function of the joint and the condition of the person, since the deformed areas prevent the femoral head 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 down more and more. Then, in some areas, it disappears completely, which leads to bone exposure and a sharp increase in the load on the joint. Since when moving inside the acetabulum, the femoral head rubs directly against the bone, this causes severe pain and a sharp limitation of mobility. In this case, the pressure of bone structures between them leads to the formation of bone growths on their surface.
The osteophytes that form may have sharp parts that can injure the muscles and ligaments surrounding the hip joint. This leads to the appearance of strong pains both directly in the joint area and in the groin, buttocks and thighs. As a result, the patient spares the injured leg, puts less pressure on it and tries to avoid unnecessary movements with it. This causes muscle atrophy to develop, which further worsens mobility disorders and eventually leads to lameness.
Reasons
There are many reasons for the development of coxarthrosis, although in rare cases it occurs in the context of the absence of any prerequisites. In this case they speak of the presence of primary or idiopathic coxarthrosis. In the vast 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 caused by:
- injuries of the hip joint of various nature, including fractures, dislocations, bruises, sprains or torn ligaments;
- hard physical work, professional sports, especially weightlifting, parachuting, jumping sports.
- sedentary life?
- excess weight, 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 be the result of a fracture of the femoral neck, especially during 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 the symptoms. Therefore, in the initial stages, it can be asymptomatic or only occasionally cause anxiety to patients, but then the condition of the hip joint worsens, which leads to an increase in the severity of the symptoms of coxarthrosis up to unbearable pain and a significant limitation ofmobility.
Thus, degenerative-dystrophic changes in the hip joint are accompanied by:
- Pain of varying intensity, which initially occurs after physical exercise or walking and subsides after rest. Gradually, the severity of the pain syndrome increases, occurs more often, lasts longer, and the periods between the moment of applying the load to the joint and the onset of pain decrease. Later, the pain is present almost constantly, including at rest, and becomes unbearable. Increased pain at any stage of the disease progression during hypothermia and lifting heavy objects is characteristic.
- Limitations in the mobility of the hip joint, which initially manifest themselves with small difficulties in the implementation 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 severe and persistent, i. e. they do not disappear after warming up. Patients notice a decrease in the amplitude of leg movements, and then completely lose the ability to perform certain movements.
- Cracking in the hip joint, occurring when walking or performing physical work, especially when performing extension. It becomes the result of the friction of bare bone structures against each other, which is accompanied by a sharp increase in pain.
- Spasm of the thigh muscles, leading to radiating pain in the thigh. This can be a result of the attachment of various intra-articular disorders, including nerve compression, excessive stretching of the ligaments surrounding the joint, as well as the development of arthritis, that is, 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 affected joint and transfer weight to the healthy leg to avoid the appearance or intensification of pain and then the development of muscle contraction. The latter phenomenon appears already in the last stages of coxarthrosis and leads to the fact that the patient is not able to fully straighten the leg and, moreover, keep it in this position. Thus, the lower limb with the affected hip joint is constantly in a slightly bent position, which causes lameness.
- Reduction in leg length, which occurs mainly already with severe degenerative-dystrophic changes in the hip joint, accompanied not only by narrowing of the joint space, but also by flattening of the femoral head, 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 and 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 just be bilateral, but will also differ in intensity. It depends on the degree of destruction of each hip joint.
Grades 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 the onset of degenerative-dystrophic changes in the hip joint, only episodic pains can be observed. As a rule, this happens after intense physical exertion, sports or a long walk. Therefore, patients usually ignore them, attributing them to fatigue and considering them normal age-related changes. In this regard, coxarthrosis of the 1st degree is diagnosed only in isolated cases, which usually appears during an examination for another reason.
As the disease progresses, its symptoms intensify and already with 2nd degree coxarthrosis they become noticeable. This stage of development of the pathology is characterized by a narrowing of the joint space by 50%, 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 with the 3rd degree the coxarthrosis is almost completely absent. This is already accompanied by the formation of multiple osteophytes. At this stage of the development of the disease, the pain becomes not only 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 that pass here, which leads to pain that radiates to the groin, buttocks, as well as the thigh and even the lower leg. This also causes the inability to move independently without the use of assistive devices such as crutches or walking sticks.
Grade 3 coxarthrosis is an immediate indication for surgical treatment. If the operation is not performed in time, the femoral head will be firmly fused to the surface of the acetabulum with osteophytes. This will lead to shortening of the leg, the complete absence of the possibility of independent movement, as the joint will completely lose mobility, that is, disability.
Diagnostics
If signs of coxarthrosis appear, it is recommended to contact an orthopedist as soon as possible. First, the doctor will interview the patient and find out the nature of the complaints, and then proceed to examine 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 certainty about the presence of coxarthrosis.
But because such a clinical picture can accompany a number of other diseases of the hip joints, inflammatory and non-inflammatory in nature, instrumental diagnostic methods are required. With their help, a specialist will be able not only to confirm the presence of coxarthrosis, to differentiate it from the root syndrome caused by pathologies of the spine, but also to correctly assess the degree of its development, which means the choiceof the most effective treatment tactics.
Today, the following are used to diagnose coxarthrosis:
- X-ray of the hip joints - the resulting 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 space.
- Computed tomography is a more modern method for diagnosing bone pathologies, providing clearer data than x-rays, but more accurate. Therefore, computed tomography is prescribed in controversial cases, when it is necessary to clarify the diagnosis and the degree of destruction of the hip joint.
- Magnetic resonance imaging is an extremely informative method for examining 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.
Patients are prescribed a number of laboratory tests, including KLA, OAM, rheumatic tests, biochemical blood tests and others.
Conservative treatment of coxarthrosis
When diagnosing coxarthrosis of 1 or 2 degrees, treatment is carried out with conservative methods. For each patient they are selected individually, taking into account the detected comorbidities. Therefore, it may often be necessary to consult not only an orthopedist, but also doctors of other specialties who will choose 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 development 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 load is due to sports. In some cases, it is recommended to use special bandages and braces that will stabilize the hip joint and relieve it during physical exercise.
Medical treatment
As part of drug therapy, patients are selected individualized drugs, taking into account the existing accompanying diseases. As a rule, drugs of 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, injectable solutions, which allows you to choose the most effective and convenient form of application).
- corticosteroids - drugs that have a strong anti-inflammatory effect, but due to the high risk of side effects, especially when oral forms are used, 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, which are often observed in coxarthrosis.
- chondroprotectors - a group of drugs that contain 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.
- B vitamins - indicated for nerve conduction disorders caused by compression of nerves by altered elements of the hip joint.
If the coxarthrosis has caused an attack of acute pain that cannot be stopped with the help of prescribed NSAIDs, intra-articular or peri-articular blockade is recommended for patients. Its essence lies 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 eliminate pain and reduce the inflammatory process. But the blockade can be carried out only by qualified health personnel in a specially prepared room. Performing such procedures at home is not shown.
exercise therapy
Upon diagnosis of coxarthrosis, regular exercise therapy is mandatory. In the same way as drug therapy, 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, the nature of accompanying diseases (special attention is paid to cardiovascular pathologies).
Thanks to daily exercise therapy, you can:
- reduce the severity of pain.
- increasing the mobility of the hip joint.
- reducing the risk of muscle atrophy.
- eliminate thigh muscle spasms.
- activates blood circulation and therefore improves the nutrition of the affected joint.
All exercises must be performed smoothly, avoiding sudden movements and jerks. But if pain occurs during exercise therapy, you should definitely contact your doctor to correct the selected complex or carry out a re-diagnosis to exclude the progression of the disease and the need for surgery.
Physiotherapy
The comprehensive treatment of coxarthrosis includes courses of physical therapy procedures that have anti-inflammatory, analgesic, decongestant and tonic effects on the body. Therefore, most often patients are prescribed 10-15 procedures:
- ultrasound therapy;
- electrophoresis?
- UVT?
- magnetotherapy?
- laser treatment etc.
Recently, plasmolifting is increasingly used as part of the conservative treatment of coxarthrosis, which can significantly increase the speed of hyaline cartilage regeneration. 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 a patient is diagnosed with coxarthrosis of the 3rd degree, it is indicated for surgery, since conservative methods in such cases are already ineffective. Unfortunately, such situations are extremely common today, as a very large number of patients seek medical help when they can no longer bear the pain or have severe motor limitations that deprive them of their ability to work and move independently.
Early surgery 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, which cannot be eliminated.
- severe movement disorders;
- femoral neck fracture.
The gold standard for treating severe coxarthrosis, including in the elderly, is hip arthroplasty. This operation involves the replacement of a damaged hip joint with an artificial endoprosthesis made of durable and at the same time biologically compatible materials. Endoprosthetics allow 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 surgery is the resection of the femoral head and a small fragment of its neck. Also, the surgeon will need to prepare the surface of the acetabulum for the installation of the endoprosthesis, i. e. remove all the formed osteophytes and achieve the maximum restoration of its normal shape. After that, an endoprosthesis of the selected type is placed, which is fixed with a special cement (preferably for the treatment of the elderly) or in a cement-free manner. In the latter case, the endoprosthesis has a special spongy part in contact with bony structures. Its fixation to the acetabulum is provided 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 the 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 preservation of 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. For this purpose, endoprostheses of different designs are used: unipolar and bipolar.
The only disadvantage of arthroplasty can be considered the need to replace the installed endoprosthesis after 15–30 years.
After the endoprosthesis is replaced, patients undergo rehabilitation, the duration of which depends on the rate of tissue recovery. As part of rehabilitation, exercise therapy, physiotherapy and therapeutic massage are prescribed.
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, today arthrodesis is practically not performed.
Osteotomy involves performing 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 result, and in the future the need for arthroplasty still arises.
Thus, coxarthrosis of the hip joint is quite a dangerous disease, which can lead to disability. It seriously reduces the quality of life and deprives a person of the ability to work. But if you pay attention to the early signs of pathology and get timely advice from an orthopedic surgeon, you can slow down its progression and achieve a significant improvement in well-being. But with the already current coxarthrosis, there can be only one solution - arthroplasty. Fortunately, this method can be used even with severe degenerative-dystrophic changes and fully restore the normal function of the hip joint.