Every year, diseases of the musculoskeletal system worry more and more people, and their development at a young age is increasingly observed. This is facilitated not only by a change in lifestyle, but also by an increase in the level of injuries, which is largely interconnected. One of the most common pathologies of the musculoskeletal system is arthrosis of the hip joint, which is characterized by the occurrence of progressive pain and limited mobility. Ultimately, the disease can lead to complete immobility of the joint and disability. In order to avoid the occurrence of such undesirable consequences, it is important to start treatment of arthrosis as early as possible. And if in the early stages of development it can be stopped by conservative methods, then in case of severe changes, it is possible to restore the functions of the hip joint and eliminate unbearable pain only with the help of a high-tech operation.
What is arthrosis of the hip joint
Arthrosis of the hip joint is a chronic degenerative-dystrophic disease in which the gradual destruction of the hip joint occurs. At the same time, all its components are gradually involved in the pathological process, but hyaline cartilage is especially affected, which leads to a narrowing of the joint space and deformation of its other components. More often, pathological changes occur in only one hip joint, although both can also be affected simultaneously.
The hip joints are the largest in the human body, since they bear the greatest load during the day. Each of them is formed by the head of the femur and the acetabulum, which is a bowl-shaped depression in the pelvis. Both surfaces are covered with smooth, moderately elastic hyaline cartilage. It is he who ensures the smoothness and unhindered sliding of the femoral head in a natural depression and thus makes it possible to make movements in various planes.
The movement of the hip joint is provided by a group of muscles connected to it by fasciae. It is also surrounded by ligaments, the tasks of which are to limit its mobility within physiological limits and ensure the stability of its position.
The entire joint is surrounded by an articular capsule covered with a synovial membrane. Its main task is the synthesis of synovial fluid, which lubricates the contiguous 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 femoral head and the surface of the acetabulum constantly receives components for the formation of new cells, i. e. , regeneration. This is extremely important for this cartilaginous formation, since with each movement of the hip it wears out, but normally it is immediately restored. But when injured or under the influence of other factors, this does not happen, which leads to the development of arthrosis of the hip joint, i. e. thinning and destruction of its hyaline cartilage.
As a result, deformed areas are formed in ideally smooth cartilage, which increase as the pathology progresses. As it is abraded, the surfaces of the bones that form the joint are exposed. When they come into contact, there is a characteristic crunch and severe pain. This provokes the formation of osteophytes and, at the final stages of development, the femoral head completely fuses with the acetabulum, making any movement in the hip joint impossible.
At the same time, arthrosis of the hip joint can provoke the development of various inflammatory processes inside the joint, including:
- bursitis - inflammation of the synovial bag;
- tendovaginitis - an inflammatory process in the sheath of the sheath of the tendons of the muscles;
- tunnel syndrome - compression of the nerves, causing radiating pain along the strangulated nerve.
The reasons
One of the common causes of the development of arthrosis of the hip joint is mechanical damage, not only direct injuries, but also microdamages caused by the destructive effect of excessive loads on it. One of the most common causes of the development of the disease is a fracture of the femoral neck.
It departs from the femur at an angle of 120 ° and connects it to the head. The presence of osteoporosis significantly increases the likelihood of a hip fracture, but this kind of injury can also be the result of a traffic accident, falling on 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, ruptures of its ligaments, transcondylar fractures or fractures of the acetabulum also creates favorable conditions for damage to its structures. In such situations, post-traumatic arthrosis of the hip joint is diagnosed.
Often, post-traumatic hip arthrosis occurs in professional light and weightlifters, parachutists, loaders, and skaters.
The development of arthrosis of the hip joint after injury is due to a violation of the congruence (comparability) of the articular surfaces, a decrease in the quality of the blood supply to the joint components and prolonged immobilization. As a result of prolonged immobility, there is not only a deterioration in blood circulation in the fixed area, but also a shortening of the muscles, a decrease in their tone. The likelihood 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 increase with excessively early loading of the joint and inadequate exercise therapy, including too intense, started late 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 provoke changes in the hip joint, as they lead to microtrauma. Regular tissue damage activates the division of chondrocytes (cartilage cells). This is accompanied by an increase in the intensity of the production of cytokines, which are normally produced in small quantities. Cytokines are mediators of inflammation, in particular, the cytokine IL-1 leads to the synthesis of specific enzymes that destroy the hyaline cartilage of the hip joint.
In addition, high loads can provoke microfractures of the subchondral plate. This leads to its gradual compaction and the formation of bone growths on the surface, called osteophytes. They can have sharp edges and cause more damage to the joint, as well as injury to surrounding tissues.
The subchondral plate is the extreme part of the bone that is in direct contact with the hyaline cartilage.
In some cases, it is not possible to determine exactly what provoked the development of degenerative-dystrophic changes in the hyaline cartilage of the femoral head and acetabulum. In such situations, idiopathic or primary arthrosis of the hip joint is diagnosed.
Today it has been established that the tendency to develop it can be inherited, i. e. the presence of this pathology in close relatives significantly increases the chances of developing arthrosis of the hip joint. Presumably, it has a polygenic inheritance, i. e. its development depends on the presence of many genes. Each of them individually creates mild prerequisites 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 labor.
There is a theory that arthrosis of the hip joints is the result of a congenital or acquired mutation of the type II procollagen gene.
There is also secondary arthrosis of the hip joint, which develops against the background of the presence of concomitant diseases and age-related changes.
Symptoms
The disease is characterized by the occurrence of pain, limited mobility and crunch in the hip joint, the severity of which directly depends on the degree of neglect of pathological changes. At the final stages of development, shortening of the affected leg and complete immobility of the hip joint can be observed, which is due to the complete fusion of the bone structures that form it.
Initially, the disease can proceed without pronounced signs and cause mild, short-term pain. As a rule, they appear after physical exertion, in particular walking, carrying heavy loads, squatting, bending over. But as the 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 start of physical activity and their appearance is also reduced. At the same time, rest, even a long one, may not bring relief. Subsequently, pain can torment a person even with prolonged immobility of the hip joint, for example, after a night's sleep.
If the intra-articular structures infringe on nearby nerves, pain can radiate to the groin, buttocks, thigh, and knee. However, they tend to intensify with hypothermia. At the last stage of the development of the disease, the pain becomes unbearable. This causes an unconscious desire to feel sorry for the leg and put less stress on it, which leads to lameness.
Another symptom of arthrosis of the hip joint is a decrease in the range of motion. Most often, there is a limitation in the ability to turn the leg in and out, to raise the leg bent at the knee to the chest. Over time, so-called morning stiffness occurs, which disappears after the patient "diverges". Subsequently, a compensatory curvature of the pelvis is possible, which leads 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 deviated forward is observed.
All this may be accompanied by the formation of edema in the hip joint. But in the presence of excess weight, they can go unnoticed.
Often, during movements, especially extensor ones, a crunch occurs in the affected joint. It is a consequence of the exposure of the bone surfaces of the femoral head and acetabulum and their friction with each other. In this case, there is a sharp increase in pain.
Also, with arthrosis of the hip joint, painful spasms of the femoral muscles can occur. With extremely advanced degenerative-dystrophic diseases, when the joint space almost completely disappears, and the femoral head begins to flatten, shortening of the affected limb by 1 cm or more is observed.
In general, there are 3 degrees of arthrosis of the hip joint:
- Grade 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 the formation of osteophytes. Clinically, there is a slightly pronounced pain syndrome and some movement restrictions.
- Grade 2 - the joint space is narrowed by more than 50%, but less than 60%. Significant osteophytes are observed, as well as signs of cysts in the epiphyses of the bones. Patients note significant limitations of movements in the hip joint, the presence of a crunch during movements, pain, and atrophy of the thigh muscles of varying severity can be traced.
- Grade 3 - the joint space is reduced by more than 60% or is completely absent, and osteophytes occupy a large surface and are large in size, subchondral cysts are observed. The hip joint is stiff, the pain can become unbearable.
Diagnostics
The appearance of pain and other symptoms characteristic of arthrosis of the hip joints is the reason for contacting an orthopedist. The doctor will be able to suspect its presence, especially if he has suffered hip or pelvic injuries in the past, already on the basis of the data obtained during the interview and examination.
The presence of arthrosis of the hip joint is indicated by pain, the intensity of which increases over several years. Much less often, there is a rapid development of degenerative-dystrophic changes, when several months pass from the appearance of the first signs to a powerful permanent pain syndrome. This is characterized by increased pain while standing or when performing physical work. Also, for arthrosis, the presence of morning stiffness, which lasts up to half an hour, is typical, and also occurs after prolonged immobility. Gradually, there is an increase in mobility restrictions and deformation of the hip joint, which in the later stages of development, the orthopedist may notice during the examination.
Nevertheless, all patients are necessarily assigned instrumental methods of research, with the help of which it will be possible to confirm the presence of hip arthrosis and establish its degree, as well as differentiate it from some other diseases accompanied by similar symptoms. As a rule, diagnostics is carried out using:
- Radiography - allows you to detect the main signs of arthrosis, in particular the narrowing of the joint space and the presence of osteophytes. But recently, CT has become a more informative research method, which makes it possible to assess the condition of the hip joint with greater accuracy.
- MRI is a highly informative method for diagnosing various changes in the state of soft tissue structures, including cartilage tissue, which makes it possible to detect the slightest signs of hyaline cartilage degeneration.
Also, patients may be prescribed laboratory tests, including KLA, OAM, a biochemical blood test, etc. They are required to establish concomitant diseases that have created prerequisites for the development of secondary arthrosis of the hip joint.
Treatment of arthrosis of the hip joint without surgery
Treatment of degenerative-dystrophic changes in the hip joint through the methods of conservative therapy is possible only with arthrosis of the 1st and 2nd degree. The prescribed measures can improve the patient's condition, stop or at least slow down the progression of the pathology and thereby maintain working capacity. But they are not able to lead to a complete regression of changes that have already occurred in the joint.
Today, as part of the conservative treatment of arthrosis of the hip joint, the following are prescribed:
- drug therapy;
- exercise therapy;
- physiotherapy.
Also, patients are advised to make certain adjustments to their lifestyle. So, in the presence of excess weight, it is worth taking measures to reduce it, that is, increase the level of physical activity and reconsider the nature of nutrition. If the patient is actively involved 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 arthrosis of the hip joint is always complex and includes drugs from different groups aimed at reducing the severity of symptoms of the disease and improving the flow of metabolic and other processes in the joint. It:
- NSAIDs - drugs with anti-inflammatory and analgesic effects, produced both in oral forms and in the form of local agents, which allows you to choose the most effective and convenient option for use;
- corticosteroids - drugs that have powerful anti-inflammatory properties and are used in most cases in the form of an injection solution, since when choosing systemic therapy they cause the development of unwanted side effects;
- chondroprotectors - drugs synthesized on the basis of natural components of cartilage tissue used by the body to restore it (prescribed for long courses);
- muscle relaxants - drugs indicated for muscle spasm, which causes pain of varying severity;
- B vitamins - help to improve nerve conduction, which is required for the development of carpal tunnel syndrome;
- preparations that improve microcirculation - help to increase the intensity of blood circulation in the affected area, which leads to an increase in the rate of metabolic processes and helps to restore damaged cartilage.
If concomitant diseases are detected, consultation of related specialists and appropriate treatment are indicated.
With very strong, debilitating pain syndrome that cannot be eliminated with the help of prescribed NSAIDs, intra-articular or periarticular blockades can be performed. They involve the injection of a local anesthetic in combination with a corticosteroid directly into the joint cavity, which quickly leads to an improvement in well-being. But procedures of this kind can only be carried out in a medical institution by a qualified specialist, otherwise there is a high risk of complications.
exercise therapy
Physiotherapy exercises play one of the leading roles in the non-surgical treatment of hip joint arthrosis, both idiopathic and post-traumatic forms. But a set of exercises must be selected on an individual basis, taking into account the nature of the previous injury, the level of the patient's physical development, and existing concomitant diseases.
Exercise therapy should be done daily in comfortable conditions without haste. All movements should be performed smoothly without jerking, so as not to harm 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 the prescribed measures, it is often recommended that patients with arthrosis of the hip joint undergo a course of physiotherapy procedures. Traditionally, those that have anti-inflammatory, anti-edematous and analgesic effects are chosen. It:
- ultrasound therapy;
- electrophoresis;
- magnetotherapy;
- laser therapy;
- shock wave therapy, etc.
In some cases, plasmolifting is indicated, i. e. , the introduction of purified and platelet-saturated patient's own blood plasma. To obtain it, venous blood is taken, which is then subjected to centrifugation. As a result, it is divided into erythrocyte mass and plasma, which is used to treat degenerative-dystrophic changes in the hip joint.
Surgery for arthrosis of the hip joint
When diagnosing arthrosis of the hip joint of the 3rd degree, surgical intervention is indicated for patients. It can also be carried out with the ineffectiveness of conservative therapy and persistent pain and mobility restrictions already at the 2nd stage of the development of the disease.
In general, the indications for hip surgery are:
- a significant decrease in the size of the joint space;
- the presence of persistent, severe pain;
- significant mobility restrictions.
The most effective and safe operation for arthrosis 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 to replace part of the components of the hip joint or its entirety with artificially created endoprostheses. The prostheses themselves are made from biocompatible materials and are durable.
Their installation allows you to completely restore the normal mobility of the pathologically altered hip joint, eliminate pain and provide the patient with the opportunity to lead a full life. For each patient, the type of arthroplasty is selected individually based on the degree of destruction of various components of the joint.
The most effective is total or total hip arthroplasty. It involves the replacement of the entire joint with an artificial endoprosthesis, i. e. , the acetabulum, the femoral head and its neck. Such prostheses are able to serve uninterruptedly for 15-30 years and ensure the restoration of the full volume of the functioning of the joint.
They are installed without cement or with the help of special cement. The first method is more suitable for young patients, since it involves fixing the prosthesis in the pelvis by growing into the spongy layer of its own bone in it. For older people, the method of installing an endoprosthesis using cement is more suitable, which firmly holds the artificial material to the bone surfaces even in the presence of osteoporosis.
If normal hyaline cartilage lining the surface of 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 kind: monopolar and bipolar.
The former are less reliable; after their installation, there subsequently becomes a need for total arthroplasty. This is due to the fact that the replaced artificial femoral head, when making movements, rubs directly against the cartilage of the acetabulum, which provokes its faster wear.
Bipolar endoprostheses do not have such a disadvantage, since in them the artificial femoral head is already enclosed in a special capsule, which is adjacent to the acetabulum. Therefore, the cartilage covering it is not deformed, since the capsule serves as a kind of buffer and artificial replacement for the natural hyaline cartilage of the femoral head.
Nevertheless, regardless of the type of endoprosthesis performed, postoperative rehabilitation is indicated for all patients. It consists in 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 compliance with the doctor's recommendations during the rehabilitation period.
Thus, arthrosis of the hip joint is a common disease of the musculoskeletal system, which can occur even in the absence of direct prerequisites 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 even at the first signs. Nevertheless, the current level of development of medicine makes it possible to cope with advanced cases of arthrosis of the hip joint and restore the full range of motion in it, as well as permanently get rid of severe pain.