How to treat coxarthrosis of the hip joint

Coxarthrosis is a common degenerative-dystrophic disease of the hip joint, in which, due to age-related changes or other factors, there is a gradual destruction of the joint joint of the femoral head and acetabulum of the hip bone. It is accompanied by pain and limitation of the amplitude of movements of varying severity, which depends on the stage of development. And if in the initial stages it is possible to cope with coxarthrosis with conservative methods, in the 3rd stage it is possible to save the situation and maintain the working capacity of the hip joint, that is, to avoid disability, only by performing an operation.

It belongs to the number of osteoarthritis and can be accompanied by the development of similar processes in other joints, and this pathology accounts for about 12% of all diseases of the musculoskeletal system. But the term "coxarthrosis" can only be used to describe degenerative-dystrophic changes in the hip joint.

What is coxarthrosis

Coxarthrosis is a complex pathology of one or both hip joints, in which the cartilaginous layers covering the femoral head and acetabulum are destroyed, which leads to a decrease in the size of the joint space. As the disease progresses, deformations of the surfaces of the bones and the formation of bone growths on them, called osteophytes, are observed.

Coxarthrosis is the second most common disease of the musculoskeletal system. More often, only gonarthrosis is diagnosed, that is, a degenerative-dystrophic change in the knee joint. However, the likelihood of disability in coxarthrosis is significantly higher.

The entire hip joint is enclosed in a specific case, called the joint capsule. It has a so-called synovial membrane, which produces synovial fluid. This fluid is essential for the proper functioning of the joint, as it not only lubricates the hyaline cartilage, but is also a source of nutrients for it.

Normally, the cartilage is constantly worn out and immediately restored due to the continuous regeneration process, which is carried out with the help of substances that penetrate it from the synovial fluid. But with age-related injuries or changes, the speed of regeneration processes decreases, which leads to gradual wear of hyaline cartilage and the development of coxarthrosis.

This is due to changes in the amount of synovial fluid produced and its composition. Under the influence of adverse factors, it becomes more dense and produced in a smaller volume. As a result, the synovial fluid is no longer able to supply the hyaline cartilage with all the substances it needs in the right amount, which leads to its rapid dehydration and thinning. Gradually, the strength and elasticity of the cartilage decrease, the areas of delamination of the fibers that form it, cracks form, and the thickness also decreases. These changes can be noticed during instrumental diagnostic methods, especially the narrowing of the joint space draws attention to itself.

The narrowing of the joint space leads to greater friction between the bone structures that form the hip joint and to an increase in pressure on the already decaying hyaline cartilage. This causes it even more damage, which affects the functioning of the joint and the condition of the person, as the deformed areas prevent the head of the femur from sliding easily into the acetabulum. As a result, there are symptoms of coxarthrosis.

If left untreated, the pathological changes worsen and the hyaline cartilage wears out more and more. Later, in some areas, it completely disappears, which leads to exposure of the bones and a sharp increase in the load on the joint. Since when moving inside the acetabulum, the head of the femur rubs directly against the bone, this causes the appearance of severe pain and severe limitation of mobility. In this case, the mutual pressure of the bone structures leads to the formation of bone growths on their surface.

Formed osteophytes can have sharp parts that can injure the muscles and ligaments surrounding the hip joint. This leads to the appearance of severe pain both directly in the joint area and in the groin, buttocks and thigh. As a result, the patient spares the injured leg, stresses it less and tries to avoid making unnecessary movements with it. This causes the development of muscle atrophy, which further aggravates mobility disorders and ultimately leads to lameness.

Causes

There are many reasons for the development of coxarthrosis, although in rare cases it occurs against the background of the absence of any prerequisites. In this case we speak of the presence of primary or idiopathic coxarthrosis. In the vast majority of cases, secondary coxarthrosis is diagnosed, which becomes a logical consequence of a number of diseases or changes in the state of the musculoskeletal system. It can be caused by:

• hip joint injuries of various kinds, including fractures, dislocations, bruises, sprains or torn ligaments;
• hard physical work, professional sports, especially weightlifting, skydiving, jumping sports;
• sedentary lifestyle;
• being overweight, which significantly increases the load on the hip joints;
• foci of chronic infection in the body;
• congenital malformations of the hip joints, such as dysplasia or dislocation;
• metabolic pathologies and endocrine disorders, in particular gout, diabetes mellitus, especially in decompensated form;
• aseptic necrosis of the femoral head, which may be the result of a fracture of the femoral neck, especially during conservative treatment;
• inflammatory diseases of the joints, including rheumatoid arthritis, bursitis, tendonitis;
• diseases of the spine;
• genetic predisposition;
• the presence of bad habits, especially smoking.

However, the main cause of coxarthrosis is still the inevitable age-related changes and the presence of the aforementioned factors only increases the probability and speed of its development.

Coxarthrosis Symptoms

The disease is characterized by a gradual progression with a systematic increase in the intensity of symptoms. Therefore, in the initial stages, it can be asymptomatic or only occasionally cause anxiety in patients, but subsequently the condition of the hip joint worsens, which leads to an increase in the severity of the signs of coxarthrosis up to unbearable pain and significant limitation of mobility. .

So, degenerative-dystrophic changes in the hip joint are accompanied by:

• Pain of varying intensity, which occurs initially after physical exertion or walking and subsides after rest. Gradually, the severity of the pain syndrome increases, appears more often, lasts longer, and the periods between the moment of applying the load on the joint and the appearance of pain are reduced. Thereafter, the pain is present almost constantly, even at rest, and becomes unbearable. The increase in pain at any stage of the development of the disease during hypothermia and lifting heavy objects is characteristic.
• Restrictions in the mobility of the hip joint, which initially manifest themselves with slight difficulties in the implementation of rotational movements of the leg. Over time, morning stiffness appears, which disappears after the patient has "dispersed". This can be accompanied by the appearance of edema in the hip joint. As the disease progresses, restrictions on mobility become more pronounced and persistent, that is, they do not disappear after rewarming. Patients notice a decrease in the amplitude of leg movements and, subsequently, completely lose the ability to perform certain movements.
• Cracks in the hip joint, which appear when walking or doing physical work, especially when doing extension. It becomes the result of the friction of bare bone structures against each other, which is accompanied by a sharp increase in pain.
• Spasm of the thigh muscles, leading to widespread pain in the thigh. This can be the result of the attachment of various intra-articular disorders, including compression of the nerves, excessive stretching of the ligaments surrounding the joint, as well as the development of synovitis, that is, inflammation of the synovial membrane and accumulation of inflammation effusion into the cavity of the hip joint.
• Lameness, which is at first the result of the patient's unconscious desire to reduce the load on the diseased joint and transfer weight to the healthy leg to avoid the onset or intensification of pain, and then the development of muscle contractures. The latter phenomenon occurs already in the later stages of coxarthrosis and leads to the fact that the patient is unable to fully straighten the leg and, moreover, to keep it in this position. Therefore, the lower limb with the affected hip joint is constantly in a slightly bent position, which causes lameness.
• A decrease in the length of the legs, which mainly occurs already with severe degenerative-dystrophic changes in the hip joint, accompanied not only by narrowing of the joint space, but also by flattening of the femoral head, muscle atrophy. As a result, the diseased leg becomes shorter than the healthy one by 1 or more centimeters.

Coxarthrosis can affect either one hip joint or both at the same time. But if in the first case the symptoms of the disease will be observed only on one side, then in the second they will not only be bilateral, but also differ in intensity. It depends on the degree of destruction of each hip joint.

Degrees of coxarthrosis

The nature of the manifestations of the disease depends on the stage of its development. In total, there are 3 degrees of coxarthrosis, of which the first is considered the simplest. In the initial stages of the occurrence of degenerative-dystrophic changes in the hip joint, only episodic pains can be observed. As a rule, this occurs after intense physical exertion, after playing sports or a long walk. Therefore, patients usually do not pay attention to them, attributing them to fatigue and considering them normal age-related changes. In this regard, coxarthrosis of the 1st degree is diagnosed only in isolated cases, which usually occur during an examination for another reason.

As the disease progresses, its symptoms intensify and already with 2nd degree coxarthrosis are felt. This stage of development of the pathology is characterized by a narrowing of the joint space by 50%, as well as the appearance of signs of deformation of the femoral head with its displacement.

With the further progression of the pathology, the joint space narrows even more, and with the 3rd degree of coxarthrosis it is almost completely absent. This is already accompanied by the formation of multiple osteophytes. At this stage of the development of the disease, the pain becomes not only severe, but unbearable, and often occurs even in a state of complete rest, even at night. Since the hip joint is severely deformed, its elements can violate the nerves that pass here, which leads to pain that radiates to the groin, buttocks, thigh, and even lower leg. This also results in the inability to move independently without the use of aids, such as crutches or canes.

3rd degree coxarthrosis is a direct indication for surgical treatment. If the operation is not done in time, the head of the femur will firmly fuse with the surface of the acetabulum with the osteophytes. This will entail a shortening of the leg, the complete absence of the possibility of independent movement, since the joint will completely lose mobility, i. e. disability.

Diagnostics

If signs of coxarthrosis occur, it is recommended to contact an orthopedist as soon as possible. Initially, the doctor will interview the patient and find out the nature of the complaints, then proceed to the examination and performance of functional tests, comparing the length of the legs. As a rule, the data obtained are sufficient to speak with a high degree of confidence about the presence of coxarthrosis.

But since such a clinical picture can accompany a number of other diseases of the hip joints, both of an inflammatory and non-inflammatory nature, instrumental diagnostic methods are required. With their help, a specialist will be able not only to confirm the presence of coxarthrosis, to differentiate it from the radicular syndrome caused by pathologies of the spine, but also to correctly assess the degree of its development, which means choosing treatment tactics more effective.

Today for the diagnosis of coxarthrosis are used:

• X-ray of the hip joints - the resulting images allow you to detect signs of destructive changes, the presence of osteophytes, the nature of the deformation of bone structures and measure the thickness of the joint space.
• CT is a more modern method of diagnosing bone disease, providing clearer data than X-rays, but more expensive. Therefore, CT is prescribed in controversial cases, when it is necessary to clarify the diagnosis and the degree of destruction of the hip joint.
• MRI is a highly informative method of examining the joints, providing the maximum amount of information about the state of the joint and all its structures, especially hyaline cartilage, ligaments and characteristics of the blood supply.

Patients are prescribed numerous laboratory tests, including KLA, OAM, rheumatic tests, biochemical blood tests, and others.

Conservative treatment of coxarthrosis

When diagnosing coxarthrosis of 1 or 2 degrees, treatment is carried out by conservative methods. For each patient, they are selected individually, taking into account the detected comorbidities. Therefore, it may often be necessary to consult not only an orthopedist, but also doctors of other specialties who will select the necessary treatment to combat concomitant diseases.

As part of the treatment of coxarthrosis, patients are prescribed:

• pharmacological therapy;
• physical therapy;
• Physiotherapy.

It is mandatory for all patients to take measures to eliminate the effects of factors that increase the load on the legs and contribute to the progression of degenerative changes in the hip joint. This includes adjusting the diet and increasing the level of physical activity if you are overweight. If the patient is regularly exposed to excessive physical exertion, it is recommended to change the type of activity or to reduce the intensity of training, if the load is due to sport. In some cases, it is recommended to use special bandages and orthoses that will fix the hip joint and unload it during physical exertion.

Medical therapy

As part of drug treatment, patients are individually selected drugs, taking into account the existing concomitant diseases. As a rule, drugs of the following pharmacological groups are indicated for coxarthrosis:

• NSAIDs - a large group of drugs that show analgesic and anti-inflammatory effects (available in various dosage forms, including tablets, capsules, gels, creams, solutions for injection, which allows you to choose the most effective and convenient form of application);
• corticosteroids - drugs that have a powerful anti-inflammatory effect, but due to the high risk of side effects, especially when using oral forms, they are prescribed only for short courses in the form of injections;
• muscle relaxants - drugs that help reduce muscle tone, which allows you to effectively cope with muscle spasms, often observed in coxarthrosis;
• chondroprotectors - a group of drugs containing components used by the body for the regeneration of cartilage tissue;
• preparations that improve microcirculation - help improve the nutrition of soft tissues and activate the course of metabolic processes in the affected area;
• B vitamins - are indicated for nerve conduction disorders caused by nerve compression from altered components of the hip joint.

If coxarthrosis has caused an acute pain attack, which cannot be stopped with the help of prescribed NSAIDs, intra-articular or periarticular block is recommended for patients. Its essence lies in the introduction directly into the hip joint cavity of an anesthetic solution in combination with corticosteroids. This will allow you to quickly get rid of pain and reduce the inflammatory process. But the blocking can only be done by a qualified healthcare professional in a specially prepared room. Performing such procedures at home is not shown.

physical therapy

When diagnosing coxarthrosis, regular physical therapy is mandatory. In the same way as with drug therapy, a set of physical therapy exercises for each patient is selected individually, taking into account the degree of destruction of the hip joint, the level of physical development of the patient, the nature of concomitant diseases (special attention is paid to cardiovascular pathologies).

Thanks to daily physical therapy, you can:

• reduce the severity of pain;
• increase the mobility of the hip joint;
• reduce the risk of muscle atrophy;
• eliminate spasms of the thigh muscles;
• activate blood circulation and thus improve nutrition of the affected joint.

All exercises must be performed smoothly, avoiding sudden movements and jerks. But if pain occurs during physical therapy, you should definitely contact your doctor to correct the selected complex or conduct a new diagnosis to exclude the progression of the disease and the need for an operation.

Physiotherapy

The complete treatment of coxarthrosis involves cycles of physiotherapeutic procedures that have anti-inflammatory, analgesic, decongestant and tonic effects on the body. Therefore, very often patients are prescribed 10-15 procedures:

• ultrasound therapy;
• electrophoresis;
• UVT;
• magnetotherapy;
• laser therapy, etc.

Recently, plasmolifting has been increasingly used as part of the conservative treatment of coxarthrosis, which can significantly increase the regeneration rate of hyaline cartilage. The essence of the procedure is the introduction into the hip joint cavity of purified blood plasma, obtained by centrifugation from the patient's own blood.

Surgery for coxarthrosis

If a patient is diagnosed with 3rd degree coxarthrosis, it is indicated for surgical intervention, since conservative methods in such cases are already powerless. Unfortunately, such situations are extremely common today, as very large numbers of patients seek medical assistance when they can no longer bear pain or have severe mobility restrictions that deprive them of their ability to work and move independently.

Prompt surgery can completely eliminate these ailments and restore the patient's ability to move normally, greatly improving his quality of life. The indications for its implementation are:

• a significant decrease in joint space by more than 80%;
• the presence of severe pain in the hip joint, which cannot be eliminated;
• pronounced mobility disorders;
• fracture of the femoral neck.

The gold standard for the treatment of severe coxarthrosis, even in the elderly, is hip arthroplasty. This operation involves replacing a destroyed hip joint with an artificial endoprosthesis made of durable and at the same time biologically compatible materials. Endoprosthesis allows you to completely restore the functionality of the hip joint, eliminate pain and return a person to a full-fledged active life.

The essence of this type of surgery is the resection of the head of the femur and a small fragment of its neck. In addition, the surgeon will have to prepare the surface of the acetabulum for the installation of the endoprosthesis, that is, remove all formed osteophytes and achieve maximum restoration of its normal shape. Subsequently, an endoprosthesis of the chosen type is installed, which is fixed with a special cement (preferably for the treatment of the elderly) or in an uncemented way. In the latter case, the endoprosthesis has a special spongy part in contact with the bone structures. Its fixation in the acetabulum is provided by the germination of bone tissue through the sponge.

For each patient, the type of arthroplasty is selected individually. The most effective is total arthroplasty, which involves the complete replacement of the entire hip joint, i. e. the neck and head of the femur, as well as the acetabulum.

If the patient has preservation of normal hyaline cartilage on the surface of the acetabulum, she can undergo partial arthroplasty with replacement of the femoral head and / or neck only. For this purpose, endoprostheses of different models are used: monopolar and bipolar.

The only disadvantage of arthroplasty can be considered the need to replace the installed endoprosthesis after 15-30 years.

After replacement of the endoprosthesis, patients are shown rehabilitation, the duration of which depends on the speed of tissue repair. As part of the recovery, physical therapy exercises, physiotherapy and therapeutic massage are prescribed.

Before the advent of modern endoprostheses, patients with grade 3 coxarthrosis were prescribed osteotomy or arthrodesis. Today these techniques are used less and less, as they have a number of disadvantages. Therefore, arthrodesis involves fixation of the bony structures of the hip joint with metal plates. As a result, the pain syndrome is completely eliminated, but the joint completely loses its mobility. Therefore, after arthrodesis, the patient can only stand but is no longer able to walk independently due to the lack of movement of the hip joint. Therefore, arthrodesis is practically not performed today.

Osteotomy involves performing an artificial fracture of the femur with such a combination of bone fragments that it will reduce the load on the affected hip joint. But the operation gives only a short-term effect, and the need for arthroplasty still arises in the future.

Therefore, coxarthrosis of the hip joint is a rather dangerous disease, which can cause disability. It severely reduces the quality of life and deprives a person of working capacity. But if you pay attention to the first signs of pathology and receive prompt advice from an orthopedist, you can slow down its progression and achieve a significant improvement in well-being. But with coxarthrosis already underway, there can only be one solution: arthroplasty. Fortunately, this method can be used even with severe degenerative-dystrophic changes and completely restore the normal functioning of the hip joint.