How to treat coxarthrosis of the hip joint

Coxarthrosis is a common degenerative-dystrophic disease of the hip joint, where, due to age-related changes or other factors, the gradual destruction of the articular joint of the head of the femur and the pelvic acetabulum occurs.It is accompanied by pain and limited range of motion of varying severity, which depends on the stage of development.And if at the initial stage it is possible to overcome coxarthrosis using conservative methods, then at the 3rd stage it is possible to save the condition and maintain the function of the hip joint, that is, avoid deformity, only through surgery.

It is classified as arthrosis and can be accompanied by the development of the same process 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 destruction of the cartilage layer covering the head of the femur and the acetabulum occurs, which leads to a reduction in the size of the joint space.As the disease progresses, deformation of the bone surface and the formation of bony growths on them, called osteophytes, occur.

Coxarthrosis is the second most common disease in the musculoskeletal system.More often, only gonarthrosis is diagnosed, that is, degenerative-dystrophic changes in the knee joint.However, the possibility of disability with coxarthrosis is higher.

The entire hip joint is enclosed in a specific case, called the joint capsule.It has a so-called synovial membrane, which produces synovial fluid.This fluid is very important for the proper functioning of the joint, as it not only lubricates the hyaline cartilage, but also supplies it with a source of nutrients.

Normally, cartilage is constantly worn out and quickly restored due to the continuous regeneration process, carried out with the help of substances that enter it from the synovial fluid.But with injuries or age-related changes, the rate of the regeneration process decreases, which leads to the gradual wear and tear 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 unfavorable factors, it becomes thicker and is produced in less quantity.As a result, the synovial fluid can no longer supply the hyaline cartilage with all the necessary substances in the required quantity, which leads to dehydration and rapid thinning.Gradually, the strength and elasticity of the cartilage decreases, the area of separation of the fibers that make it up, cracks form in it, and its thickness also decreases.These changes can be seen during instrumental diagnostic methods, especially the narrowing of the joint space.

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 degrading hyaline cartilage.This creates greater damage, which affects the function of the joint and the condition of the person, because the deformed area prevents the femoral head from sliding easily in the acetabulum.As a result, symptoms of coxarthrosis occur.

If left untreated, the pathological changes become worse, and the hyaline cartilage wears away.After that, in some areas it disappears completely, which leads to exposed bones and a sharp increase in the load on the joints.Since, when moving in the acetabulum, the head of the femur rubs directly against the bone, this causes severe pain and sharp limitation of movement.In this case, the pressure of bone structures on each other leads to the formation of bone growth on their surface.

Osteophytes that form may have sharp edges that can injure the muscles and ligaments surrounding the hip joint.This leads to severe pain both directly in the joint area and in the groin, buttocks and thighs.As a result, the patient saves the injured leg, reduces the load on it and tries to avoid making unnecessary movements with it.This causes muscle atrophy to develop, which worsens mobility disorders and eventually leads to lameness.

Cause

There are many reasons for the development of coxarthrosis, although in rare cases it occurs without any prerequisites.In this case, they talk about the presence of primary or idiopathic coxarthrosis.In most cases, secondary coxarthrosis is diagnosed, which is a logical consequence of some disease or change 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 labor, professional sports, especially weightlifting, parachuting, jumping sports;
• sedentary lifestyle;
• overweight, which significantly increases the load on the hip joint;
• the focus of chronic infection in the body;
• congenital abnormalities of the hip joint, such as dysplasia or dislocation;
• metabolic pathology and endocrine disorders, especially gout, diabetes mellitus, especially in the 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, tendonitis;
• spinal disease;
• genetic predisposition;
• the presence of bad habits, especially smoking.

However, the main cause of coxarthrosis is still 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 development with a systematic increase in the intensity of symptoms.Therefore, in the early stages it can be asymptomatic or only occasionally cause concern to the patient, but subsequently the condition of the hip joint worsens, which leads to an increase in the severity of coxarthrosis symptoms up to unbearable pain and significant mobility limitations.

Therefore, degenerative-dystrophic changes in the hip joint are accompanied by:

• Pain of varying intensity, initially occurs 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 period between the moment when the load is applied to the joint and the appearance of pain decreases.Then, 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.
• Limited mobility of the hip joint, which initially manifests itself as a slight difficulty in performing leg rotation movements.Over time, morning stiffness appeared, which disappeared after the patient "dispersed."This may be accompanied by the appearance of swelling in the hip joint.As the disease progresses, restrictions on mobility become more pronounced and persistent, that is, they do not disappear after warming up.Patients notice a decrease in the amplitude of leg movements, and subsequently completely lose the ability to make certain movements.
• Irritation in the hip joint that appears when walking or doing physical work, especially when doing extensions.It becomes the result of the friction of exposed bone structures against each other, which is accompanied by a sudden increase in pain.
• Muscle spasm of the thigh, which leads to the appearance of pain that radiates into the thigh.This may be the result of the addition of various intra-articular disorders, including nerve compression, excessive stretching of ligaments around the joint, as well as the development of synovitis, which is inflammation of the synovial membrane and the accumulation of inflammatory effusion in the hip joint cavity.
• Lameness, initially caused by the patient's unconscious desire to reduce the load on the diseased joint and transfer body weight to the healthy leg to avoid the appearance or intensity of pain, and then the development of muscle contractures.The latter phenomenon already occurs in the final stage of coxarthrosis and leads to the fact that the patient cannot fully straighten his leg and, moreover, keep it in this position.Therefore, the lower limb with an affected hip joint is always in a slightly bent position, which creates lameness.
• The reduction in leg length, which mainly occurs with severe degenerative-dystrophic changes in the hip joint, is accompanied not only by narrowing of the joint space, but also by 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 are not only bilateral, but will also differ in intensity.This depends on the degree of destruction of each hip joint.

Stage of coxarthrosis

The nature of the manifestation of the disease depends on the stage of its development.In total, there are 3 degrees of coxarthrosis, where the first is considered the mildest.In the early stages 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 walks.Therefore, patients usually do not pay attention to them, associate them with fatigue and consider them normal age-related changes.In this regard, stage 1 coxarthrosis is diagnosed only in isolated cases, which usually occur during an examination for other reasons.

As the disease progresses, the symptoms intensify and already with coxarthrosis of the 2nd degree they feel.The stage of development of this 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 development of the pathology, the joint space becomes narrower and at the 3rd stage of coxarthrosis it is almost completely absent.This is already accompanied by the formation of various osteophytes.At the advanced stage of the disease, the pain becomes not only severe, but unbearable and often occurs even at complete rest, including at night.Because the hip joint is severely deformed, the elements can affect the nerves that pass through it, which leads to pain that spreads to the groin, buttocks, thighs and even the lower legs.This also creates the inability to move independently without the use of aids, for example, crutches or crutches.

Coxarthrosis of the 3rd degree is a direct indication for surgical treatment.If the operation is not performed in time, the head of the femur will be united with the surface of the acetabulum by osteophytes.This will lead to the shortening of the legs, the lack of ability to move freely, because the joints will lose their mobility completely, i.e. deformity.

Diagnostics

If signs of coxarthrosis occur, it is recommended to consult an orthopedic specialist as soon as possible.At first, the doctor will interview the patient and find out the nature of the complaint, and then proceed to examine and perform a functional test, comparing the length of the leg.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 several other diseases of the hip joint, both inflammatory and non-inflammatory, instrumental diagnostic methods must be prescribed.With their help, specialists will be able not only to confirm the presence of coxarthrosis, distinguishing it from radicular syndrome caused by spinal pathology, but also to correctly assess the level of its development, and therefore choose the most effective treatment tactics.

Today, the following are used to diagnose coxarthrosis:

• X-ray of the hip joint - the resulting image allows you to detect signs of destructive changes, the presence of osteophytes, the nature of the deformation of the bone structure and measure the thickness of the joint space.
• CT is a more modern method for diagnosing bone pathology, providing clearer data than x-ray, but 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 studying joints, providing the maximum amount of information about the state of the joint and all its structures, especially hyaline cartilage, ligaments and blood supply characteristics.

Patients are prescribed several laboratory tests, including OAC, OAM, rheumatic tests, biochemical blood tests and others.

Conservative treatment of coxarthrosis

When diagnosing coxarthrosis 1 or 2 degrees, treatment is carried out using conservative methods.For each patient, they are selected individually, taking into account the concomitant pathology detected.Therefore, it is often necessary to consult not only orthopedic specialists, but also doctors of other specialties who will choose the necessary treatment to combat concomitant diseases.

As part of the treatment of coxarthrosis, patients are prescribed:

• drug therapy;
• exercise therapy;
• physiotherapy.

It is important that all patients take steps 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 involves adjusting your diet and increasing your physical activity level if you are overweight.If the patient is frequently exposed to excessive physical activity, it is recommended to change the type of activity or reduce the intensity of the exercise if the load is caused by sports.In some cases, it is recommended to use special bandages and orthoses that will improve the hip joint and relieve it during physical activity.

Drug therapy

As part of drug treatment, drugs are selected individually for the patient, 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 show analgesic and anti-inflammatory effects (available in various dosage forms, including tablets, capsules, gels, creams, injection solutions, which allow you to choose the most effective and convenient form of use);
• corticosteroids are drugs that have a strong anti-inflammatory effect, but due to the high risk of side effects, especially when using the oral form, they are only prescribed 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 containing components used by the body for the regeneration of cartilage tissue;
• drugs that improve microcirculation - help improve soft tissue nutrition and activate metabolic processes in the affected area;
• Vitamin B - indicated for nerve conduction disorders caused by nerve compression by altered hip joint components.

If coxarthrosis causes acute pain attacks that cannot be relieved with the help of prescribed NSAIDs, the patient is recommended to undergo intra-articular or periarticular blockade.Its essence is to inject directly into the hip joint cavity an anesthetic solution in combination with corticosteroids.This will eliminate pain in the shortest possible time and reduce the inflammatory process.But restraints can only be performed by a qualified medical professional in a specially prepared room.Doing such a procedure at home is not recommended.

Exercise therapy

When diagnosing coxarthrosis, regular physical therapy training is required.Similar to 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 concomitant diseases (special attention is paid to cardiovascular pathology).

Thanks to daily exercise therapy classes, it is possible to:

• reduce the severity of pain;
• increase the mobility of the hip joint;
• reduce the risk of developing muscle atrophy;
• eliminate thigh muscle spasms;
• activates blood circulation and thus improves the nutrition of the affected joints.

All exercises should be done 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 repeated diagnostics to exclude the development of the disease and the need for surgery.

Physiotherapy

Complex treatment of coxarthrosis involves a course of physiotherapeutic procedures that have anti-inflammatory, analgesic, decongestant and tonic effects on the body.Therefore, 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 hyaline cartilage regeneration.The essence of the procedure is the introduction of purified blood plasma into the hip joint cavity, obtained by centrifugation from the patient's own blood.

Surgery for coxarthrosis

If the patient is diagnosed with grade 3 coxarthrosis, he is indicated for surgical intervention, because conservative methods in such cases are no longer effective.Unfortunately, this kind of situation is very common today, because a large number of patients seek medical help when they can no longer tolerate pain or have serious mobility limitations that prevent their ability to work and move freely.

Timely surgical intervention can completely eliminate this disorder and restore the patient's ability to move normally, significantly improving his quality of life.Indications for its implementation are:

• a significant reduction in common space of more than 80%;
• the presence of severe pain in the hip joint that cannot be eliminated;
• severe movement disorders;
• femoral neck fracture.

The gold standard for the treatment of 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 allow you to fully restore the function of the hip joint, eliminate pain and return a person to a fully active life.

The essence of this type of surgical intervention is the resection of the head of the femur and a small fragment of its neck.The surgeon also needs to prepare the surface of the acetabulum for the installation of the endoprosthesis, that is, remove all the osteophytes that have formed and achieve maximum restoration of its normal shape.After this, the selected type of endoprosthesis is installed, which is installed using special cement (better for treating the elderly) or in a cementless way.In the second case, the endoprosthesis has a special spongy part that is in contact with the bone structure.Its fixation in the acetabulum is ensured by the growth of bone tissue through the sponge.

For each patient, the type of endoprosthetic is selected individually.The most effective is total endoprosthetics, which implies a complete replacement of the entire hip joint, that is, 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 may undergo partial arthroplasty with replacement of only 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, the patient is given rehabilitation, the duration of which depends on the speed 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, this technique is used less and less, because it has several disadvantages.Therefore, arthrodesis involves fixing the bony structure of the hip joint with a metal plate.As a result, the pain syndrome is completely eliminated, but the joint loses its mobility completely.Therefore, 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 a combination of bone fragments that will reduce the load on the affected hip joint.But the operation only gives a short-term effect and in the future there is still a need for endoprosthetics.

Therefore, coxarthrosis of the hip joint is a rather dangerous disease, which can lead to disability.It seriously reduces the quality of life and takes away a person's work capacity.But if you pay attention to the early signs of pathology and get a timely consultation with an orthopedic specialist, you can slow down its development and achieve a significant improvement in your well-being.But with advanced coxarthrosis, there is only one solution - endoprosthetics.Fortunately, this method can be used even with severe degenerative changes and fully restore the normal function of the hip joint.