Every year, diseases of the musculoskeletal system worry more and more people, and their development at a young age is increasingly observed. This is facilitated not only by a change in lifestyle, but also by an increase in the level of injuries, which is largely interconnected. One of the most common pathologies of the musculoskeletal system is arthrosis of the hip joint, which is characterized by the onset of progressive pain and limited mobility. Ultimately, the disease can lead to complete joint immobility and disability. In order to avoid the appearance of such undesirable consequences, it is important to start treatment for arthrosis as early as possible. And if in the early stages of development it can be stopped by conservative methods, then in case of severe changes it is possible to restore the functions of the hip joint and eliminate unbearable pain only at theusing a high-tech operation.
What is osteoarthritis of the hip joint
Osteoarthritis of the hip joint is a chronic dystrophic degenerative disease in which the progressive destruction of the hip joint occurs. At the same time, all its components are gradually involved in the pathological process, but the hyaline cartilage is especially affected, which leads to a narrowing of the joint space and deformation of its other components. Most often, pathological changes occur in a single hip joint, although both can also be affected simultaneously.
The hip joints are the largest in the human body, as they bear the greatest load during the day. Each of them is formed by the head of the femur and the acetabulum, which is a bowl-shaped depression in the pelvis. Both surfaces are covered with smooth, moderately elastic hyaline cartilage. It is he who ensures the softness and the unhindered sliding of the femoral head in a natural depression and thus allows to perform movements in different planes.
The movement of the hip joint is provided by a group of muscles connected to it by fascia. It is also surrounded by ligaments whose tasks are to limit its mobility within physiological limits and to ensure the stability of its position.
The entire joint is surrounded by a joint capsule covered with a synovial membrane. Its main task is the synthesis of synovial fluid, which lubricates the adjoining parts of the hip joint and at the same time acts as a carrier of nutrients for it. It is from the synovial fluid that the hyaline cartilage covering the femoral head and the surface of the acetabulum constantly receives components for the formation of new cells, that is, regeneration. This is extremely important for this cartilaginous formation, because with each movement of the hip it wears out, but normally it is immediately restored. But when injured or under the influence of other factors, this does not occur, which leads to the development of arthrosis of the hip joint, that is, thinning and destruction ofits hyaline cartilage.
As a result, deformed areas are formed in an ideally smooth cartilage, which increases as the pathology progresses. As it is abraded, the surfaces of the bones that form the joint are exposed. When they come into contact, there is a characteristic crunch and severe pain. This causes osteophytes to form, and in later stages of development the femoral head fuses completely with the acetabulum, making movement of the hip joint impossible.
At the same time, osteoarthritis of the hip joint can cause various inflammatory processes to develop inside the joint, including:
- bursitis - inflammation of the synovial sac;
- tendovaginitis - an inflammatory process in the sheath of the tendon sheath of the muscles;
- tunnel syndrome - compression of the nerves, causing radiating pain along the strangulated nerve.
The reasons
One of the common causes of the development of arthrosis of the hip joint is mechanical damage, not only direct injury, but also microdamage caused by the destructive effect of excessive loads on it. One of the most common causes of the development of the disease is a fracture of the femoral neck.
It departs from the femur at an angle of 120° and connects it to the head. The presence of osteoporosis greatly increases the likelihood of a hip fracture, but this type of injury can also be the result of a traffic accident, a fall on the feet from a height, aimpact, etc.
A fracture of the femoral neck can be accompanied by aseptic necrosis of the femoral head, which will become a trigger for the development of degenerative-dystrophic changes in the joint. The presence of dysplasia or subluxation of the hip joint, ruptures of its ligaments, transcondylar fractures or fractures of the acetabulum also create favorable conditions for damage to its structures. In such situations, post-traumatic arthrosis of the hip joint is diagnosed.
Often, post-traumatic hip osteoarthritis occurs in light and professional weightlifters, skydivers, loaders and skaters.
The development of arthrosis of the hip joint after injury is due to a violation of the congruence (comparability) of the articular surfaces, a decrease in the quality of blood supply to the articular components and prolonged immobilization. As a result of prolonged immobility, there is not only a deterioration in blood circulation in the fixed area, but also a shortening of the muscles, a decrease in their tone. The likelihood of post-traumatic arthrosis increases significantly when an inappropriate situation or untimely treatment is performed, which leads to the preservation of defects of varying severity. In addition, the risks of its development increase with too early loading of the joint and therapy with inadequate exercises, including too intense, started late or vice versa early.
Sometimes the disease occurs after surgeries on the hip joint due to scar formation and additional tissue trauma. Although in some cases surgery is the only way to eliminate the consequences of the injury.
Excessive loads can also cause changes in the hip joint, as they lead to microtrauma. Regular tissue damage activates the process of division of chondrocytes (cartilage tissue cells). This is accompanied by an increase in the intensity of the production of cytokines, which are normally produced in small quantities. Cytokines are mediators of inflammation, in particular the cytokine IL-1 leads to the synthesis of specific enzymes which destroy the hyaline cartilage of the hip joint.
In addition, high loads can cause microfractures of the subchondral plate. This leads to its gradual compaction and the formation of bony growths on the surface, which are called osteophytes. They can have sharp edges and cause more damage to the joint, as well as injury to surrounding tissue.
The subchondral plate is the extreme part of the bone which is in direct contact with the hyaline cartilage.
In some cases, it is not possible to determine exactly what caused the development of degenerative-dystrophic changes in the hyaline cartilage of the femoral head and acetabulum. In such situations, idiopathic or primary arthrosis of the hip joint is diagnosed.
Today it is established that the tendency to develop it can be hereditary, that is, the presence of this pathology in close relatives significantly increases the risk of developing arthrosis of the hip. Presumably, he has a polygenic inheritance, that is, his development depends on the presence of many genes. Each of them individually creates mild prerequisites for the development of the disease, but when combined it becomes a matter of time, especially when leading a sedentary lifestyle and obesity, or vice versa, workpainful physical.
There is a theory that osteoarthritis of the hip joints is the result of a congenital or acquired mutation in the type II procollagen gene.
There is also secondary arthrosis of the hip joint, which develops against the background of the presence of concomitant diseases and age-related changes.
Symptoms
The disease is characterized by the appearance of pain, limited mobility and squeezing of the hip joint, the severity of which directly depends on the degree of neglect of pathological changes. At the later stages of development, one can observe a shortening of the affected leg and complete immobility of the hip joint, which is due to the complete fusion of the bone structures that make it up.
Initially, the disease can progress without pronounced signs and cause mild, short-term pain. As a rule, they appear after physical exertion, including walking, carrying heavy loads, squatting, bending. But as the degenerative-dystrophic changes in the joint progress, the pain intensifies. Over time, they not only become more intense, but also last longer, and the interval between the start of physical activity and their onset is also reduced. At the same time, even long rest may not bring relief. Subsequently, pain can torment a person even with prolonged immobility of the hip joint, for example, after a night's sleep.
If intra-articular structures impinge on nearby nerves, pain may radiate to the groin, buttocks, thigh, and knee. However, they tend to intensify with hypothermia. At the last stage of the development of the disease, the pain becomes unbearable. This causes an unconscious desire to feel sorry for the leg and put less stress on it, which leads to lameness.
Another symptom of osteoarthritis of the hip joint is a decreased range of motion. Most often there is a limitation in the ability to turn the leg inward and outward, to lift the bent leg at the knee to the chest. Over time, so-called morning stiffness occurs, which disappears after the patient "diverges". Subsequently, a compensatory curvature of the pelvis is possible, which leads to a change in gait. In the future, patients will completely lose the ability to perform certain movements with the affected leg.
If arthrosis of both hip joints develops at the same time, the development of the so-called duck gait with the pelvis retracted and the body deflected forward is observed.
All this can be accompanied by the formation of edema in the hip joint. But in the presence of excess weight, they can go unnoticed.
Often during movements, especially those of the extensors, a crackle occurs in the affected joint. It is a consequence of the exposure of the bony surfaces of the femoral head and acetabulum and their friction with each other. In this case, there is a sharp increase in pain.
Also, with arthrosis of the hip joint, painful spasms of the femoral muscles may occur. With extremely advanced degenerative-dystrophic diseases, when the joint space almost completely disappears and the femoral head begins to flatten, a shortening of the affected limb by 1 cm or more is observed.
In general, there are 3 degrees of arthrosis of the hip joint:
- Grade 1 - the joint space of the hip joint is narrowed, and the edges of the bone structures are slightly sharp, which indicates the beginning of the formation of osteophytes. Clinically, there is a slightly pronounced pain syndrome and some movement restrictions.
- Grade 2 - the joint space is narrowed by more than 50%, but less than 60%. Significant osteophytes are observed, as well as signs of cysts in the epiphyses of the bones. Patients note significant limitations of movement in the hip joint, the presence of a creak during movement, pain and atrophy of the thigh muscles of varying severity can be traced.
- Grade 3 - the joint space is reduced by more than 60% or is completely absent, and osteophytes occupy a large area and are large in size, subchondral cysts are observed. The hip joint is stiff, the pain may become unbearable.
Diagnostic
The appearance of pain and other symptoms characteristic of arthrosis of the hip joints is the reason for contacting an orthopedist. The doctor will be able to suspect his presence, especially if he has already suffered injuries to the hip or pelvis, already on the basis of the data obtained during the interview and examination.
The presence of osteoarthritis of the hip joint results in pain whose intensity increases over several years. Much less often there is a rapid development of degenerative-dystrophic changes, when several months pass from the appearance of the first signs to a powerful permanent pain syndrome. This is characterized by increased pain when standing or performing physical labor. Also, for arthrosis, the presence of morning stiffness, which lasts up to half an hour, is typical and also occurs after prolonged immobility. Gradually, there is an increase in mobility restrictions and deformity of the hip joint, which the orthopedist may notice in the later stages of development during the examination.
Nevertheless, all patients are necessarily assigned instrumental research methods, with the help of which it will be possible to confirm the presence of arthrosis of the hip and establish its degree, as well as to differentiate it from some other accompanied diseasessimilar symptoms. As a rule, diagnosis is carried out using:
- X-ray - can detect the main signs of osteoarthritis, including the narrowing of the joint space and the presence of osteophytes. But recently, computed tomography has become a more informative research method, which allows to assess the condition of the hip joint with greater accuracy.
- MRI is a very informative method for diagnosing various changes in the condition of soft tissue structures, including cartilage tissue, which allows you to detect the slightest signs of hyaline cartilage degeneration.
In addition, patients may be prescribed laboratory tests including KLA, OAM, biochemical blood test, etc. They are required to establish concomitant diseases that created prerequisites for the development of secondary arthrosis of the hip joint.
Treatment of osteoarthritis of the hip joint without surgery
Treatment of degenerative-dystrophic changes in the hip joint by the methods of conservative therapy is possible only with arthrosis of the 1st and 2nd degrees. The prescribed measures can improve the patient's condition, stop or at least slow down the progression of the pathology and thus maintain working capacity. But they cannot lead to a complete regression of the changes that have already occurred in the joint.
Today, as part of the conservative treatment of arthrosis of the hip joint, the following are prescribed:
- pharmacotherapy;
- exercise therapy;
- physiotherapy.
Also, patients are advised to make certain lifestyle adjustments. So, in the presence of excess weight, one should take measures to reduce it, that is, increase the level of physical activity and reconsider the nature of nutrition. If the patient is actively involved in sports and overloads the joint, which causes microtrauma, it is recommended to reduce the intensity of training.
medical therapy
Drug treatment of arthrosis of the hip joint is always complex and includes drugs of different groups aimed at reducing the severity of the symptoms of the disease and improving the flow of metabolic and other processes in the joint. This:
- NSAIDs - drugs with anti-inflammatory and analgesic effects, produced both in oral form and in the form of local agents, which allows you to choose the most effective and convenient option for use;
- corticosteroids - drugs with powerful anti-inflammatory properties and in most cases used in the form of a solution for injection, since when choosing systemic treatment they cause the development of undesirable side effects;
- chondroprotectors - drugs synthesized from natural components of cartilage tissue used by the body to restore it (prescribed for long courses);
- muscle relaxants - drugs indicated for muscle spasms, which cause pain of varying intensity;
- B vitamins - help improve nerve conduction, which is necessary for the development of carpal tunnel syndrome;
- preparations that improve microcirculation - help increase the intensity of blood circulation in the affected area, which leads to an increase in the rate of metabolic processes and helps restore damaged cartilage.
If concomitant diseases are detected, consultation of relevant specialists and appropriate treatment are indicated.
With a very strong debilitating pain syndrome that cannot be eliminated with the help of prescribed NSAIDs, intra-articular or periarticular blockages can be performed. They involve the injection of a local anesthetic in combination with a corticosteroid directly into the joint cavity, which quickly leads to an improvement in well-being. But procedures of this type can be performed only in a medical institution by a qualified specialist, otherwise the risk of complications is high.
exercise therapy
Physical therapy exercises play one of the main roles in the non-surgical treatment of hip osteoarthritis, both idiopathic and post-traumatic. But a set of exercises should be selected on an individual basis, taking into account the nature of the previous injury, the level of physical development of the patient and existing concomitant diseases.
Exercise therapy should be performed daily in comfortable, unhurried conditions. All movements should be performed smoothly, without jerks, so as not to harm the already deformed hip joint. This will allow :
- reduce the intensity of the pain syndrome;
- increase joint mobility;
- reduce the risk of muscle atrophy;
- increase the intensity of blood circulation and metabolic processes.
Physiotherapy
To increase the effectiveness of the prescribed measures, patients with arthrosis of the hip are often recommended to undergo a series of physiotherapy procedures. Traditionally, we choose those that have anti-inflammatory, anti-edematous and analgesic effects. This:
- ultrasound therapy;
- electrophoresis;
- magnetic therapy;
- laser therapy;
- shock wave therapy, etc.
In some cases, plasmolifting is indicated, that is, the introduction of the patient's own blood plasma purified and saturated with platelets. To obtain it, venous blood is taken, which is then subjected to centrifugation. Accordingly, it is divided into erythrocyte mass and plasma, which is used to treat degenerative-dystrophic changes in the hip joint.
Hip osteoarthritis surgery
When diagnosing osteoarthritis of the hip joint of the 3rd degree, surgery is indicated for patients. It can also be carried out with the ineffectiveness of conservative treatment and persistent pain and mobility restrictions already in the 2nd stage of the development of the disease.
In general, the indications for hip surgery are:
- a significant decrease in the size of the joint space;
- the presence of severe and persistent pain;
- significant mobility restrictions.
Arthroplasty is the most effective and safest operation for osteoarthritis of the hip joint. Today it is recognized as the gold standard for the treatment of this pathology, regardless of the reasons for its development. The essence of this type of surgical intervention is to replace part of the components of the hip joint or its entirety with artificially created endoprostheses. The prostheses themselves are made from biocompatible materials and are durable.
Their installation allows you to completely restore the normal mobility of the pathologically impaired hip joint, eliminate pain and give the patient the opportunity to lead a full life. For each patient, the type of arthroplasty is selected individually depending on the degree of destruction of the various components of the joint.
The most effective is the total or total hip prosthesis. It consists of replacing the entire joint with an artificial endoprosthesis, ie the acetabulum, the femoral head and its neck. Such prostheses can serve without interruption for 15-30 years and ensure the restoration of the full volume of the functioning of the joint.
They are installed without cement or using special cement. The first method is more suitable for young patients, as it involves fixing the prosthesis in the pelvis, growing into the spongy layer of its own bone. For the elderly, the method of installing a stent using cement is more suitable, which firmly holds the artificial material to the bone surfaces even in the presence of osteoporosis.
If the normal hyaline cartilage lining the surface of the acetabulum is preserved, patients may be offered partial arthroplasty. Its essence is to replace only the head and neck of the femur with an endoprosthesis. Today, there are 2 types of such structures: monopolar and bipolar.
The first are less reliable, after their installation, it then becomes necessary to resort to total arthroplasty. This is due to the fact that the replaced artificial femoral head, during movement, rubs directly against the cartilage of the acetabulum, which causes its faster wear.
Bipolar stents do not have such a drawback, because the artificial femoral head is already enclosed in a special capsule adjacent to the acetabulum. Therefore, the cartilage covering it is not deformed, because the capsule serves as a sort of buffer and artificial replacement for the natural hyaline cartilage of the femoral head.
Nevertheless, regardless of the type of endoprosthesis performed, postoperative rehabilitation is indicated for all patients. It consists in the appointment of drug therapy, exercise therapy and therapeutic massage. Recovery time depends on individual characteristics. But it is important to remember that the effectiveness of the operation directly depends on the quality of compliance with the doctor's recommendations during the rehabilitation period.
Thus, arthrosis of the hip joint is a common disease of the musculoskeletal system, which can occur even in the absence of direct prerequisites for its development. This pathology can lead not only to severe pain, but also to disability, so it is important to diagnose and take measures to stop its progression at the first signs. Nevertheless, the current level of development of medicine makes it possible to cope with advanced cases of arthrosis of the hip joint and restore its full range of motion, as well as permanently get rid of severe pain.