Arthrosis of the hip joint is a very complex disease in which the destruction of the hyaline cartilage that lines the surface of the femoral head (it has a spherical shape) and the acetabulum occurs. Arthrosis is a degenerative disease that most often develops in older people.
Specialized periodicals often publish the results of surveys and medical studies, according to which the female half of the population who have reached the age of 40 are most susceptible to arthrosis of the hip joint. This is primarily due to the anatomical features of the female hip joint, which has a different shape and position than in men. Such differences can be explained by the fact that the hip joint plays an important role in the process of childbirth. The bones of the female pelvis experience heavy stress every day, as a result of which they are more often susceptible to various diseases. Males at a later age (by the age of 60) may experience arthrosis.
blood loss during surgery;
thromboembolism (pulmonary artery) – 0.05% of cases;
development of infection (after surgery) – 0.5%-2% of cases.
Modern medicine divides this disease into the following categories:
Primary arthrosis develops for no apparent reason.
Secondary arthrosis develops against the background of previous injuries to the hip joint.
To date, the following reasons for the development of arthrosis of the hip joint have been identified:
depression, as well as prolonged exposure to stress;
excess weight (even a slight gain of excess weight can cause the development of this disease, since additional stress will be placed on the joints);
suffered injuries: sprains, bruises, blows, fractures, etc.;
damage to cartilage tissue in the joint;
diseases of the endocrine system (in particular diabetes mellitus) that have a negative impact on the functioning of the adrenal glands;
poor heredity, against which a joint deformity may develop (a genetic predisposition to arthrosis is the most common cause of this disease);
displacement or curvature of the femurs;
hip dysplasia (most often diagnosed in newborns);
protrusion of the acetabulum;
sedentary lifestyle;
changes in the structure of blood vessels;
disruption of metabolic processes in the body;
high concentration of uric acid in the patient’s blood (determined by laboratory blood testing);
gout, osteoradionecrosis, bone tuberculosis, Perthes disease, rheumatoid arthritis and other diseases in which the hip joint becomes infected with bacteria;
degeneration of the synovial membrane of the joint into cartilage;
poor circulation in the hip joint;
hormonal disorders in the body;
severe physical stress exerted on the hip joint during sports;
difficult working conditions;
advanced age, etc.
severe pain in the area of the hip and knee joint, as well as in the groin (pain syndrome accompanies this disease constantly, and as arthrosis progresses, it can integrate into the area of the lower extremities);
impaired motor function (due to excruciating pain, patients cannot move independently, which is why they are forced to use special devices: crutches, canes);
shortening of the lower (arthrosis-affected) limb;
crunching in the joint that occurs with any movement;
lameness and gait disturbance;
stiffness and limited movements of the limbs;
When performing X-rays in this category of patients, atrophy of the muscle tissue located in the thigh area is revealed;
during hardware diagnostics, bone growths may be detected in patients;
at the 2nd stage of arthrosis, patients experience deformation and upward displacement of the head of the femoral bone (it significantly increases in size and acquires uneven outlines);
with the 3rd degree of arthrosis in patients, the head of the femoral bone expands, as a result of which the joint space begins to narrow, etc.
Today, medicine knows three degrees of arthrosis of the hip joint. They are accompanied by certain symptoms and directly depend on the stage of the disease.
With the development of arthrosis of the hip joint of the 1st degree, the following occurs:
the liquid begins to lose its properties;
the consistency of the liquid becomes more viscous;
the fluid is not able to ensure unimpeded movement of the joint.
At the first stage of this disease, the structure of the cartilage tissue begins to deteriorate and microcracks form in it. Over time, as arthrosis progresses, thinning of the cartilage tissue is observed. In many patients, replacement processes begin to occur, against the background of which bone growths form at the location of the cartilage.
At the first stage, arthrosis of the hip joint is very easy to completely cure. The problem is that patients, due to late access to specialists, cannot receive medical care. That is why doctors strongly recommend that people who discover any of the symptoms of arthrosis immediately visit the nearest clinic and undergo a comprehensive diagnosis.
thinning of cartilage tissue;
narrowing of the space between parts of the joint;
changes in the structure of the femoral head;
the appearance of various neoplasms;
displacement of the head of the hip joint;
the number of bone growths (osteophytes) increases.
When carrying out diagnostic measures in this category of patients, inflammation of the periosteum is detected. If this disease is not treated, patients will experience increased pain, motor functions will be impaired, and muscle tissue dystrophy will develop in the lower extremities. Such patients will experience unbearable pain, even while at rest.
During the transition of arthrosis of the hip joint to the third stage, patients experience:
almost complete destruction of hyaline cartilage tissue;
impairment of motor functions (patients have limited movements);
shortening of the lower limb;
severe narrowing of the joint space;
spread of bone formations (spike-shaped), etc.
At the 3rd stage, treatment of this disease is possible only surgically, since no medications can restore cartilage and restore mobility to a person. Currently, this category of patients undergoes sparing operations, during which the damaged hip joint is replaced with an artificial prosthesis. Thanks to endoprosthetics, patients, after undergoing long-term rehabilitation, can return to normal life.
Deforming arthrosis of the hip joint (coxarthrosis) is a severe form of osteoarthritis. This form of the disease is most often (40% of cases) diagnosed in patients who visited a medical facility for problems with the musculoskeletal system. Both women and men who have reached the age of 40 suffer from deforming coxarthrosis. According to world statistics, deforming arthrosis of the hip joint is more often diagnosed in the female half of the population.
There are a large number of factors that provoke the development of coxarthrosis. The most important reason for the appearance of this disease is poor circulation in the pelvic organs. As a result, harmful enzymes begin to accumulate in the body of patients, which have a negative effect on cartilage, leading to their gradual destruction.
The causes of coxarthrosis include physical and mechanical effects on the hip joint. Most often, this disease manifests itself in people who are professionally involved in sports. Excess weight also puts stress on both the patient's joints and his body as a whole. Deforming arthrosis of the hip joint is usually accompanied by severe pain and limited mobility of the lower extremities. These symptoms should alert the patient and encourage him to contact a specialized medical institution. At the appointment, the patient will be examined and given an x-ray, which will determine the degree of damage and the type of arthrosis.
Many people who develop hip arthrosis may experience pain when moving or doing any other physical activity. Initially, pain occurs only during physical fatigue, but subsequently patients begin to experience pain even during rest. Pain sensations are often integrated from the hip joint to the lower back, knee, hip, etc. Against the background of pain, some people begin to self-medicate, which often leads to irreversible consequences. That is why it is necessary, when such a primary symptom of arthrosis appears, to contact highly qualified specialists who will carry out a diagnosis.
When visiting a medical facility, patients who suspect hip arthritis should seek advice from the following specialists:
Therapist. This specialist will assess the patient’s general health and determine the cause of the pain syndrome (sometimes pain occurs due to the progression of various chronic diseases).
Neurologist. Very often, pain in the hip joint is a consequence of the formation of intervertebral hernias, so if such symptoms appear, consultation with a specialist is important.
Urologist. In the male half of the population, pain in the hip joint occurs as a result of inflammatory processes in the prostate gland. A consultation with a urologist will confirm or refute this suspicion.
Gynecologist. All women who come to a medical facility with complaints of pain in the hip joint are referred to this specialist. This is due to the fact that during the development of adhesions in the pelvic organs, patients often experience pain, therefore, when diagnosing arthrosis, it is important to obtain the opinion of this highly specialized specialist.
Rheumatologist or arthrologist. These specialists can diagnose arthrosis of the hip joint in the early stages of its development. With a timely visit to a rheumatologist or arthrologist, the patient will be guaranteed a successful cure for this disease.
Orthopedist and surgeon. Patients with advanced stage arthrosis of the hip joint are referred to these specialists.
When carrying out diagnostic measures, the specialist will first conduct a personal examination of the patient and collect a history of the disease. During palpation, he will be able to palpate the upper third of the lateral surface of the thigh and identify serious damage to it.
A specialist can carry out a number of simple manipulations, thanks to which it will be possible to make a preliminary diagnosis - arthrosis of the hip joint:
flexion and extension of the lower extremities;
turns the lower extremities in and out, etc.
To make an accurate diagnosis, patients are prescribed hardware and laboratory examinations:
x-ray examination (an x-ray will reveal any damage to the hip joint);
ultrasound examination of the pelvic area;
magnetic resonance or computed tomography (this diagnostic method allows you to identify arthrosis at the very initial stage of development, when it is not yet accompanied by pronounced symptoms);
laboratory testing of blood and urine (clinical, biochemical) will reveal any inflammatory processes in the patient’s body.
The main task of hardware diagnostics is to identify arthrosis of the hip joint, as well as determine the degree of this disease. It is very important to determine the cause of arthrosis, since the method of treating this disease will depend on this.
There are diseases (for example, bone tuberculosis) that provoke the development of arthrosis, for which traditional treatment cannot be carried out (such diseases can be detected by laboratory tests of urine and blood):
use ointments and gels that have a warming effect;
physiotherapeutic procedures performed at high temperatures;
physical therapy, etc.
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At the first stage, arthrosis of the hip joint responds well to conservative treatment. The first task of the attending physician is to relieve pain that prevents the patient from moving.
During drug treatment the following is performed:
restoration of damaged cartilage;
restoration of nutrition and blood circulation in muscle and cartilage tissues;
physical stress on the damaged joint is reduced;
activation of hidden reserves of the human body, which will promote tissue regeneration at the microcellular level;
increased joint space;
restoration of joint mobility, etc.
During drug treatment of arthrosis of the hip joint, the following drugs are prescribed to this category of patients:
drugs that have an anti-inflammatory effect (non-steroidal);
muscle relaxants that restore blood circulation in muscle and cartilage tissues;
chondroprotectors that can restore joint function and stop their destruction;
steroids are prescribed to patients by injection during an exacerbation of the disease to eliminate pain;
medications that can dilate blood vessels, etc.
During conservative treatment, patients should adhere to a diet specifically designed for patients with arthrosis of the hip joint. The course of therapeutic therapy includes therapeutic massage, which is indicated for patients with stages 1 and 2 of arthrosis.
At the 3rd stage of arthrosis of the hip joint, patients undergo surgical treatment of this disease.
Before surgery, each patient must undergo mandatory preparation:
take blood and urine tests;
undergo a hardware examination (ultrasound, x-ray, fluorography, cardiogram, EEG, etc.);
get advice from highly specialized specialists who will give permission for the operation (therapist, rheumatologist, arthrologist, orthopedist, etc.).
The day before surgery, the patient must stop eating solid food. It is mandatory to cleanse the intestines (this can be done either with special medications or with an enema). In the evening, the patient will be given a sedative injection to help him fall asleep. Before surgery, the patient should empty his bladder, into which a catheter will be inserted (it will drain urine during the operation). The patient, in the operating room, will have to lie on his side, after which the surgeon will make markings.
Endoprosthesis replacement is performed under general anesthesia (the type of which is chosen by the anesthesiologist based on the state of the patient’s cardiovascular system), after which the patient will come to his senses within a few hours. To prevent the appearance of a gag reflex after anesthesia, you should limit your fluid intake for 5-6 hours. If the patient is extremely thirsty, he should moisten his lips with gauze or a cotton pad.
In order to prevent the formation of blood clots in the lower extremities, each patient's legs (to the knees) are wrapped in elastic bandages. He should wear such a tight bandage for 3-5 days after surgery, especially when moving (if the patient is in bed, in a supine position, he can remove the elastic bandages).
During endoprosthetics, the surgeon performs the following actions:
cuts off the head of the femur;
a pin made of a special metal used in the medical industry is inserted into the bone cut;
the endoprosthesis is tightly fixed on the installed pin (it has an exact copy of the femoral head).
During surgery, the surgeon partially removes the surface of the pelvic bone. Instead, a stock made of polymer materials is installed. This stock is firmly connected to the titanium head, thanks to which the joint can continue to function fully for 20 years. At the final stage of the surgical intervention, the wound is sutured and after that a sterile bandage treated with antiseptic agents is applied to its surface.
Currently, surgeons perform endoprosthesis fixation in two ways:
using a fragment of spongy bone (the prosthesis is driven in);
using special medical cement (it is used in surgical treatment of bones).
Many specialists prefer to use bone cement during endoprosthetics, which very firmly fixes the prosthesis and allows patients to move independently after the postoperative scar has healed. This method is ideal for elderly patients. After such endoprosthetics, there is no need for a repeat operation, the purpose of which is to replace the endoprosthesis.
After completing a course of treatment for arthrosis of the hip joint, patients need to gradually return to their usual rhythm of life. Much attention should be paid to restoring motor functions of the joint and lower extremities. For this, experts recommend undergoing rehabilitation, which includes both a special course of physiotherapeutic procedures and therapeutic exercises.
Osteoarthritis of the hip joint is a very dangerous disease that is difficult to treat. That is why, when choosing the level of physical activity for patients, specialists take into account their age, the severity of the disease, the characteristics of their body, etc. Physical therapy classes should be conducted within the walls of special medical institutions that have premises equipped for these purposes. During daily training, patients are monitored by an orthopedic doctor, who will immediately come to the rescue if necessary.
To prevent physical activity from worsening the patient’s condition, remember the following:
physical activity must be given gradually;
each exercise should be performed carefully, without sudden movements;
before starting classes, you need to warm up all the muscles (this can be done with a regular warm-up);
If pain occurs in the hip joint during exercise, you should stop training for a while, etc.
Many experts recommend that this category of patients combine therapeutic exercises and other sports:
skiing, etc.
A healing hip joint will benefit greatly from daily walks in the fresh air, during which strong physical activity is not applied to the site of injury. After completing the rehabilitation carried out in a medical institution, the patient can perform a course of therapeutic exercises at home. During training with an instructor, each patient learns to perform each exercise correctly, as a result of which possible injury during independent physical exercise is almost completely eliminated.
For daily training, it is best to use special mats (orthopedic). During the training process, you should not forget about proper breathing, which should be corrected immediately if necessary. After completing the last exercise from the treatment complex, the patient should perform a short self-massage. For these purposes, you can use special massagers, thanks to which additional stress will be placed on weakened muscles.
If the patient discovers the following symptoms, he needs to stop daily activities for a while and contact a medical facility for consultation:
exacerbation of chronic diseases;
increase in temperature;
hernias, cysts and other neoplasms, etc.
To prevent the development of arthrosis in the hip joint, it is necessary to carry out timely prevention of this disease:
timely receipt of qualified medical care for any injuries of the hip joint;
giving up a sedentary lifestyle;
normalization of body weight;
timely correction of congenital or acquired defects of the hip joint;
giving up bad habits (smoking, alcohol, etc.);
water sports, etc.
Author of the article: Kaplan Alexander Sergeevich, traumatologist, orthopedist
Arthrosis is a joint disease considered dystrophic and associated with the slow destruction of cartilage inside the joint. With arthrosis, over a long period of time, changes occur, restructuring of the articular ends of bones, inflammatory processes occur and degeneration of periarticular tissues occurs.
Osteoarthritis of the knee joint is the deformation and destruction of cartilage tissue. The disease is chronic and degenerative, accompanied by pain of varying severity. It can lead to complete immobilization and loss of functionality. The disease develops more often in women than in men.
Arthrosis of the shoulder joint is a fairly common problem that most older people face. This chronic and rapidly progressive degenerative disease affects both men and women. As a result of the development of arthrosis, not only cartilage tissue is affected, but also bone tissue.
Arthrosis of the ankle joint is a disease in which degenerative processes develop in cartilage tissue. As arthrosis progresses, irreversible processes begin to occur in the cartilage of the joint, which cause serious consequences. Today, modern medicine classifies arthrosis of the ankle joint as follows.
Proteins and carbohydrates cannot be combined in one dish. Moreover, you should not eat fruit after meat. The speed of fruit digestion is 15–20 minutes. The digestion speed of animal proteins is about 2 hours. Therefore, digested fruits are not evacuated from the stomach until the meat is digested.
Another real life incident. One woman living alone suffered from arthrosis, rheumatism and polyarthritis and there was no one to help her. She couldn’t even get to work because the pain in her knee joints made her faint. Doctors told her that they couldn’t help her at this stage of the disease.
Traumatologist, 5 years experience
Publication date November 24, 2017
Osteoarthritis of the knee joint (gonarthrosis) is a progressive chronic disease of the knee joints with damage, thinning and destruction of its cartilaginous part (articular surfaces of the femur and tibia), as well as damage to the subchondral bone. [2] [5] [16] It has been proven by studies (arthroscopy and MRI) that in addition to damage to the articular cartilage, the menisci and synovial membrane are involved in the process. Gonarthrosis is one of the most common orthopedic pathologies. [4] [6] [9] [22] There are its synonyms - osteoarthritis (OA), arthrosis deformans. The disease is an important socio-economic problem, as it is widespread and significantly worsens the quality of life of patients due to constant pain and, in addition, causes high disability. [15] [27]
Schematic representation of a knee joint with normal cartilage (left) and affected arthrosis (right)
Until the mid-eighties of the last century, there was no unified definition of the disease. It was not until 1995 that the osteoarthritis committee of the American College of Rheumatology characterized the disease as the result of mechanical and biological factors leading to an imbalance between the processes of degradation and synthesis of the extracellular matrix of articular cartilage. [11] [19] As a result, fiber disintegration and degeneration occur, cracks, osteosclerosis and compaction of the cortical layer of the subchondral bone are formed, osteophytes grow and subchondral cysts are formed. [12] [29]
Many factors lead to gonarthrosis, including:
Osteoarthritis of the knee joint is characterized by:
As the disease progresses, the pain becomes more intense, appearing even with minor exertion and long walking. Localized along the anterior-inner surface of the joint. [22] Prolonged rest usually helps the pain go away. The range of joint movements may decrease, a crunch may appear, and sharp pain appears when the leg is bent to the maximum. The configuration of the joint changes, as if it is expanding. Synovitis is more common, lasts longer and involves a large amount of fluid.
The last stage of gonarthrosis is different in that the pain becomes almost constant, causing anxiety not only while walking, but also at rest, and even at night, [10] [18] when patients have to look for a comfortable position to sleep. Movement is more limited: it is difficult to bend and straighten the leg completely. The joint becomes deformed and increases in volume. Valgus (X-shaped) or varus (O-shaped) deformity of the legs is often observed. [8] [24] The gait becomes unstable and waddles. In severe cases, a cane or crutches are needed.
Deformation of the lower extremities as a result of advanced arthrosis of the knee joints
According to researchers, 76% of older people who complain of knee pain have radiographs showing gonarthrosis. [2] [7] [17] According to statistics, women are more often affected by the disease, which is associated with hormonal changes after 45 years. [12] [19]
There are primary and secondary osteoarthritis. [8] [15] [20]
Formation of arthrosis as a result of a fracture of the internal condyle of the tibia
With arthrosis (osteoarthrosis), in addition to the progressive destruction of cartilage, loss of its elasticity and shock-absorbing properties, bones are gradually involved in the process. [7] [29] Under load, sharp edges (exostoses) appear, which are mistakenly considered “salt deposits” - with classic arthrosis, no salt deposition occurs. As arthrosis progresses, it continues to “eat” the cartilage. Then the bone becomes deformed, cysts form there, all structures of the joint are affected, and the leg becomes bent. [11] [17]
In addition to the inner or outer part of the knee, arthrosis can also affect the surfaces between the patella and the intercondylar groove of the femur. This option is called patellofemoral arthrosis . [16]
Its cause is usually a subluxation, fracture, or lateralization of the patella.
Regardless of the cause, there are three stages of the disease:
Depending on the number of affected joints, unilateral and bilateral gonarthrosis is distinguished.
The most common complication of stages II and III is tendovaginitis of the adductor muscle group of the thigh. [22] [24] This is manifested by pain along the inner surface of the joint, which intensifies with movement. The cause is muscle imbalance and deformation. With a long-term decrease in range of motion, contracture develops. [11] [14] In addition, synovitis often occurs. Advanced gonarthrosis affects the entire musculoskeletal system, disrupting the biomechanics of the spinal column and other large joints of the lower extremities. This can lead to herniated discs and arthritis of other joints. [16] The second knee joint is overloaded (if the disease is unilateral), since the patient spares the sore leg, transferring the weight to the other, healthy one.
The diagnosis is made by an orthopedic traumatologist, and in the vast majority of cases, an examination and x-ray of the knee joint in two projections (direct and lateral) is sufficient. [2] [19] Clinical findings and imaging help determine the stage of the disease.
X-ray of the knee joint - gonarthrosis: a - 1st grade, b - 2nd grade, c - 3rd grade.
In the early stages of the disease, with minor changes in bone tissue, X-ray examination is not so valuable. [5] [8] At this stage, gonarthrosis can be diagnosed through arthroscopy. [5] [8] The accuracy of the method is very high; only its invasive nature and price can stop it.
Ultrasound does not allow clear visualization of changes in articular cartilage and intra-articular structures. [15] Using MRI, it is possible to detect changes in the bone, cartilage and soft tissue structures of the joint, as well as subchondral bone, with 85% accuracy. [15] Scintigraphy can evaluate the metabolic activity of periarticular bone tissue.
An increased content of phosphorus and calcium in dehydrated synovial fluid is evidence of the destruction of osteochondral tissue of the joint and the accumulation of degradation products. Blood is also examined - general analysis and erythrocyte sedimentation rate (ESR); determine the level of fibrinogen, urea and other biochemical parameters of blood and urine. [16]
Conservative - anti-inflammatory drugs, painkillers, muscle relaxants, vascular, chondroprotectors, compresses, kinesiotaping, physical therapy, physiotherapy, orthoses.
Minimally invasive - paraarticular blockades (Novocaine + medication relieves pain and inflammation), injection of artificial lubricant into the joint itself, plasma lifting.
Surgical - arthroscopy (a low-traumatic method of treating intra-articular pathologies and removing damaged structures), endoprosthetics.
Conservative methods are most effective at the initial stage of the disease. [9] [16] They help reduce pain and temporarily slow down the destruction of cartilage. At stage II, more effective methods are needed. [8] [23] The introduction of hyaluronic acid preparations into the joint cavity is used to reduce friction and trauma to the cartilage. There is no clear evidence for the restoration of cartilage, but it is good for lubricating surfaces. “PRP therapy” (plasmolifting) is the injection of platelet-rich plasma into the knee joint, which is obtained from the patient’s own blood by centrifugation. [4] [13] [18] It nourishes cartilage and promotes its restoration, since autoplasma platelets contain numerous growth factors and cytokines that promote the regeneration of damaged tissue.
Endoprosthesis replacement is a common and effective surgical method for treating severe gonarthrosis, [16] [24] [25] which allows you to maintain limb mobility and the ability to lead a full life subsequently. This is a high-tech operation lasting approximately one and a half hours. In the postoperative period, long-term rehabilitation and development of the joint are necessary. [16] [18] After 25-30 years, when the artificial joint wears out, it must be replaced again.
You need to understand that if arthrosis begins to develop, then it must be treated immediately. [6] [18] [22] If you are at risk for this disease, you can delay the onset, for this it is recommended:
Before starting therapeutic exercises, you should definitely consult your doctor. Exercises are performed at a slow pace. If pain or discomfort occurs during gymnastics, exercises should be stopped.
It is necessary to use only effective drugs. Rubbing, compresses and other folk methods are ineffective; they do not act on the cause of the disease, but only help to distract from the pain. Avoid injuries and overload - jumping, carrying heavy objects, standing for a long time or sitting in an uncomfortable position. [2] [20] [21] This accelerates the progression of the disease.
It is also necessary to promptly diagnose and treat rheumatoid arthritis, gout and systemic diseases.
The prognosis depends on the stage at which the patient went to the doctor and the correct therapy. [23] The earlier competent treatment is started, the higher the chances of avoiding surgery.
The first signs of arthrosis of the hip joint begin with pain and limitation of movement. This is due to limb shortening and muscle atrophy.
This disease often affects older people. Factors for the development of the disease can be infections, joint diseases, injuries, curvature of the spine or a hereditary factor. Treatment of arthrosis is quite complex and lengthy, often requiring surgical intervention if drug therapy does not help.
A progressive disease of the degenerative-dystrophic type is arthrosis of the hip joint, the symptoms and treatment of which must be known. Another name for the disease is osteoarthritis, and most often this is the diagnosis made by specialists. When the disease occurs, an inflammatory process occurs in the joint area, which affects the structure of cartilage tissue and begins to change it. This process results in degeneration, cracking and disintegration, leading to complete destruction of the joint.
The disease itself is not inherited, but diseases that can provoke arthrosis, for example, those associated with the metabolic process and genetic features of the skeletal structure, can be genetically transmitted.
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Arthrosis of the hip joint occurs in the presence of the following diseases:
The disease develops quite slowly and can occur on one side or on both sides at once. This disease can be caused by scoliosis, kyphosis, osteochondrosis, flat feet, and knee arthrosis.
In addition to these reasons, we can also list hormonal disorders caused by various diseases of the endocrine system. In addition, there is excessive physical activity, especially among professional athletes.
The development of this disease mainly occurs in old age. So, sensations of pain and a sedentary limb are all arthrosis of the hip joint, symptoms. Treatment of the disease must begin as soon as possible. Therefore, you should immediately go to a specialist for a diagnosis.
The main diagnostic methods are MRI and CT. The first method allows you to establish the condition of soft tissues, and the second method is needed to consider pathologies of bone tissue. To make a diagnosis, it is necessary to collect a complete clinical picture of the course of the disease. It is important to establish the extent of the disease, as this will help prescribe adequate treatment. Among other things, it would not be amiss to establish the exact cause of the disease, since effective treatment will require its elimination. Most often, it is enough to take an x-ray to understand the cause of arthrosis.
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According to available statistics, patients who have undergone surgical treatment for arthrosis of the hip joint may develop various complications:
Most often, in this category of patients, infection occurs in the area of the endoprosthesis that performs the functions of the joint. In this case, doctors perform a second operation, during which the endoprosthesis is removed, and after that a course of antibiotics is prescribed.
During thrombolism, the patient experiences a blockage of the pulmonary artery. This type of complication is often fatal, especially for those patients who have a predisposition to blood clots. To prevent such a complication after surgery, patients are given special medications that reduce blood viscosity.
Severe bleeding during surgery is a common complication of surgical treatment of arthrosis of the hip joint. In modern medical centers there is a large supply of blood and its substitutes, thanks to which specialists can easily cope with this complication.
Understanding the problem of treating arthrosis of the hip joint will not be complete if a person does not know the main parts and structure of this part of the musculoskeletal system of his body.
The hip joint consists of:
Surrounding the joint is a layer of muscle tissue (gluteal, thigh muscles, etc.), the functionality of which largely determines its condition.
Osteoarthritis of the hip joint is a process of destruction of the hyaline (articular) cartilage lining the surface of the acetabulum and the spherical head of the femur.
However, in modern medicine this disease also includes various degenerative processes occurring in the structures surrounding the main elements of the joint:
The changes underlying the degenerative processes of cartilage are always associated with some kind of primary damage, against the background of which inflammation then occurs.
Subsequently, the bone tissue is also subject to destruction.
It is for this reason that all arthrosis is called deforming or osteoarthrosis (“osteo” - bone).
With arthrosis of the hip joint, patients experience the following symptoms:
With arthrosis of the hip joint, there are 3 degrees of severity of the disease. Each of them is characterized by certain symptoms, which allow us to establish the correct diagnosis. The clinical manifestation of arthrosis is quite clear:
Arthrosis of the hip 1st degree is characterized by severe pain only after active physical activity, especially after running or walking. The pain is localized only in the groin area, rarely radiating to the knee joint. The gait is preserved, there is no lameness, and the muscles are not atrophied. The examination reveals the proliferation of bone tissue, there are no other pathologies.
Grade 3 is considered the most severe and is usually treated only with surgery and joint replacement. The pain becomes unbearable, the patient practically cannot move independently. Aids such as crutches, walkers, and canes are required for movement. The movement of the joint is severely limited, the muscles atrophy. The hip joint is destroyed, which leads to shortening of the leg, the patient tilts the body to the side when walking. Due to the fact that the center of gravity shifts when walking, the load on the affected joint doubles. Upon examination, multiple growths of bone tissue, an enlarged femoral head, and a narrowed joint space are observed.
As soon as such a problem is discovered, treatment must be started immediately. To do this, you should contact a specialist. Which doctor treats arthrosis? This is a completely understandable question from patients. In order to start treatment, you need to visit a rheumatologist, orthopedist and arthrologist. All these specialists together will be able to develop an individual effective treatment regimen. If surgical treatment is required, you must consult a surgeon.
At the first stage of this disease, patients do not experience pronounced symptoms, as a result of which people rarely go to a medical facility.
Arthrosis of the hip joint of the 2nd degree is accompanied by severe pain, which can be integrated from the hip and pelvis to the knee. At this stage of the disease, patients experience severe damage to cartilage tissue.
All damage can be seen using radiography:
Before figuring out how to treat arthrosis of the hip joint, it is necessary to make a correct diagnosis. If coxarthrosis is suspected, a person will be referred for a biochemical blood test - if the disease is present, patients will experience a slight increase in ESR, globulins, immunoglobulins and seromucoid.
The next stage in identifying arthrosis is an x-ray photo. It will reveal:
Unfortunately, the X-ray photo does not allow one to see the joint capsule and the cartilage themselves; if it is necessary to obtain information about these soft tissues, the patient will be referred for tomography.
This study combines radiography and modern computer technologies, which allows for a more detailed, almost layer-by-layer study of the joint cavity and all intra-articular components.
To carry out the study, a special device is used - a computed tomograph. Before starting the examination, the patient removes all metal jewelry ( since metal is impenetrable to X-rays, it can interfere with the tomogram ) and lies down on a special retractable table, which is then moved inside the device. After this, a special X-ray machine begins to rotate around the area under study, which takes many pictures of the joint from different angles. The obtained information is transferred to a computer, processed and presented in the form of a detailed three-dimensional image of all articular components and adjacent tissues.
CT scan of the hip joint allows you to more accurately assess the nature of the lesion of the femur and pelvic bones and their articular surfaces, identify deformations of hyaline cartilage, osteophytes and other changes characteristic of arthrosis.
MRI is another modern method that allows you to examine in detail not only bone and cartilage formations, but also soft tissues of the joint ( such as ligaments, joint capsule, and so on ). The principle of the method is the phenomenon of nuclear magnetic resonance - when body tissues are placed in a strong electromagnetic field, the nuclei of atoms are charged with a certain energy, which is emitted into the external environment when the exposure ceases. This energy is recorded by special sensors, and the composition and shape of tissues in the area under study can be determined by the nature and strength of its radiation.
Before an MRI, it is also necessary to remove all metal jewelry, since the electromagnetic field created during the examination can heat the metal to such an extent that the patient may suffer burns. During MRI, the human body does not experience any radiation load, so the only contraindication for its implementation is the presence of metal implants, fragments, and so on in the body.
MRI for coxarthrosis can reveal:
Also, to identify the cause of coxarthrosis and to assess the degree of disruption of the blood supply to the joint, an MRI with contrast can be performed - a contrast agent is injected into the blood vessels feeding the structures of the hip joint, after which an MRI examination is performed. This allows you to evaluate the structure of blood vessels and identify areas of damage or narrowing.
As mentioned earlier, in the later stages of coxarthrosis, shortening of the lower limb on the affected side occurs, which can be determined by measuring and comparing the length of the patient’s legs. It is immediately worth noting that with bilateral coxarthrosis, the value of this method decreases, since both legs will be shortened approximately equally.
Bone landmarks are used to measure leg length, which allows for the most accurate assessment of the data obtained. The superior landmark is the anterior superior spine of the pelvic bone, which can be palpated on the anterolateral surface of the abdomen in the area of the outer edge of the inguinal ligament. Inferior landmarks may be the bony formations of the patient's knee, ankle, or heel. The examination is carried out in a standing position, while the legs should be straightened as much as possible at the hip and knee joints.
Also, during the diagnostic process, it is important to try to establish the cause of the disease, since its elimination is often a necessary condition for successful treatment.
To identify the cause of coxarthrosis, the following may be prescribed:
ESR may also indicate the presence of an inflammatory process in the body . This laboratory indicator reflects the time during which red blood cells placed in a test tube will sink to the bottom. An increase in ESR during inflammation is caused by the release of a large amount of so-called acute phase proteins into the blood. These proteins attach to the surface of red blood cells and “glue” them together, as a result of which the rate of their sedimentation in the test tube increases significantly.
Normal ESR values are considered:
Exceeding these figures in combination with clinical manifestations of coxarthrosis may indicate the infectious-inflammatory nature of the disease.
How to treat arthrosis of the hip joint? In order to avoid ending up on the operating table, it is necessary to promptly identify the disease and begin adequate treatment. In the case of arthrosis, traditional medicine will not help solve all problems, so you should not rely on it. The first thing you need to do is strictly follow all the specialist’s recommendations.
1 week of treatment consists of taking Paracetomol as a pain reliever. However, if there is no effect from taking it, then stronger analgesics are prescribed together with proton pump blockers. For better results, a chondroprotector is prescribed. This combination should help relieve pain and stop bone destruction. However, many drugs prescribed by specialists have a number of side effects. Long-term use of such drugs can greatly harm the body. The most common side effect is dehydration of cartilage tissue. For this reason, analgesics should only be used under the supervision of a specialist; the prescribed dosage should not be exceeded, and if your health condition worsens, you should immediately stop taking the medications.
To relieve pain, the following are prescribed: Celebrex, Arcoxia, Nise, Nimisulide, Diclofenac, Ibuprofen, etc. You can reduce pain with the help of warming ointments and balms, although they do not have a special therapeutic effect, they can help reduce pain. Among the local drugs, Gevkamen, Espol, Menovazin are especially distinguished.
In extremely severe forms of coxarthrosis, a person should seek help from an orthopedist.
However, if the patient only has guesses that, for example, he has developed arthrosis of the left hip joint, because after running 10 km he felt pain in the groin on the left side the next day at the start of walking, then he needs to contact a rheumatologist.
In general, it is recommended that all people over 30 years of age, without exception, undergo periodic examination by this medical specialist.
How to treat arthrosis of the hip joint? Of course, for the best effect of treatment, it is necessary to restore blood circulation. For this purpose, drugs from the Glucosamine and Chondroitin sulfate group are prescribed, but they can improve the condition only at the very beginning of the development of the disease. Such drugs are sold in the form of creams, tablets or injections. Along with these medications, a course of vasodilators, such as Stugeron, Cinnarizine, Agapurin, is prescribed. And the effect on the body is twofold: on the one hand, they relieve pain and improve blood circulation, and on the other, they reduce muscle tone.
An integrated approach to the treatment of the hip joint provides better results compared to the use of only one therapeutic agent - this is a fact recognized by the world's leading arthrologists. Therefore, the patient is often simultaneously prescribed several types of treatment from the following:
A hip joint bandage will relieve the load on the joint and reduce the factor that is the main reason for the onset of tissue irritation leading to the inflammatory process. Therefore, together with drug therapy, fixation of the damaged area is often prescribed.
In addition to prescribing anti-inflammatory drugs, intra-articular injections and other drugs, the patient can undergo physiotherapy and take advantage of alternative methods of therapy.
Some of the recipes not only do not contribute to improvement, but also lead to the opposite effect, provoking accelerated destruction of cartilage.
In folk medicine, there are many successful methods for treating coxarthrosis:
When using all folk remedies, it is necessary to remember that there is no guarantee of 100% recovery.
For this purpose, today there is a huge selection of various NSAIDs - non-steroidal anti-inflammatory drugs, which, although they relieve pain, do not affect the development of the disease; they cannot stop the process of destruction of cartilage tissue. They have a number of serious side effects, the long-term use of which is also unacceptable due to the fact that these drugs affect the synthesis of proteoglycans, promoting dehydration of cartilage tissue, which only aggravates the condition. Of course, it is unacceptable to endure pain, but painkillers should be used with caution, under the supervision of a doctor, only during periods of exacerbation of the disease.
NSAIDs include: Celebrex, Arcoxia, Texamen, Nise, Nimulid, Nimica, Nalgesin, Movalis, Meloxicam Artrozan, Ketanov, Ketorolac, Ketarol, Artrosilen, Ketonal, Bystrumcaps, Flexen, Burana, Ibuprofen, Faspik, Nurofen, Voltaren, Diclofenac, Ortofen , Diklak. (see the full list, side effects and contraindications of all NSAIDs in our article injections for back pain).
Such local remedies for the treatment of deforming arthrosis, such as warming ointments, are not drugs with a pronounced therapeutic effect, but they reduce pain, acting as a distraction and partially relieve muscle spasm, such remedies include Gevkamen, Espol, Menovazin, Nicoflex-cream.
Only according to strict indications can muscle relaxants be prescribed - drugs that promote muscle relaxation, such as Tizanidine - Sirdalud, Tizalud, Tizanil, as well as Tolperisone - Mydocalm. Their use can have both a positive and negative effect, muscle relaxation, on the one hand, reduces pain, improves blood circulation, but on the other hand, muscle spasm and tension is a protective reaction of the body, and removing it can only accelerate the destruction of joint tissue.
All these therapeutic measures are very useful in the complex treatment of the disease; they help strengthen the muscles surrounding the joint, increase its mobility and, when properly combined with drug treatment, can help increase the distance from the head to the socket and reduce pressure on the head of the femur. This is especially true for physical therapy; without its competent selection and regular implementation outside of exacerbations, it is impossible to achieve a real improvement in the patient’s condition.
If the patient is overweight, then, of course, the diet can help reduce the load on the diseased joint, but it does not have an independent therapeutic effect.
Such operations today are performed quite often, only after a thorough examination, routinely under general anesthesia. They ensure complete restoration of hip function with proper and careful implementation of all postoperative measures - antimicrobial antibiotic therapy and a rehabilitation period of about six months. Such hip prostheses last up to 20 years, after which they require replacement.
Modern medicine today has only one natural solution available - joint replacement, during which the following procedures are performed:
With a successful operation and proper use, such a joint will serve for about two decades.
Due to the fact that such procedures are associated with a fairly high risk of developing all kinds of complications, many well-known doctors, such as Dr. Evdokimenko, recommend postponing the operation and using the latest methods of therapeutic treatment.
Treatment of arthrosis of the hip joint with physical exercise is to achieve two goals: increase the mobility of the legs and prevent muscle atrophy. All standard exercise therapy complexes for coxarthrosis also have a general strengthening character and a positive effect on the entire body.
The diet will reduce the load on the hip joints and provide them with everything necessary for tissue restoration.
Pregnancy with arthrosis in the hip joint is double stress for the woman’s body. Taking most medications during pregnancy is prohibited. At the very least, they must be taken with great care so as not to harm the child.
In addition to drug treatment, physiotherapy is widely used. However, experts have two opinions about this procedure. Some believe that such therapy is simply necessary, while others, on the contrary, believe that it is useless. Laser and magnetic procedures help most in treating arthrosis. Other influences are simply useless, since the hip joint sits quite deep, and not every device can influence it properly.
The combined effects of manual therapy and massage help reduce symptoms, strengthen muscles and increase joint mobility.
If coxarthrosis, a deformity of the hip joint, develops, then surgery is indispensable. Most likely, if the joint is completely destroyed, it will not be possible to restore it, so it is worth considering prosthetics. This procedure will help restore joint mobility and normalize the ability to walk. A bipolar prosthesis is used, which replaces the head and socket or replaces only the femoral head. The operation can be performed only after a thorough examination and in urgent need, when there are no other ways to restore the joint. The operation is performed under general anesthesia and then requires recovery time. After the operation, a course of antibiotics and antibacterial drugs is prescribed. Rehabilitation lasts about 6 months. At this time, a person learns to walk again. At first this is only possible with the help of aids, but after getting used to the prosthesis you can begin to walk independently. Dentures are installed for a period of 20 years, after which they need to be replaced.
After surgery and rehabilitation, it is possible to return to normal life, even engage in moderate physical activity, which is simply necessary to maintain healthy muscle tissue.
It is imperative to be checked once a year for problems with other joints, and to treat all infectious and inflammatory diseases that can cause complications.
In the later stages of the disease, it becomes impossible to cure coxarthrosis in the usual way. Prompt surgical intervention is required. The operation is a last resort and can be performed in different ways.
All types of surgical intervention are temporary, but without them the patient becomes disabled.
Early diagnosis of coxarthrosis and a properly prescribed course of restorative therapy is the only reliable way to combat the disease. Ignoring symptoms leads to disability.
Undoubtedly, arthrosis of the hip joint in any case is a dangerous disease, which if not treated correctly leads to disability.
However, there are very special cases when coxarthrosis poses a greater threat than in typical cases: for example, when children and pregnant women suffer.
This natural question can be answered unequivocally - yes, but there are some peculiarities here.
If a woman has a congenital predisposition or already has the initial stage of this disease, then childbirth will lead to its development or complication (during childbirth there is a huge load on the joints themselves, and on the surrounding ligaments and muscles).
Therefore, women are recommended to resort to caesarean section.
Coxarthrosis occurs at any age and even in the early years of life.
The most common form of this disease in childhood is dysplastic arthrosis of the hip joint.
Congenital underdevelopment of joints is the main cause of this disease.