Hip arthrosis (deformation of arthrosis, coxarthrosis, osteoarthrosis) is a slowly progressive degenerative-dystrophic disease that leads to time to destroy the affected joint, constant pain and limiting mobility.
The disease affects people over 40, women become ill several times more than men.
In the overall structure of arthrosis, hip arthrosis belongs to the leading role.This is due to the widespread congenital pathology of the hip joints (dysplasia), as well as to the significant physical activity, to which these joints are susceptible.
Risk factors and causes of hip arthrosis joint
In the pathological mechanism of the development of arthrosis of the hip joint, the main role belongs to a change in the physicochemical characteristics of the synovial (intracematic) fluid, which resulted in more dense and viscous.This impairs its lubricating qualities.When they move, the surfaces of the joint cartilage begin to rub against each other, becoming rough, covered with cracks.Small particles of hyaline cartilage are abandoned and fall into the joint cavity, causing the development of aseptic (non -infectious) inflammation in it.As the disease progresses into the inflammatory process, bone tissue is inserted into the inflammatory process, leading to aseptic necrosis of the heads of the femur and the surface of the acetabulum, the formation of osteophytes (bone growth), increased inflammation and causes severe pain.
In the late degree of arthrosis of the hip joint, the inflammation is also thrown into the surrounding joint of the tissue (blood vessels, nerves, ligaments, muscles), which leads to the appearance of signs of periarthritis.As a result, the hip joint is completely destroyed, its functions are lost, the movement in IT ceases.This condition is called ankylosis.
Causes of hip arthrosis joint:
- congenital lip on the hips;
- Hip dysplasia;
- aseptic necrosis of the femur head;
- Peters' disease;
- Hip injuries;
- infectious arthritis of the hip joint;
- gonarthrosis (deformation of osteoarthrosis of the knee joint);
- osteochondrosis;
- Excess weight;
- professional sport;
- flat legs;
- spine curvature;
- A sedentary lifestyle.
The pathology is not inherited, but the child inherits the characteristics of the structure of the musculoskeletal system by their parents, which can cause arthrosis of the hip joint in these conditions.This explains the fact of the existence of families, the frequency of which is higher than in the total population.
Forms of the disease
Depending on the etiology, hip arthrosis is divided into primary and secondary.Secondary arthrosis develops against other diseases of the hip joint or its injuries.The main form is not related to the previous pathology, the cause of its development is often not possible, in which case they speak of idiopathic arthrosis.
Coxarthrosis is one- or bilateral.
Stages
Three stages (degree) are distinguished during arthrosis of the hip joint:
- Initial - pathological changes are slightly expressed, provided that timely and adequate treatment is reversible.
- Progressive coxarthrosis - characterized by a gradual increase in symptoms (pain in the joint and disrupts its mobility), changes in the tissues of the joints are already irreversible, but therapy can delay the degenerative processes.
- The final movement in the joint is lost, ankylosis is formed.Treatment is only possible surgically (replacing the joint with artificial).
In 95% of cases, endoprotetic surgery guarantees complete restoration of limb mobility, restoration of patient effectiveness.
Symptoms of arthrosis of the hip joint
The main signs of arthrosis of the hip joint:
- pain in the groin, hips and knee;
- a sense of stiffness in the affected becomes the restriction of its mobility;
- lame;
- Restricting abduction;
- Atrophic changes in the thigh muscles.
The presence of certain symptoms of arthrosis of the hip joint, as well as their severity depends on the degree of disease.
In the 1st degree of arthrosis of the hip joint, patients complain of the pain in the affected joint, which occurs under the influence of physical activity (prolonged walking, running).In some cases, the pain is localized in the knee or thigh.After a short break, the pain goes away by itself.The volume of limb movements is completely preserved, the gait is not disturbed.The following changes are noted on the X -ray:
- slightly uneven reduction of the lumen of the joint precipice;
- Osteophytes located on the inner edge of the rotating.
Any changes from the neck and head of the femur are not detected.
With grade II arthrosis of the hip joint, pain also occurs, including at night.After physical activity, the patient begins to limp, a characteristic gait of "duck" is formed.This is how they appear - called initial pain - after a long period of immobility, the first few steps cause pain and discomfort, which then pass and then return after a long load.The volume of movements (abduction, internal rotation) is limited in the affected.Radiography shows that the joint gap is uneven and its lumen is 50% of normal.The osteophytes are located both on the inner and on the outer edge of the joint cavity, exceeding the boundaries of cartilage.The contours of the femur head become uneven due to deformation.
With III degree of arthrosis of the hip joint of pain, intense and constant, not stopping at night.Walking is significantly difficult, the patient is forced to rely on a cane.The volume of movements in the affected joint is sharply restricted, later it completely stops.Due to hip muscle atrophy, the pelvis deviates into the front plain and the limb is shortened.Trying to compensate for this shortening, patients are forced to reject the body to the lesion when walking, which further increases the load of the inflamed joint.Radiographs detect multiple bone growths, a significant narrowing of the joint gap and a pronounced enlargement of the femur head.
Diagnostics
The diagnosis of hip arthrosis is based on data from the clinical picture of the disease, the results of medical examination and instrumental tests, among which the basic value belongs to the visualization methods - radiography, calculated or magnetic resonance imaging.They not only determine the presence of arthrosis of the hip joint and to evaluate its degree, but also to identify the possible cause of the disease (trauma, youth epiphysiolism, Peters disease).
The differential diagnosis of hip arthrosis with other diseases of the musculoskeletal system is quite complicated.II and III degree of arthrosis of the hip joint develops muscle atrophy, which can cause intense pain in the knee joint, characteristic of propulsion or gonarthrosis (diseases of the knee joint).For the differential diagnosis of these conditions, palpation of the knee and hip joints is palpated, the volume of motion in them is determined and they are also examined by radiologically.
In diseases of the spine, in some cases the nerve roots of the spinal cord with the development of pain syndrome are pressed.The pain can emit in the area of the hip joint and imitate the clinical picture of its lesion.However, the nature of the pain with radicular syndrome is slightly different than in the arthrosis of the hip joint:
- The pain occurs as a result of lifting weight or abruptly inconvenient movement rather than under the influence of exercise;
- The pain is localized in the gluteal rather than in the inguinal region.
In radicular syndrome, the patient can safely take his leg on the side, while with arthrosis of the hip joint, abduction is limited.A characteristic sign of radicular syndrome is a positive symptom of tension - the appearance of acute pain when you are trying to raise a straight leg on the patient's back.
Hip arthrosis affects people over 40, women become ill several times more than men.
Hip arthrosis should also be differentiated with loyal bursitis (trochanterite).Vable Bursitis is developing faster within a few weeks.It is usually preceded by significant physical exertion or injuries.In this disease, the pain is much more pronounced than in arthrosis of the hip joint.At the same time, shortening of the limb and limiting its mobility is not detected.
The clinical picture of atypical reactive arthritis and ankylosing spondylitis may resemble the clinical manifestations of hip arthrosis.However, the pain occurs in patients mainly at night or at rest, when walking does not increase, but, on the contrary, weakens.In the morning, patients note stiffness in the joints, which passes after a few hours.
Treatment of hip arthrosis joint
Orthopedians are involved in the treatment of arthrosis of the hip joints.I and II degree of the disease indicates conservative therapy.With pronounced pain syndrome, patients are prescribed non -steroidal anti -inflammatory drugs in a short course.They should not be taken for a long time as they are not only able to have a negative effect on the organs of the gastrointestinal tract, but also inhibit the regenerative capacity of the cartilage of hyaline.
In the treatment of hip arthrosis, they include chondroprotectors and vasodilators, which creates optimal possibilities for repairing damaged cartilage tissues.With pronounced muscle spasm, the appointment of central muscle relaxants may require.
In these cases, when it is not possible to stop the pain syndrome with non -steroidal anti -inflammatory drugs, they resort to intra -articular injections of corticosteroids.
Topical treatment of hip arthrosis with the help of warming ointments allows you to reduce muscle spasm and somewhat weakens the pain due to a scattering effect.
In the complex therapy of hip arthrosis, physiotherapy methods are also used:
- magnetotherapy;
- inductothermia;
- UHF;
- laser therapy;
- ultrasound treatment;
- massage;
- medical gymnastics;
- Manual therapy.
Dietary nutrition for hip arthrosis is aimed at correcting body weight and normalizing metabolic processes.Reducing body weight reduces the load on the hip joints and thus slows down the progression of the disease.
To unload the affected joint, the doctor may recommend that patients go to the crutches or a cane.
With III degree of arthrosis of the hip becomes conservative treatment is ineffective.In this case, it is possible to improve the patient's condition, it is possible to return normal mobility only as a result of surgery - replacement of the destroyed joint with an artificial (joint endoprothetics).
Possible consequences and complications
The most serious complication of progressive hip arthrosis is damage due to loss of movement in the joint.With bilateral coxarthrosis, the patient loses his ability to move independently and needs constant external care.The long stay in the bed in one position creates the prerequisites for the appearance of a stagnant (hypostatic) pneumonia, which is difficult to succumb and can lead to death.
The pathology is not inherited, but the child inherits the characteristics of the structure of the musculoskeletal system by their parents, which can cause arthrosis of the hip joint.
Forecast
Hip arthrosis is a progressive chronic disease that can only be completely cured in the early stages, subject to elimination of the cause of the disease.In other cases, therapy allows you to slow down your course, but over time it needs to implant HIP endoprosthesis.Such operations in 95% of cases provide complete restoration of limb mobility, restore the patient's effectiveness.The official life of modern dentures is 15-20 years, after which they are replaced.
Prevention
The prevention of hip arthrosis is aimed at eliminating the causes that can lead to the development of this disease, and includes:
- Timely detection and treatment of diseases and injuries to the hip joint;
- rejection of a sedentary lifestyle, regular but not excessive physical activity;
- body weight control;
- rational nutrition;
- Refusing bad habits.