Osteoarthritis of the hip joint: symptoms, treatment and prevention

The hip joint is the largest joint in our body.It has a hinge configuration that allows for movement in different planes.At the same time, the joint is surrounded by strong ligaments and muscles.The hip joints bear the main load when walking, running, or carrying heavy loads.Coxarthrosis (another name for arthrosis of the hip joint) is quite common in people, both old and young.Once it begins, it can remain undiagnosed for a long time, because visible limitation of hip movements does not immediately occur.

Often, patients, without being examined by a doctor or without presenting all their complaints, begin to treat lumbosacral osteochondrosis or arthrosis of the knee joints without any visible effect.Meanwhile, the untreated disease progresses and leads to lameness, constant pain, shortening of the leg, and the inability to bend and extend.And treatment at this stage is only possible surgically, that is, the joint has to be replaced with prosthetics.

Causes of coxarthrosis

Primary arthrosis of the hip joint develops more often in people over 40 years of age.Its causes have not yet been studied.The hyaline cartilage that covers the articular surfaces and provides gliding begins to thin and collapse.Due to increased friction and pressure on the bones, bone spurs appear on them.The joint is deformed, movements in it are limited.In primary coxarthrosis, both the knee joints and the spine are often affected.

Secondary arthrosis develops against the background of various diseases:

• Hip dysplasia.This term refers to congenital underdevelopment of the components of this joint in a child.As a result, the femoral head is not centered as it should be in the acetabulum.There are three types of dysplasia: preluxation, subluxation and dislocation of the hip.With a congenital dislocation, the femoral head is located outside the socket and, if appropriate treatment is not carried out, arthrosis subsequently develops.
• Aseptic necrosis.The bone tissue of the femoral head begins to dissolve due to impaired blood supply.The bone tissue is focally resorbed, the head of the joint is deformed.Arthrosis develops secondarily.
• Legg-Calvé-Perthes disease.This is osteochondropathy of the femoral head, occurring in children aged 3 to 14 years, mainly in boys.Occurs, as a rule, as a result of complications after infectious processes, as well as injuries, physical overload, and metabolic diseases.The cartilaginous area of the head is not well supplied with blood, which leads to necrosis of this area and deformation of the joint.
• Inflammation, infections.If arthritis of the hip joint has developed, the synovial fluid loses its lubricating properties, the lining of the joint thickens, the hyaline cartilage is subjected to mechanical stress, and at the same time metabolic disorders occur in the joint.
• Injuries: bruises, fractures of the femur, acetabulum, hip dislocations, chronic trauma, that is, microtraumas received systematically.
• Overload of the hip joint associated with sports and professional activities.For example, long walking without rest, vibration effects, constant jumping, and carrying heavy loads are undesirable for the joint.The muscular corset of a child or teenager cannot always compensate for such loads.
• Increased body weight, especially at a young age, when cartilage is not yet able to withstand large axial loads.In addition, such patients usually have metabolic problems.
• Coxarthrosis itself is not inherited, but genetically relatives may have a certain structure of cartilage tissue, metabolic disorders that lead to the development of arthrosis.Therefore, it is worth considering whether parents or more distant relatives have joint diseases.
• Osteoporosis.The vulnerable area for this disease is the femoral neck.Its structure becomes more rarefied, pathological fractures are possible.All this secondary leads to arthrosis.
• Diabetes mellitus.In this case, arthrosis develops due to vascular disorders.
• Polyneuropathy with impaired sensation in the legs.
• Diseases of other parts of the musculoskeletal system.These include: scoliosis, arthrosis and knee injuries, flat feet.The distribution of the load on the hip joints changes, shock-absorbing properties decrease, and as a result, the cartilage coating suffers.

Symptoms of coxarthrosis

To prevent the disease and its early diagnosis, it is important to know the signs of incipient arthrosis of the hip joint (stage 1 coxarthrosis):

• Pain that occurs periodically after physical activity.Specific pain sensations can be localized in the groin area, side, hip or knee.After rest they go away, so they are not given any importance.Meanwhile, this is an alarming sign.
• Slight limitation of hip rotation (inward and outward).This can be easily checked while lying on your back, rotating the entire leg in clockwise and counterclockwise directions.
• An x-ray may reveal a slight uneven narrowing of the joint space.

With arthrosis of the 2nd stage, the signs are more pronounced:

• Pain occurs in the projection of the joint, most often in the inguinal fold, and is also noted at rest.
• Restrictions appear not only when turning the leg, but also when abducting the hip to the side.Movements in the joint are somewhat painful, especially in extreme positions (with maximum abduction of the hip, bending the leg towards the stomach).
• On an x-ray, you can see a moderate narrowing of the joint space and isolated bone growths at the edges of the acetabulum.Cysts can also form in the bone structure of the femoral head.

Arthrosis of the hip joint of the 3rd stage is easily diagnosed, its symptoms are severe:

• Pain in the joint during exercise, at night.
• Lameness, patients often use a cane.
• Marked limitation of movements in the joint, as a result of which it is difficult for a person to put on socks or put on shoes.
• The leg becomes thinner due to hypotrophy of the muscles of the thigh and lower leg.The muscles of the gluteal region also weaken.
• It is possible to shorten the leg due to its incomplete extension and deformation of the femoral head.As a result, scoliosis of the lumbar region (lateral curvature) is formed, and pain appears in the lumbosacral region.
• Signs of the 3rd stage, revealed by x-rays, are a pronounced narrowing of the joint space up to its complete absence, bone growths, deformation of the head and neck of the hip joint.

Diagnostics

In diagnosis, it is of great importance to clarify subjective complaints, collect anamnesis, evaluate symptoms, and also to clarify the stage - radiography, CT and MRI.Computed tomography allows you to study in detail the bone structure of the hip joint, and the magnetic resonance method visualizes soft tissues, the condition of the joint capsule, and the presence of synovitis.

Treatment

Therapy for coxarthrosis depends on the stage of the process and, in most cases, includes a whole range of procedures.Of course, the earlier treatment is started, the greater its effectiveness.

1. Conservative treatment
   • Drug therapy.To relieve pain, non-steroidal anti-inflammatory drugs are used in tablets, suppositories or intramuscular injections.Dosage forms such as ointments, gels, creams are not effective enough due to the surrounding of the hip joint by large muscles and subcutaneous tissue.Long courses of non-steroidal anti-inflammatory drugs are not recommended due to side effects on the cardiovascular system and gastrointestinal tract.To help them, the doctor may prescribe medications that relieve muscle spasm - a muscle relaxant.In cases of severe inflammation, intra-articular glucocorticoids may be required.Chondroprotectors are one of the main groups of drugs for the treatment of coxarthrosis.They are administered both intramuscularly and intraarticularly; in milder cases, tablet forms can be taken.These drugs are aimed at improving the restoration processes in cartilage tissue and slowing down its degeneration.The doctor may also prescribe vascular medications to improve local blood circulation.
   • Physiotherapy.Her procedures improve blood flow in the joint area and relax muscles.These are UHF, magnetic therapy, laser treatment, diadynamic currents, electrophoresis.Purpose - according to individual indications.
   • Therapeutic massage.An indispensable method of treatment for coxarthrosis: relieves muscle spasms, has a beneficial effect on blood circulation, and when carried out systematically, strengthens muscles.
   • Therapeutic gymnastics.Improves blood flow and strengthens the muscle corset of the joint.Exercises recommended for coxarthrosis (performed on a solid support):
     • “bicycle” in a supine position;
     • lying on your back, grab your knee with your hand and pull it towards your stomach, and do the same with the other leg;
     • while lying on your back, bend your knees, press your soles to the floor and raise your pelvis, hold in this position;
     • lying on your back, move your thigh as far as possible to the side;
     • sitting on a chair, squeeze the ball between your thighs;
     • lying on your back, turn your legs in and out;
     • standing with your right foot on a slight elevation and holding the support with your hands, swing your left leg back and forth and left and right, then do the same, changing your leg.
2. Surgical treatment.Endoprosthetics, that is, replacement of a joint with an artificial one, is performed at the 3rd stage of coxarthrosis in the presence of shortening of the limb, constant pain, and severe contracture.Endoprosthetics can be cemented (in the presence of osteoporosis) or cementless.The prosthesis itself can be unipolar (replacement of only the head) and total (replacement of both components).Already on the next day after the operation, some elements of exercise therapy are performed while lying in bed, the patient can stand up, but for now without supporting his leg, and a few days later - on crutches.After 2-3 months, crutches will no longer be needed and full weight bearing on the leg will be allowed.Patients who have undergone endoprosthetics are recommended to undergo rehabilitation consisting of physical therapy, massage, and physical therapy.In most cases, limb function is restored.The service life of the prosthesis is from 10 to 20 years, then it is replaced with a new one.

Prevention of coxarthrosis

Prevention measures are very important, especially if you have a history of hip dysplasia, fractures, severe bruises or purulent processes in this area.

• Avoiding heavy lifting and jumping (especially from heights).Try not to be on your feet for long periods of time.
• Body weight control (reduce the consumption of flour products, table salt, sweet, strong tea and coffee in the diet).Being overweight increases the risk of hip arthrosis.
• Dosed physical exercises aimed at strengthening the muscles of the thighs and buttocks (cycling or exercise bike, swimming, therapeutic exercises).
• If there are diseases associated with metabolism (diabetes mellitus, atherosclerosis), they must be compensated.

Compliance with preventive measures, early detection of coxarthrosis and its adequate treatment are the key to a positive prognosis for this disease.

Which doctor should I contact?

If you experience pain in the leg or hip joint, you should consult a physician.He will prescribe primary diagnostic measures, in particular, x-rays of the hip joint.Once the stage of the disease has been established, the patient will be referred to a rheumatologist or orthopedist.A nutritionist and endocrinologist can provide additional assistance in losing weight and slowing the progression of the disease.It would be useful for women to consult a gynecologist to prescribe hormone replacement therapy to prevent osteoporosis.