Coxarthrosis: osteoarthritis of the hip joint

Osteoarthritis of the hip joint or coxarthrosis is a chronic and slow degenerative process in the joint of the head of the femur and the acetabulum of the pelvic bone. With this disease, bone and cartilaginous tissues become deformed, which, as it progresses, leads to significant limitation of leg movements and disability. All components of the joint are involved in the process: bones, joint capsules that cover them, cartilage, ligaments, muscles. The symptoms and treatment of osteoarthritis 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 osteoarthritis 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 an inflammatory and non-inflammatory nature. Coxarthrosis is one of the most common arthrosis, associated with a significant load on the hip joint.

In its development, the disease goes through several stages. In the initial 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 making an appointment. In clinics you can undergo examinations and receive conservative treatment.

Causes

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

• Exogenous- these are environmental factors: intense physical activity, consequences of serious injuries - fractures, dislocations, ligament ruptures, unfavorable working conditions associated with lifting weights, prolonged sitting.
• Endogenous— these are infectious, inflammatory and chronic autoimmune diseases: rheumatoid, reactive and psoriatic arthritis. As well as metabolic disorders: gout, diabetes.
• Congenital diseases.Dysplasia (difficulty in 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.
• Advanced age.More often, the development of coxarthrosis of the hip joint is due to inevitable age-related changes.
• Floor. Osteoarthritis is believed to occur more frequently 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 osteoarthritis. The greater the body weight, the greater the likelihood of developing osteoarthritis of the hip joint, since excess adipose tissue increases the load on the joints and adipose tissue produces pro-inflammatory substances that damage cartilaginous tissue.
• Professional sportscan cause the development of coxarthrosis due to excessive stress on the joints and frequent injuries. Potentially dangerous sports include weightlifting, skydiving and acrobatics.

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

Symptoms

How quickly does osteoarthritis of the hip joint (coxarthrosis) develop? Symptoms gradually increase and, in the early stages, the person may not pay due attention to them and describe them as fatigue. This is dangerous, as it is at the beginning of the degenerative process that the treatment has the greatest 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 its appearance is prolonged walking or intense physical activity.

Limitation of joint mobility occurs due to intense pain. The patient's gait changes: the buttocks protrude backwards, 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 of the joints during movement, functional shortening of the lower limb.

The presence of certain signs and their severity depend on the stage of the 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 region, less frequently spreading throughout the thigh and even the knee. After rest it usually disappears. There are no changes on the radiograph of the hip joint or there is a slight narrowing of the joint space. Magnetic resonance imaging reveals signs of heterogeneity of cartilaginous tissue.
• For 2nd degree coxarthrosisThe 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 of the joint decreases: abduction and internal rotation of the hip are limited. Radiographic photographs reveal a clear, irregular 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 3rd degree coxarthrosisthe pain becomes constant and often disturbs patients during sleep. Walking is difficult, which forces the patient to assume a forced body position, leaning on a healthy leg or a cane. The range of motion in the joint is quite 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 cartilaginous tissue. However, the third stage can still be treated conservatively.
• Stage 4 osteoarthritis 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 x-ray: multiple large osteophytes, the joint space is absent or reduced to a minimum. Stage 4 is not amenable to conservative treatment; hip replacement is performed. The operation reduces pain, improves leg function and the patient's quality of life.

Diagnosis of arthrosis of the hip joint

The basis for diagnosing osteoarthritis of the hip joint is an initial consultation with a specialist. The doctor clarifies the complaints: where the pain is located, when and why it occurs, where it goes, what reduces and intensifies it, what causes it. Next, visual inspection, palpation, gait assessment, and special tests are needed to detect joint dysfunction.

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 osteoarthritis, however, a clinical blood test may be necessary 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 usually 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. Radiographs of patients with coxarthrosis may also reveal changes indicative of trauma.

Computed tomography and magnetic resonance imaging can be used as other instrumental diagnostic methods. Computed tomography allows a more detailed study of pathological changes in bone structures, and MRI provides the opportunity to evaluate soft tissue disorders.

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 necessary:

• 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 compression of the spinal nerve roots by an intervertebral hernia of the lumbosacral spine is suspected.

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. In phase 2, conservative treatment is used, which includes medications and physiotherapeutic procedures. Stage 3 is less treatable, but surgery can still be avoided, which cannot be said for stage 4. The goal of conservative treatment is to improve quality of life, as well as stop or slow the rate of development of degenerative changes in the articulation.

Drug therapy for Coxarthrosis includes medications that reduce the symptoms of the disease. These are nonsteroidal anti-inflammatory medications used short-term to relieve pain and inflammation. Sometimes corticosteroids and muscle relaxants are 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 instructed 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 to 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.
• Kinésio recording.This involves applying special adhesive tapes to the skin, which relieves the load on the joint.
• Acupuncture.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 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, and drug therapy alone may not give the expected result.

Hip arthroplasty 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, leg movements are severely 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 intense, sharp pain in the back of the leg.
• Ankylosis is the 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 will lead to obesity and depression.
• Stomach and heart diseases if you take nonsteroidal anti-inflammatory drugs for a long time and often.

Prevention

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

• Visit a doctor immediately if you experience pain in your hip joint.
• Be careful when playing strenuous sports, performing physical activities at home and at work, and lifting heavy objects.
• Control body weight through a balanced diet and regular physical activity.
• Avoid heavy physical work and sports overload. It is a 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, caused by a significant load on the hip joint.
2. The main signs of osteoarthritis 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, in stage 3, surgery can still be avoided if you follow all the doctor's recommendations.
4. Specialists use an integrated approach to treating coxarthrosis, which includes medications, physiotherapy, manual therapy, nutritional correction and physical activity.