How to treat coxarthrosis of the hip joint

Coxarthrosis is a common degenerative-dystrophic disease of the hip joint, in which, due to age-related changes or other factors, a progressive destruction of the articular joint of the head of the femur and the acetabulum of the pelvis occurs.It is accompanied by pain and limited range of movement of varying severity, which depends on the stage of development.And if in the early stages it is possible to cope with coxarthrosis using conservative methods, then in the 3rd stage it is possible to save the situation and maintain the functionality of the hip joint, that is, to avoid disability, only through surgery.

It is classified as osteoarthritis and can be accompanied by 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 coxarthrosis

Coxarthrosis is a complex pathology of one or both hip joints, in which the destruction of the cartilaginous layers covering the head of the femur and the acetabulum occurs, which leads to a decrease in the size of the joint space.As the disease progresses, deformation of bone surfaces and the formation of bony growths, called osteophytes, occur.

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

The entire hip joint is enclosed in a specific housing, called the joint capsule.It has a so-called synovial membrane, which produces synovial fluid.This fluid is extremely important for the proper functioning of the joint, as it not only lubricates the hyaline cartilage, but also provides it with a source of nutrients.

Normally, cartilage is constantly worn out and immediately restored thanks to the continuous process of regeneration, carried out with the help of substances that enter it from the synovial fluid.But with injuries or age-related changes, the rate of regeneration processes decreases, which leads to gradual wear 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 unfavorable factors, it becomes thicker and produced in less volume.As a result, the synovial fluid is no longer able to supply the hyaline cartilage with all the substances it needs in the required quantity, which leads to its rapid dehydration and thinning.Gradually, the strength and elasticity of the cartilage decreases, zones of separation of the fibers that form it, cracks form in them, and the thickness also decreases.These changes can be noticed during instrumental diagnostic methods, including narrowing of the joint space.

Narrowing of the joint space leads to increased friction between the bony structures that form the hip joint and increased pressure on the already degraded hyaline cartilage.This causes even greater damage, which affects the functioning of the joint and the condition of the person, since the deformed areas prevent the femoral head from sliding easily into the acetabulum.As a result, symptoms of coxarthrosis appear.

If left untreated, the pathological changes worsen and the hyaline cartilage wears out more and more.Subsequently, in some areas it disappears completely, which leads to exposed bones and a sharp increase in the load on the joint.Since when moving inside the acetabulum, the head of the femur rubs directly against the bone, this causes severe pain and severe limitation of mobility.In this case, the pressure of bone structures on each other leads to the formation of bony 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 severe pain both directly in the joint area and in the groin, buttocks and thigh.As a result, the patient spares the injured leg, puts less load on it and tries to avoid making unnecessary movements with it.This causes muscle atrophy to develop, which further worsens the motor impairment and ultimately leads to lameness.

Causes

There are many reasons for the development of coxarthrosis, although in rare cases it occurs in the absence of any 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 a number of diseases or changes in the state of the musculoskeletal system.Its development can be caused by:

• hip joint injuries of various types, including fractures, dislocations, bruises, sprains or torn ligaments;
• heavy physical labor, professional sports, including weightlifting, skydiving, show jumping;
• sedentary lifestyle;
• excess weight, which significantly increases the load on the hip joints;
• foci of chronic infection in the body;
• congenital anomalies of the hip joints, such as dysplasia or dislocation;
• metabolic pathologies and endocrine disorders, notably gout, diabetes mellitus, particularly in decompensated form;
• aseptic necrosis of the femoral head, which can be a consequence of a fracture of the femoral neck, especially during conservative treatment;
• inflammatory joint diseases, including rheumatoid arthritis, bursitis, tendinitis;
• spinal diseases;
• genetic predisposition;
• presence of bad habits, including smoking.

Nevertheless, the main cause of coxarthrosis remains inevitable age-related changes, and the presence of the above factors only increases the likelihood and speed of its development.

Symptoms of coxarthrosis

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

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

• Pain of varying intensity, initially occurring after physical activity or walking and easing after rest.Gradually, the severity of the pain syndrome increases, it appears more often, lasts longer, and the delays between the moment the load is applied to the joint and the appearance of pain are reduced.Later, the pain is present almost constantly, including at rest, and becomes unbearable.Intensification of pain is typical at any stage of the disease with hypothermia and lifting heavy objects.
• Limitations in mobility of the hip joint, which initially manifest themselves as minor difficulties when performing 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 warming up.Patients notice a decrease in the range of movement of the legs and subsequently completely lose the ability to perform certain movements.
• A cracking sound in the hip joint that occurs when walking or performing physical work, especially when extending.This becomes the result of rubbing of exposed bone structures against each other, which is accompanied by a sharp increase in pain.
• Spasms of the thigh muscles, leading to the appearance of diffuse pain in the thigh.This can be the result of the addition of various intra-articular disorders, including compression of the nerves, excessive stretching of the ligaments surrounding the joint, as well as the development of synovitis, that is, inflammation of the synovial membrane and accumulation of inflammatory effusion in the cavity of the hip joint.
• Lameness, initially resulting from the patient's unconscious desire to reduce the load on the diseased joint and transfer weight to the healthy leg in order to avoid the appearance or intensification of pain, and then the development of muscle contracture.The latter phenomenon occurs already in the later stages of coxarthrosis and leads to the fact that the patient is not able to completely straighten his leg and, moreover, keep it in this 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 occurs mainly 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 and muscle atrophy.As a result, the diseased leg becomes shorter than the healthy leg by one or more centimeters.

Hip osteoarthritis can affect either one hip joint or both at the same time.But if in the first case the symptoms of the disease will be 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, the first of which is considered the lightest.In the early stages of the appearance of degenerative-dystrophic changes in the hip joint, only occasional pain can be observed.Typically, this happens after intense physical activity, sports or a long walk.Therefore, patients usually do not pay attention to them, attributing them to fatigue and considering them a normal age-related change.In this regard, coxarthrosis of the 1st degree is diagnosed only in isolated cases, which usually arise during examination for another reason.

As the disease progresses, its symptoms intensify and already with coxarthrosis of the 2nd degree they make themselves felt.This stage of development of 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 at the 3rd degree of coxarthrosis is almost completely absent.This is already accompanied by the formation of multiple osteophytes.At this stage of development of the disease, the pain becomes not only intense, but unbearable and often occurs even in a state of complete rest, including at night.Since the hip joint is severely deformed, its elements can affect the nerves passing through it, resulting in pain radiating to the groin, buttocks, as well as the thigh and even the lower leg.It also causes the inability to move independently without the use of auxiliary devices, for example crutches or a cane.

Third degree coxarthrosis is a direct indication for surgical treatment.If the operation is not performed in time, the head of the femur will firmly fuse with the surface of the acetabulum through osteophytes.This will lead to shortening of the leg, complete inability to move independently, since the joint will completely lose mobility, that is, to disability.

Diagnosis

If signs of coxarthrosis appear, it is recommended to consult an orthopedist as soon as possible.Initially, the doctor will interview the patient and find out the nature of the complaints, then conduct an examination and 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 since a similar clinical picture can accompany a number of other diseases of the hip joints, both inflammatory and non-inflammatory, instrumental diagnostic methods are necessarily prescribed.With their help, a specialist will not only be able to confirm the presence of coxarthrosis, differentiate it from radicular syndrome caused by pathologies of the spine, but also correctly assess the degree of its development and therefore select the most effective treatment tactics.

Today, the following are used to diagnose coxarthrosis:

• X-ray of the hip joints - the images obtained allow you to detect signs of destructive changes, the presence of osteophytes, the nature of deformation of bone structures and measure the thickness of the joint space.
• Computed tomography is a more modern method of diagnosing bone pathologies, providing clearer data than X-rays, but it is 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 very informative method for studying joints, providing the maximum information about the state of the joint and all its structures, especially hyaline cartilage, ligaments and features of the blood supply.

Patients are prescribed a number of laboratory tests, including OAC, OAM, rheumatic tests, biochemical blood tests and others.

Conservative treatment of coxarthrosis

When diagnosing coxarthrosis of 1 or 2 degrees, treatment is carried out using conservative methods.For each patient, they are selected individually, taking into account the detected concomitant pathologies.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 imperative 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 involves adjusting your diet and increasing your level of physical activity if you are overweight.If the patient is regularly exposed to excessive physical activity, he is recommended to change the type of activity or reduce the intensity of training if the load is due to sports.In some cases, it is recommended to use special bandages and orthotics that will fix the hip joint and provide relief during physical activity.

Drug therapy

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

• NSAIDs are a large group of drugs that exhibit analgesic and anti-inflammatory effects (available in various dosage forms, including tablets, capsules, gels, creams, solutions for injection, which allows you to choose the most effective and convenient form of use);
• corticosteroids are drugs that have a powerful anti-inflammatory effect, but due to the high risk of side effects, especially when using oral forms, they are prescribed only in short courses by injection;
• muscle relaxants - drugs that help reduce muscle tone, which makes it possible to effectively combat muscle spasms, often observed with coxarthrosis;
• chondroprotectors – a group of drugs containing components used by the body for the regeneration of 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 compression of the nerves by altered components of the hip joint.

If coxarthrosis causes an acute pain attack that cannot be relieved with prescribed NSAIDs, patients are recommended to undergo intra-articular or periarticular blockade.Its essence is to directly inject into the cavity of the hip joint an anesthetic solution in combination with corticosteroids.This will eliminate pain in the shortest possible time and reduce the inflammatory process.But the blockade can only be carried out by a qualified medical professional in a specially prepared room.It is not recommended to perform such procedures at home.

Exercise therapy

When diagnosing coxarthrosis, regular physiotherapy exercises are necessary.Just like 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 level of physical development of the patient and the nature of concomitant diseases (special attention is paid to cardiovascular pathologies).

Thanks to daily exercise therapy classes, it is possible to:

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

All exercises should be performed smoothly, avoiding sudden movements and jerks.But if pain occurs during exercise therapy, you should definitely contact your doctor in order to correct the selected complex or carry out repeated diagnostics to exclude progression of the disease and the need for surgical intervention.

Physiotherapy

The complex treatment of coxarthrosis involves a series of physiotherapeutic procedures that have an anti-inflammatory, analgesic, decongestant and tonic effect on the body.Therefore, most often, 10-15 procedures are prescribed to patients:

• ultrasound therapy;
• electrophoresis;
• UVT;
• magnetic therapy;
• laser therapy, etc.

Recently, plasmolifting has been increasingly used as part of the conservative treatment of coxarthrosis, which can significantly increase the rate of hyaline cartilage regeneration.The essence of the procedure is the introduction of purified blood plasma into the cavity of the hip joint, obtained by centrifugation from the patient's blood.

Surgery for hip osteoarthritis

If a patient is diagnosed with coxarthrosis grade 3, surgical intervention is indicated, since conservative methods in such cases are no longer effective.Unfortunately, such situations are extremely common today, as a huge number of patients seek medical attention when they can no longer tolerate pain or have severe mobility limitations 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, thereby significantly increasing their quality of life.The indications for its implementation are:

• significant reduction in joint space by more than 80%;
• the presence of severe pain in the hip joint that cannot be eliminated;
• severe motor impairments;
• fracture of the femoral neck.

The gold standard for treatment of severe hip osteoarthritis, including in the elderly, is hip arthroplasty.This operation involves replacing the destroyed hip joint with an artificial endoprosthesis made of durable and at the same time biologically compatible materials.Endoprostheses allow you to completely restore the functionality of the hip joint, eliminate pain and return a person to a full-fledged active life.

The essence of this type of surgical intervention is the resection of the head of the femur and a small fragment of its neck.The surgeon will also need to prepare the surface of the acetabulum for installation of the endoprosthesis, that is, remove all formed osteophytes and achieve maximum restoration of its normal shape.Next, an endoprosthesis of the selected type is installed, which is fixed with special cement (preferably for the treatment of elderly people) or without cement.In the latter case, the endoprosthesis has a particular spongy part which is in contact with the bone structures.Its fixation in the acetabulum is ensured by the growth of bone tissue through the sponge.

For each patient, the type of stent is selected individually.The most effective is the total endoprosthesis, which involves a complete replacement of the entire hip joint, that is, the neck and head of the femur, as well as the acetabulum.

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

The only drawback of stent replacement is the need to replace the installed stent after 15-30 years.

After endoprostheses, patients benefit from rehabilitation, the duration of which depends on the speed of tissue restoration.As part of recovery, exercise therapy, physiotherapy and therapeutic massage are prescribed.

Before the advent of modern endoprostheses, patients with grade 3 coxarthrosis were prescribed osteotomy or arthrodesis.Today, these techniques are used less and less because they have many disadvantages.So, 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 mobility.So, after arthrodesis, the patient can only stand, but is no longer able to walk independently due to the lack of movement of the hip joint.Therefore, today, arthrodesis is practically not performed.

Osteotomy involves making 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 endoprostheses will still be needed.

So, coxarthrosis of the hip is a rather dangerous disease that can lead to disability.This significantly reduces the quality of life and deprives a person of their ability to work.But if you pay attention to the first signs of pathology and timely consult an orthopedist, you can slow down its progression and achieve a significant improvement in your well-being.But with already advanced hip osteoarthritis, there can only be one solution: endoprostheses.Fortunately, this method can be used even in cases of severe degenerative changes and completely restore normal functioning of the hip joint.