Osteoarthritis of the hip joint
- What causes hip arthrosis?
- How to understand that hip joint hurts?
- When do you need advice from other profiles?
- Treatment of hip arthrosis
- If conventional treatment does not help ...
The most common reason for the treatment of people to orthopedic surgeons is that they are other manifestations of osteoarthritis. The share of hip joint arthrosis (coxarthrosis) accounts for about a third of all complaints, and these are dozens and hundreds of patients a year.
What causes hip arthrosis?
According to statistics, coxarthrosis in most cases occurs in women older than 40 years, but by the 60-year-old milestone among those affected by this ailment, the number of men increases significantly. Why are women affected in the first place? It is known that the representatives of the fair sex have other than men, the structure and shape of the bones of the pelvis. The female pelvis is otherwise inclined; it is more horizontally positioned, as it were. This is due to the role of gestation and the birth of children. Such anatomical features lead to the fact that the hip joint of women daily experiences more pressure than it does in men.
Other risk factors
What else leads to the development of coxarthrosis?
- Significant physical exertion: hard physical labor, as well as work associated with the constant stay "on their feet" (sellers, guides, teachers) and professional sports (weightlifters, jumpers, gymnasts).
- Injuries (fall, direct hit).
- Congenital abnormalities of the hip joint (hypoplasia, dysplasia).
- Pain in the lower back. It is noticed that in case of one-sided back pain, the body is slightly tilted towards the pain. So the body is "protected" - relieves stress from the muscles. This protection has a wrong side: the load on the opposite hip joint increases many times. From this exorbitant load, its wear is much faster than it could have been with a healthy back.
- Obesity. This is one of the most important risk factors for osteoarthritis. In the late twentieth and early twenty-first centuries, overweight became literally the scourge of civilization, causing a variety of health problems. That is why in recent decades and osteoarthritis is diagnosed more often.
How to understand that hip joint hurts?
Patients may be bothered by sharp pains when walking in the thigh, in the buttock, in the groin. These pains may radiate (reflected) to the lower back, back, side or front of the thigh, or knee. It is characteristic that at rest, especially in the prone position, this pain is reduced. Each such case is individual, so a visit to an orthopedic surgeon or a rheumatologist should not be postponed in any way, just as one should not engage in self-treatment.
To suspect the presence of a patient with coxarthrosis can be already at the stage of examination. The only available place where you can grope for the structure of the hip joint is the upper third of the lateral surface of the thigh. The region of the so-called big trochanter is located close (the section of the femur). But the inflammation in the area of the greater skewer is not coxarthrosis.
No matter how the hip joint hurts, the patient’s hip appearance doesn’t change - this structure is deeply hidden in the muscle. But it is perfectly clear that a person limps when walking or drags his leg behind him. In order to diagnose coxarthrosis, it is necessary to carry out certain tests (manipulations), which include flexion, extension of the legs in the hip joint, turns outward and inward, and several others. The patient informs the doctor about his unpleasant feelings, and on the basis of these data a preliminary diagnosis is made.
What else can hurt the hips?
The reasons for the occurrence of pain in this area a lot. In addition to the pain caused by arthrosis itself, that is, destructive (destructive) changes in the joint, there are at least four reasons for pain in the hip area. First, it can be bursitis (inflammation of the articular bag). Articular bags, similar to bags of fat and fluid, provide a slip of the tendons of the muscles. Complaints of a patient with bursitis are usually associated with pulling, aching sensations, aggravated in the prone position on the patient's side. Increased pain is observed when the position of the body changes (when standing up), and in a stationary state (sitting for a long time, legs crossed), and during active movements (climbing steps, running).
The second cause of pain, not related to bone structures, may be tendonitis (inflammation of the tendons themselves). Thirdly, local (local) changes in surrounding tissues (for example, a hematoma after a bruise). Fourth, muscle breaks, for example, the average gluteus. This can occur due to injury or physical overvoltage. Fifth, the deposition of crystals ("sand") of uric acid in the tendon area, if the patient has gout . Rarely, pain in the area of the greater skewer occurs in people with systemic (inflammatory) rheumatological diseases, such as rheumatoid arthritis , psoriatic arthritis and others. That is why it is so important to explain in detail and in detail to the doctor the nature of the pain, the time of its occurrence, the connection with injury or stress, to recall whether there was a hypothermia or an infectious disease. Finally, the formidable condition is aseptic (that is, non-purulent) necrosis (destruction) of the femoral head. It is manifested by the same signs as coxarthrosis, is diagnosed only by X-ray and is treated, alas, only surgically. This condition usually occurs on the background of alcohol abuse or continuous use of glucocorticosteroids (for example, in the same systemic inflammatory diseases).
Laboratory and instrumental studies help the doctor to clarify the diagnosis and select the treatment, taking into account the characteristics of this particular patient.
- General and biochemical blood tests. These studies will help the doctor to assess the severity of inflammation, confirm or deny the presence of gout (this will tell the level of uric acid in the blood). The levels of cholesterol, bilirubin, liver enzymes will allow you to choose the drug, taking into account its potential danger to this patient. If you suspect an inflammatory disease of the joints (rheumatoid arthritis, psoriatic arthritis), the doctor will prescribe clarifying tests - immunological.
- Radiography of the hip joints - the “gold standard” for the diagnosis of osteoarthritis. To make a diagnosis, it is enough to perform a so-called overview of the pelvis in a direct projection. The radiologist will assess the evenness of the contours of the bones, the width of the gap between them, determine the presence of osteophytes - tubercles and outgrowths that can cause pain. In addition, the survey radiograph shows how symmetrical the pelvic bones are, because it is known that a “distortion” of the pelvic ring, regardless of the causes, can be a purely mechanical cause of the development of coxarthrosis. Using radiographs, you can roughly estimate the density of bone tissue, to make a preliminary conclusion about the danger of a hip fracture. If it is intended to introduce into the joint cavity with the medical purpose of any drugs, radiography will help determine the possibility of this action or contraindication to its implementation.
- Ultrasound of the hip joints. Can replace radiographs? More likely no than yes. Ultrasound examination is more “subjective,” that is, it depends on the qualifications and experience of the diagnostician, on the sensitivity of the ultrasound machine, on the angle at which the sensor is installed in relation to the joint. In this type of study, the soft, non-bone structures of the joint itself, as well as the muscles surrounding the joint, are more visible. The amount of intraarticular fluid is also well defined, as well as uric acid crystals, the accumulation of which may be the cause of pain in the hip joint, but is not directly related to the diagnosis of osteoarthritis.
- Magnetic resonance imaging (MRI). With the help of this study, literally every millimeter of the joint can be examined, the amount of intra-articular fluid, the condition of the articular cartilage, meniscus, perineal (subchondral) bone can be determined. The extra-articular structures are also clearly visible - muscles, blood vessels, and subcutaneous fat. The method is accurate, informative enough, and, most importantly, non-invasive, that is, it does not require the penetration of any additional equipment into the joint.
When do you need advice from other profiles?
- Neurologist . According to statistics, more than 60% of patients with a diagnosis of coxarthrosis who applied to a medical institution complaining of pain in the groin and hip, suspect radicular symptoms at first, and in some cases even suggest the presence of a herniated disc, is a purely neurological diagnosis. And vice versa: back pain, similar to “radiculitis”, may be a “mask” of coxarthrosis. In any case, neglect the advice of a neurologist is not worth it.
- Gynecologist . Inflammation of the uterus, adhesions in the pelvis, compression of surrounding structures by growing myoma - these are the minimum list of causes that can cause pain in the groin, increase with walking, and have signs that seem to be characteristic of hip joint arthrosis. The most correct strategy in this case is to simultaneously examine both the hip joints and the pelvic organs.
- Urologist . In some cases, pain in the groin may be due to the pathology of the prostate gland. It makes sense to contact this specialist when the diagnosis of coxarthrosis was not confirmed.
Treatment of hip arthrosis
The basic principle is an integrated approach to the treatment of this disease. This means a combination of medicinal methods with non-medicinal and detailed elaboration of the “strategy” of treatment together with the patient.
It is important to convince the patient that adherence to recommendations is the main thing that he can do for his joints.
Physical therapy for coxarthrosis includes a set of exercises, exercises on a stationary bike and classes in a swimming pool with an exercise therapy instructor.
The fight against flatfoot should be carried out at any age and regardless of the type of foot changes: longitudinal, transverse or mixed. In any of these three cases, there is a serious danger of “snowball”: a phenomenon in which pain in the foot and ankle joint leads to painful knees and meniscus, and pain in the knee joints - to try to “spare” the leg, to limp, and, ultimately, to the development of hip arthrosis!
The most important moment of the entire treatment and rehabilitation program is the normalization of body weight. It should be remembered that the weight of a person is "calculated" by nature in advance based on heredity, bone density, elasticity of ligaments. Modern man has no reason to guess what his ideal parameters are: everyone will calculate the tables and calculators! Little will remain - “agree” with your own appetite and keep the weight within acceptable limits.
The next non-drug method is physiotherapy, or physiotherapy. The principle of action is to improve the blood supply in the area of the damaged joint. A variety of techniques are used: UHF, laser treatment, treatment with magnetic waves, short-term exposure to cold (cryotherapy), the effect of special electrical currents on the muscles surrounding the joint. These methods of treatment, on the one hand, are attractive because of their relative cheapness, on the other hand, because there is no need to take drugs. But one should never forget that there are no absolutely harmless drugs, and absolutely harmless procedures do not happen either. There are a number of limitations and contraindications for physiotherapy: oncological diseases (including those that were in the past), refractory (this is called “uncompensated”) hypertension, thyroid diseases, gynecological diseases in women and prostate adenoma in men. Physiotherapy is prescribed with caution in case of skin diseases, for example, in case of psoriasis and in case of pronounced signs of inflammation in the joints. In addition, the patient may have inflammatory (systemic) rheumatological disease. And in this case, physiotherapeutic procedures will not only not help, but they are also quite capable of causing a worsening of the disease.
1) Pain relief. For arthrosis of the hip joint, either so-called “simple” analgesics, such as paracetamol, or nonsteroidal anti-inflammatory drugs (NSAIDs) are used. The main disadvantage of this group of drugs is that they should not be used for a long time, given the wide range of side effects. Taking NSAIDs (nonsteroidal anti-inflammatory drugs) for a long time, few people think about the potential harm of these drugs. They can cause erosive and ulcerative changes of the gastric mucosa and duodenal ulcer, kidney damage, liver, and some even cause diseases of the cardiovascular system. In addition, there is evidence that some NSAIDs themselves are capable of destroying articular cartilage.
2) It is believed that drugs with glucosamine or chondroitin have a pronounced analgesic effect and a lower risk of undesirable effects. Thus, instead of conventional NSAIDs (nise, aertal, arcoxia), it is recommended to prescribe drugs of this group (for example, arthrodarin).
3) Chondroprotectors. These include combination products containing both chondroitin sulfate and glucosamine. The most famous of them are arthra, don, struktum. These medications are taken for a long time, treatment courses last several months with a mandatory break of several months. Form release - pills, sachets (bags) or capsules. It was noted that with sufficiently high efficiency, chondroprotectors are also well tolerated by patients, and do not cause serious side effects. Along with the listed drugs, pharmacies often sell biological food supplements - dietary supplements. These funds usually cost several times cheaper than chondroprotectors, but their effectiveness and safety have never been confirmed by anyone, which means that by taking them at your own peril and risk, a person may face, at best, the uselessness of a pseudo-drug.
4) Recent large-scale studies have shown the efficacy of strontium ranelate for osteoarthritis, affecting large joints. In the pharmacy network, it is sold under the name "Bivalos". This remedy slows down the changes in bone tissue and articular cartilage, that is, not only helps to reduce inflammation, but acts on a subtle level, virtually eliminating the cause of the disease.
5) Hyaluronic acid preparations. The undoubted advantages of this group of drugs is the long duration of the therapeutic effect. Developed drugs, whose effect lasts from four months to a year! In addition, this drug does not cause changes in the structure of the bone, unlike hormonal agents for intra-articular administration. The latter are rarely used, the frequent introduction of steroids into the hip joint can cause aseptic necrosis of the femoral head, therefore it is not recommended as a routine treatment method now. Of course, the use of hyaluronates is also devoid of the risk of harmful effects on the gastrointestinal tract, liver and kidneys, as is the case when taking NSAIDs inside.
Cons of treatment:
- the need to insert the needle directly into the joint (there is a risk of infection);
- after the introduction of hyaluronic acid is rare, but still there is a short-term exacerbation of pain, which was called “pseudo-gouty attack”
What is better - local treatment or regular intake of drugs?
Patients often ask this question. “If my knee hurts, I have to treat my knee, my hip hurts - let's treat the thigh, smear it, take physiotherapy courses, if necessary, give an injection ... Why am I going to swallow any chemistry, and yes, not cheap?” The answer that osteoarthritis can affect not only large joints (knee, hip), which suffer in the first place, but also the joints of the feet, hands, spine. And taking drugs to restore and strengthen the articular cartilage, the patient makes a kind of "contribution to the future" for all joints.
Rehabilitation. How long is coxarthrosis treated and how long are physical exercises impossible?
Usually this question concerns athletes and young people with post-traumatic arthrosis of the joints. Given the fact that osteoarthritis is a chronic process, that is, once started, it will slowly but surely progress, the answer suggests itself. This disease has been treated for years. A reasonable approach to physical exertion, elimination of overloads, alternating courses of local and systemic (i.e., taking medication inside) anti-inflammatory therapy, supporting treatment - these are the rules that must be followed in order to be mobile in 30–40 years whom not to depend, and just keep going light.
If conventional treatment does not help ...
В случае стойкой потери функции, выраженном болевом синдроме, который не купируется (не устраняется) ни нестероидными противовоспалительными средствами, ни стероидами, поднимается вопрос об оперативном лечении.
Как хирургически лечат коксартроз? Операция называется эндопротезированием тазобедренного сустава.
Выглядит это примерно так. Хирург удаляет поврежденные суставные структуры, подготавливает «площадку» для установки эндопротеза и помещает его таким образом, чтобы искусственный сустав «встал» четко на то же место, где ранее находился сустав пациента. Рану зашивают, а через несколько дней больному уже предлагают подняться и сделать несколько самостоятельных шагов. При отсутствии осложнений и гладком течении послеоперационного периода уже через три недели пациент полностью самостоятельно передвигается, функция конечности восстанавливается.