How to treat hip joint coxarthrosis

Coxarthrosis is a common degenerative-dystrophic disease of the hip joint, in which, due to age-related changes or other factors, there is gradual destruction of the articular joint of the head of the femur and the acetabulum of the pelvis.It is accompanied by pain and limited range of motion 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, then in the 3rd stage it is possible to save the situation and maintain the functionality of the hip joint, that is, to avoid disability, only through surgery.

It is classified as arthrosis and can be accompanied by the development of similar processes in other joints, with this pathology being responsible for around 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 head of the femur and acetabulum are destroyed, which leads to a decrease in the size of the joint space.As the disease progresses, deformations of the bone surfaces occur and the formation of bony protuberances on them, called osteophytes.

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 with coxarthrosis is significantly higher.

The entire hip joint is enclosed in a specific box called the joint capsule.It has the so-called synovial membrane, which produces synovial fluid.This fluid is extremely important for the proper functioning of the joint, as in addition to lubricating the hyaline cartilage, it also provides it with a source of nutrients.

Normally, cartilage is constantly worn out and immediately restored due to the continuous regeneration process, carried out with the help of substances that enter it from synovial fluid.But with injuries or age-related changes, the rate of regeneration processes slows down, 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 produced in a smaller volume.As a result, synovial fluid is no longer able to supply 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 decrease, areas of separation 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.

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 greater damage, which affects the functioning of the joint and the person's condition, as the deformed areas prevent the femoral head from sliding easily into the acetabulum.As a result, symptoms of coxarthrosis occur.

If left untreated, the pathological changes worsen and the hyaline cartilage becomes increasingly worn away.Subsequently, in some areas it disappears completely, which leads to the exposure of the bones and a sharp increase in the load on the joint.As, when moving within the acetabulum, the head of the femur rubs directly against the bone, this causes severe pain and severe mobility limitations.In this case, the pressure of bone structures on each other leads to the formation of bone protrusions on their surface.

The osteophytes formed may have sharp parts that can damage the muscles and ligaments that surround the hip joint.This leads to severe pain directly in the joint area and in the groin, buttocks and thigh.With this, the patient spares the injured leg, puts less load on it and tries to avoid unnecessary movements with it.This causes the development of muscle atrophy, which further worsens 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 any prerequisites.In this case, they talk about 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.Its development can be provoked by:

• hip joint injuries of various types, including fractures, dislocations, bruises, 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 may 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 inevitable age-related changes, and the presence of the above factors only increases the likelihood and speed of its development.

Coxarthrosis symptoms

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 in patients, but later the condition of the hip joint worsens, which leads to an increase in the severity of signs of coxarthrosis up to unbearable pain and significant limitation of mobility.

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

• Pain of varying intensity, initially occurring after physical activity or walking and decreasing after rest.Gradually, the severity of the pain syndrome increases, it appears more frequently, lasts longer and the periods between the moment the load is applied to the joint and the appearance of pain are reduced.Later, 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 in mobility of the hip joint, which initially manifest as minor 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, i.e., they do not disappear after warming.Patients notice a decrease in the range of movement of the legs and subsequently completely lose the ability to perform certain movements.
• A crisis 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, which is accompanied by a sharp increase in pain.
• Spasms of the thigh muscles, which leads to the appearance of diffuse pain in the thigh.This may be the result of the addition of various intra-articular disorders, including compression of 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, in order to avoid the onset or intensification of pain and, subsequently, the development of muscle contracture.This last phenomenon occurs in the later stages of coxarthrosis and means that the patient is unable to fully straighten the leg and, furthermore, maintain it in this position.Thus, the lower limb with the affected hip joint is constantly in a slightly flexed position, which causes lameness.
• Decrease in the length of the legs, 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 is 1 or more centimeters shorter than the healthy leg.

Coxarthrosis can affect 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, 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.

Coxarthrosis degrees

The nature of the manifestations of the disease depends on the stage of its development.In total, there are 3 degrees of coxarthrosis, with the first being considered the mildest.In the initial stages of the occurrence 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 often do not pay attention to them, attributing them to tiredness and considering them a normal age-related change.In this regard, 1st degree coxarthrosis is diagnosed only in isolated cases, which usually occurs during an examination for another reason.

As the disease progresses, its symptoms intensify and are already felt in second-degree coxarthrosis.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.

As the pathology progresses, the joint space narrows even further and in the 3rd degree of coxarthrosis it is almost completely absent.This is accompanied by the formation of multiple osteophytes.At this stage in the development of the disease, the pain becomes not just intense, but unbearable and often occurs even in a state of complete rest, including at night.Since the hip joint is severely deformed, its elements can collide with the nerves passing through here, which leads to pain that radiates to the groin area, buttocks, thigh and even the lower leg.It also causes the inability to move independently without the use of assistive devices, for example crutches or a cane.

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

Diagnosis

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 carry out functional tests, comparing the length of the legs.As a rule, the data obtained is 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, the specialist will be able not only to confirm the presence of coxarthrosis, differentiate it from radicular syndrome caused by pathologies of the spine, but also to correctly assess the degree of its development and thus select the most effective treatment tactics.

Today, to diagnose Coxarthrosis, the following are used:

• X-ray of the hip joints - the resulting images make it possible to detect signs of destructive changes, the presence of osteophytes, the nature of deformation of bone structures and measure the thickness of the joint space.
• Computed tomography is a more modern method for 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.
• Magnetic resonance imaging is a highly informative method for studying joints, providing maximum information about the state of the joint and all its structures, primarily hyaline cartilage, ligaments and features of the blood supply.

Patients receive a series 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 detected concomitant pathologies.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;
• exercise therapy;
• physiotherapy.

It is imperative 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 involves adjusting your diet and increasing your physical activity level if you are overweight.If the patient is regularly exposed to excessive physical activity, it is recommended that he change the type of activity or reduce the intensity of training if the load is due to sports.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, medications 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 wide group of medicines that have analgesic and anti-inflammatory effects (available in different pharmaceutical forms, including tablets, capsules, gels, creams, injectable solutions, which allows you to choose the most effective and convenient form of use);
• corticosteroids are medications that have a powerful anti-inflammatory effect, but due to the high risk of side effects, especially in oral form, they are prescribed only in short courses via injection;
• muscle relaxants - medicines that help reduce muscle tone, which makes it possible to effectively combat muscle spasms, which are often observed in coxarthrosis;
• chondroprotectors – group of medicines containing components used by the body for the regeneration of cartilage tissue;
• medicines that improve microcirculation - help improve soft tissue nutrition and activate metabolic processes in the affected area;
• B vitamins - indicated for nerve conduction disorders caused by compression of nerves by altered components of the hip joint.

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

Exercise therapy

When diagnosing Coxarthrosis, regular physiotherapy exercises are required.Just like drug therapy, a set of exercise 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 (special attention is paid to cardiovascular pathologies).

Thanks to daily exercise therapy classes, you can:

• reduce pain intensity;
• increase the mobility of the hip joint;
• reduce the risk of developing muscle atrophy;
• eliminate muscle spasms in the thighs;
• 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 exercise therapy, you should definitely contact your doctor to correct the selected complex or carry out repeated diagnostics to exclude the progression of the disease and the need for surgery.

Physiotherapy

Complex treatment of coxarthrosis involves courses of physiotherapeutic procedures that have an anti-inflammatory, analgesic, decongestant and tonic effect on the body.Therefore, most often patients receive 10-15 procedures:

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

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

Coxarthrosis surgery

If the 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 mobility limitations that deprive them of the ability to work and move independently.

Timely surgical intervention can completely eliminate these disorders and restore the patient's ability to move normally, significantly increasing their quality of life.Indications for its implementation are:

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

The gold standard for the treatment of severe coxarthrosis, including in the elderly, is hip arthroplasty.This operation involves replacing the 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 and active life.

The essence of this type of surgical intervention is the resection of the head of the femur and a small fragment of its neck.The surgeon will also need to prepare the surface of the acetabulum for installation of the endoprosthesis, that is, remove all osteophytes formed and achieve maximum restoration of its normal shape.Then, an endoprosthesis of the selected type is installed, which is fixed with special cement (preferred for treating the elderly) or in a non-cemented way.In the latter case, the endoprosthesis has a special spongy part that 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, that is, the neck and head of the femur, as well as the acetabulum.

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

The only disadvantage of stent replacement is the need to replace the installed stent graft after 15–30 years.

After endoprosthetics, patients receive rehabilitation, the duration of which depends on the speed of tissue restoration.As part of recovery, exercise therapy, 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 series of disadvantages.Thus, arthrodesis involves fixing 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.Thus, after arthrodesis, the patient can only stand, but can no longer walk independently due to the lack of movement in the hip joint.Therefore, today arthrodesis is practically not performed.

Osteotomy involves creating an artificial fracture of the femur with a combination of bone fragments that will reduce the load on the affected hip joint.But the operation only has a short-term effect and in the future there is still a need for endoprostheses.

Thus, coxarthrosis of the hip joint is a rather dangerous disease that can result in 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 consult an orthopedist in a timely manner, you can slow down its progression and achieve a significant improvement in your well-being.But with the coxarthrosis already advanced, there can only be one solution - the endoprosthesis.Fortunately, this method can be used even with severe degenerative changes and completely restore the normal functioning of the hip joint.