Osteoarthritis of the hip joint

Osteoarthritis of the hip joint, or coxarthrosis, is characterized by a course with progressive dynamics, which disrupts all the statodynamic functions of the musculoskeletal system. Osteoarthritis arthritis of the hip joint is a very common disease, unfortunately, occupying a leading position in the list of diseases with degenerative-dystrophic processes.

WHO statistics show that degenerative joint changes are diagnosed in 5% of the world's population, regardless of nationality, gender and social status. According to the latest data, arthrosis of the hip joint, especially in the elderly, is ahead of cardiovascular diseases and diabetes.

The disease begins with chondrosis - the degeneration of the articular cartilage, which is rather thinning, collapsing and losing its damping properties. In order to compensate for the loss of depreciation, the organism triggers a mechanism for the formation of bone marginal growths, as a consequence, surrounding tissues are sclerosed, cysts are formed in the areas of articulation of the head of the femur and the articular fossa - the acetabulum.

[1], [2], [3], [4]

What causes arthrosis of the hip joint?

Despite the widespread and rather old, centuries-old history, arthrosis of the hip joint does not have a single pathogenetic foundation. Many researchers are inclined to the version of ischemic processes that provoke the disease, when blood circulation and nutrition of the joint tissues are disturbed. Venous outflow is also disturbed, therefore, it changes its rhythm and arterial inflow. Due to hypoxia, the tissues accumulate unoxidized substances that cause destruction of the cartilage. Other versions call as the main causes mechanical factors that overload the joint, provoking its deformation, biochemical changes and depletion of the cartilaginous lining.

The causes of arthrosis of the hip joint, which today are taken as a basis: 

• Mechanical factors, overload of the joint apparatus - intensive physical activity (sports, overweight, physical work).
• Disturbance of blood supply to the joint. 
• Pathological changes in metabolism, provoking biochemical failures, hormonal imbalance. 
• Traumatic factor. 
• AN - aseptic necrosis of the head of the hip. 
• Inflammation of the joint of infectious etiology. 
• Pathological deformation of the spine because of flat feet, kyphosis and scoliosis. 
• Congenital dislocation of the femoral joint. 
• Dysplasia of the joint. 
• The age factor. 
• Genetic factor, presumably causing "weakness" of the musculoskeletal system, skeleton.

Deforming arthrosis of the hip joint is classified according to the possible etiology. There are the following types of coxarthrosis: 

• Primary deforming arthrosis of the hip joint, which is considered a disease of unspecified etiology and which often extends to the spine and knee joint. 
• Secondary arthrosis of the hip joint is coxarthrosis, which has a very obvious cause in the form of such diseases:
• Hip dysplasia is congenital (congenital dislocation).
• AN or aseptic necrosis, necrosis of the head of the femur due to impaired blood supply (embolism of nearby arteries).
• Osteochondropathy or Perthes disease
• Bruising, trauma, including hip fracture.
• Inflammation of the hip joint or coxitis.

. The deforming arthrosis of the hip joint can be diagnosed as one-sided, but also quite often the deformation affects both joints simultaneously.

Osteoarthritis of the hip joint: symptoms

Coxarthrosis is a disease that can begin after forty years, when quite explainable age-related hormonal changes occur and bone tissue needs additional stabilization.

Symptoms of arthrosis of the hip joint: 

• Pain localized in the region of the hip joint. Pain can increase due to meteorological factors, exacerbated by physical overload. 
• Intermittent claudication, shaky gait, fatigue when walking. 
• A characteristic crunch, which is a sign of an already developed disease. 
• Restriction of motor activity, stiffness of movements. 
• Atrophy of the muscle tissue of the thighs, buttocks.
• Reducing the tone leads to a decrease in the volume of the thighs. 
• Pain radiating to the knee joint.

Classification of arthrosis of the hip joint in terms of severity

[5], [6], [7], [8], [9], [10], [11]

Osteoarthritis of the hip joint of the 1st degree

This stage of coxarthrosis is characterized by transient pains that occur after intense physical exertion (running, physical work). The pain is localized in the femoral joint, sometimes it goes to the knee. Symptoms pass quickly after a short rest. The joint continues to work, its amplitude does not change.

Osteoarthritis of 2nd degree of hip joint

The second stage of the disease is characterized by a more intense symptomatology, as the pains begin to irradiate to the entire thigh, they do not pass during rest. Moreover, if a person continues to actively work and move, lameness may appear, since the hip joint is no longer able to function normally. Internal rotation is limited, hip withdrawal becomes difficult (flexion contracture). Muscles lose their tone, weaken.

Osteoarthritis of the hip joint coxarthrosis of the third degree

It is accompanied by constant pains, which intensify at night. Walking becomes difficult, causes severe pain, a person starts using a stick. The formation of the leading and flexing contracture passes into the final stage, accompanied by atrophy of the buttock, shin and thigh muscles. The pelvis leans forward, lumbar lordosis develops, the limb shortens. In this stage of the disease the joint is destroyed almost completely.

Osteoarthritis of the hip joint of the 4th degree

This ankylosis, that is, complete immobility, disability of the joint. There is a classification according to Kosinskaya, where the deforming arthrosis is divided into only three degrees.

How to diagnose arthrosis of the hip joint?

• Anamnesis. 
• Primary visual examination and orthopedic tests. 
• Direction for clinical laboratory studies of blood serum, including biochemical analysis. 
• X-ray of the hip joints. 
• Computer tomography of the hip joints.

Osteoarthritis of the hip joint: treatment

Deforming arthrosis of the hip joint treatment involves a symptomatic, at the first stage is a mandatory condition, since the pathogenesis of coxarthrosis is poorly understood. Medications for arthrosis of the hip joint are drugs that reduce painful sensations, which neutralize the statodynamic changes in the bone system.

How to cure arthrosis of the hip joint in the first and second stages?

As a rule, treatment at these stages of development of coxarthrosis is carried out on an outpatient basis, the therapeutic complex includes agents that relieve pain and inflammation, improve the trophicity of the surrounding tissues, increase the stability of the joint and activate blood supply in the area of inflammation. Medications for arthrosis of the hip joint in the period of exacerbation are prescribed in accordance with clinical manifestations. With severe pain, non-steroidal anti-inflammatory drugs - diclofenac, ibuprofen, indomethacin, nimulide, and orthophene are indicated. Sometimes analgesics are prescribed by injection, intramuscularly. Vitamin complexes and preparations containing aloe vera extract (vitreous, Rumalon) help to improve the oxidation-reduction processes in the cartilage.

Arthrosis of the hip joint treatment also includes intra-articular injections, which are used in extreme cases when therapy with tableted forms does not give stable results. Injection treatment is rather difficult, since the hip joint has an extremely narrow gap, which is even narrower in the course of the disease. Therefore, many doctors introduce a drug not an articular cavity, but into the periarticular region through the thigh. As a rule, corticosteroids are applied that relieve the pain symptom and improve the state of cartilage, this is kenalog, diprospan, hydrocortisone, flosteron. Also through the hip, chondroprotectors are injected - Objective T, alflutop. Chondroprotectors, preparations containing chondroitin sulfate and glucosamine, nutrients designed to restore cartilage structure and in tablet form are effective. Also relieve pain and inflammation compresses with a solution of dimexide, which need to take a course of 10 to 15 compresses. Massage with arthrosis of the hip joint is prescribed with caution and only after passing the primary medication course, which neutralizes pain and inflammation.

Arthrosis of the hip joint traction is a traction that helps to reduce the dynamic and static load on the damaged cartilage by means of the articulation of the joints. This procedure is rather painful, so the patient is fixed on a special table and to perform traction, and so that he does not aggravate the condition of the hip with a sharp movement. Hardware traction in recent years increasingly began to be replaced by a more effective in terms of effectiveness and less traumatic for the patient manual therapy.

Arthrosis of the hip joint operation is an extreme measure when the disease passes to the third stage. The choice of the method of surgery depends on the degree of degeneration and dystrophy of cartilage and tissues, the general state of health and concomitant diseases. Endoprosthetics partial is implantation of the Trotsenko-Nuzhdin plate. Total endoprosthetics is a complete replacement of the joint surface with a biocompatible construction that provides almost natural smoothness of movement in the hip joint.

After the operation, exercises for the restoration of the functions and properties of bone and muscle tissues are performed for arthrosis of the hip joint. This is the so-called isometric gymnastics, which involves the dosed tension of certain muscle groups. Then gymnastics with arthrosis of the hip joint includes gentle exercises aimed at restoring movements in the knee joint, a little later - exercises for the hip joint. Lfk with arthrosis of the hip joint is performed by sweat control of the attending physician and medical staff. In many clinics today there are special training rooms, where a professional instructor is engaged with the patient. Two weeks after the operation, the patient is allowed to walk with a support - a cane, crutches. A good effect after the seams are removed, gives a massage for arthrosis of the hip joint, performed in the water in the pool. Underwater massage perfectly strengthens and restores the muscle tissue surrounding the damaged joint surfaces. A month after the operation, careful walking with the load on the operated limb is allowed. Completely restore the motor activity provided that the exercises for arthrosis of the hip joint will be performed regularly and in full, maybe after six months. At home, you need to continue massage with arthrosis of the hip joint, involving kneading the muscles of the buttocks, thighs. Also shows swimming lessons. Long-term statistical loads, professional sports, contact sports should be excluded.

Diet for arthrosis of the hip joint

Nutrition for arthrosis of the hip joint is neither a basic nor even an auxiliary method of treating such a disease as coxarthrosis. However, the first thing that needs to be done is to normalize the body weight, since one of the factors that provoke the destruction of articular cartilage is overweight. The diet for arthrosis of the hip joint is also shown, which restores the total metabolism and is rich in Group B vitamins. It is useful to include in the diet all kinds of products containing phosphorus (fish, especially sea, eggs, cauliflower, beans), phospholipids and collagen. Collagen - it's all possible zhelenye dishes: jelly, jellied, fruit jelly, marmalade and so on. These products will help to restore cartilage and bone tissue more quickly.

If the disease is identified, treatment should be as comprehensive as possible - from medications to all possible additional methods. Both possible traction and exercise therapy for arthrosis of the hip joint are indispensable in combination with massage and diet therapy. Osteoarthritis of the hip joint is easier to prevent than diagnose and treat for a long time.

[12], [13], [14], [15]