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, gradual destruction of the articular joint of the femoral head and acetabulum of the pelvis occurs.It is accompanied by pain and limited mobility 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 stage 3 it is possible to save the situation and maintain the functionality of the hip joint, that is, avoid disability, only through surgical intervention.

It is classified as arthrosis 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 destruction of the cartilaginous layers covering the head of the femur and the acetabulum occurs, resulting in a decrease in the size of the joint space.As the disease progresses, deformation of bone surfaces and the formation of bone growths on them, called osteophytes, occur.

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 probability of disability in case of 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 extremely important for the proper functioning of the joint, as it not only lubricates the hyaline cartilage, but also provides it with a source of nutrients.

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

This is explained by changes in the amount of synovial fluid produced and its composition.Under the influence of unfavorable factors, it becomes thicker and is produced in less volume.As a result, the synovial fluid is no longer able to provide the hyaline cartilage with all the substances it needs in the required quantity, which leads to its rapid dehydration and thinning.Gradually, the strength and elasticity of the cartilage decreases, areas of separation of the fibers forming it form, cracks form, and the thickness also decreases.These changes can be noted during instrumental diagnostic methods, especially narrowing of the joint space.

Narrowing of the joint space leads to increased friction between the bony structures that form the hip joint and increased pressure on the already degraded hyaline cartilage.This causes 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, symptoms of coxarthrosis occur.

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

The osteophytes formed may have sharp edges that can damage the muscles and ligaments surrounding the hip joint.This leads to severe pain both directly in the joint area and in the groin, buttocks and thigh.As a result, the patient spares the injured leg, puts less load on it and tries to avoid making unnecessary movements with it.This causes the development of muscle atrophy, which further aggravates the mobility impairment and ultimately leads to lameness.

Causes

There are many reasons for the development of coxarthrosis, although in rare cases it occurs in the absence of 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 condition of the musculoskeletal system.Its development can be caused by:

• hip joint injuries of various types, including fractures, dislocations, contusions, sprains, or torn ligaments;
• heavy physical work, professional sports, especially weightlifting, parachuting, jumping sports;
• sedentary lifestyle;
• excess weight, which significantly increases the load on the hip joints;
• foci of chronic infection in the body;
• congenital anomalies 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 can be a consequence of a fracture of the femoral neck, especially during conservative treatment;
• inflammatory joint diseases, including rheumatoid arthritis, bursitis, tendonitis;
• spinal diseases;
• genetic predisposition;
• presence of bad habits, especially smoking.

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

Symptoms of coxarthrosis

The disease is characterized by 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 to patients, but later the condition of the hip joint worsens, which leads to an increase in the severity of coxarthrosis signs 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 initially appears after physical activity or walking and eases after rest.Gradually, the severity of the pain syndrome increases, it appears more often, lasts longer, and the periods between the moment the load is applied to the joint and the appearance of pain are reduced.Subsequently the pain is present almost constantly, even at rest, and becomes unbearable.Intensification of pain is typical at any stage of the disease with hypothermia and lifting heavy objects.
• Limitations of mobility of the hip joint, which initially manifest themselves as slight difficulties in performing rotational movements of the leg.Over time, morning stiffness appears, which disappears after the patient “disperses”.This may be accompanied by the appearance of swelling in the hip joint.As the disease progresses, mobility restrictions become more pronounced and persistent, that is, they do not disappear after warming.Patients notice a decrease in the range of leg movements and subsequently completely lose the ability to perform certain movements.
• A creaking noise in the hip joint that appears when walking or performing physical work, especially when performing extension.It becomes the result of friction of exposed bone structures against each other, accompanied by a sharp increase in pain.
• Spasms of the thigh muscles, leading to the appearance of widespread pain in the thigh.This may be the result of the addition 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 inflammatory effusion in the cavity of the hip joint.
• Lameness, initially resulting from the patient's unconscious desire to reduce the load on the diseased joint and transfer weight to the healthy leg to avoid the appearance or intensification of pain and therefore the development of muscle contracture.The latter phenomenon occurs already in the later stages of coxarthrosis and leads to the fact that the patient is not able to completely straighten the leg and, moreover, 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 leg, which occurs mainly with severe degenerative-dystrophic changes in the hip joint, accompanied not only by a narrowing of the joint space, but also by flattening of the femoral head and muscle atrophy.As a result, the diseased leg becomes shorter than the healthy one by 1 or more centimeters.

Coxarthrosis can affect one or both hip joints 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 will also differ in intensity.This 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 mildest.In the initial stages of the onset of degenerative-dystrophic changes in the hip joint only occasional pain can be observed.As a rule, this occurs after intense physical activity, sports or long walks.Therefore, patients usually do not pay attention to them, attributing them to tiredness and considering them a normal age-related change.In this regard, coxarthrosis of the 1st degree is diagnosed only in isolated cases, which usually occur during examination for another reason.

As the disease progresses, its symptoms intensify and already with 2nd degree coxarthrosis they make themselves 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 further progression of the pathology, the joint space narrows even more and at the 3rd degree coxarthrosis is almost completely absent.This is already accompanied by the formation of more osteophytes.At this stage of 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 interfere with the nerves passing here, causing pain radiating to the groin area, buttocks, as well as the thigh and even the lower leg.This also causes the inability to move independently without the use of assistive devices, such as crutches or a cane.

Third degree coxarthrosis is a direct indication for surgical treatment.If the operation is not performed in time, the femoral head will firmly fuse with the surface of the acetabulum by osteophytes.This will lead to a shortening of the leg, a complete lack of ability to move independently, since the joint will completely lose mobility, i.e.to disability.

Diagnostics

If signs of coxarthrosis occur, it is recommended to consult an orthopedist as soon as possible.Initially, the doctor will interview the patient and find out the nature of the complaints, and then proceed to examine and perform 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 a similar clinical picture can accompany a number of other diseases of the hip joints, both inflammatory and non-inflammatory in nature, instrumental diagnostic methods are necessarily prescribed.With their help, a specialist will be able not only to confirm the presence of coxarthrosis, to differentiate it from radicular syndrome caused by spinal pathologies, but also to correctly assess the degree of its development and thus select the most effective therapeutic tactics.

Today, the following are used to diagnose coxarthrosis:

• 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 pathologies, providing clearer data than x-rays, but it is 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 studying joints, as it provides the maximum amount of information about the condition of the joint and all its structures, especially hyaline cartilage, ligaments and the characteristics of the blood supply.

Patients are prescribed a variety of laboratory tests, including OAC, OAM, rheumatic tests, biochemical blood tests and others.

Conservative treatment of coxarthrosis

When diagnosing coxarthrosis of 1 or 2 degrees, treatment is carried out using conservative methods.For each patient they are selected individually, taking into account the concomitant pathologies detected.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:

• drug therapy;
• physical therapy;
• physiotherapy.

It is imperative that all patients 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 involves adjusting your diet and increasing your level of physical activity if you are overweight.If the patient is regularly exposed to excessive physical activity, it is recommended to change the type of activity or 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 relieve it during physical activity.

Drug therapy

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

• NSAIDs are a large group of drugs that have analgesic and anti-inflammatory effects (available in various dosage forms, including tablets, capsules, gels, creams, injectable solutions, which allows you to choose the most effective and convenient form of use);
• corticosteroids are 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 in short courses by injection;
• muscle relaxants - drugs that help reduce muscle tone, which allows you to effectively combat muscle spasms, often observed with coxarthrosis;
• chondroprotectors – a group of drugs containing components used by the body for the regeneration of cartilage tissue;
• drugs that improve microcirculation - help to improve the nutrition of soft tissues and activate metabolic processes in the affected area;
• B vitamins - indicated for nerve conduction disorders caused by compression of the nerves by altered components of the hip joint.

If coxarthrosis causes a sharp pain attack that cannot be relieved with the help of prescribed NSAIDs, patients are advised to undergo intra-articular or periarticular blockade.Its essence is to inject directly into the cavity of the hip joint a solution of anesthetic in combination with corticosteroids.This will eliminate the pain in the shortest possible time and reduce the inflammatory process.But the blockade can only be carried out by a qualified doctor in a specially prepared room.It is not recommended to carry out such procedures at home.

Physical therapy

When diagnosing coxarthrosis, regular physiotherapy exercises are necessary.Just like 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 and the nature of concomitant diseases (particular attention is paid to cardiovascular pathologies).

Thanks to daily physical therapy lessons it is possible to:

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

All exercises should be performed smoothly, avoiding sudden movements and jerks.But if pain occurs during exercise therapy, you should definitely contact your doctor to correct the selected complex or carry out repeated diagnoses to exclude the progression of the disease and the need for surgical intervention.

Physiotherapy

The complex treatment of coxarthrosis involves cycles of physiotherapeutic procedures that have an anti-inflammatory, analgesic, decongestant and tonic effect on the body.Therefore, most 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 rate of hyaline cartilage regeneration.The essence of the procedure is the introduction of purified blood plasma into the cavity of the hip joint, obtained by centrifugation from the patient's blood.

Surgery for coxarthrosis

If a patient is diagnosed with grade 3 coxarthrosis, he is indicated for surgical intervention, since conservative methods in these cases are no longer effective.Unfortunately, such situations are extremely common today, as a large number of patients seek medical help when they can no longer tolerate pain or have severe motor limitations that deprive them of the ability to work and move independently.

Timely surgery can completely eliminate these disorders and restore the patient's ability to move normally, significantly increasing his quality of life.The indications for its implementation are:

• significant reduction in joint space of more than 80%;
• the presence of severe pain in the hip joint that cannot be eliminated;
• severe motor disabilities;
• fracture of the femoral neck.

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

The essence of this type of surgery is the resection of the femoral head and a small fragment of the neck.The surgeon will also need 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.Next, an endoprosthesis of the selected type is installed, which is fixed with special cement (preferable for the treatment of elderly people) or without cement.In the latter case the endoprosthesis has a special spongy part which is in contact with the bone structures.Its fixation in the acetabulum is ensured by the growth of bone tissue through the sponge.

For each patient, the type of endoprosthesis is selected individually.The most effective is the total endoprosthesis, 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 preserved normal hyaline cartilage on the surface of the acetabulum, he or she may undergo partial arthroplasty with replacement of only the head and/or neck of the femur.For this purpose, endoprostheses of different models are used: monopolar and bipolar.

The only disadvantage of endoprosthesis replacement is the need to replace the installed endoprosthesis after 15-30 years.

After endoprosthesis, patients are performed rehabilitation, the duration of which depends on the speed of tissue recovery.As part of 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 numerous 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 mobility.Therefore, after arthrodesis, the patient can only stand, but is no longer able to walk independently due to lack of movement in the hip joint.Therefore, today arthrodesis is practically not performed.

An osteotomy involves making an artificial fracture of the femur with a combination of bone fragments that reduce the load on the affected hip joint.But the operation gives only a short-term effect and in the future the endoprosthesis will still be needed.

Therefore, coxarthrosis of the hip joint is a rather dangerous disease, which can cause disability.It seriously reduces the quality of life and deprives a person of the ability to work.But if you pay attention to the first signs of pathology and timely consult an orthopedist, you can slow down its progression and achieve a significant improvement in your well-being.But with coxarthrosis already advanced there can only be one solution: the endoprosthesis.Fortunately, this method can be used even in cases of severe degenerative changes and completely restore the normal functioning of the hip joint.