Hip Arthrosis (Coxartrosis)- This is a chronic degenerative joint disease that leads to bone deformation.With cOKSARROSIS, all joint components are involved in the pathological process: joint cartilage, bone structures adjacent to cartilage, synovial shell, ligaments, capsule and adjacent muscles.In case of disease, joint cartilage is destroyed, occurs the bone and osteophyte micro-ediments (bone growths) and an inflammation of the muscle ligament of the hip joint occurs.
In the world, every fifth person complains about joint problems with the joints.This can be pain or restriction of joint movement and a combination of these symptoms.Each outpatient view falls into patients with bone muscle disorders, while 66 % of cases are people under 65.According to the latest epidemiological research, the prevalence of knee and hip joint arthrosis between the adult population is 13 %.
Risk factors for the development of coxarthrosis:
- Genetic predisposition.A common cause of hip joint cOKSARROSIS is the congenital or acquired mutation of the type II prolagen type.
- Elderly age.The probable cause of the prevalence of arthrosis in old age is a discrepancy between the harmful effect on the joint cartilage of the external environment and its capacities to restore.
- Floor.Women suffer from osteoarthritis more often than men.This is due to the effects of the influence of female sex hormones of estrogen on bone mineral metabolism.However, the influence of the floor is ambiguous - according to some authors, unlike damage to other joints, there are no differences in the sexual basis for cksartrosis: in men, hip articulation arthrosis is as often found as in women.
- Overweight body weight.The relationship is proven between excess body mass and the occurrence of arthrosis.Excess adhesive tissue increases the harmful load in the cartilage.In addition, adipose tissue produces pro -inflammatory enzymes that damage the cartilage tissue.
- Frequent development of bones and joints.According to the studies, 80 % of coxartrosis, which occurs without apparent reason, is associated with defects previously diagnosed in the development of hip joint - dysplasia and subluxation.
- Heavy physical work.An excessive load on hip joints with certain types of physical work can lead to articulation damage and arthrosis formation.At risk are agricultural workers, excavators and similar work specialties.
- Wounds.The risk of developing thigh increases after an injury to the hip joint.In addition, a wounded joint and both may be involved in the process.
- Professional practicing sports.Professional sports can cause thigh due to excessive joint and lesions.Potentially dangerous sports include heavy athletics, athletics leap, stopping sports.
- Bones and joint diseases- Rheumatoid arthritis, psoriatic arthritis, joint infections, avascular necrosis, gout arthritis, etc.
- Endocrine pathologies- Hypothyroidism, hypoparathyroidism, acromegaly (impaired function of the anterior pituitary gland), diabetes, obesity.
If similar symptoms are detected, consult a doctor.Don't be self -service - it's dangerous for your health!
Hip joint arthrosis symptoms
The main symptoms of coxarthrosis include: pain, restrictions on mobility and joint crisis, deformation, functional shortening of the lower limb and periodic joint swelling.
Pain of various intensity.Articulation pain is initially insignificant and arises for a short period of time.They appear or intensify during walking or with another physical effort, for example, during squats, inclinations and weight lifting.As the disease develops, the pain intensifies and even a long rest does not bring relief.In addition, the pain occurs with prolonged immobility and fixation of the joint in a position.
Patients complain about "beginner" pain in hip joints after bed, driving in a car and other prolonged immobility.The "beginner" pain for coxarthrosis lasts no more than 30 minutes.The pain intensifies during hypothermia or in a stressful situation.They can be located in the buttock or groin area, on the front or side surface of the thigh.With the spread of pain on the nerves of the lumbar plexus, it can be transmitted to the distant thighs of the center of the body or in the knee.Sometimes the pain applies to the lumbosacra spine and on the tail pipe.
Restriction of joint mobility.Hip joint movements with cOKSARROSIS are limited due to pain.At the same time, rotation (rotates both inside and out) and bringing the lower limb (movement to the middle of the body) are more disturbed, but can be limited (the movement of the average axis of the body) as well as flexion and extension.The inability to make passive movements in the joint due to a pronounced pain syndrome causes a compensatory pelvic bias.The patient's march changes, the buttocks stand out, the body dodges in front of transferring weight to the damaged side.With bilateral damage to patients with cOKSARTROSIS, a "duck march" is formed.
With thigh occurs periodicallyswelling in the articulationwhich can be invisible due to the muscle and fat layer.In addition, the disease is characteristicCryst in the joints during movement, its gradual deformation and functional shortening of the lower limb.
Often, an articulation is affected with the disease, so the process applies to other people.But sometimes arthrosis affects several joints at once and polesoarthritis occurs.Polyseteoarthritis is characteristic of elderly or with a hereditary predisposition and concomitant diseases - bone diseases, joints and endocrine disorders.
Pathogenesis of hip joint arthrosis
In the pathogenesis of hip joint arthrosis, an important role is played by mechanical damage (lesions and microtraums due to increased physical effort in the joint) and genetic, hormonal and metabolic factors.Often, it is not possible to find out which factor influenced the development of the disease in a particular patient, but often the disease develops after damage to mechanical tissues.
Fabric damage stimulates the division of cartilage tissue cells (chondrocytes), while the production of pro -inflammatory cytokines increases, which are usually present in cartilage in only small quantities.Cytokines launch the inflammatory process, for example, under the influence of proinflammatory cytokine IL-1, the enzymes that destroy the articulation cartilage are distinguished.In addition, under the influence of cytokines, the production of the TSOG-2 enzyme and other substances that have a toxic effect on the increase in cartilage.
Synovites also play a major role in the development of thighment - inflammatory diseases of the synovial shell of joints or ligaments with the accumulation of liquid in the cavity.
A decrease in elasticity and strength of joint cartilage associated with metabolic disorders leads to a decrease in its resistance to mechanical stress.With cOKSARROSIS, all joint components are involved in the pathological process, including a subchondral bone.Due to the fact that large joints from the lower extremities represent large joints of the body, they suffer significant mechanical stress, because microvaloma occur in the subcondral plate and cartilage.As a result of microvellomas, the subcondral bone is compacted, which leads to the regional growth of bone tissue - osteophytes.And this, in turn, stimulates an additional degradation of joint cartilage.
In some cases, hip arthrosis is inherited.Hereditary arthrosis is supposedly polygenic heritage - due to the action of many genes, each of which we weakly affect.The cause of some diseases is a mutation in genes that encode macromolecules of joint cartilage, which causes their ruptures.The genes responsible for the division of chondrocytes may also suffer.In addition, metabolic disorders are inherited, such as pyrophosphate arthropathy - a disease in which calcium pyrophosphate crystals accumulate in joint cartilage and synovial fluid.
Classification and internships of arthrosis development of the hip joints
Depending on the causes of the disease, coxarthrosis is divided into two main forms: primary (idiopathic) and secondary (due to or because of other diseases).
Primary COKSARROSIS:
- Located (only hip joints affects):
- unilateral;
- bilateral.
- Generalized (polyothesis) with an injury of at least three joint groups (eg hip, knee and small joints of brushes or feet).
Secondary Arthrosis:
- Post -traumatic:
- Acute - as a consequence of acute lesions;
- Chronic - Due to classes of some sports or as a result of professional activity.
- Metabolic Diseases (Gool, Hemochromatosis, Wilson's disease, Gaucher's disease).
- Congenital pathologies and developmental defects (congenital hip articulation dysplasia belong disease, slipping from femur epicia, hypermobility syndrome, lower limb shortening, scoliosis, bone dysplasia).
- Endocrine pathologies (acromegaly, hypothyroidism, diabetes mellitus, hyperparathyroidism, obesity).
- Calcium salts (pyrophosphate arthropathy, calcifying tendonitis).
- Bone and joint diseases (rheumatoid arthritis, psoriatic arthritis, pedestrian disease, avascular necrosis, infections).
According to clinical manifestations, the following forms of thighment are distinguished:
- Little symptom.
- Manifesto, manifested by brilliant clinical symptoms:
- quickly progressive, in which symptoms develop in the first four years since the beginning of the disease;
- Slowly progressive - clinically significant symptoms appear after five years of the course of the disease.
According to image x -ray, two types of hip joint arthrosis can be identified:
- Hypertrophic - with signs of increased repair response (lesions are replaced by a new tissue, for example osteophytes appear);
- Atrophic (decreased tissue volume).
The stages of the disease can be determined radiologically and clinically.To determine the radiological stage of hip joint arthrosis, the Kellgren and Lawrence classification (1957) is most often used.
Arthrosis stages in radiological classification
| Internship | Signs |
|---|---|
| 0 | There are no signs of arthrosis in X -ray images |
| 1 | The joint gap is not changed, unique regional osteophytes are viewed |
| 2 | The joint gap is not changed, significant regional osteophytes are viewed |
| 3 | The height of the joint gap is moderately reduced, significant regional osteophytes are viewed |
| 4 | The height of the joint gap is significantly reduced, significant regional osteophytes and subcondral osteosclerosis (bone tissue compaction under the lower cartilage surface with the cartilage structure) are viewed) |
To determine the clinical stage of the disease, classification (1961) is used, which uses clinical signs and visualization criteria.
Clinical internships of arthrosis
| Internship | Signs |
|---|---|
| 0 | The joint gap is unequivocally reduced and unequal, the edges of joint cracks are slightly pointed (initial osteophytes), a slight restriction of movements is observed |
| 1 | Articular gap is significantly reduced (50-60 %), significant osteophytes, subcondral osteocosclerosis and cystic lighting in bone epifiers;The clinic is predominated by the restriction of mobility in the joints, a difficult crisis during movements, insignificant or moderate muscle atrophy |
| 2 | deformation, articulation stiffness;Articular gap is reduced by more than 60-70 % of the norm or completely absent extensive osteophytes, subcondral cysts, joint "mice" are visualized bones, cartilage or mixed pathological formations located in the joint cavity |
Complications of hip joint arthrosis
With thigh, all complications are precisely associated with pathological changes in the joints.
The course of cOKSARTROSIS can be complicated by local inflammatory processes:
- Burso - inflammation of synovial bags in the joints;
- having vaginitis - inflammation of the inner shell of the vagina of muscle tendons;
- Tunnel syndrome stinging the nerve due to the formation of large osteophytes or with joint deformation.
With the progression of coxarthrosis and its transition to clinical stages II and III, the pain limits the mobility of the joint and, over time, joint ankylosis occurs (fibrous, bone or cartilage), accompanied by its complete immobility.
Significant joint deformation can lead toFractures or aseptic necrosis of bones.For cOKSARROSIS, femoral head aseptic necrosis is the most formidable complication.
With pronounced cOKSARROSIS, it can occursubluxation and dislocation of the jointas well as the penetration of the femoral head in the pelvic cavity.Dislocations and subluxation of the hip joint lead to pain (in the first acute, then dull and painful), intensifying during walking and other physical efforts, as well as joint deformation, lame and sometimes to reduce the affected limb.
Despite the lack of systemic manifestations of arthrosis itself, in modern clinical practice, more attention to diseases associated with it is paid.These are pathological conditions that exist or arise against the antecedents of the current disease.In connection with inflammatory reactions that arise during arthrosis, the formation of atherosclerotic plates in the internal walls of the vessels is improved, which increases the riskCardiovascular diseases.A decrease in physical activity due to pain and restriction of joint mobility leads toObesity, depression and deterioration in quality of life.With prolonged use of non -esteroid anti -inflammatory drugs,The upper gastrointestinal sections are affected,And alsoThe risk of cardiovascular pathologies and kidney disease increases.
Diagnosis of arthrosis of hip joints
The diagnosis of "cOKSARROSIS" is based on clinical manifestations and radiological examination.There are no characteristic laboratory signs for the diagnosis of arthrosis.
Among clinical manifestationsThe main one for the diagnosis of arthrosis of the hip joint is pain and its character.Pain in hip joint arthrosis occurs and grows gradually over several years (sometimes several months with a quick progressive form).Pain occurs or increases during physical effort or in standing position.If the patient begins to feel pain alone, inflammation (synovitis) has entered.The statement is observed up to 30 minutes in the morning and with prolonged immobility.
The limitation of joint mobility is increasing gradually, this applies to active and passive movements.With the development of the disease, the joints are deformed, functional shortening of the limb length may occur.
In a physical examinationThere is a limitation of joint mobility, their deformation, limb shortening, pain in the palpation of the joint and a great turnover of the femur, muscle atrophy.
Laboratory methodsFor the diagnosis of arthrosis of the hip joints, they are not necessary.However, they can be used for the differential diagnosis of arthritis (rheumatoid and chronic) thigh, because with arthrosis there are no inflammatory changes in the overall blood examination and rheumatoid factor, and uric acid levels are not increased.In addition, using laboratory tests, against -indications are revealed to drug treatment methods.
Instrumental MethodsFor the diagnosis of hip joint arthrosis:
- Radiography- This is the main method of diagnosis of arthrosis of hip joints.Radiography determines the characteristic changes of cOKSARTROSIS: narrowing of the joint gap, osteophyte, erosion and ulceration of cartilage, subcondral cysts and osteosclerosis.The -x ray examination is a classic method for the diagnosis of thigh, and radiological signs are underlying the classification of thigh.However, currently other joint visualization methods are increasingly used, such as ultrasound and magnetic resonance imaging.
- Ultrasound Exam (Ultrasound) -The advantage of ultrasound lies in the absence of a radial load on the body.
- Magnetic Resonance Tomography (Magnetic Resonance)- compared to other methods, it allows you to more clearly visualize joint damage.
- Arthroscopy-Allows you to identify articular cartilage damage: from chondomation zones (joint cartilage softening) with a diameter of less than 10 mm to deep cracks that penetrate the subcondral bone and the formation of deep ulcers.Superficial and medium cracks and surface erosion can also be viewed.
Identification of COKSARROSIS usually does not represent special difficulties, but when evaluating a specific clinical situation, it is necessary to remember the possible secondary origin of hip joint arthrosis (such as complications of other diseases, for example, with endocrine disorders).
Treatment of hip joint arthrosis
The treatment of hip joint arthrosis can be conservative (medication and united) or operational.Conservative treatment is used in 1-2 stages of the disease, surgical in 3 stages.Surgical treatment can be recommended in 2 stages with persistent pain and lack of reaction to conservative therapy.
The objectives of conservative therapy:
- Improve quality of life - reduce pain and increase joint mobility;
- Stop or slow down the development of the disease.
No -Drug treatment methods include:
- Discharging hip joint (decreased body weight, additional support and transfer of body weight to cane or crutches);
- Physical Education of Physiotherapy;
- Physiotherapeutic treatment methods.
The treatment of coxarthrosis begins with non -Drug methods, an important role to physical therapy exercises is given.With intense pain, the patient should use the support.With a pronounced disease and the presence of contraindications to endoprothetic, support should be used for life.
Medicinal Cuxartrosis TherapyIncludes medications that reduce symptoms of the disease.These are painkillers, as well as drugs from the non -steroid (NSAIDs) anti -inflammatory drugs.The NSAIDs are divided into non -election and selective.
Analgesics and NSAIDs for hip joint arthrosis are used for a short time to relieve pain and inflammation.Currently, there is no proven advantage of an anti -inflammatory non -esteroid agent over another;Therefore, choosing a specific drug depends on the side effects and a specific clinical situation caused by it.
It should be remembered that NSAIDs have several side effects.At levá them, the mucous membrane of the stomach and duodenum is affected as a result of which ulcers and bleeding are possible.Several NSAIDs have a toxic effect on the liver and kidneys.In addition, NSAIDs interrupt platelet aggregation and, as a result, the patient is interrupted by thrombosis and there is a tendency to bleed.Prolonged NSAIDs suppress hematopoiesis processes and can cause anemia and aplastic agranulocytosis.The reception of selective NSAIDs causes significantly fewer complications.
Locally used ointments and gels cause fewer side effects than oral products.For the treatment of arthrosis, drugs with heating and reduction of pain are used.They may contain hope, menthol, nicotinic acid esters, salicylates, bee poison.In addition, NSAIDs have a good effect.
In the absence of the effect of painkillers and NSAIDs or, if it is impossible to choose the ideal dose of the medicine, central action painkillers may be prescribed in the short term.
In case of inflammation, intra -articular administration of corticosteroids is used.Corticosteroids are used no more than 2-3 times a year, as the most frequent use can lead to cartilage degeneration.
Action drugs slowly weaken the symptoms of the disease include chondroprotectors, inadequate compounds of avocados or soy, hyaluronic acid.These medications are included in the European Anti -Immatic League recommendations for the treatment of hip joint arthrosis.Preparations reduce pain and improve joint mobility.
Endoprosthetic hip jointsIt is used in severe cases of stage III, when pain syndrome cannot be eliminated and joint mobility is significantly limited.Hip joint prostheses lead to a decrease in pain syndrome, an improvement in the functional state of the joint and the quality of life of the patient.The effect persists for 10 to 15 years, after which a second operation may be required.During surgery, the hip joint is replaced by artificial ceramic imitation, metal (more often titanium prostheses) or polymer.
Forecast.Prevention
The prognosis of hip joint arthrosis in relation to the patient's life is favorable, but the disease usually leads to disability.According to the World Health Organization, 80 % of elderly patients with coxarthrosis have a mobility violation and 25 % cannot ask everyday issues.In this sense, the primary prevention of arthrosis of the hip joints is important.
Prevention measures:
- Reduce body weight.It is necessary to adjust nutrition to reduce weight and load in the joint.In addition, a decrease in adipose tissue volume reduces the amount of inflammation mediators that has released.
- Avoid heavy physical work and sports overload.Physical overloads are often the cause of hip joint arthrosis, while moderate physical activity, on the contrary, improves the condition of joint cartilage, maintains its normal mobility and reduces load in other joints.
- Correct the underlying disease.If the patient is detected in diseases that can lead to secondary cOKSARROSIS (endocrine, rheumatic and others), underlying disease is required.Standardization of the hormonal fund and obtaining persistent remission of rheumatic diseases are the primary prevention of arthrosis and allows you to reduce its development.
- Bring a healthy lifestyle.A balanced diet with sufficient plant and animal protein content, polyunsaturated fatty acids and simple carbohydrate limitation, as well as moderate physical activity, avoiding the occurrence of thigh, even in the presence of risk factors.
Currently, the prevention of hip joint diseases is mandatory in neonatology and pediatrics.Over time, adjusted congenital hip joint dysplasia significantly reduces the risk of adulthood coxarthrosis.