Arthrosis of the hip joint (coxarthrosis)- This is a chronic degenerative joint disease, which leads to deformation of bone tissue.With coksartrosis, all components of the joint are involved in the pathological process: articular cartilage, bone structures adjacent to cartilage, synovial shell, ligaments, capsule and adjacent muscles.In case of disease, articular cartilage is destroyed, micro-redimits of bones and osteophytes (bone growths) appear, and an inflammation of the muscle-ligamentous apparatus of the hip joint occurs.
In the world, every fifth person complains of joint problems with joints.This can be both pain or restriction of movement in the joints, and a combination of these symptoms.Each second outpatient vision falls on patients with bone-muscular disorders, while 66 % of cases are people under 65 years old.According to the latest epidemiological research, the prevalence of arthrosis of the knee and hip joints among the adult population is 13 %.
Risk factors for the development of coxarthrosis:
- Genetic predisposition.A common cause of coksartrosis of the hip joints is the congenital or acquired mutation of the type of type of type II prollagen.
- Elderly age.The probable cause of the prevalence of arthrosis in old age is a discrepancy between the damaging effect on the joint cartilage of the external environment and its capabilities to restore.
- Floor.Women suffer from osteoarthritis more often than men.This is due to the effects of the influence of female sex hormones of estrogen on the bone-mineral metabolism.However, the influence of the floor is ambiguous - according to some authors, unlike damage to other joints, there are no differences in the sexual basis for coksartrosis: in men, arthrosis of the hip joint is as often found as in women.
- Excess body weight.The relationship is proved between the excess body mass and the occurrence of arthrosis.Excess adhesive tissue increases the damaging load on cartilage.In addition, adipose tissue produces pro -inflammatory enzymes that damage cartilage tissue.
- Frequent development of bones and joints.In accordance with studies, 80 % of coxarthrosis, which occurs for no apparent reason, is associated with previously not diagnosed defects in the development of the hip joint - dysplasia and subluxation.
- Heavy physical labor.An excess load on the hip joints with certain types of physical labor can lead to damage to the joints and the formation of arthrosis.At risk are agricultural workers, diggers and people of similar working specialties.
- Injuries.The risk of developing coxarthrosis increases after an injury to the hip joint.Moreover, both one injured joint and both can be involved in the process.
- Professional playing sports.Professional sport can provoke the occurrence of coxarthrosis both because of the excessive load on the joints and due to injuries.Potentially dangerous sports include heavy athletics, athletics jumping, parachute sport.
- Bones and joint diseases- rheumatoid arthritis, psoriatic arthritis, joint infections, avascular necrosis, gouty arthritis, etc.
- Endocrine pathologies- hypothyroidism, hypoparathyroidism, acromegaly (impaired function of the anterior pituitary gland), diabetes, obesity.
If similar symptoms are detected, consult a doctor.Do not self -medicate - it is dangerous for your health!
Symptoms of arthrosis of the hip joints
The main symptoms of coxarthrosis include: pain, mobility restrictions and crunch in the joints, their deformation, functional shortening of the lower limb and periodic swelling in the joints.
Pain of various intensity.The pain in the joint is initially insignificant and arise for a short time.They appear or intensify while walking or with other physical exertion, for example, during squats, inclinations and weight lifting.As the disease develops, pain intensifies and even a long rest does not bring relief.In addition, pain occurs with prolonged immobility and fixation of the joint in one position.
Patients complain of the so -called "starting" pains in the hip joints after sleeping, driving in a car and other prolonged immobility."Starting" pain for coxarthrosis lasts no more than 30 minutes.Pain intensifies during hypothermia or in a stressful situation.They can be localized in the area of the buttock or groin, on the front or side surface of the thigh.With the spread of pain over the nerves of the lumbar plexus, it can be transmitted to the thighs distant from the center of the body or in the knee.Sometimes the pain applies to the lumbosacral spine and tailbone.
Restriction of joint mobility.Movements in the hip joint with coksartrosis are limited due to pain.At the same time, rotation (turns both inside and out) and bringing the lower limb (movement to the middle of the body) are more often disturbed, but can be limited (movement from the middle axis of the body), as well as flexion and extension.The inability to make passive movements in the joint due to a pronounced pain syndrome causes a compensatory pelvic bias.The patient's gait changes, the buttocks stick out back, the body deviates forward when transferring weight to the damaged side.With bilateral damage in patients with coksartrosis, a "duck gait" is formed.
With coxarthrosis periodically occursswelling in the jointwhich can be invisible due to the muscle and fat layer.Also, the disease is characteristicCryst in the joints during movement, their gradual deformation and functional shortening of the lower limb.
Often, one joint is affected with the disease, then the process applies to others.But sometimes arthrosis affects several joints at once and polyosostoarthritis occurs.Polyosteoarthrosis is characteristic of elderly people or with a hereditary predisposition and concomitant diseases - diseases of bones, joints and endocrine disorders.
Pathogenesis of arthrosis of the hip joints
In the pathogenesis of arthrosis of the hip joints, an important role is played by mechanical damaging (injuries and microtraumas due to increased physical exertion on the joint) and genetic, hormonal and metabolic factors.Often it is not possible to find out which factor has influenced the development of the disease in a particular patient, but often the disease develops after tissue damage with mechanical injury.
Damage to the tissue stimulates the division of cartilage tissue cells (chondrocytes), while the production of pro -inflammatory cytokines increases, which are normally present in cartilage in only small quantities.The cytokines launch the inflammatory process, for example, under the influence of pro-inflammatory cytokine IL-1, enzymes are distinguished that destroy the cartilage of the joint.Also, under the influence of cytokines, the production of the TsOG-2 enzyme and other substances that have a toxic effect on the cartilage increases.
Synovites also play a large role in the development of coxarthrosis - inflammatory diseases of the synovial shell of joints or ligaments with the accumulation of fluid in the cavity.
A decrease in the elasticity and strength of the articular cartilage associated with the metabolic disorders leads to a decrease in its resistance to mechanical stress.With coksartrosis, all components of the joints are involved in the pathological process, including a subchondral bone.Due to the fact that large joints of the lower extremities account for large joints of the body, they experience significant mechanical stress, due to which microvalomas occur in the subchondral plate and cartilage.As a result of microvelomas, the subchondral bone is compacted, which leads to the regional growth of bone tissue - osteophytes.And this, in turn, stimulates further degradation of the articular cartilage.
In some cases, arthrosis of the hip joint is inherited.Hereditary arthrosis is supposedly polygenic inheritance - due to the action of many genes, each of which affects weakly.The cause of some diseases is a mutation in genes encoding macromolecules of articular cartilage, which causes its ruptures.Genes responsible for the division of chondrocytes may also suffer.In addition, metabolic disorders are inherited, such as pyrophosphate arthropathy - a disease in which crystals of calcium pyrophosphate accumulate in the articular cartilage and synovial fluid.
Classification and stages of development of arthrosis of the hip joints
Depending on the causes of the disease, coxarthrosis is divided into two main forms: primary (idiopathic) and secondary (arising from or because of other diseases).
Primary coksartrosis:
- Localized (only hip joints affects):
- unilateral;
- bilateral.
- Generalized (polyosteoarthrosis) with a lesion of at least three joint groups (for example, hip, knee and small joints of brushes or feet).
Secondary arthrosis:
- Post -traumatic:
- acute - as a consequence of acute injury;
- Chronic - due to classes of some sports or as a result of professional activity.
- Metabolic diseases (oconosis, hemochromatosis, Wilson's disease, Gaucher disease).
- Congenital pathologies and development defects (congenital dysplasia of the hip joint, Pertes disease, slipping of the epiphyse of the femur, hypermobility syndrome, shortening of the lower limb, scoliosis, bone dysplasia).
- Endocrine pathologies (acromegaly, hypothyroidism, diabetes mellitus, hyperparathyroidism, obesity).
- Calcium salts (pyrophosphate arthropathy, calcifying tendonitis).
- Diseases of bones and joints (rheumatoid arthritis, psoriatic arthritis, Pedhetic disease, avascular necrosis, infections).
According to clinical manifestations, the following forms of coxarthrosis are distinguished:
- Little symptomic.
- Manifest, manifested by bright clinical symptoms:
- rapidly progressive, in which symptoms develop in the first four years from the onset of the disease;
- Slowly progressive - clinically significant symptoms appear after five years of the course of the disease.
In accordance with the X -ray picture, two types of arthrosis of the hip joints can be identified:
- hypertrophic - with signs of increased reparative response (lesions are replaced by a new tissue, for example, osteophytes appear);
- Atrophic (decrease in tissue volume).
The stages of the disease can be determined radiologically and clinically.To determine the radiological stage of arthrosis of the hip joint, the classification of Kellgren and Lawrence (1957) is most often used.
Stages of arthrosis in radiological classification
| Stage | Signs |
|---|---|
| 0 | There are no signs of arthrosis in X -ray images |
| 1 | The joint gap is not changed, single regional osteophytes are visualized |
| 2 | The joint gap is not changed, significant regional osteophytes are visualized |
| 3 | The height of the joint gap is moderately reduced, significant regional osteophytes are visualized |
| 4 | The height of the joint gap is significantly reduced, significant regional osteophytes and subchondral osteosclerosis are visualized (bone tissue compaction under the lower surface of the cartilage with the structure of the cartilage) |
To determine the clinical stage of the disease, classification (1961) is used, which uses both clinical signs and visualization criteria.
Clinical stages of arthrosis
| Stage | Signs |
|---|---|
| 0 | The articular gap is narrowed unequivocally and unevenly, the edges of the articular cracks are slightly pointed (initial osteophytes), a slight restriction of movements is noted |
| 1 | The articular gap is significantly narrowed (50-60 %), significant osteophytes, subchondral osteocosclerosis and cystic enlightenment in bone epiphysees;The clinic is predominated by the restriction of mobility in the joints, a rough crunch during movements, insignificant or moderate muscle atrophy |
| 2 | deformation, stiffness of the joint;The articular gap is narrowed by more than 60-70 % of the norm or completely absent, extensive osteophytes, subchondral cysts, articular “mice” are visualized-bone, cartilage or mixed pathological formations located in the joint cavity |
Complications of arthrosis of the hip joints
With coxarthrosis, all complications are associated precisely with pathological changes in the joints.
The course of coksartrosis can be complicated by local inflammatory processes:
- Bursite - inflammation of synovial bags in the joints;
- tendovaginitis - inflammation of the inner shell of the vagina of muscle tendons;
- Tunnel syndrome-pinches of the nerve due to the formation of large osteophytes or with joint deformation.
With the progression of coxarthrosis and its transition to the II and III clinical stages, the pain limits the mobility of the joint, and over time, the joint ankylosis (fibrous, bone or cartilage) occurs, accompanied by its complete immobility.
Significant joint deformation can lead toFractures or aseptic necrosis of bones.For coksartrosis, aseptic necrosis of the femoral head is the most formidable complication.
With pronounced coksartrosis, may occursubluxation and dislocation of the jointas well as the penetration of the femoral head into the pelvic cavity.The dislocations and subluxation of the hip joint lead to pain (at first acute, then dull and aching), intensifying during walking and other physical exertion, as well as to deformation of the joint, lame, and sometimes to shorten the affected limb.
Despite the lack of systemic manifestations of arthrosis itself, in modern clinical practice, more attention is paid to the diseases associated with it.These are such pathological conditions that exist or arise against the background of the current disease.In connection with inflammatory reactions arising during arthrosis, the formation of atherosclerotic plaques on the internal walls of the vessels is enhanced, which increases the riskCardiovascular diseases.A decrease in physical activity due to pain and restriction of joint mobility leads toobesity, depression and deterioration in the quality of life.With prolonged use of non -steroidal anti -inflammatory drugs,The upper gastrointestinal sections are affected,And alsoThe risk of cardiovascular pathologies and kidney diseases increases.
Diagnosis of arthrosis of the hip joints
The diagnosis of "coksartrosis" is made on the basis of clinical manifestations and radiological examination.There are no characteristic laboratory signs for the diagnosis of arthrosis.
Among the clinical manifestationsThe main for the diagnosis of arthrosis of the hip joint is the pain and its character.Pain for arthrosis of the hip joint occurs and grows gradually over several years (sometimes several months with a rapidly progressive form).The pain occurs or enhances during physical exertion or in a standing position.If the patient begins to feel pain alone, then inflammation (synovitis) joined.Statement is noted up to 30 minutes in the morning and with prolonged immobility.
The limitation of joint mobility is gradually increasing, this applies to both active and passive movements.With the development of the disease, joints are deformed, functional shortening of the limb length may occur.
On a physicine examinationThere is a limitation of joint mobility, their deformation, shortening of the limbs, pain on palpation of the joint and a large spinning of the femur, muscle atrophy.
Laboratory methodsFor the diagnosis of arthrosis of the hip joints are not required.However, they can be used for the differential diagnosis of coxarthrosis with arthritis (rheumatoid and chronic), since with arthrosis there are no inflammatory changes in the overall blood test and rheumatoid factor, and uric acid levels are not increased.In addition, using laboratory tests, contraindications are revealed for drug treatment methods.
Instrumental methodsFor the diagnosis of arthrosis of the hip joints:
- Radiography- This is the main method of diagnosing arthrosis of the hip joints.The radiograph determines the changes characteristic of coksartrosis: narrowing of the joint gap, osteophyte, erosion and ulceration of the cartilage, subchondral cysts and osteosclerosis.X -ray examination is a classic method for the diagnosis of coxarthrosis, and radiological signs underlie the classification of coxarthrosis.However, at present, other methods of visualization of the joint are increasingly used, such as ultrasound and magnetic resonance imaging.
- Ultrasound examination (ultrasound) -The advantage of ultrasound is in the absence of a radial load on the body.
- Magnetic resonance tomography (MRI)- In comparison with other methods, it allows you to more clearly visualize joint damage.
- Arthroscopy-Allows you to identify damage to the articular cartilage: from the zones of chondromation (softening of the articular cartilage) with a diameter of less than 10 mm to deep cracks that penetrate up to the subchondral bone and the formation of deep ulcers.Superficial and medium cracks and surface erosion can also be visualized.
The identification of coksartrosis usually does not represent special difficulties, but when assessing a specific clinical situation, it is necessary to remember the possible secondary origin of arthrosis of the hip joints (as complications of other diseases, for example, with endocrine disorders).
Treatment of arthrosis of the hip joints
Treatment of arthrosis of the hip joints can be both conservative (medication and non -united) or operational.Conservative treatment is used at 1-2 stages of the disease, surgical-at 3 stages.Surgical treatment can be recommended at 2 stages with persistent pain and lack of reaction to conservative therapy.
The goals of conservative therapy:
- improve the quality of life - reduce pain and increase joint mobility;
- Stop or slow down the development of the disease.
Non -drug treatment methods include:
- unloading of the hip joint (decrease in body weight, the creation of additional support and the transfer of part of the body weight to cane or crutches);
- physiotherapy physical education;
- Physiotherapeutic treatment methods.
Treatment of coxarthrosis begins with non -drug methods, an important role is given to physiotherapy exercises.With severe pain, the patient should use the support.With a pronounced disease and the presence of contraindications to endoprosthetics, the support has to be used for life.
Medicinal therapy of CuxartrosisIncludes drugs that reduce the symptoms of the disease.These are analgesics, as well as drugs from the group of non -steroidal anti -inflammatory drugs (NSAIDs).The NSAIDs are divided into non -election and selective.
Analgesics and NSAIDs for arthrosis of the hip joint are used for a short time to relieve pain and inflammation.Currently, there is no proven advantage of one non -steroidal anti -inflammatory agent over another, so the choice of a particular drug depends on the side effects and a specific clinical situation caused by it.
It must be remembered that NSAIDs have a number of side effects.When taking them, the mucous membrane of the stomach and duodenum is affected, as a result of which ulcers and bleeding are possible.A number of NSAIDs have a toxic effect on the liver and kidneys.In addition, NSAIDs disrupt platelet aggregation, and, as a result, the patient is disrupted by thrombosis and there is a tendency to bleeding.The NSAIDs with prolonged use suppress the processes of hematopoiesis and can cause aplastic anemia and agranulocytosis.Reception of selective NSAIDs causes significantly less complications.
Ointments and gels used locally cause less side effects than oral products.For the treatment of arthrosis, drugs with warming and reducing pain are used.They can contain turpentine, menthol, nicotinic acid esters, salicylates, bee venom.Also, the NSAIDs have a good effect.
In the absence of the effect of analgesic and NSAIDs or if it is impossible to choose the optimal dose of the drug, painkillers of central action can be prescribed short -term.
In case of inflammation, intra -articular administration of corticosteroids is used.Corticosteroids are used no more than 2-3 times a year, since more frequent use can lead to cartilage degeneration.
Slowly acting drugs weakens the symptoms of the disease include chondroprotectors, inappropriate compounds of avocados or soy, hyaluronic acid.These drugs are included in the recommendations of the European Antirematic League for the treatment of arthrosis of the hip joints.Preparations reduce pain and improve joint mobility.
Endoprosthetics of the hip jointsIt is used in severe cases of stage III, when the pain syndrome cannot be eliminated, and the mobility of the joint is significantly limited.Prosthetics of the hip joint leads to a decrease in the pain syndrome, an improvement in the functional state of the joint and the quality of the patient's life.The effect persists for 10-15 years, after which a second operation may be required.During surgery, the hip joint is replaced by artificial imitation of ceramics, metal (most often used titanium prostheses) or polymer.
Forecast.Prevention
The prognosis of arthrosis of the hip joints in relation to the patient’s life is favorable, but the disease often leads to disability.According to the World Health Organization, 80 % of elderly patients with coxarthrosis have a violation of mobility, and 25 % cannot do everyday matters.In this regard, the primary prevention of arthrosis of the hip joints is important.
Prevention measures:
- Reduce body weight.It is necessary to adjust the nutrition in order to reduce the weight and load on the joint.In addition, a decrease in the volume of adipose tissue reduces the amount of inflammation mediators it released.
- Avoid heavy physical labor and sports overloads.Physical overloads are often the cause of arthrosis of the hip joints, while moderate physical activity, on the contrary, improves the condition of the articular cartilage, retains its normal mobility and reduces the load on other joints.
- Correct the underlying disease.If the patient is detected in diseases that can lead to secondary coksartrosis (endocrine, rheumatic and others), the underlying disease is necessary.The normalization of the hormonal background and the achievement of persistent remission of rheumatic diseases is both the primary prevention of arthrosis, and allows you to slow down its development.
- Lead a healthy lifestyle.A balanced diet with a sufficient content of plant and animal protein, polyunsaturated fatty acids and limiting simple carbohydrates, as well as moderate physical activity, avoid the occurrence of coxarthrosis even in the presence of risk factors.
Currently, the prevention of diseases of the hip joint is mandatory in neonatology and pediatrics.In time, the adjusted congenital dysplasia of the hip joint significantly reduces the risk of coxarthrosis in adulthood.