Osteoarthritis of the hip joint: symptoms, treatment and prevention.

The hip joint is the largest joint in our body.It has a hinge configuration that allows movement in different planes.At the same time, the joint is surrounded by strong ligaments and muscles.The hip joints bear the main load when walking, running or carrying heavy loads.Coxarthrosis (another name for osteoarthritis of the hip joint) is quite common in people, both old and young.Once it starts, it can remain undiagnosed for a long time, because visible limitation of hip movements does not occur immediately.

Often, patients, without being examined by a doctor or presenting all their complaints, begin to treat lumbosacral osteochondrosis or osteoarthritis of the knee joints without any visible effects.Meanwhile, the untreated disease progresses, causing lameness, constant pain, shortening of the leg, and an inability to bend and extend.And treatment at this stage is only possible surgically, that is, the joint must be replaced with a prosthesis.

Causes of coxarthrosis

Primary osteoarthritis of the hip joint most often develops in people over 40 years of age.Its causes have not yet been studied.The hyaline cartilage that covers the joint surfaces and provides gliding begins to thin and collapse.Due to increased friction and pressure on the bones, bone spurs appear.The joint is deformed, movements in it are limited.In primary coxarthrosis, both the knee joints and the spine are often affected.

Secondary osteoarthritis develops against the background of various diseases:

• Hip dysplasia.This term refers to the congenital underdevelopment of the components of this joint in a child.As a result, the femoral head is not centered as it should be in the acetabulum.There are three types of dysplasia: preluxation, subluxation and hip dislocation.In case of congenital dislocation, the femoral head is located outside the socket and, if proper treatment is not carried out, osteoarthritis subsequently develops.
• Aseptic necrosis.The bone tissue of the femoral head begins to dissolve due to poor blood supply.The bone tissue is focally resorbed and the joint head is deformed.Osteoarthritis develops secondarily.
• Legg-Calvé-Perthes disease.It is an osteochondropathy of the femoral head that occurs in children between 3 and 14 years old, mainly in boys.It occurs, as a rule, as a result of complications after infectious processes, as well as injuries, physical overload and metabolic diseases.The cartilaginous area of the head does not receive enough blood, which causes necrosis of this area and deformation of the joint.
• Inflammation, infections.If arthritis has developed in the hip joint, the synovial fluid loses its lubricating properties, the lining of the joint thickens, the hyaline cartilage is subjected to mechanical stress, and at the same time metabolic disorders occur in the joint.
• Injuries: hematomas, fractures of the femur, acetabulum, hip dislocations, chronic trauma, that is, microtrauma received systematically.
• Overload of the hip joint associated with sports and professional activities.For example, long walks without rest, the effects of vibrations, constant jumping and carrying heavy loads are undesirable for the joint.The muscular corset of a child or adolescent cannot always compensate for such loads.
• Increased body weight, especially at a young age, when the cartilage cannot yet withstand large axial loads.Additionally, these patients often have metabolic problems.
• Coxarthrosis itself is not inherited, but genetically relatives may have a certain structure of cartilaginous tissue, metabolic disorders that lead to the development of osteoarthritis.Therefore, it is worth considering whether parents or more distant relatives suffer from joint diseases.
• Osteoporosis.The vulnerable area to this disease is the femoral neck.Its structure becomes rarer, pathological fractures are possible.All this secondary leads to osteoarthritis.
• Diabetes mellitus.In this case, osteoarthritis develops due to vascular disorders.
• Polyneuropathy with altered sensation in the legs.
• Diseases of other parts of the musculoskeletal system.These include: scoliosis, osteoarthritis and knee injuries, flat feet.The load distribution on the hip joints changes, the shock absorption properties decrease and, as a result, the cartilage layer suffers.

Symptoms of coxarthrosis

To prevent the disease and its early diagnosis, it is important to know the signs of incipient osteoarthritis of the hip joint (stage 1 coxarthrosis):

• Pain that occurs periodically after physical activity.Specific pain sensations can be localized in the groin area, side, hip or knee.After the break they leave, so no importance is given to them.In the meantime, this is an alarming sign.
• Slight limitation of hip rotation (in and out).This can be easily checked by lying on your back, rotating your entire leg clockwise and counterclockwise.
• An x-ray may reveal slight uneven narrowing of the joint space.

With arthrosis of the second stage, the signs are more pronounced:

• Pain occurs in the projection of the joint, most often in the inguinal fold, and is also noticeable at rest.
• Restrictions appear not only when turning the leg, but also when abducting the hip to the side.Movements in the joint are somewhat painful, especially in extreme positions (with maximum abduction of the hip, bending the leg towards the stomach).
• On an x-ray, moderate narrowing of the joint space and isolated bone growths can be seen at the edges of the acetabulum.Cysts can also form in the bone structure of the femoral head.

Osteoarthritis of the hip joint of the third stage is easily diagnosed, and its symptoms are severe:

• Pain in the joint during exercise, at night.
• For lameness, patients often use a cane.
• Marked limitation of movements in the joint, making it difficult for a person to put on socks or shoes.
• The leg becomes thinner due to hypotrophy of the muscles of the thigh and lower leg.The muscles in the gluteal region also become weak.
• It is possible to shorten the leg due to its incomplete extension and deformation of the femoral head.As a result, scoliosis of the lumbar region (lateral curvature) forms and pain appears in the lumbosacral region.
• Signs of the third stage, revealed by X-rays, are a pronounced narrowing of the joint space up to its complete absence, bone growths and deformation of the head and neck of the hip joint.

Diagnosis

In diagnosis, it is of great importance to clarify subjective complaints, collect a history, evaluate symptoms, and also clarify the stage: x-ray, CT and MRI.Computed tomography allows you to study the bone structure of the hip joint in detail, and the MRI method visualizes the soft tissues, the state of the joint capsule and the presence of synovitis.

Treatment

Therapy for coxarthrosis depends on the stage of the process and, in most cases, includes a wide range of procedures.Of course, the sooner treatment is started, the greater its effectiveness.

1. Conservative treatment
   • Drug therapy.To relieve pain, non-steroidal anti-inflammatory drugs in tablets, suppositories or intramuscular injections are used.Pharmaceutical forms such as ointments, gels and creams are not effective enough because the hip joint is surrounded by large muscles and subcutaneous tissue.Long courses of non-steroidal anti-inflammatory drugs are not recommended due to side effects on the cardiovascular system and gastrointestinal tract.To help them, the doctor may prescribe medications that relieve muscle spasms: a muscle relaxant.In cases of severe inflammation, intra-articular glucocorticoids may be necessary.Chondroprotectors are one of the main groups of drugs for the treatment of coxarthrosis.They are administered both intramuscularly and intra-articularly;in milder cases, tablets can be taken.These drugs aim to improve the restoration processes of cartilage tissue and slow down its degeneration.The doctor may also prescribe vascular medications to improve local blood circulation.
   • Physiotherapy.Their procedures improve blood flow in the joint area and relax the muscles.These are UHF, magnetotherapy, laser treatment, diadynamic currents, electrophoresis.Purpose: according to individual indications.
   • Therapeutic massage.An indispensable method of treatment for coxarthrosis: it relieves muscle spasms, has a beneficial effect on blood circulation and, when carried out systematically, strengthens the muscles.
   • Therapeutic gymnastics.Improves blood flow and strengthens the muscular corset of the joint.Recommended exercises for coxarthrosis (performed on a solid support):
     • supine “bicycle”;
     • lying on your back, grab your knee with your hand and pull it towards your stomach, and do the same with the other leg;
     • lying on your back, bend your knees, press the soles of your feet to the floor and raise your pelvis, hold in this position;
     • lying on your back, move your thigh as far as possible to the side;
     • sitting on a chair, squeeze the ball between your thighs;
     • lying on your back, turn your legs in and out;
     • Standing with your right foot slightly elevated and holding the support with your hands, swing your left leg back and forth and left and right, then do the same by switching legs.
2. Surgical treatment.Endoprosthesis, that is, the replacement of a joint with an artificial one, is performed at the third stage of coxarthrosis in the presence of shortening of the limb, constant pain and severe contracture.Endoprostheses can be cemented (in the presence of osteoporosis) or cementless.The prosthesis itself can be unipolar (replacement of the head only) and total (replacement of both components).Already the day after the operation, some elements of physiotherapy are performed while lying in bed, the patient can stand up, but for now without supporting the leg, and after a few days, with crutches.After 2 or 3 months, crutches will no longer be necessary and you will be able to bear all your weight on your leg.Patients undergoing stents are recommended to undergo rehabilitation consisting of physical therapy, massage, and physiotherapy.In most cases, limb function is restored.The useful life of the prosthesis is 10 to 20 years, then it is replaced with a new one.

Prevention of coxarthrosis

Prevention measures are very important, especially if you have a history of hip dysplasia, fractures, severe bruises or purulent processes in this area.

• Avoid lifting heavy objects and jumping (especially from heights).Try not to stand for long periods of time.
• Control of body weight (reduce the consumption of flour products, table salt, sweet and strong tea in the diet).Being overweight increases the risk of hip osteoarthritis.
• Dosed physical exercises aimed at strengthening the muscles of the thighs and buttocks (cycling or stationary bike, swimming, therapeutic exercises).
• If there are diseases associated with metabolism (diabetes mellitus, atherosclerosis), it is necessary to compensate for them.

Compliance with preventive measures, early detection of coxarthrosis and its adequate treatment are the key to a positive prognosis of this disease.

Which doctor should I contact?

If you feel pain in your leg or hip joint, you should consult a doctor.He will prescribe primary diagnostic measures, in particular, x-rays of the hip joint.Once the stage of the disease is established, the patient will be referred to a rheumatologist or orthopedist.A nutritionist and endocrinologist can provide additional assistance in losing weight and slowing the progression of the disease.It would be helpful for women to consult a gynecologist to prescribe hormone replacement therapy to prevent osteoporosis.