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 the acetabulum of the pelvis occurs.It is accompanied by pain and limited range of motion of varying severity, which depends on the stage of development.And if in the initial stages it is possible to deal with coxarthrosis using conservative methods, then in the 3rd stage it is possible to save the situation and preserve the functionality of the hip joint, i.e., avoid disability, only through surgery.
It is classified as arthrosis and can be associated with 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 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 space.As the disease progresses, there is deformation of the bone surfaces and the formation of bone growths on them, called osteophytes.
Coxarthrosis is the second most common disease of the musculoskeletal system.Most often, only gonarthrosis is diagnosed, i.e., a degenerative-dystrophic change in the knee joint.However, the likelihood of disability with coxarthrosis is significantly higher.
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 extremely important for the proper functioning of the joint, as it not only lubricates the hyaline cartilage, but also provides it with a source of nutrients.
Normally, the cartilage is constantly worn out and immediately restored due to the continuous process of regeneration, 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 the gradual wear 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 volume.As a result, the synovial fluid is no longer able to provide the hyaline cartilage with all the substances it needs in the necessary quantity, which leads to its rapid dehydration and thinning.Gradually, the strength and elasticity of the cartilage decreases, the areas of separation of the fibers that form it, cracks are created in it, and the thickness also decreases.These changes can be observed during instrumental diagnostic methods, especially the narrowing of the key space.
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 degraded hyaline cartilage.This provokes even greater damage, which affects the functioning 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, symptoms of coxarthrosis appear.
If left untreated, the pathological changes worsen and the hyaline cartilage wears away more and more.Then, in some areas it disappears completely, which leads to bone exposure and a sharp increase in the load on the joints.Since, when moving inside the acetabulum, the head of the femur rubs directly against the bone, this provokes 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 damage the muscles and ligaments surrounding the hip joint.This leads to severe pain both directly in the joint area and in the hips, buttocks and thighs.As a result, the patient spares the injured leg, loads it less and tries to avoid unnecessary movements with it.This causes the development of muscle atrophy, which further worsens impaired mobility and eventually leads to lameness.
Causes
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, which becomes a logical consequence of a number of diseases or changes in the state of the musculoskeletal system.Its development can be provoked by:
- hip joint injuries of various types, including fractures, dislocations, bruises, sprains, or torn ligaments;
- heavy physical work, professional sports, especially weightlifting, skydiving, dance sports;
- sedentary lifestyle;
- excess weight, which significantly increases the load on the hip joints;
- foci of chronic infection in the body;
- congenital abnormalities 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 can be a consequence of a fracture of the femoral neck, especially during conservative treatment;
- inflammatory joint diseases, 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 gradual progression with a systematic increase in the intensity of 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 coxarthrosis signs up to unbearable pain and significant limitation of mobility.
So, degenerative-dystrophic changes in the hip joint are accompanied by:
- Pain of varying intensity, which first appears after physical activity or walking and subsides after rest.Gradually, the severity of the pain syndrome increases, it appears more often, lasts longer, and the periods between the moment of applying the load to the joint and the appearance of pain decrease.Later, the pain is present almost constantly, including at rest, and becomes unbearable.Intensification of pain is typical at any stage of the disease with hypothermia and lifting heavy objects.
- Limitations of the mobility of the hip joint, which initially appear as minor difficulties in performing rotational movements of the leg.Over time, morning stiffness appears, which disappears after the patient "disperses".This can be accompanied by the appearance of swelling in the hip joint.As the disease progresses, limitations in mobility become more pronounced and more persistent, that is, they do not go away after warming up.Patients notice a decrease in the amplitude of leg movements, and then completely lose the ability to make certain movements.
- A crack in the hip joint that occurs when you walk or do physical work, especially when you perform extension.It is the result of friction of exposed bone structures against each other, which is accompanied by a sharp increase in pain.
- Spasm of the thigh muscles, which leads to the appearance of diffuse 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 surrounding 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, initially as a result of the unconscious desire of the patient to reduce the load on the diseased joint and transfer the weight to the healthy leg to avoid the occurrence or intensification of pain and then the development of muscle contracture.The latter phenomenon already occurs in the later stages of coxarthrosis and leads to the fact that the patient is unable to fully straighten his 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 provokes lameness.
- A decrease in the length of the leg, which mainly occurs with severe degenerative-dystrophic changes in the hip joint, accompanied not only by the narrowing of the joint space, but also by the flattening of the femoral head and muscle atrophy.As a result, the diseased leg becomes shorter than the healthy leg by 1 or more centimeters.
Coxarthrosis can affect either 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 vary in intensity.This depends on the degree of destruction of each hip joint.
Levels 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 mildest.In the initial stages of the appearance of degenerative-dystrophic changes in the hip joint, only occasional pain can be observed.As a rule, this happens after intense physical activity, sports or long walking.Therefore, patients usually do not pay attention to them, attributing them to fatigue and considering them as a normal age change.In this regard, coxarthrosis of the first degree is diagnosed only in isolated cases, which usually occurs during examination for another reason.
As the disease progresses, its symptoms intensify and already with 2nd degree coxarthrosis they are felt.This stage of the 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 the further progress of the pathology, the joint space narrows even more and in the third degree of coxarthrosis it is almost completely absent.This is already associated with the formation of numerous osteophytes.At this stage of the development of the disease, the pain becomes not only severe, 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 hit the nerves that pass here, which leads to pain that radiates to the hip area, buttocks, as well as the thigh and even the lower part of the leg.This also provokes the inability to move independently without the use of assistive devices, for example, crutches or a cane.
Coxarthrosis of the 3rd degree is a direct indication for surgical treatment.If the operation is not performed in time, the femoral head will be firmly fused with the surface of the acetabulum by osteophytes.This will lead to the shortening of the leg, a complete lack of ability to move independently, since the joint will completely lose mobility, that is, to disability.
Diagnosing
If signs of coxarthrosis appear, it is recommended to consult an orthopedist as soon as possible.Initially, the doctor will interview the patient and find out the nature of the complaints and then proceed with the examination and performing 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 a similar clinical picture can accompany a number of other hip joint diseases, both inflammatory and non-inflammatory in nature, instrumental diagnostic methods are necessarily prescribed.With their help, a specialist will be able not only to confirm the presence of coxarthrosis, to differentiate it from radicular syndrome caused by spinal pathologies, but also to correctly assess the rate of its development, and therefore choose the most effective treatment tactics.
Today, the following are used to diagnose coxarthrosis:
- X-rays of bone 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.
- CT is a more modern method for diagnosing bone pathologies, providing clearer data than X-rays, but it is 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 very informative method for the study of joints, providing the maximum amount of information about the state of the joint and all its structures, especially the hyaline cartilage, ligaments and blood supply characteristics.
Patients are prescribed a variety of laboratory tests, including OAC, OAM, rheumatic tests, biochemical blood tests and others.
Conservative treatment of coxarthrosis
When coxarthrosis of 1 or 2 degrees is diagnosed, treatment is carried out using conservative methods.For each patient, they are selected individually, taking into account the accompanying pathologies detected.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 associated diseases.
As part of coxarthrosis treatment, patients are prescribed:
- drug therapy;
- exercise therapy;
- physiotherapy.
It is imperative that all patients 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 activity, 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 bandages and special orthoses that will fix the hip joint and make it easier during physical activity.
Drug therapy
As part of drug treatment, drugs are selected individually for patients, taking into account existing concomitant diseases.As a rule, drugs from the following pharmacological groups are indicated for coxarthrosis:
- NSAIDs are a wide 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 use);
- corticosteroids are drugs that have a powerful anti-inflammatory effect, but due to the high risk of side effects, especially when oral forms are used, they are prescribed only in short courses by injection;
- muscle relaxants - drugs that help reduce muscle tone, which allows you to effectively fight muscle spasms, often observed with coxarthrosis;
- chondroprotectors - a group of drugs that contain components used by the body to regenerate cartilage tissue;
- drugs that improve microcirculation - help to improve the nutrition of soft tissues and activate metabolic processes in the affected area;
- B vitamins - are indicated for nerve conduction disorders caused by nerve compression from altered components of the hip joint.
If coxarthrosis causes an attack of acute pain that cannot be relieved with the help of prescribed NSAIDs, patients are recommended to undergo intra-articular or peri-articular blockade.Its essence is to inject directly into the cavity of the hip joint a solution of an anesthetic in combination with corticosteroids.This will eliminate the pain in the shortest possible time and reduce the inflammatory process.But the blockade can only be performed by a qualified medical professional in a specially prepared room.Carrying out such procedures at home is not recommended.
Exercise therapy
During the diagnosis of coxarthrosis, regular physical therapy exercises are necessary.Like 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 and the nature of accompanying diseases (special attention is paid to cardiovascular pathologies).
Thanks to daily hours of exercise therapy, it is possible to:
- reduce the severity of pain;
- increased mobility of the hip joint;
- reduce the risk of developing muscle atrophy;
- elimination of thigh muscle spasms;
- activate the blood circulation and in this way improve the nutrition of the affected joint.
All exercises should be performed smoothly, avoiding sudden movements and jerks.But if pain appears during exercise therapy, you should definitely contact your doctor to correct the chosen complex or to perform repeated diagnostics to rule out the progression of the disease and the need for surgery.
Physiotherapy
Complex treatment of coxarthrosis includes courses of physiotherapeutic procedures that have an anti-inflammatory, analgesic, decongestant and tonic effect on the body.Therefore, most often patients are prescribed 10-15 procedures:
- ultrasound therapy;
- electrophoresis;
- UVT;
- magnetic therapy;
- laser therapy etc.
Recently, plasmolifting has been 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 of purified blood plasma into the hip joint cavity, which is obtained by centrifugation from the patient's own blood.
Surgery for coxarthrosis
If a patient is diagnosed with grade 3 coxarthrosis, he is indicated for surgical intervention, as conservative methods in such cases are no longer effective.Unfortunately, such situations are extremely common today, as a very large number of patients seek medical help when they can no longer tolerate pain or have serious mobility limitations that deprive them of the ability to work and move independently.
Timely surgical intervention can completely eliminate these disorders and restore the patient's ability to move normally, significantly increasing his quality of life.The indications for its implementation are:
- significant reduction of joint space by more than 80%;
- the presence of severe pain in the hip joint that cannot be eliminated;
- severe mobility impairments;
- femoral neck fracture.
The gold standard for treating severe coxarthrosis, including in older people, is hip replacement.This operation involves replacing the destroyed hip joint with an artificial endoprosthesis made of durable and at the same time biologically compatible materials.Endoprosthetics 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 the resection of the femoral head and a small fragment of its neck.The surgeon will also need to prepare the surface of the acetabulum for the installation of the endoprosthesis, i.e., remove all the formed osteophytes and achieve maximum restoration of its normal shape.After that, an endoprosthesis of the selected type is placed, which is fixed using special cement (preferable for the treatment of the elderly) or cement-free.In the latter case, the endoprosthesis has a special spongy part that is in contact with the bone structures.Its fixation in the acetabulum is ensured by the growth of bone tissue through the sponge.
For each patient, the type of endoprosthetics is selected individually.The most effective is total endoprosthetics, which means 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 preservation of normal hyaline cartilage on the surface of the acetabulum, he can undergo partial arthroplasty with single replacement of the femoral head and/or neck.For this purpose, endoprostheses of different designs are used: monopolar and bipolar.
The only disadvantage of endoprosthesis replacement is the need to replace the installed endoprosthesis after 15-30 years.
After endoprosthetics, patients are given rehabilitation, the duration of which depends on the speed of tissue restoration.As part of recovery, 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 mobility.Thus, after arthrodesis, the patient can only stand, but is no longer able to walk independently due to the lack of movement in the hip joint.Therefore, today arthrodesis is practically not performed.
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 there is still a need for endoprosthetics.
Thus, coxarthrosis of the hip joint is a very dangerous disease, which can result in 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 receive a timely consultation with an orthopedist, you can slow down its progress and achieve a significant improvement in your well-being.But with already advanced coxarthrosis, there can be only one solution - endoprosthetics.Fortunately, this method can be used even with severe degenerative changes and completely restore the normal functioning of the hip joint.