Every year, diseases of the musculoskeletal system worry more and more people, and their development at a young age is becoming more and more noticeable. This is due not only to lifestyle changes, but also to an increase in the degree of injuries, which are largely interrelated. One of the most common pathologies of the musculoskeletal system is arthrosis of the hip joint, which is characterized by the appearance of progressive pain and limited mobility. Ultimately, the disease can lead to complete joint immobility and disability. To avoid the occurrence of such side effects, it is important to start treatment for osteoarthritis as soon as possible. And if in the early stages of development it can be stopped by conservative methods, then in the case of severe changes, it is possible to restore the functions of the hip joint and remove unbearable pain only with the help of high-tech surgery.
What is hip arthrosis
Osteoarthritis of the hip joint is a chronic degenerative-dystrophic disease in which there is a gradual destruction of the hip joint. At the same time, all its components are gradually included in the pathological process, but hyaline cartilage is especially affected, which leads to narrowing of the joint space and deformation of its other components. More often, pathological changes occur only on one hip joint, although both can be affected at the same time.
Hip joints are the largest in the human body, because they can withstand the greatest load during the day. Each of them consists of the head of the femur and the acetabulum, which is a pelvic-shaped recess in the pelvis. Both surfaces are covered with smooth, moderately elastic hyaline cartilage. It is he who ensures the smoothness and smooth gliding of the femoral head in a natural depression and thus allows movement in different planes.
The movement of the hip joint is ensured by a group of muscles connected to it by fascia. It is also surrounded by ligaments, whose task is to limit its mobility within physiological limits and 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 adjacent 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 that covers the head of the femur and the surface of the acetabulum constantly receives components for the creation of new cells, ie regeneration. This is extremely important for this cartilaginous formation, because with each movement, the hip wears out, but it is normally restored immediately. But when he is injured or under the influence of other factors, this does not happen, which leads to the development of osteoarthritis of the hip joint, or thinning and destruction of his hyaline cartilage.
As a result, deformed areas are formed in ideally smooth cartilage, which increases as the pathology progresses. As it abrasions, the surfaces of the bones that make up the joint are exposed. When they come in contact, there is a characteristic squeaking and severe pain. This causes the formation of osteophytes and, in the final phase of development, the head of the femur completely merges with the acetabulum, which prevents any movement in the hip joint.
At the same time, osteoarthritis of the hip joint can cause the development of various inflammatory processes within the joint, including:
- bursitis - inflammation of the synovial sac;
- tendovaginitis - an inflammatory process in the lining of the muscle tendon sheath;
- tunnel syndrome - nerve compression, causing radiating pain along a strangled nerve.
Reasons
One of the common causes of the development of osteoarthritis of the hip joint is mechanical damage, not only direct injuries, but also micro-damage caused by the destructive effects of excessive loads on it. One of the most common causes of disease development is a fracture of the femoral neck.
It starts from the femur at an angle of 120 ° and connects it to the head. The presence of osteoporosis significantly increases the probability of hip fractures, but such an injury can also be the result of a car accident, falling to your feet from a height, impact, etc.
A fracture of the femoral neck may 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, rupture of its ligaments, transcondylar fractures or fractures of the acetabulum also create favorable conditions for damage to its structures. In such situations, post-traumatic osteoarthritis of the hip joint is diagnosed.
Post-traumatic hip osteoarthritis often occurs in professional light and weight lifters, parachutists, loaders and skaters.
The development of osteoarthritis of the hip joint after injury is caused by a violation of the congruence (comparability) of the joint surfaces, reduced quality of blood supply to the joint components and prolonged immobilization. As a result of prolonged immobility, there is not only a worsening of blood circulation in the fixed area, but also a shortening of muscles, a decrease in their tone. The probability of post-traumatic arthrosis increases significantly when an inappropriate situation or untimely treatment is carried out, which leads to the preservation of defects of varying severity. Also, the risks of its development are increased by excessively early joint loading and inadequate exercise therapy, including too intensive, late started or vice versa early.
Sometimes the disease occurs after surgical interventions on the hip joint due to the formation of scars 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 chondrocyte division (cartilage tissue cells). This is accompanied by an increase in the production of cytokines, which are normally produced in small quantities. Cytokines are mediators of inflammation, and especially the cytokine IL-1 leads to the synthesis of specific enzymes that destroy hyaline cartilage of the hip joint.
In addition, high loads can be caused by subchondral plate microfractures. This leads to its gradual compaction and the formation of bony growths on the surface, called osteophytes. They can have sharp edges and cause more damage to the joint, as well as injuries to the surrounding tissue.
The subchondral plate is the end part of the bone that 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 osteoarthritis of the hip joint is diagnosed.
Today, it has been determined that the tendency towards its development can be inherited, ie the presence of this pathology in close relatives significantly increases the chances of developing osteoarthritis of the hip joint. It is assumed to have a polygenic inheritance, ie its development depends on the presence of many genes. Each of them individually creates mild preconditions 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, hard physical work.
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 osteoarthritis of the hip joint, which develops against the background of the presence of concomitant diseases and changes in age.
Symptoms
The disease is characterized by the appearance of pain, limited mobility and creaking in the hip joint, the severity of which directly depends on the degree of neglect of pathological changes. In the final stages of development, shortening of the affected leg and complete immobility of the hip joint can be noticed, which is a consequence of the complete merging of the bone structures that form it.
Initially, the disease may be asymptomatic and cause mild, short-lived pain. They usually occur after physical exertion, especially walking, carrying heavy loads, squats, bending over. But as degenerative-dystrophic changes in the joint progress, the pain intensifies. Over time, they become not only more intense, but also last longer, and the interval between the beginning of physical activity and their appearance decreases. At the same time, a vacation, even a long one, may not bring relief. After that, the pain can torment a person even with prolonged immobility of the hip joint, for example, after a night's sleep.
If intra-articular structures penetrate nearby nerves, the pain can radiate to the groin, buttocks, thigh and knee. However, they tend to intensify with hypothermia. In the last stage of disease development, the pain becomes unbearable. This causes an unconscious desire to pity the leg and put less strain on it, leading to lameness.
Another symptom of osteoarthritis of the hip joint is a decrease in range of motion. Most often there is a limitation in the ability to turn the leg inwards and outwards, lifting the leg bent at the knee to the chest. Over time, the so-called morning stiffness occurs, which disappears after the patient "disperses". After that, compensatory curvature of the pelvis is possible, leading to a change in gait. In the future, patients completely lose the ability to make 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 curved forward is observed.
All this can be accompanied by the formation of edema in the hip joint. But in the presence of excess weight, I can go unnoticed.
Crunching in the affected joint often occurs during movements, especially extensor ones. This is due to the exposure of the bony surfaces of the femoral head and acetabulum and their mutual friction. In this case, there is a sudden increase in pain.
Also, arthrosis of the hip joint can cause painful cramps in the femoral muscles. In extremely advanced degenerative-dystrophic diseases, when the joint space almost completely disappears, and the head of the femur begins to flatten, a shortening of the affected limb by 1 cm or more is observed.
In general, there are 3 degrees of hip arthrosis:
- Stage 1 - the joint space of the hip joint is narrowed, and the edges of the bone structures are slightly pointed, which indicates the beginning of osteophyte formation. Clinically, there is a mild pain syndrome and certain limitations of movement.
- Grade 2 - joint space is narrowed by more than 50%, but less than 60%. Significant osteophytes are observed, as well as signs of cysts in the bone epiphyses. Patients notice significant limitations of movement in the hip joint, the presence of crunch when moving, pain, may be accompanied by atrophy of the thigh muscles of varying severity.
- Grade 3 - 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 can become unbearable.
Diagnosis
The appearance of pain and other symptoms characteristic of osteoarthritis of the hip joints is the reason for contacting an orthopedist. Based on the information obtained during the interview and examination, the doctor will be able to suspect his presence, especially if he has previously suffered hip or pelvic injuries.
The presence of osteoarthritis of the hip joint is indicated by pain, the intensity of which increases over several years. Rapid development of degenerative-dystrophic changes occurs much less often, when several months pass from the appearance of the first signs to a strong permanent pain syndrome. This is characterized by increased pain when standing or performing physical work. Also, arthrosis is characterized by the presence of morning stiffness that lasts up to half an hour, and occurs even after prolonged immobility. Gradually, there is an increase in the limitation of mobility and deformation of the hip joint, which in the later stages of development, the orthopedist can notice during the examination.
However, all patients are necessarily assigned instrumental research methods, with the help of which it will be possible to confirm the presence of hip arthrosis and determine its degree, as well as to distinguish it from some other diseases accompanied by similar symptoms. As a rule, diagnostics is performed using:
- Radiography - allows you to detect the main signs of osteoarthritis, especially the narrowing of the joint space and the presence of osteophytes. But recently, CT has become a more informative research method, which enables the assessment of the condition of the hip joint with greater precision.
- MRI is a highly informative method for diagnosing various changes in the state of soft tissue structures, including cartilage tissue, which allows the detection of even the slightest signs of hyaline cartilage degeneration.
Also, patients may be prescribed laboratory tests, including KLA, OAM, biochemical blood test, etc. They are obliged to determine the accompanying diseases that have created the preconditions for the development of secondary arthrosis of the hip joint.
Treatment of osteoarthritis of the hip without surgery
Treatment of degenerative-dystrophic changes in the hip joint with methods of conservative therapy is possible only with arthrosis of the 1st and 2nd degree. Prescribed measures can improve the patient's condition, stop or at least slow the progression of the pathology and thus maintain working ability. But they are not able to lead to a complete withdrawal of changes that have already occurred in the joint.
Today, as part of the conservative treatment of osteoarthritis of the hip joint, the following are prescribed:
- drug therapy;
- exercise therapy;
- physiotherapy.
Also, patients are advised to make certain adjustments in their lifestyle. Therefore, in the presence of excess weight, it is worth taking measures to reduce it, or increase the level of physical activity and reconsider the nature of the diet. If the patient is actively engaged in sports and overloads the joint, which causes microtrauma in it, it is recommended to reduce the intensity of training.
Medical therapy
Drug therapy for osteoarthritis of the hip joint is always complex and includes drugs from different groups aimed at reducing the severity of disease symptoms and improving the course of metabolic and other processes in the joint. To:
- NSAIDs - drugs with anti-inflammatory and analgesic action, produced in oral forms and in the form of topical agents, which allows you to choose the most effective and convenient option for use;
- corticosteroids - drugs that have strong anti-inflammatory properties and are used in most cases in the form of a solution for injection, because when choosing a systemic therapy they cause the development of side effects;
- chondroprotectors - drugs synthesized on the basis of natural components of cartilage tissue that the body uses to restore it (prescribed in long courses);
- muscle relaxants - drugs indicated for muscle spasm, which causes 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 speed of metabolic processes and helps to restore damaged cartilage.
If concomitant diseases are detected, consultation with related specialists and appropriate treatment are indicated.
In very severe, debilitating pain syndrome that cannot be eliminated with the help of prescribed NSAIDs, intra-articular or peri-articular blockades may be reported. They include the injection of a local anesthetic in combination with a corticosteroid directly into the joint cavity, which quickly leads to improved well-being. But such procedures in a medical institution can be performed only by a qualified specialist, otherwise there is a high risk of complications.
exercise therapy
Physiotherapy exercises have one of the leading roles in the non-surgical treatment of osteoarthritis of the hip joint, both idiopathic and post-traumatic. But the set of exercises must be chosen on an individual basis, taking into account the nature of the previous injury, the level of physical development of the patient and the existing concomitant diseases.
Exercise therapy should be done daily in comfortable conditions without haste. All movements should be performed smoothly, without jerks, so as not to damage 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 prescribed measures, it is often recommended that patients with osteoarthritis of the hip undergo physiotherapy procedures. Traditionally, those with anti-inflammatory, anti-edematous and analgesic effects are selected. To:
- ultrasound therapy;
- electrophoresis;
- magnetotherapy;
- laser therapy;
- shock wave therapy, etc.
In some cases, plasmolifting is indicated, ie the introduction of purified and platelet-saturated blood plasma of the patient. To obtain, venous blood is taken, which is then centrifuged. As a result, it is divided into erythrocyte mass and plasma, which is used to treat degenerative-dystrophic changes in the hip joint.
Hip arthrosis surgery
When diagnosing osteoarthritis of the hip joint of the 3rd degree, patients are indicated for surgical intervention. It can be performed with the ineffectiveness of conservative therapy and persistent pain and limited mobility already in the 2nd phase of disease development.
In general, the indications for hip surgery are:
- significant reduction in the size of the joint space;
- the presence of persistent, severe pain;
- significant mobility constraints.
The most effective and safest operation for osteoarthritis of the hip joint is arthroplasty. 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 the replacement of part of the components of the hip joint or its entirety with artificially made endoprostheses. The prostheses themselves are made of biocompatible materials and are durable.
Their installation allows you to fully restore the normal mobility of the pathologically altered hip joint, eliminate pain and give the patient the opportunity to lead a full life. For each patient, the type of arthroplasty is chosen individually based on the degree of destruction of various components of the joint.
Total or total hip arthroplasty is the most effective. It involves the replacement of the entire joint with an artificial endoprosthesis, ie the acetabulum, the head of the femur and its neck. Such prostheses can serve without interruption for 15-30 years and ensure the restoration of the full volume of joint function.
They are installed without cement or with the help of special cement. The first method is more suitable for young patients, because it involves fixing the prosthesis in the pelvis by growing into the spongy layer of its own bone in it. For the elderly, a more suitable way is to install an endoprosthesis using cement, which holds the artificial material firmly on the bone surfaces even in the presence of osteoporosis.
If the normal hyaline cartilage lining 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 structures of this type: monopolar and bipolar.
The former are less reliable; after their installation, the need for total arthroplasty subsequently arises. This is due to the fact that the replaced artificial head of the femur rubs directly against the cartilage of the acetabulum during movement, which causes it to wear faster.
Bipolar endoprostheses do not have such a disadvantage, because in them the artificial head of the femur is already closed in a special capsule, which is located next to the acetabulum. Thus, the cartilage that covers it is not deformed, because the capsule serves as a kind of buffer and an artificial replacement for the natural hyaline cartilage of the femoral head.
However, regardless of the type of endoprosthesis, postoperative rehabilitation is indicated for all patients. It consists of 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 following the doctor's recommendations during the rehabilitation period.
Thus, osteoarthritis of the hip joint is a common disease of the musculoskeletal system, which can occur even if there are no direct preconditions 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. However, the current level of development of medicine allows to deal with advanced cases of osteoarthritis of the hip joint and restore the full range of motion in it, as well as to permanently get rid of severe pain.