How to treat hip joint coxarthrosis

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 joint joint of the femoral head and the acetabulum of the pelvis. It is accompanied by pain and limited range of motion of varying severity, which depends on the stage of development. And if in the initial stages it is possible to deal with coxarthrosis by conservative methods, in 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 performing an operation.

It belongs to the number of 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. 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 cartilaginous layers 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 deformation of the surfaces of the bones and the formation of bony growths on them, called osteophytes, is observed.

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

The entire hip joint is enclosed in a specific case, which is called a joint capsule. It has the so-called synovial membrane, which 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, cartilage is constantly worn down and immediately restored due to the process of continuous regeneration, which is carried out with the help of substances that enter the synovial fluid. But with age-related injuries or changes, the rate of regeneration processes slows down, 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 adverse factors, it becomes thicker and is produced in a smaller volume. As a result, the synovial fluid is no longer able to supply the hyaline cartilage with all the substances it needs in the right amount, which leads to its rapid dehydration and thinning. Gradually, the strength and elasticity of the cartilage decrease, areas of delamination of the fibers that form it, cracks form in it, and the thickness also decreases. These changes can be noticed during instrumental diagnostic methods, in particular, joint space narrowing draws attention to itself.

The narrowing of the joint space leads to increased friction between the bony structures that form the hip joint and an increase in pressure on the already degraded hyaline cartilage. This causes even more damage to it, which affects the functioning of the joint and the condition of the person, as the deformed areas prevent the femoral head from sliding easily into the acetabulum. As a result, there are symptoms of coxarthrosis.

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

The formed osteophytes may have sharp parts that can injure the muscles and ligaments surrounding the hip joint. This leads to the appearance of severe pain directly in the joint area and in the groin, buttocks and thigh. As a result, the patient spares the injured leg, puts less stress on it, and tries to avoid making unnecessary movements with it. This causes muscle atrophy to develop, which further exacerbates mobility disorders and ultimately leads to lameness.

Causes

There are many reasons for the development of coxarthrosis, although in rare cases it occurs in the context of the absence of prerequisites. In this case, they speak of the presence of primary or idiopathic coxarthrosis. In the vast majority of cases, secondary coxarthrosis is diagnosed, which becomes a logical consequence of various diseases or changes in the state of the musculoskeletal system. It can be caused by:

• hip joint injuries of various natures, including fractures, dislocations, bruises, sprains, or torn ligaments;
• heavy physical work, professional sports, especially weightlifting, skydiving, jumping sports;
• sedentary lifestyle;
• being overweight, which significantly increases the load on the hip joints;
• foci of chronic infection in the body;
• congenital malformations of the hip joints, such as dysplasia or dislocation;
• metabolic pathologies and endocrine disorders, in particular gout, diabetes mellitus, especially in a decompensated way;
• aseptic necrosis of the femoral head, which may result from a fracture of the femoral neck, especially during conservative treatment;
• inflammatory joint diseases including rheumatoid arthritis, bursitis, tendinitis;
• spinal diseases;
• genetic predisposition;
• the presence of bad habits, mainly smoking.

However, the main cause of coxarthrosis is still the inevitable age-related changes, and the presence of the above factors only increases the probability and speed of its development.

Symptoms of coxarthrosis

The disease is characterized by a gradual progression with a systematic increase in the intensity of symptoms. Therefore, in the early stages it can be asymptomatic or only occasionally cause anxiety to patients, but later on the condition of the hip joint worsens, which leads to an increase in severity of the signs of coxarthrosis to unbearable pain and significant limitation of mobility .

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

• Pain of variable intensity, appearing initially after physical exertion or walking and disappearing after rest. Gradually, the severity of the pain syndrome increases, appears more often, lasts longer, and the periods between the moment of application of load on the joint and the onset of pain are reduced. Later, the pain is present almost constantly, even at rest, and becomes unbearable. Increased pain at any stage of disease development during hypothermia and lifting of heavy objects is characteristic.
• 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 may be accompanied by the appearance of swelling in the hip joint. As the disease progresses, mobility restrictions become more pronounced and persistent, that is, they do not disappear after a warm-up. Patients notice a decrease in leg range of motion and subsequently completely lose the ability to perform certain movements.
• Crack in the hip joint, which appears when walking or performing physical work, especially when performing extension. 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 thigh muscles, which leads to diffuse pain in thigh. This can be a result of the fixation of various intra-articular disorders, including compression of the nerves, excessive stretching of the ligaments that surround the joint, as well as the development of synovitis, i. e. inflammation of the synovial membrane and accumulation of inflammatory tissue. effusion in the cavity of the hip joint.
• Lameness, which at first is the result of the patient's unconscious desire to reduce the load on the diseased joint and shift weight to the healthy leg in order to prevent the onset or intensification of pain and then the development of muscle contracture . This last phenomenon occurs already in the most advanced stages of coxarthrosis and leads to the fact that the patient is not able to fully straighten the leg and, moreover, keep it in that position. Thus, the lower limb with the affected hip joint is constantly in a slightly bent position, which causes lameness.
• A decrease in leg length, which mainly occurs already with severe degenerative-dystrophic changes in the hip joint, 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 is shorter than the healthy leg by 1 centimeter or more.

Coxarthrosis can affect 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 not only be bilateral, but will also differ in intensity. It depends on the degree of destruction of each hip joint.

degrees 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, of which the first is considered the easiest. In the early 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, playing sports or a long walk. Therefore, patients usually do not pay attention to them, attributing them to fatigue and regarding them as normal age changes. In this regard, 1st degree coxarthrosis is diagnosed only in isolated cases, which usually occurs during an examination for another reason.

As the disease progresses, its symptoms intensify and already with 2nd degree coxarthrosis they are felt. 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 femoral head with its displacement.

With the progression of the pathology, the joint space narrows even more and with the 3rd degree of coxarthrosis it is almost completely absent. This is already accompanied by the formation of multiple osteophytes. At this stage of the development of the disease, the pain becomes not only severe, but unbearable and often occurs even in a state of complete rest, including at night. As the hip joint is severely deformed, its elements can impinge on the nerves that pass here, which leads to pain that radiates to the groin, buttocks, thigh, and even the leg. This also causes the inability to move independently without the use of assistive devices such as crutches or canes.

3rd degree coxarthrosis is a direct indication for surgical treatment. If the operation is not performed in time, the femoral head will fuse firmly with the surface of the acetabulum with osteophytes. This will lead to a shortening of the leg, the complete absence of the possibility of independent movement, as the joint will completely lose mobility, that is, disability.

Diagnosis

If signs of coxarthrosis occur, it is recommended to contact an orthopedist as soon as possible. Initially, the doctor will interview the patient and find out the nature of the complaints, and then proceed to the examination and performance of functional tests, comparing the length of the legs. As a rule, the data obtained are sufficient to speak with a high degree of confidence about the presence of coxarthrosis.

But as this clinical picture can accompany several other diseases of the hip joints, both inflammatory and non-inflammatory in nature, instrumental diagnostic methods are needed. With their help, a specialist will not only be able to confirm the presence of coxarthrosis, differentiate 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 detect 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 pathologies, providing clearer data than X-rays, 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 highly informative method for examining joints, providing as much information as possible about the state of the joint and all its structures, especially the hyaline cartilage, ligaments and the characteristics of the blood supply.

Patients receive a series of laboratory tests, including KLA, OAM, rheumatic tests, biochemical blood tests, and others.

Conservative treatment of coxarthrosis

When diagnosing 1 or 2 degree coxarthrosis, treatment is carried out by conservative methods. For each patient, they are selected individually, taking into account the comorbidities detected. 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;
• physiotherapy.

It is mandatory that all patients 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 level of physical activity if you are overweight. If the patient is regularly exposed to excessive physical exertion, it is recommended to change the type of activity or reduce the intensity of training if the load is due to sport. In some cases, it is recommended to use special bandages and orthoses that will fix the hip joint and unload it during physical exertion.

medical therapy

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

• NSAIDs - an extensive group of drugs that have analgesic and anti-inflammatory effects (available in various pharmaceutical forms, including tablets, capsules, gels, creams, injectable solutions, allowing you to choose the most effective and convenient application form);
• corticosteroids - drugs that have a powerful anti-inflammatory effect, but due to the high risk of side effects, especially when using oral forms, 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, often seen in coxarthrosis;
• chondroprotectors - a group of drugs containing components used by the body for the regeneration of cartilage tissue;
• preparations that improve microcirculation - help improve soft tissue nutrition and activate the course of metabolic processes in the affected area;
• B-complex vitamins - are indicated for nerve conduction disorders caused by nerve compression by altered components of the hip joint.

If the coxarthrosis has caused an attack of acute pain, which cannot be stopped with the help of prescribed NSAIDs, then intra-articular or periarticular block is recommended for patients. Its essence lies in the direct introduction into the cavity of the hip joint of an anesthetic solution in combination with corticosteroids. This will allow you to quickly eliminate pain and reduce the inflammatory process. But blocking can only be performed by a qualified healthcare professional in a specially prepared room. The performance of such procedures at home is not shown.

exercise therapy

When diagnosing coxarthrosis, regular exercise therapy is mandatory. As with 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 patient's level of physical development, the nature of concomitant diseases (attention special payment is paid to cardiovascular pathologies).

Thanks to daily exercise therapy, you can:

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

All exercises should be performed gently, avoiding sudden movements and bumps. But if pain occurs during exercise therapy, you should definitely contact your doctor to correct the selected complex or carry out a re-diagnosis to exclude the progression of the disease and the need for an operation.

Physiotherapy

Comprehensive treatment of coxarthrosis involves courses of physical therapy 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 the conservative treatment of coxarthrosis, which can significantly increase the speed of hyaline cartilage regeneration. The essence of the procedure is the introduction into the hip joint cavity of purified blood plasma, obtained by centrifuging the patient's own blood.

Surgery for coxarthrosis

If a patient is diagnosed with 3rd degree coxarthrosis, he is indicated for surgical intervention, as conservative methods in these cases are already impotent. Unfortunately, such situations are extremely common today, as a very large number of patients seek medical help when they can no longer bear the pain or have severe mobility restrictions that deprive them of their ability to work and move independently.

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

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

The gold standard for the treatment of severe coxarthrosis, including in the elderly, is hip arthroplasty. This operation involves replacing a destroyed hip joint with an artificial endoprosthesis made of durable yet biologically compatible materials. Endoprosthesis allows you to completely restore the functionality of the hip joint, eliminate pain and return a person to a full active life.

The essence of this type of surgical intervention is the resection of the femoral head and a small fragment of its neck. In addition, the surgeon will need to prepare the surface of the acetabulum for the placement of the endoprosthesis, that is, remove all formed osteophytes and obtain the maximum restoration of its normal shape. Then, an endoprosthesis of the selected type is installed, which is fixed with a special cement (preferably for the treatment of the elderly) or in a non-cemented way. In the latter case, the endoprosthesis has a special spongy part in contact with the bone structures. Its fixation in the acetabulum is provided by the germination of bone tissue through the sponge.

For each patient, the type of arthroplasty is selected individually. The most effective is total arthroplasty, which involves the complete replacement of the entire hip joint, that is, the neck and head of the femur, in addition to the acetabulum.

If the patient has the preservation of normal hyaline cartilage on the surface of the acetabulum, he/she can undergo partial arthroplasty with replacement only of the head and/or neck of the femur. For this, endoprostheses of different designs are used: monopolar and bipolar.

The only disadvantage of arthroplasty can be considered the need to replace the installed endoprosthesis after 15 to 30 years.

After endoprosthesis replacement, patients receive rehabilitation, the duration of which depends on the rate of tissue repair. As part of recovery, therapeutic exercises, physical therapy and massage therapy are prescribed.

Before the advent of modern endoprostheses, patients with grade 3 coxarthrosis were prescribed osteotomy or arthrodesis. Today, these techniques are less and less used, as they have several disadvantages. Thus, arthrodesis involves fixing the bony structures of the hip joint with metal plates. As a result, the pain syndrome is completely eliminated, but the joint completely loses its mobility. Thus, after arthrodesis, the patient is only able to stand, but is no longer able to 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 gives only a short-term effect, and in the future, the need for arthroplasty still arises.

Thus, coxarthrosis of the hip joint is quite a dangerous disease, which can result in disability. It seriously reduces the quality of life and deprives a person of the ability to work. But if you pay attention to the first signs of pathology and receive advice from an orthopedist in a timely manner, you can slow down its progression and achieve a significant improvement in well-being. But with coxarthrosis already running, there can only be one solution - arthroplasty. Fortunately, this method can be used even with severe degenerative-dystrophic changes and completely restore the normal functioning of the hip joint.