Osteoarthritis of the hip joint degenerative pathology, which is characterized by destruction of hyaline cartilage. The disease develops gradually, associated with pain and reduced range of motion. In the absence of medical intervention at the initial stages of osteoarthritis in a few years, there is atrophy of the thigh muscles. The injured limb is shortened, and the fusion of the joint space leads to partial or complete paralysis of the hip joint. Causes pathology become previous trauma, curvature of the spine, systemic diseases of musculoskeletal system.
Arthritis is usually manifested in patients of middle age and older people. The diagnosis put on the basis of results of instrumental investigations — x-ray, MRI, CT, arthroscopy. Treatment of disease 1 and 2 degrees of severity conservative. Upon detection of ankylosis or ineffectiveness of drug therapy, surgical operation (arthrodesis, arthroplasty).
The mechanism of development of pathology
The hip joint consists of two bones — the iliac and femoral. The lower part of the Ilium presents her body, which participates in plexus with the femur, forming the upper section of the acetabulum. During the movement of the stationary glenoid fossa and the femoral head moves freely. This "hinge" device, the hip joint allows him to bend, stretch, rotate, facilitates drainage, bringing thighs. The smooth gliding of the articular structures provides smooth, elastic, hyaline cartilage lining the socket and the femoral head. Its main function is the redistribution of loads when driving, preventing rapid deterioration of bone tissue.
Under the influence of external or internal factors disturbed trophic cartilage. He doesn't have a circulatory system — nutrients fabric provides synovial fluid. In case of arthrosis it thickens and becomes viscous. The shortage of nutrients provokes a drying out of the surface of hyaline cartilage. It is covered with cracks, which leads to a constant micro-trauma in flexion or extension of hip joint. The cartilages become thinner, lose their cushioning properties. To "adapt" to the increase of pressure, the bones are deformed. And against the background of deterioration of metabolism in the tissues of the progress of the destructive-degenerative changes.
Causes and predisposing factors
Idiopathic or primary osteoarthritis develops without any reason. It is believed that the destruction of the cartilage occurs due to natural aging, slower recovery processes, decrease the production of collagen and other compounds necessary for proper regeneration of the structures of the hip joint. Secondary osteoarthritis occurs on a background already present in the organism a morbid condition. The most common causes of secondary disease include:
- previous injury — damage of the tendon unit, muscle tears, their complete separation from the bone base fractures, dislocations;
- developmental disorders of the joints, congenital dysplastic disorders;
- autoimmune disease — rheumatoid, reactive, psoriatic arthritis, systemic lupus erythematosus;
- nonspecific inflammatory diseases, for example suppurative arthritis;
- specific infections — gonorrhea, syphilis, brucellosis, anaplasmosis, trichomoniasis, tuberculosis, osteomyelitis, encephalitis;
- disruption of the functioning of the endocrine system;
- degenerative pathology — osteochondropathy of the femoral head;
- hypermobility of the joints due to the production of "more than a loose" collagen that trigger their excessive mobility, weakness of the ligaments.
Since the cause of development of osteoarthritis may be hemarthrosis (bleeding in the cavity of the hip joint), the precipitating factors include violation of hematopoiesis. Prerequisites to the disease are excess weight, excessive exercise, sedentary lifestyle. To its development lead to a wrong organization of trainings, a deficiency in the diet products with a high content of minerals, fat - and water-soluble vitamins. Postoperative arthrosis occurs several years after the surgical intervention, especially if it was accompanied by the excision of a large volume of tissue. Osteoarthritis of the hip joint cannot be transferred by inheritance. But in the presence of certain congenital features (violation of metabolism, the structure of the skeleton), the probability of its development is significantly increased.
Symptoms
Leading symptoms of osteoarthritis of the hip joint pain when walking in the thigh, the knee joint. A person suffers from stiffness in the limbs, stiffness, especially in the morning. To stabilize the joint, the patient begins to limp, changing his gait. Over time due to muscle atrophy and deformation of the joint the limb is considerably shortened. Another characteristic feature of the pathology — limitation of hip abduction. For example, difficulties arise when trying to sit on a stool, legs apart to the sides.
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For arthrosis of first degree characterized by periodic pain that occurs after intensive physical loads. They are located in the area of articulation and disappear after long periods of rest.
In the second degree osteoarthritis of the hip joints the pain intensity increases. Discomfort occur even at rest, extend to the hip and groin, worse when lifting weights or increasing physical activity. To address hip pain, a person begins a barely noticeable limp. Marked limitation of motion of the joint, especially in abduction and internal rotation of the hip.
Arthrosis of the third degree is characterized by constant severe pain. When driving challenges arise, so when walking, the person is forced to use a cane or crutches. Due to the weakness of abductor muscles of the hip is offset from the pelvic bone in the frontal plane. To compensate for the fact that there has been a shortening of the leg when moving the patient leans towards the affected limb. This provokes a shift of the center of gravity and increased stress on the joint. At this stage of the arthrosis develops a pronounced ankylosis of the joint.
| Degree | Radiographic signs |
| First | Changes are expressed not sharply. The articular slits moderately, irregularly constricted, there is no destruction of the surface of the femur. On the outer or inner edge of the acetabulum, there was a slight bony growths |
| Second | The height of the joint space is significantly reduced due to its uneven seam. Bone head of the femur is displaced upward, deformed, enhanced, its outline becomes irregular. Osteophytes are formed on the surface of the inner and outer edges of the glenoid fossa |
| Third | There is a complete or partial fusion of the joint space. The head of the femur is strongly expanded. Multiple bone growths located on the surface of the acetabulum |
Diagnosis
When setting the diagnosis, the doctor considers the clinical manifestations of the disease, anamnesis, external examination of the patient and instrumental examinations. Radiography is most informative. With its help, the estimated state of the hip joint, it sets the stage of its course, the degree of damage to cartilage tissues, and in some cases, the cause of development. If cervico-diaphyseal node is increased, and the acetabulum is flattened and beveled, then with high probability it is possible to assume congenital dysplastic changes in the joints. In Perthes disease form shows broken thigh bone. X-ray allows the identification and preparation of post-traumatic osteoarthritis, despite lack of history of previous disease of injury. Also, use other diagnostic methods:
- CT helps to identify the edges of growth plates of bone that formed osteophytes;
- An MRI is performed to assess the condition of connective tissue structures and the extent of their involvement in the pathological process.
If necessary, the inner surface of the joint is examined with the help of arthroscopic instruments. Differential diagnosis done to rule out osteoarthritis, lumbar-sacral or thoracic degenerative disc disease. Pain in osteoarthritis may masquerade as clinical manifestations of radicular syndrome is caused by pinching or inflammation of a nerve. To exclude neurogenic pathology usually through a series of tests. Osteoarthritis of the hip joint necessarily differentialsa from the top of bursitis of the hip, ankylosing spondylitis, reactive arthritis. To exclude autoimmune pathologies are conducted biochemical studies of blood and synovial fluid.
Surgery
With the ineffectiveness of conservative therapy Il diagnosing complicated pathology surgery performed. To restore cartilage in a joint damaged by arthritis, no surgeries impossible, but with the right approach to treatment, compliance with all medical regulations, maintain proper lifestyle, medical gymnastics, regular courses of massage, vitamins and nutrition, you can stop the process of destruction and destruction of cartilage and hip joints.