How to treat coxarthrosis of the hip joint

Coxarthrosis is a common degenerative-dystrophic disease of the hip joint, in which, due to age-related changes or other factors, there is a gradual destruction of the femoral head joint and acetabulum. It is accompanied by pain and a restriction in the amplitude of movements of varying severity, which depends on the stage of development. And if at the initial stage it is possible to cope with coxarthrosis by conservative methods, then at the 3rd stage it is possible to save the situation and maintain the working capacity of the hip joint, that is, to avoid disability just by conducting an operation.

It belongs to arthrosis and can be accompanied by the development of similar processes in other joints, and this pathology accounts for about 12% of all diseases of the musculoskeletal system. However, 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 layers of cartilage covering the femoral head and acetabulum are destroyed, which leads to a decrease in the size of the joint space. As the disease progresses, the appearance of deformations of the bone surfaces and the formation of bony outgrowths called osteophytes on them are observed.

Coxarthrosis is the second most common disease of the musculoskeletal system. More often only gonarthrosis is diagnosed, i. e. a degenerative-dystrophic change in the knee joint. Nevertheless, the probability of disability with coxarthrosis is significantly higher.

The entire hip joint is enclosed in a special housing called the joint capsule. It has a so-called synovial membrane that produces synovial fluid. This fluid is essential for the proper functioning of the joint as it not only lubricates the hyaline cartilage but is also a source of nutrients for it.

Normally, the cartilage is constantly worn out and immediately restored as a result of the continuous regeneration process carried out with the help of substances entering it from the synovial fluid. However, with injuries or age-related changes, the speed of regenerative processes decreases, which leads to gradual wear and tear of hyaline cartilage and the development of coxarthrosis.

This is due to changes in the amount of synovial fluid produced and its composition. Under the influence of unfavorable factors, it becomes thicker and produced in a smaller volume. As a result, the synovial fluid can no longer supply the hyaline cartilage with all the necessary substances in the right amount, which leads to rapid dehydration and thinning. Gradually, the strength and elasticity of the cartilage decreases, areas of delamination of the fibers that make up it, cracks form in it, and the thickness also decreases. These changes can be detected with instrumental diagnostic procedures, in particular, the narrowing of the joint space draws attention to itself.

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 degrading hyaline cartilage. This damages it even more, which affects the function of the joint and the condition of the person, since the deformed areas prevent the femoral head from easily sliding in the acetabulum. As a result, there are symptoms of coxarthrosis.

If left untreated, the pathological changes worsen and the hyaline cartilage wears out more and more. Subsequently, in some areas it completely disappears, which leads to the exposure of the bones and a sharp increase in the load on the joint. Since the femoral head rubs directly against the bone when moving in the acetabulum, severe pain and a severe restriction of movement occur. In this case, the pressure of bone structures on each other leads to the formation of bone growths on their surface.

Formed osteophytes can have sharp parts 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 thigh. As a result, the patient protects the injured leg, puts less strain on it and tries to avoid unnecessary movements with it. This creates muscle atrophy, which further aggravates movement disorders and eventually leads to lameness.

causes

There are many reasons for the development of coxarthrosis, although in rare cases it occurs against the background of the absence of any prerequisites. In this case one speaks of the presence of a 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. It can be provoked by:

• Hip joint injuries of various kinds, including fractures, dislocations, contusions, sprains or torn ligaments;
• heavy physical work, professional sports, in particular weightlifting, skydiving, jumping sports;
• sedentary lifestyle;
• Obesity, which significantly increases the load on the hip joints;
• foci of chronic infections in the body;
• congenital malformations of the hip joints such as dysplasia or dislocation;
• Metabolic diseases and endocrine disorders, in particular gout, diabetes mellitus, especially in a decompensated form;
• aseptic necrosis of the femoral head, which can result from a fracture of the femoral neck, especially during conservative treatment;
• inflammatory diseases of the joints, including rheumatoid arthritis, bursitis, tendonitis;
• 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, at the initial stage it can be asymptomatic or only occasionally cause anxiety to patients, but subsequently the condition of the hip joint worsens, which leads to an increase in the severity of signs of coxarthrosis, up to unbearable pain and a significant reduction in mobility .

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

• Pain of varying intensity, which occurs initially after exercise or walking and subsides after rest. Gradually, the severity of the pain syndrome increases, it occurs more often, lasts longer, and the periods between the moment of loading the joint and the appearance of pain are reduced. Later, the pain is almost constant, even at rest, and becomes unbearable. Characteristic is increased pain at any stage of the development of the disease with hypothermia and when lifting heavy objects.
• Restrictions in the mobility of the hip joint, which are initially manifested by minor difficulties in implementing rotational movements of the leg. Over time, morning stiffness appears, which disappears after the patient "disperses". This can be accompanied by the appearance of edema in the hip joint. As the disease progresses, the mobility limitations become more pronounced and persistent, that is, they do not disappear after a warm-up period. Patients notice a decrease in the amplitude of leg movements, and subsequently completely lose the ability to perform certain movements.
• Popping in the hip joint that occurs when walking or doing physical work, especially when stretching. It becomes the result of the friction of bare bone structures against each other, which is accompanied by a sharp increase in pain.
• Spasm of the thigh muscles, leading to diffuse pain in the thigh. This can be the result of the attachment of various intra-articular disorders, including compression of the nerves, excessive stretching of the ligaments surrounding the joint, as well as the development of synovitis, i. e. H. inflammation of the synovial membrane and accumulation of inflammatory effusion in the cavity of the hip joint.
• Lameness, which is initially the result of the patient's unconscious desire to unload the diseased joint and shift weight to the sound leg to avoid the occurrence or aggravation of pain, and then the development of a muscle contracture. The latter phenomenon occurs already in the later stages of coxarthrosis and leads to the patient's inability to fully straighten the leg and, moreover, to hold it in this position. As a result, the lower extremity with the affected hip joint is constantly in a slightly bent position, which provokes lameness.
• Decrease in leg length, which occurs especially 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, muscle atrophy. As a result, the diseased leg becomes 1 or more centimeters shorter than the healthy one.

Coxarthrosis can affect both one hip joint and both at the same time. But if in the first case the symptoms of the disease are observed only on one side, then in the second they will be not only bilateral, but also different in intensity. It depends on the degree of destruction of the respective hip joint.

degree 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, the first of which is considered the lightest. In the initial stages of the occurrence of degenerative-dystrophic changes in the hip joint, only episodic pain can be observed. As a rule, this occurs after intense physical exertion, sports or a long walk. Therefore, patients usually do not pay attention to it, attributing it to fatigue and considering it as normal age-related changes. In this regard, first-degree coxarthrosis is diagnosed only in isolated cases, which usually occurs during an examination for another reason.

In the further course, the symptoms intensify and are already noticeable in second-degree coxarthrosis. This stage of 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 head of the femur with its displacement.

With further progression of the pathology, the joint space narrows even more and is almost completely absent in coxarthrosis of the 3rd degree. This is accompanied by the formation of multiple osteophytes. At this stage of the development of the disease, the pain becomes not only strong, but unbearable, and often occurs even with complete rest, including at night. Since the hip joint is severely deformed, its elements can injure the nerves that pass here, causing pain that radiates to the groin, buttocks, as well as the thigh and even the lower leg. This also provokes the inability to move independently without aids such as crutches or canes.

Third-degree coxarthrosis is a direct indication for surgical treatment. If the operation is not performed in time, the femoral head will become firmly fused with the surface of the acetabulum with osteophytes. This leads to a shortening of the leg, the complete lack of the possibility of independent movement, since the joint completely loses mobility, i. e. H. Invalidity.

diagnosis

If there are signs of coxarthrosis, it is recommended to consult an orthopedist as soon as possible. First, the doctor will question the patient and find out the nature of the ailments, and then proceed to examine and conduct functional tests, comparing the length of the legs. As a rule, the data obtained is sufficient to speak with high certainty about the presence of coxarthrosis.

However, since such a clinical picture can be associated with a number of other diseases of the hip joints, both inflammatory and non-inflammatory in nature, instrumental diagnostic methods are required. With their help, a specialist can not only confirm the presence of coxarthrosis, distinguish it from the radicular syndrome caused by pathologies of the spine, but also correctly assess the degree of its development, which means choosing the most effective treatment tactics .

Today for the diagnosis of coxarthrosis are used:

• X-ray of the hip joints - the resulting images allow you to identify 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 of diagnosing bone diseases that provides clearer data than X-rays, but 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 highly informative method for examining joints, which provides the highest level of information about the condition of the joint and all its structures, especially hyaline cartilage, ligaments and blood supply characteristics.

Patients are prescribed a number of laboratory tests, including KLA, OAM, rheumatism tests, biochemical blood tests, and others.

Conservative therapy of coxarthrosis

When diagnosing coxarthrosis of 1 or 2 degrees, treatment is carried out using conservative methods. They are selected for each patient individually, taking into account the identified concomitant diseases. Therefore, it may often be necessary to consult not only an orthopedist, but also doctors of other specialties who will select the necessary treatment to combat concomitant diseases.

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

• drug therapy;
• exercise therapy;
• Physical therapy.

It is imperative for all patients to 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 physical activity if you are overweight. If the patient is regularly subjected to excessive physical exertion, he is recommended to change the type of activity or reduce the intensity of training if the stress is due to sports. In some cases, it is recommended to use special bandages and orthoses that fix the hip joint and provide relief during physical exertion.

Medical therapy

As part of drug treatment, patients are administered individually selected drugs, taking into account the existing concomitant diseases. As a rule, with coxarthrosis, drugs of the following pharmacological groups are indicated:

• NSAIDs - an extensive group of drugs that have 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 - drugs that have a powerful anti-inflammatory effect, but due to the high risk of side effects, especially when administered orally, they are prescribed only for short courses in the form of injections;
• muscle relaxants - drugs that help reduce muscle tone, which allows you to effectively deal with muscle spasms, which are often observed with coxarthrosis;
• Chondroprotectors - a group of drugs containing components used by the body to regenerate cartilage tissue;
• Preparations that improve microcirculation - help improve the nutrition of soft tissues and activate the course of 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 the coxarthrosis caused an acute attack of pain that cannot be stopped with the help of prescribed NSAIDs, then intra-articular or periarticular blockade is recommended to patients. Its essence lies in the introduction of an anesthetic solution in combination with corticosteroids directly into the cavity of the hip joint. This allows you to quickly eliminate pain and reduce the inflammatory process. However, the blockade can only be performed by a qualified health worker in a specially prepared room. Carrying out such procedures at home is not shown.

exercise therapy

When diagnosing coxarthrosis, regular exercise therapy is mandatory. As with drug therapy, a set of physical therapy exercises is selected for each patient 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 (particular attention is paid to cardiovascular pathologies).

Thanks to daily exercise therapy, you can:

• reduce the severity of pain;
• increase the mobility of the hip joint;
• reduce the risk of muscle atrophy;
• eliminate spasms of thigh muscles;
• activate blood circulation and thereby improve nutrition of the affected joint.

All exercises should be performed smoothly, avoiding sudden movements and jerks. However, if pain occurs during exercise therapy, you should definitely contact your doctor to correct the selected complex or to conduct a re-diagnosis in order to exclude the progression of the disease and the need for surgery.

physical therapy

Comprehensive treatment of coxarthrosis includes courses of physiotherapeutic procedures that have anti-inflammatory, analgesic, decongestant and tonic effects on the body. Therefore, most often patients are prescribed 10-15 procedures:

• ultrasound therapy;
• electrophoresis;
• UVT;
• magnetotherapy;
• laser therapy etc.

Recently, plasmolifting has been increasingly used as part of conservative therapy for coxarthrosis, thanks to which it is possible to significantly accelerate the regeneration of hyaline cartilage. The essence of the procedure is the introduction into the hip joint cavity of purified blood plasma, obtained from the patient's own blood by centrifugation.

Coxarthrosis surgery

If a patient is diagnosed with coxarthrosis of the 3rd degree, then surgical intervention is indicated, since conservative methods in such cases are already powerless. Unfortunately, such situations are very common today, as so many patients seek medical help when they can no longer endure pain or have severe mobility impairments that deprive them of their ability to work and move independently.

Timely surgical intervention can completely eliminate these disorders and restore the patient's normal ability to move, significantly improving his quality of life. The indications for its implementation are:

• a significant decrease in joint space by more than 80%;
• the presence of severe pain in the hip joint that cannot be eliminated;
• pronounced mobility disorders;
• fracture of the femoral neck.

The gold standard for the treatment of severe coxarthrosis, even in older people, is hip arthroplasty. In this operation, a destroyed hip joint is replaced 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-fledged 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. In addition, the surgeon must prepare the surface of the acetabulum for the installation of the endoprosthesis, i. H. remove all formed osteophytes and achieve the maximum restoration of its normal shape. After that, an endoprosthesis of the selected type is inserted, which is fixed with a special cement (preferably for old-age care) or cementless. In the latter case, the endoprosthesis has a special spongy part in contact with bone structures. Its fixation in the acetabulum is provided by the germination of bone tissue through the sponge.

For each patient, the type of endoprosthetics is selected individually. The most effective is total arthroplasty, in which the entire hip joint, i. H. The neck and head of the femur, as well as the acetabulum, are completely replaced.

If the patient has the preservation of normal hyaline cartilage on the surface of the acetabulum, they may undergo a partial arthroplasty, replacing only the femoral head and/or neck. For this purpose, endoprostheses of different designs are used: monopolar and bipolar.

The only disadvantage of endoprosthetics is the need to replace the implanted endoprosthesis after 15-30 years.

After the replacement of the endoprosthesis, patients are shown rehabilitation, the duration of which depends on the rate of tissue repair. 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 because they have a number of disadvantages. During arthrodesis, the bone structures of the hip joint are fixed with metal plates. This completely eliminates the pain syndrome, but the joint completely loses its mobility. After the arthrodesis, the patient can only stand, but can no longer walk independently due to the lack of movement in the hip joint. Therefore, arthrodesis is practically not performed today.

Osteotomy involves performing an artificial fracture of the femur with such a combination of bone fragments that reduces the load on the affected hip joint. However, the effect of the operation is only short-term, and in the future there is still a need for endoprosthetics.

Therefore, coxarthrosis of the hip joint is a rather dangerous disease that can lead to disability. It seriously reduces the quality of life and deprives a person of the ability to work. However, if you pay attention to the early signs of pathology and seek timely advice from an orthopedist, you can slow down its progression and achieve a significant improvement in well-being. But if there is already coxarthrosis, there can only be one solution - endoprosthetics. Fortunately, this method can be used even with severe degenerative-dystrophic changes and fully restore the normal functioning of the hip joint.