How to treat coxarthrosis of the hip joint?

Coxarthrosis is a common degenerative-dystrophic disease of the hip joint, in which there is gradual destruction of the articular joint of the femoral head and pelvic socket due to age-related changes or other factors.It is accompanied by pain and restricted mobility, which vary in severity depending on the stage of development.And if at the initial stage it is possible to cope with coxarthrosis using conservative methods, then at the 3rd stage it is possible to save the situation and maintain the functionality of the hip joint only through surgery, i.e.h.to avoid disability.

It is classified as osteoarthritis and may be accompanied by the development of similar processes in other joints.This pathology accounts for about 12% of all diseases of the musculoskeletal system.However, the term “coxarthrosis” can only 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 cartilage layers covering the femoral head and acetabulum are destroyed, resulting in a reduction in the joint space.As the disease progresses, the bone surfaces become deformed and bone growths called osteophytes form.

Coxarthrosis is the second most common musculoskeletal disorder.More often, only gonarthrosis is diagnosed, i.e. a degenerative-dystrophic change in the knee joint.However, the likelihood of disability is significantly higher with coxarthrosis.

The entire hip joint is surrounded by a special covering called the joint capsule.It has a so-called synovial membrane that produces joint 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 nutrients.

Normally, due to the continuous regeneration process that enters the cartilage with the help of substances from the synovial fluid, the cartilage is constantly worn down and immediately restored.However, 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 produced in less volume.As a result, the synovial fluid is no longer able to supply the hyaline cartilage with all the substances it needs in the required quantities, which leads to its rapid drying out and thinning.Gradually, the strength and elasticity of the cartilage decreases, points of separation of the fibers that form it appear, cracks form in it, and the thickness also decreases.These changes, especially the narrowing of the joint space, can be detected during instrumental diagnostics.

The narrowing of the joint space leads to increased friction between the bone structures that form the hip joint and increased pressure on the already degrading hyaline cartilage.This leads to even greater damage, affecting the function of the joint and the person's condition, since the deformed areas prevent the femoral head from sliding easily in the acetabulum.As a result, symptoms of coxarthrosis appear.

If left untreated, the pathological changes worsen and the hyaline cartilage wears out more and more.Subsequently, it disappears completely in some areas, resulting in exposed bones and a large increase in joint stress.Since the femoral head rubs directly against the bone when moving within the hip socket, this leads to severe pain and a severe limitation of mobility.In this case, the pressure of bone structures on each other leads to the formation of bone growths on their surface.

Osteophytes formed can have sharp parts that can injure the muscles and ligaments around the hip joint.This leads to severe pain both directly in the joint area and in the groin, buttocks and thigh.In this way, the patient protects the injured leg, puts less strain on it and tries to avoid unnecessary movements with it.This causes muscle atrophy, which further worsens the mobility impairment and ultimately leads to lameness.

Causes

The reasons for the development of coxarthrosis are varied, but in rare cases it occurs without any prerequisites being present.In this case one speaks of the presence of primary or idiopathic coxarthrosis.In the vast majority of cases, secondary coxarthrosis is diagnosed, which is a logical consequence of a number of diseases or changes in the condition of the musculoskeletal system.Its development can be provoked by:

• Injuries to the hip joint of various types, including fractures, dislocations, bruises, sprains or torn ligaments;
• heavy physical work, professional sports, especially weightlifting, skydiving, jumping sports;
• sedentary lifestyle;
• Excess weight, which significantly increases the load on the hip joints;
• foci of chronic infections in the body;
• congenital anomalies of the hip joints, such as dysplasia or dislocation;
• Metabolic diseases and endocrine disorders, especially gout, diabetes mellitus, especially in decompensated form;
• aseptic necrosis of the femoral head, which can be a consequence of a femoral neck fracture, especially with conservative treatment;
• inflammatory joint diseases, including rheumatoid arthritis, bursitis, tendonitis;
• diseases of the spine;
• genetic predisposition;
• Presence of bad habits, especially smoking.

Nevertheless, inevitable age-related changes are the main cause of coxarthrosis, 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 may be asymptomatic or only occasionally frighten the patient, but subsequently the condition of the hip joint worsens, leading to an increase in the severity of the signs of coxarthrosis, up to unbearable pain and significant limitation of mobility.

Degenerative-dystrophic changes in the hip joint are accompanied by:

• Pain of varying intensity that initially occurs after physical activity or walking and subsides after rest.Gradually, the severity of the pain syndrome increases, it occurs more often, lasts longer, and the periods between the load on the joint and the appearance of pain become shorter.Later, the pain is almost constant, even at rest, and becomes unbearable.At every stage of the disease, it is typical for the pain to increase due to hypothermia and lifting heavy objects.
• Restrictions in the mobility of the hip joint, which initially manifest themselves in minor difficulties in performing rotational movements of the leg.Over time, morning stiffness occurs, which disappears after the patient “dissolves.”This can be accompanied by the appearance of swelling in the hip joint.As the disease progresses, the restrictions on movement become more pronounced and persistent, meaning they do not disappear even after warming up.Patients notice a decrease in the amplitude of leg movements and subsequently completely lose the ability to perform certain movements.
• A crunch in the hip joint that occurs when walking or doing physical work, especially when stretching.It is caused by the friction of exposed bone structures against each other, which is accompanied by a sharp increase in pain.
• Cramps in the thigh muscles, leading to the appearance of diffuse pain in the thigh.This may be due to the addition of various intra-articular diseases, including nerve compression, excessive stretching of the ligaments surrounding the joint, as well as the development of synovitis, i.e.h.an inflammation of the synovial membrane and an accumulation of inflammatory effusion in the hip joint cavity.
• Lameness, which initially results from the patient's unconscious desire to unload the diseased joint and transfer weight to the healthy leg in order to avoid the occurrence or increase of pain, and then leads to the development of muscle contracture.The latter phenomenon occurs already in the later stages of coxarthrosis and leads to the fact that the patient cannot fully straighten his leg and, moreover, keep it in this position.As a result, the lower extremity with the affected hip joint is constantly in a slightly flexed position, which leads to lameness.
• A shortening of the leg length, which occurs primarily in severe degenerative-dystrophic changes in the hip joint, is accompanied not only by a narrowing of the joint space, but also by a flattening of the femoral head and muscle atrophy.This causes the affected leg to be 1 or more centimeters shorter than the healthy leg.

Coxarthrosis can affect either one hip joint or both at the same time.However, if in the first case the symptoms of the disease are observed only on one side, in the second case they are not only bilateral, but 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, the first of which is considered the mildest.In the initial stage of the occurrence of degenerative-dystrophic changes in the hip joint, pain can only occasionally be observed.Typically, this occurs after intense physical activity, sports, or long walking.Therefore, patients usually pay no attention to them, attributing them to fatigue and considering them a normal age-related change.Grade 1 coxarthrosis is only diagnosed in isolated cases and usually occurs during an examination for another reason.

As the disease progresses, the symptoms worsen and become noticeable even in grade 2 coxarthrosis.This stage of development of 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 more and in the third degree the coxarthrosis is almost completely absent.This is accompanied by the formation of several osteophytes.At this stage of the development of the disease, the pain becomes not only severe, but unbearable and often occurs even at complete rest, including at night.Since the hip joint is severely deformed, its elements can impinge on the nerves that run here, causing pain that radiates to the groin, buttocks, as well as the thigh and even the lower leg.This also means that you cannot move independently without aids, such as crutches or a cane.

Grade 3 coxarthrosis is a direct indication for surgical treatment.If the operation is not performed in time, the femoral head will become firmly attached to the surface of the acetabulum by osteophytes.This leads to a shortening of the leg, a complete lack of independent movement, as the joint completely loses its mobility, i.e. disability.

diagnosis

If signs of coxarthrosis occur, it is advisable to see an orthopedist as soon as possible.First, the doctor interviews the patient and determines the nature of the symptoms.He then examines and carries out functional tests and compares the leg length.As a rule, the data obtained is sufficient to speak with a high degree of certainty about the presence of coxarthrosis.

However, 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 procedures are necessarily prescribed.With their help, a specialist can not only confirm the presence of coxarthrosis, distinguish it from radicular syndrome due to spinal pathologies, but also correctly assess the degree of its development and therefore select the most effective treatment tactics.

The following are used today to diagnose coxarthrosis:

• X-ray of the hip joints - the resulting images allow you to identify signs of destructive changes, the presence of osteophytes, the nature of deformation of bone structures, and measure the thickness of the joint space.
• CT is a more modern method of diagnosing bone diseases and provides clearer data than X-rays, but 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 an extremely informative method for examining joints and provides a maximum of information about the condition of the joint and all its structures, especially the hyaline cartilage, ligaments and blood supply properties.

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

Conservative treatment of coxarthrosis

If coxarthrosis of grade 1 or 2 is diagnosed, treatment is carried out using conservative methods.They are selected for each patient individually, taking into account the identified concomitant diseases.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 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 includes changing your diet and increasing physical activity if you are overweight.If the patient is regularly exposed to excessive physical activity, he is recommended to change the type of activity or reduce the intensity of training if the load is sport-related.In some cases, it is recommended to use special bandages and orthoses that fix the hip joint and relieve it during physical activity.

Drug therapy

As part of drug treatment, medications are selected individually for the patient, taking existing comorbidities into account.For coxarthrosis, drugs from the following pharmacological groups are usually indicated:

• NSAIDs are a large group of drugs with analgesic and anti-inflammatory effects (available in various dosage forms, including tablets, capsules, gels, creams and injection solutions, allowing you to choose the most effective and convenient form of use);
• Corticosteroids are drugs with strong anti-inflammatory effects, but are only prescribed in short doses by injection due to the high risk of side effects, especially when used orally;
• muscle relaxants – drugs that help reduce muscle tone, which allows you to effectively combat muscle spasms that often occur with coxarthrosis;
• Chondroprotectors – a group of drugs containing components that the body uses to regenerate cartilage tissue;
• Drugs that improve microcirculation – help to 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 acute attack of pain that cannot be relieved with the help of prescribed NSAIDs, patients are recommended intraarticular or periarticular blockade.Its essence is to inject a solution of an anesthetic in combination with corticosteroids directly into the cavity of the hip joint.This eliminates pain in the shortest possible time and reduces the inflammatory process.However, the block 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.

Movement therapy

If coxarthrosis is diagnosed, regular physiotherapy exercises are required.As with drug therapy, a set of exercise therapy exercises is selected individually for each patient, 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 diseases).

Thanks to daily exercise therapy courses, it is possible:

• reduce the severity of pain;
• increase mobility of the hip joint;
• reduce the risk of muscle atrophy;
• Elimination of cramps in the thigh muscles;
• activate blood circulation and thereby improve the nutrition of the affected joint.

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

Physiotherapy

The complex treatment of coxarthrosis includes courses of physiotherapeutic procedures that have an anti-inflammatory, analgesic, decongestant and tonic effect on the body.Therefore, patients are most often prescribed 10-15 procedures:

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

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

Surgery for coxarthrosis

If a patient is diagnosed with third-degree coxarthrosis, surgical intervention is indicated for him, since conservative methods are no longer effective in such cases.Unfortunately, such situations are very common these days, as many patients seek medical help when they can no longer tolerate their pain or have severe mobility restrictions that prevent them from working and moving independently.

Timely surgical intervention can completely eliminate these disorders and restore the patient's normal ability to move, significantly improving his quality of life.Instructions for 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 limitations;
• Fracture of the femoral neck.

The gold standard for the treatment of severe coxarthrosis, including in the elderly, is hip replacement.During this operation, the destroyed hip joint is replaced with an artificial endoprosthesis made of durable and biologically compatible materials.Endoprosthetics allows you to completely restore the functionality of the hip joint, eliminate pain and allow a person to live a fully active life again.

The essence of this type of surgical intervention is the resection of the femoral head and a small fragment of its neck.The surgeon must also prepare the surface of the acetabulum for the installation of the endoprosthesis, i.e.h.remove all formed osteophytes and achieve maximum restoration of their normal shape.An endoprosthesis of the selected type is then inserted, which is secured with special cement (preferred for the treatment of older people) or cement-free.In the latter case, the endoprosthesis has a special spongy part that is in contact with the bone structures.Its fixation in the hip socket is ensured by the growth of bone tissue through the sponge.

The type of endoprosthetics is selected individually for each patient.The most effective is total endoprosthetics, in which the entire hip joint, i.e. the femoral neck and head as well as the acetabulum, are completely replaced.

If the patient still has normal hyaline cartilage on the surface of the acetabulum, he or she may undergo partial arthroplasty, in which only the femoral head and/or neck is replaced.For this purpose, endoprostheses of different designs are used: monopolar and bipolar.

The only disadvantage of changing the endoprosthesis is that the inserted endoprosthesis must be replaced after 15-30 years.

After arthroplasty, patients receive rehabilitation, the duration of which depends on the speed of tissue recovery.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.Nowadays, these techniques are used less and less because they have a number of disadvantages.Arthrodesis involves fixing the bone structures of the hip joint with metal plates.This completely eliminates the pain syndrome, but the joint completely loses its mobility.After an arthrodesis, the patient can only stand, but can no longer walk independently due to the lack of movement in the hip joint.Therefore, arthrodesis is practically no longer performed today.

Osteotomy involves performing an artificial fracture of the femur with such a combination of bone fragments that reduces the load on the affected hip joint.However, the operation only has a short-term effect and there will still be a need for endoprosthetics in the future.

Therefore, coxarthrosis of the hip joint is a fairly dangerous disease that can lead to disability.It significantly reduces the quality of life and deprives a person of their ability to work.However, 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 if coxarthrosis is already advanced, there can only be one solution - endoprosthetics.Fortunately, this method can be used even in severe degenerative changes and can completely restore the normal function of the hip joint.