Osteoarthritis of the hip.

Arthrosis of the hip joint, or coxarthrosis, is characterized by a course with progressive dynamics, disrupting all statodynamic functions of the musculoskeletal system. Arthrosis 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 changes in joints 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 - dystrophy of the articular cartilage, which quickly becomes thinner, deteriorates and loses its shock-absorbing properties. To compensate for the loss of shock-absorbing properties, the body starts the mechanism of formation of bone marginal growths, as a result, the surrounding tissues become sclerotic, cysts are formed in the areas of articulation of the head of the femur and the glenoid fossa - the acetabulum.

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What causes hip osteoarthritis?

Despite its widespread prevalence and rather long, centuries-old history, hip arthrosis does not have a single pathogenetic basis. Many researchers are inclined to believe that the disease is caused by ischemic processes, when blood circulation and nutrition of the joint tissues are disrupted. Venous outflow is also disrupted, therefore, its rhythm and arterial inflow change. Due to hypoxia, non-oxidized substances accumulate in the tissues, which provoke the destruction of cartilage. Other versions name mechanical factors as the main causes, which overload the joint, provoking its deformation, biochemical changes and depletion of the cartilaginous pad.

The causes of hip arthrosis that are accepted today as a basis are:

• Mechanical factors, overload of the articular apparatus – intense physical activity (sports, excess body weight, physical work).
• Violation of blood supply to the joint.
• Pathological changes in metabolism, provoking biochemical disruptions, hormonal imbalance.
• Traumatic factor.
• AN – aseptic necrosis of the femoral head.
• Inflammation of the joint of infectious etiology.
• Pathological deformation of the spine due to flat feet, kyphosis and scoliosis.
• Congenital dislocation of the hip joint.
• Joint dysplasia.
• Age factor.
• A genetic factor that is believed to cause "weakness" of the musculoskeletal system and skeleton.

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

• Primary deforming arthrosis of the hip joint, which is considered a disease of unspecified etiology and which often spreads to the spine and knee joint.
• Secondary arthrosis of the hip joint coxarthrosis, which has a very clear cause in the form of such diseases:
• Congenital hip dysplasia (congenital dislocation).
• AN or aseptic necrosis, necrosis of the femoral head due to impaired blood supply (embolism of nearby arteries).
• Osteochondropathy or Perthes disease
• Contusion, injuries, including a fractured femoral neck.
• Inflammation of the hip joint or coxitis.

Deforming arthrosis of the hip joint can be diagnosed as unilateral, but also quite often the deformation affects both joints simultaneously.

Hip Arthrosis: Symptoms

Coxarthrosis is a disease that can begin after forty years of age, when completely understandable age-related hormonal changes occur and bone tissue requires additional stabilization.

Signs of hip arthrosis:

• Pain localized in the hip joint area. The pain may increase due to meteorological factors and worsen due to physical overload.
• Intermittent claudication, unsteady gait, fatigue when walking.
• A characteristic crunch, which is a sign of an already developed disease.
• Limited motor activity, stiffness of movements.
• Atrophy of muscle tissue of the thighs and buttocks.
• Decreased tone leads to a decrease in the volume of the hips.
• Pain radiating to the knee joint.

Classification of hip arthrosis by severity

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Arthrosis of the hip joint grade 1

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

Arthrosis of the hip joint grade 2

The second stage of the disease is characterized by more intense symptoms, since the pain begins to radiate to the entire hip area, and does not go away even when resting. Moreover, if a person continues to work and move actively, lameness may occur, since the hip joint is no longer able to function normally. Internal rotation is limited, hip abduction becomes difficult (flexion contracture). The muscles lose tone and weaken.

Arthrosis of the hip joint coxarthrosis grade 3

Accompanied by constant pain, which intensifies at night. Walking becomes difficult, causes severe pain, the person begins to use a stick. The formation of adductor and flexor contracture passes into the final stage, accompanied by atrophy of the muscles of the buttocks, shin and thigh. The pelvis tilts forward, lumbar lordosis develops, the limb shortens. At this stage of the disease, the joint is almost completely destroyed.

Arthrosis of the hip joint grade 4

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

How to diagnose hip arthrosis?

• Collection of anamnesis.
• Initial visual examination and orthopedic tests.
• Referral for clinical laboratory tests of blood serum, including biochemical analysis.
• X-ray of the hip joints.
• Computed tomography of the hip joints.

Hip Arthrosis: Treatment

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

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

As a rule, treatment at these stages of coxarthrosis development is carried out on an outpatient basis, the therapeutic complex includes drugs that relieve pain and inflammation, improve trophism of tissues surrounding the joint, increase joint stability and activate blood supply in the inflammation zone. Medicines for hip arthrosis during an exacerbation are prescribed in accordance with clinical manifestations. In case of severe pain, non-steroidal anti-inflammatory drugs are indicated - diclofenac, ibuprofen, indomethacin, nimulide, orthofen. Sometimes analgesics are prescribed by injection, intramuscularly. Vitamin complexes and drugs containing aloe extract (vitreous body, rumalon) help improve oxidation-reduction processes in cartilage.

Treatment of hip joint arthrosis also includes intra-articular injections, which are used in extreme cases when therapy with tablet forms does not give lasting results. Injection treatment is quite difficult, since the hip joint has an extremely narrow gap, which is narrowed even more during the disease. Therefore, many doctors inject the drug not into the joint cavity, but into the periarticular region through the hip. As a rule, corticosteroids are injected, relieving pain and improving the condition of the cartilage, these are Kenalog, Diprospan, Hydrocortisone, Flosteron. Chondroprotectors are also injected through the hip - Ziel T, Alflutop. Taking chondroprotectors is effective - drugs that include chondroitin sulfate and glucosamine, nutrients designed to restore the structure of the cartilage and in tablet form. Also, compresses with a solution of dimexide relieve pain and inflammation, which should be taken in a course of 10 to 15 compresses. Massage for arthrosis of the hip joint is prescribed with caution and only after completing the initial course of medication, neutralizing pain and inflammation.

Hip joint arthrosis traction is a traction that helps to reduce the dynamic and static load on the damaged cartilage by spreading the joint ends. This procedure is quite painful, so the patient is fixed on a special table both to perform traction and to prevent him from worsening the condition of the hip joint with a sharp movement. Hardware traction has recently been increasingly replaced by manual therapy, which is more effective in terms of results and less traumatic for the patient.

Hip joint arthrosis surgery is an extreme measure when the disease progresses to the third stage. The choice of the surgical method depends on the degree of degeneration and dystrophy of cartilage and tissues, general health condition and concomitant diseases. Partial endoprosthetics consists of implantation of the Trotsenko-Nuzhdin plate. Total endoprosthetics is a complete replacement of the articular surface with a biocompatible structure that provides almost natural smoothness of movement in the hip joint.

After the operation, exercises for hip arthrosis are performed to restore the functions and properties of bone and muscle tissue. This is the so-called isometric gymnastics, which involves dosed tension of certain muscle groups. Then, gymnastics for hip arthrosis includes gentle exercises aimed at restoring movement in the knee joint, and a little later - exercises for the hip joint. Physical therapy for hip arthrosis is performed under the supervision of the attending physician and medical staff. Many clinics today have special training rooms where a professional instructor works with the patient. Two weeks after the operation, the patient is allowed to walk with the help of a support - a cane, crutches. A good effect after the stitches are removed is given by massage for hip arthrosis, performed in water, in a pool. Underwater massage perfectly strengthens and restores muscle tissue surrounding the damaged joint surfaces. A month after the operation, careful walking with a load on the operated limb is allowed. It is possible to fully restore motor activity, provided that exercises for hip arthrosis are performed regularly and in full, after six months. At home, it is necessary to continue massage for hip arthrosis, which involves kneading the muscles of the buttocks and thighs. Swimming is also recommended. Long-term static loads, professional sports, and contact sports should be excluded.

Diet for hip arthrosis

Nutrition for hip arthrosis is neither the main nor even an auxiliary method of treating a disease such as coxarthrosis. However, the first thing to do is to normalize body weight, since one of the factors that provoke the destruction of articular cartilage is excess weight. A diet for hip arthrosis is also indicated, which restores the general metabolism and is rich in B vitamins. It is useful to include in the diet all types of products containing phosphorus (fish, especially sea fish, eggs, cauliflower, beans), phospholipids and collagen. Collagen is all possible jellied dishes: aspic, jellied meat, fruit jelly, marmalade, and so on. These products will help to quickly restore cartilage and bone tissue.

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

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