The arthrosis of the hip joint (arthrosis deforming, coxarthosis, osteoarthritis) is a slowly progressive degenerative disease, leading over time to destroy the affected articulation, the persistent pain and the limitation of mobility.
The disease affects people over the age of 40, women get sick several times than men.
In the general structure of arthrosis, the arthrosis of the hip joint belongs to the main role.This is due to the widespread congenital pathology of the hip joints (dysplasia), as well as a significant physical effort, to which these joints are susceptible.
Risk factors and causes of arthrosis of the hip joint
In the pathological mechanism of the development of arthrosis of the hip joint, the main role belongs to a change in the physical-chemical characteristics of the synovial fluid (intra-articular), due to which it becomes more dense and viscous.This worsens its lubricating qualities.When moving, the surfaces of the joint cartilage begin to rub each other against each other, they become rough, covered with cracks.Small particles of Ialil cartilage are abandoned and fall into the joint cavity, causing the development of aseptic (non -infectious) inflammation in it.As the disease progresses in the inflammatory process, the bone tissue is attracted to the inflammatory process, which leads to the aseptic necrosis of the sections of the femoral head and to the surface of acetabulum, the formation of osteophytes (bone growths), improving the influence and cause severe pain during movement.
To the late extent of the arthrosis of the hip joint, inflammation is also thrown into the surrounding articulation of the tissue (blood vessels, nerves, ligaments, muscles), which leads to the appearance of signs of periartritis.Consequently, the hip joint is completely destroyed, its functions are lost, the movement ceases in it.This condition is called ankylosis.
Causes of arthrosis of the hip joint:
- congenital lip of the thighs;
- hip dysplasia;
- aseptic necrosis of the femoral head;
- Peters disease;
- injury of the hip joint;
- Infectious arthritis of the hip joint;
- gonartrosis (osteoarthritis deforming of the knee joint);
- osteochondrosis;
- Excess weight;
- professional sports;
- flat feet;
- curvature of the spine;
- A sedentary lifestyle.
The pathology is not inherited, but the child inherits the characteristics of the structure of the musculoskeletal system of his parents, which can cause the arthrosis of the hip joint in these conditions.This explains the fact of the existence of families, whose incidence is higher than in the general population.
Forms of illness
Depending on the etiology, the arthrosis of the hip joint is divided into primary and secondary.Secondary arthrosis develops against the background of other hip joint diseases or injuries.The primary form is not related to the previous pathology, the reason for its development is often not possible, in this case they speak of idiopathic arthrosis.
Coksartrosis is one or bilateral.
Phases
Three phases (grade) are distinguished during the arthrosis of the hip joint:
- The 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 has compromised their mobility), the changes in the joint tissues are already irreversible, but the therapy can slow down degenerative processes.
- The final movement is lost in the joint, ankylosis is formed.The treatment is possible only surgically (replacing the artificial joint).
Endoprothetic operations in 95% of cases guarantee a complete restoration of the mobility of the limbs, restore the patient's performance.
Symptoms of arthrosis of the hip joint
The main signs of arthrosis of the hip joint:
- groin pain, hips and knee;
- a feeling of rigidity in the articulation concerned and the limitation of his mobility;
- zoppa;
- restriction of the kidnapping;
- Atrophic changes in the thigh muscles.
The presence of some symptoms of arthrosis of the hip joint, as well as their gravity depends on the degree of illness.
At the 1st degree of arthrosis of the hip joint, patients complain about pain in the articulation affected that occur under the influence of physical activity (prolonged walk, race).In some cases, the pain is located in the knee or thigh area.After a short rest, the pain passes by itself.The volume of the movements of the limbs is completely preserved, the pace is not broken.The following changes are noted on the X -ray:
- slight irregular decrease in the lumen of the joint gap;
- Osteophytes located on the internal edge of the swivel.
Any changes from the neck and head of the femur are not detected.
With the grade II of arthrosis of the hip joint, the pain also appears at rest, including at night.After physical activity, the patient begins to limp, a characteristic "duck" pace is formed.Thus the starting pains called - after a long period of immobility, the first steps cause pain and discomfort, which then pass and then return after a long load, will appear.In the articulation concerned, the volume of movements (abduction, internal rotation) is limited.The X -ray shows that the joint gap is upset in a non -uniform way and its light is 50% of the standard.Osteophytes are found both along the internal and external edge of the joint cavity, which goes beyond the boundaries of the cartilage.The contours of the head of the femur become irregular because of the deformation.
With grade III of arthrosis of the articulation of the hip of pain, intense and constant, not stopping at night.Walking is significantly difficult, the patient is forced to rely on the barrel.The volume of the movements in the articulation concerned is abruptly limited, later it stops completely.Due to the atrophy of the hip muscles, the basin differs in the front plane and the limb is reduced.Trying to compensate for this shortening, the patients when walking are forced to refuse the body towards the injury, which further increases the load on the painful joint.On radiographs, more bone growths are detected, a significant narrowing of the joint gap and an increase pronounced in the head of the femur.
Diagnostics
The diagnosis of arthrosis of the hip joint is based on the data of the clinical picture of the disease, on the results of the medical examination and instrumental studies, including the main value belongs to the display methods: radiography, calculated or magnetic resonance imaging.They allow not only to determine the presence of arthrosis of the hip joint and to evaluate their degree, but also to identify the possible cause of the disease (trauma, youth epiphyphysiolisi, Peters disease).
The differential diagnosis of arthrosis of the hip joint with other diseases of the musculoskeletal system is quite complicated.On the degree of arthrosis II and the III of the hip joint, muscle atrophy develops, which can cause intense pain in the knee joint characteristic of the guide or gonartrosis (knee -joint diseases).For the differential diagnosis of these states, the palpation of the joints of the knee and hip is palpated, the volume of movement in them is determined and are also examined radiologically.
In diseases of the spine, in some cases, the nerve roots of the spinal cord with the development of pain syndrome are squeezed.The pain can radiate into the hip joint area and imitate the clinical picture of its defeat.However, the nature of pain with root syndrome is slightly different from the arthrosis of the hip joint:
- Pain occurs due to weight lifting or the strong embarrassing movement and not under the influence of physical effort;
- The pain is located in the buttock, not in the inguinal region.
With root syndrome, the patient can calmly bring the leg to the side, while with the arthrosis of the hip joint, the kidnapping is limited.A characteristic sign of the root syndrome is a positive symptom of the tension: the appearance of acute pain when trying to lift a straight leg on the patient's back.
The arthrosis of the hip joint affects people over the age of 40, women get sick several times than men.
The arthrosis of the hip joint should also be differentiated with loyal bursitis (trocantery).Borsite Vable develops faster, within a few weeks.It is usually preceded by significant physical efforts or injuries.In this disease, the pain is much more pronounced than the arthrosis of the hip joint.At the same time, shorteling of the limb and limiting their mobility is not detected.
The clinical picture of atypical reactive arthritis and ankylosing spondylitis can resemble the clinical manifestations of the arthrosis of the hip joint.However, pain occurs in patients mainly at night or at rest, when walking does not intensify, but, on the contrary, weaken.In the morning, patients notice stiffness in the joints, who passes after a few hours.
Treatment of arthrosis of the hip joint
Orthopedians are engaged in the treatment of arthrosis of the hip joints.With Grado I and II of the disease, conservative therapy is indicated.With the pronounced pain syndrome, patients are prescribed anti -non -pound anti -inflammatory drugs in a short course.They should not be accepted for a long time, since they are not only able to have a negative effect on the organs of the gastrointestinal tract, but they also suppress the regenerative capabilities of the cartilage IALINA.
In the regime for the processing of the hip joint arthrosis, they include chondroprotectors and vasodilators, which creates optimal opportunities to restore damaged cartilage tissues.With the pronounced muscle spasm, it may require the appointment of central muscle relaxants.
In those cases where it is not possible to stop pain syndrome with non -pounded anti -inflammatory drugs, they resort to intra -articular injections of corticosteroids.
Local treatment of the hip joint arthrosis by means of heating ointments allows you to reduce muscle spasm and somehow weaken pain due to the distraction of the action.
In the complex therapy of arthrosis of the hip joint, physiotherapy methods are also used:
- magnetotherapy;
- Editermia;
- Uhf;
- laser therapy;
- ultrasound treatment;
- massage;
- medical gymnastics;
- Manual therapy.
Diet nutrition for arthrosis of the hip joint aims to correct body weight and normalization of metabolic processes.The reduction of body weight reduces the load on the hip joints and therefore slows down the progression of the disease.
To download the affected articulation, the doctor may recommend that patients go to crutches or barrel.
With grade III of arthrosis of the hip joint, the conservative treatment is inefficient.In this case, it is possible to improve the patient's conditions, it is possible to return normal mobility only due to surgery - by replacing the artificial destroyed articulation (joint endopropostetic).
Possible consequences and complications
The most serious complication of the progressive arthrosis of the hip joint is disability due to the loss of movement in the articulation.With bilateral Coksartrosis, the patient loses his ability to move independently and needs constant foreign care.A long stay in bed in one location creates the prerequisites for the occurrence of stagnant pneumonia (hypostatic), 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 his parents, which can cause the arthrosis of the hip joint.
Forecast
The arthrosis of the hip joints is a progressive chronic disease, which can only be treated in the early stages, subject to the elimination of the cause of the disease.In other cases, therapy allows you to slow down the path, however, over time, the endoprotesis system of the hip is necessary.These operations in 95% of cases provide a complete restoration of the mobility of the limbs, restore the patient's performance.The service of service of modern prostheses is 15-20 years, after which they are subject to replacement.
Prevention
The prevention of arthrosis of the hip joint aims to eliminate the causes that can lead to the development of this disease and includes:
- Removal and timely treatment of diseases and injuries of the hip joint;
- refusal of a sedentary lifestyle, regular but not excessive physical activity;
- body weight control;
- rational nutrition;
- Refusal of bad habits.