Hip arthropathy is a common degenerative dystrophic disease of the hip joint in which the joint between the femoral head and pelvic acetabulum is gradually destroyed due to age changes or other factors.It is associated with varying degrees of pain and limited range of motion, depending on the stage of development.If in the initial stage hip arthropathy can be managed with conservative methods, then in the third stage only surgery can save the situation and preserve the functionality of the hip joint, that is, avoid disability.
It is classified as an arthropathy and can accompany the development of similar processes in other joints, and this pathology accounts for approximately 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 hip joint disease
Hip arthropathy is a complex pathology of one or both hip joints in which the cartilage layer covering the femoral head and acetabulum is destroyed, resulting in a reduction in joint space size.As the disease progresses, the surface of the bone becomes deformed and bone growths (called osteophytes) form on it.
Hip arthropathy is the second most common disease of the musculoskeletal system.More commonly, only genuarthrosis, degenerative dystrophic changes in the knee joint, is diagnosed.However, the likelihood of disability from hip arthropathy is significantly higher.
The entire hip joint is enclosed within a specific shell called the joint capsule.It has a so-called synovial membrane, which produces synovial fluid.This fluid is extremely important for the proper function of the joint, as it not only lubricates the hyaline cartilage but also provides it with a source of nutrients.
Normally, cartilage wears away constantly, but it recovers immediately thanks to a continuous regeneration process with the help of substances that enter the cartilage in the synovial fluid.But with injury or age-related changes, the rate of the regeneration process decreases, leading to progressive wear and tear of the hyaline cartilage and the development of hip arthrosis.
This is explained by changes in the amount of synovial fluid produced and its composition.Under the influence of adverse factors, it will become thicker and the output will decrease.As a result, the synovial fluid is no longer able to supply hyaline cartilage with all the substances it needs in the required quantities, causing it to rapidly dehydrate and thin.Gradually, the strength and elasticity of the cartilage decrease, the fibers forming the cartilage separate, cracks form in the cartilage, and the thickness decreases.These changes, especially narrowing of the joint space, can be noted during instrumental diagnostic methods.
The narrowing of the joint space causes increased friction between the bony structures that form the hip joint and increases pressure on the hyaline cartilage that has degraded.This can cause more damage, affecting the function of the joint and the condition of the body, as the deformed area prevents the femoral head from sliding easily in the acetabulum.As a result, symptoms of hip joint disease appear.
If left untreated, the pathological changes will worsen and the hyaline cartilage will become increasingly worn.Subsequently, in some areas it disappears completely, resulting in bone exposure and a dramatic increase in joint loading.Because the femoral head rubs directly against the bone as it moves within the acetabulum, it can cause severe pain and severely limit mobility.In this case, the pressure of the bone structures against each other causes bone growth to form on their surface.
The osteophytes that form may have sharp edges that can damage the muscles and ligaments around the hip joint.This can lead directly to severe pain in the joint area as well as in the groin, buttocks, and thighs.Therefore, patients can protect the injured leg, reduce its load, and try to avoid unnecessary movements.This can lead to muscle atrophy, further exacerbating mobility impairment and ultimately leading to lameness.
reason
There are many reasons why hip joint disease can occur, although in rare cases it occurs without any prerequisites.In this case, they talked about the presence of primary or idiopathic hip arthropathy.In the vast majority of cases, secondary hip arthropathy is diagnosed, which is an inevitable result of many diseases or changes in the condition of the musculoskeletal system.Its development can be caused by the following factors:
- Various types of hip injuries, including fractures, dislocations, contusions, sprains, or torn ligaments;
- Heavy physical labor, professional sports, especially weightlifting, skydiving, and jumping sports;
- sedentary lifestyle;
- Being overweight significantly increases the load on the hip joints;
- Chronic infection lesions in the body;
- Congenital abnormalities of the hip joint, such as dysplasia or dislocation;
- Metabolic pathology and endocrine disorders, especially gout, diabetes, especially decompensated forms;
- Aseptic necrosis of the femoral head, which may be the result of a femoral neck fracture, especially during conservative treatment;
- Inflammatory joint diseases, including rheumatoid arthritis, bursitis, and tendonitis;
- spinal disorders;
- genetic predisposition;
- Whether you have bad habits, especially smoking.
Nonetheless, the main cause of hip arthropathy remains inevitable age-related changes, and the presence of the factors mentioned above only increases the likelihood and speed of its development.
Symptoms of Hip Arthropathy
The disease is characterized by a gradual progression with a systematic increase in the intensity of symptoms.Therefore, it may initially be asymptomatic or cause only occasional anxiety in the patient, but then the hip condition worsens, leading to increased hip symptom severity to intolerable pain and severe limitation of activity.
Therefore, degenerative dystrophic changes in the hip joint are accompanied by:
- Pain of varying intensity that initially occurs after physical activity or walking and subsides with rest.Gradually, pain syndromes increase in severity, occur more frequently, last longer, and the time interval between load on the joint and onset of pain decreases.Later, the pain was almost constant, including at rest, and became unbearable.At any stage of the disease, the pain is exacerbated by hypothermia and when lifting heavy objects.
- Limited movement of the hip joint, initially manifesting as mild difficulty performing rotational movements of the leg.Over time, morning stiffness develops and disappears after the patient "dissipates."This may be accompanied by swelling of the hip joint.As the disease progresses, limitations in activity become more pronounced and persistent, that is, they do not disappear after warming up.The patient notices a reduced range of motion in the legs, followed by a complete loss of the ability to perform certain movements.
- A tightness in the hip joint that occurs when walking or doing physical work, especially stretching.It is the result of exposed bone structures rubbing against each other and is accompanied by a sharp increase in pain.
- Muscle spasm in the thigh, causing diffuse pain in the thigh.This may be the result of an increase in various intra-articular conditions, including nerve compression, overstretching of periarticular ligaments, and the development of synovitis, which is inflammation of the synovial membrane and the accumulation of inflammatory exudate within the hip joint cavity.
- Claudication, initially due to the patient's unconscious desire to offload the affected joint and transfer weight to the healthy leg to avoid the onset or exacerbation of pain, then leads to muscle contracture.The latter phenomenon occurs already in the later stages of coxarthrosis and results in the patient being unable to fully straighten his leg and to maintain it in this position.Therefore, the lower limb of the affected hip joint is always in a slightly flexed position, which can lead to lameness.
- Shortening of leg length mainly occurs in severe degenerative dystrophic changes in the hip joint, which is not only accompanied by narrowing of the joint space, but also flattening of the femoral head and muscle atrophy.As a result, the affected leg is 1 cm or more shorter than the healthy leg.
Hip arthropathy can affect one hip joint or 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 are not only bilateral, but also vary in intensity.It depends on how damaged each hip joint is.
Degree of hip joint disease
The nature of the disease's manifestations depends on its stage of development.There are 3 degrees of hip arthritis, the first of which is considered the mildest.In the initial stages of degenerative dystrophic changes in the hip joint, only occasional pain can be observed.Typically, this occurs after strenuous physical activity, exercise, or long walks.Therefore, patients often do not notice them, attribute them to fatigue, and assume that they are normal age-related changes.In this regard, primary hip arthrosis is diagnosed only in individual cases, usually during examinations for other reasons.
As the disease progresses, its symptoms intensify, and in grade II hip arthropathy, symptoms are already evident.This stage of pathological development is characterized by a 50% reduction in the joint space and signs of deformation of the femoral head and its displacement.
With further progression of pathology, the joint space narrows further and almost completely disappears in third degree coxarthrosis.This has been accompanied by the formation of multiple osteophytes.At this stage of the development of the disease, the pain becomes not only severe, but also unbearable, often occurring even during a state of complete rest, including at night.Because the hip joint is severely deformed, its components can impinge on the nerves passing through it, causing pain to radiate to the groin area, buttocks, thighs, and even calves.This can also result in the inability to move independently without the use of assistive devices such as crutches or canes.
Third-degree hip arthropathy is a direct indication for surgical treatment.If surgery is not performed on time, the femoral head will fuse firmly with the acetabular surface due to osteophytes.This will result in a shortened leg with a complete lack of ability to move independently as the joints will have a complete loss of mobility, i.e. a disability.
diagnosis
If signs of hip joint disease appear, it is recommended to consult an orthopedic surgeon as soon as possible.First, the doctor interviews the patient and finds out the nature of the complaint, then performs an examination and functional tests to compare the length of the legs.In general, the data obtained are sufficient to state with a high degree of confidence the presence of hip arthrosis.
However, because similar clinical manifestations may accompany many other hip disorders, both inflammatory and non-inflammatory, an instrumental diagnostic approach is necessary.With their help, specialists are able not only to confirm the presence of coxarthrosis and distinguish it from radiculopathy caused by spinal lesions, but also to correctly assess its degree of development and thus choose the most effective treatment strategy.
Today, the following methods are used to diagnose hip arthropathy:
- Hip X-ray - the resulting images allow 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 of diagnosing bone pathology that provides clearer data than X-rays, but is more expensive.Therefore, when controversial cases require a clear diagnosis and degree of hip joint destruction, CT examination should be performed.
- MRI is an information-rich method of studying joints, providing maximum information about the condition of the joint and all its structures, especially hyaline cartilage, ligaments, and blood supply characteristics.
Patients need to undergo multiple laboratory tests, including OAC, OAM, rheumatology tests, biochemical blood tests, etc.
Conservative treatment of hip joint disease
When 1st or 2nd degree hip arthrosis is diagnosed, treatment is conservative.Each patient was selected individually based on the detected concomitant pathology.Therefore, it is often necessary to consult not only an orthopedic surgeon, but also doctors from other specialties, who will choose the necessary treatments to combat accompanying diseases.
As part of treatment for hip joint disease, patients are prescribed the following:
- drug treatment;
- exercise therapy;
- physiotherapy.
All patients must take steps to eliminate the effects of factors that increase the load on the legs and lead to degenerative changes in the hip joint.If you are overweight, this includes modifying your diet and increasing your physical activity level.If the patient frequently engages in excessive physical activity, it is recommended to change the type of activity or, if the load is caused by exercise, to reduce the intensity of training.In some cases, special bandages and orthotics are recommended to immobilize the hip joint and relieve it during physical activity.
drug treatment
As part of drug therapy, drugs are selected individually for the patient, taking into account existing concomitant diseases.Generally, drugs from the following pharmacological groups are suitable for the treatment of hip arthropathy:
- NSAIDs are a class of drugs with analgesic and anti-inflammatory effects (available in a variety of dosage forms, including tablets, capsules, gels, creams, and injections, allowing you to choose the most effective and convenient form of use);
- Corticosteroids are drugs with powerful anti-inflammatory effects, but due to the high risk of side effects, especially when using oral forms, they are only given by injection for short courses;
- Muscle relaxants - drugs that help reduce muscle tone and are effective in combating muscle spasms, which are often observed in hip joint disease;
- Chondroprotectants – A group of drugs containing ingredients that the body uses to regenerate cartilage tissue;
- Drugs that improve microcirculation – help improve the nutrition of soft tissues and activate metabolic processes in the affected area;
- B Vitamins - Indicated for nerve conduction disorders caused by changes in hip joint composition that compress nerves.
If hip arthropathy causes acute pain that is not relieved by prescription NSAIDs, patients may be advised to undergo an intra-articular or peri-articular block.Its essence is to inject a solution of anesthetic and corticosteroids directly into the hip joint cavity.This will eliminate pain and reduce the inflammatory process in the shortest possible time.But lockdowns can only be carried out by qualified medical professionals in specially prepared rooms.It is not recommended to perform such procedures at home.
exercise therapy
When hip joint disease is diagnosed, regular physical therapy exercises are required.Just like pharmacotherapy, a set of exercise therapy exercises is chosen individually for each patient, taking into account the degree of damage to the hip joint, the patient's level of physical development and the nature of the accompanying diseases (with special attention to cardiovascular pathology).
With daily exercise therapy sessions you can:
- Reduce the severity of pain;
- Increase hip mobility;
- Reduce the risk of developing muscle atrophy;
- Eliminate thigh muscle spasm;
- Activates blood circulation, thereby improving nutrition of affected joints.
All exercises should be performed smoothly, avoiding sudden movements and jerks.But if pain occurs during exercise therapy, you should definitely contact your doctor for correction of the selected complex or for a repeat diagnosis to rule out the progression of the disease and the need for surgery.
physical therapy
The complex treatment of hip joint disease involves a series of physical therapy procedures that have anti-inflammatory, analgesic, decongestant and tonic effects on the body.Therefore, in most cases, patients undergo 10-15 surgeries:
- Ultrasound therapy;
- electrophoresis;
- UV irradiation;
- magnet therapy;
- Laser treatment etc.
In recent years, plasma lifting has been increasingly used as part of conservative treatment of the hip joint, and it can significantly increase the regeneration rate of hyaline cartilage.The essence of the procedure is the introduction into the hip joint cavity of purified plasma, which is obtained by centrifugation from the patient's own blood.
hip surgery
If the patient is diagnosed with grade 3 hip arthropathy, surgical intervention is required because conservative methods are no longer effective in this case.Unfortunately, this condition is very common today, as a large number of patients seek medical help when they are unable to tolerate pain or have severe mobility impairments that prevent them from working and moving independently.
Timely surgical intervention can completely eliminate these diseases, restore patients' normal activities, and significantly improve their quality of life.Signs of its implementation are:
- The joint space is significantly reduced by more than 80%;
- Severe pain in the hip joint that cannot be eliminated;
- severe mobility impairment;
- Femoral neck fracture.
The gold standard for treating severe hip disease, including in the elderly, is hip replacement.The surgery involves replacing the damaged hip joint with an artificial endoprosthesis made of durable and at the same time biocompatible material.Endoprostheses allow you to fully restore the function of your hip joint, eliminate pain, and allow people to return to living an active life.
The essence of this surgical procedure is the removal of the femoral head and a small portion of its neck.The surgeon also needs to prepare the acetabular surface for placement of the endoprosthesis, i.e., remove any formed osteophytes and restore its normal shape to the greatest extent possible.After this, the chosen type of endoprosthesis is installed, fixed using a special cement (preferably used in the treatment of the elderly) or cementless.In the latter case, the endoprosthesis has a special spongy part that is in contact with the bony structure.The spongy growth of bone tissue ensures its fixation in the acetabulum.
For each patient, the type of endoprosthesis is selected individually.The most effective is a total endoprosthesis, which means complete replacement of the entire hip joint, namely the femoral neck and head and acetabulum.
If the patient retains normal hyaline cartilage on the acetabular surface, a partial joint replacement may be performed, replacing only the femoral head and/or neck.For this purpose, endoprostheses of different designs are used: monopolar and bipolar.
The only disadvantage of endoprosthetic replacement is the need to replace the installed endoprosthesis after 15-30 years.
After endoprosthetic surgery, patients will undergo rehabilitation, the duration of which depends on how quickly the tissue recovers.Exercise therapy, physical therapy, and therapeutic massage are required as part of recovery.
Before the advent of modern endoprostheses, patients with grade 3 hip arthrosis underwent osteotomy or arthrodesis.Today, these technologies are used less and less because they have many disadvantages.Therefore, arthrodesis involves fixing the bony structures of the hip joint with metal plates.As a result, the pain syndrome is completely eliminated, but the joints completely lose their mobility.Therefore, after arthrodesis, the patient can only stand but is no longer able to walk independently due to lack of movement in the hip joint.Therefore, arthrodesis is actually not performed today.
An osteotomy involves an artificial fracture of the femur using a combination of bone fragments to relieve the load on the affected hip joint.But surgery can only produce short-term results, and implants will still be needed in the future.
Therefore, coxarthrosis of the hip joint is a rather dangerous disease that can lead to disability.It severely reduces the quality of life and deprives people of their ability to work.But if you pay attention to the early signs of pathology and consult an orthopedic surgeon promptly, you can slow its progression and significantly improve your health.But for hip joints that are already advanced, there is only one solution—an endoprosthesis.Fortunately, this approach can be used even with severe degenerative changes and completely restores normal function to the hip joint.