Osteoarthritis of the hip joint
- What causes arthrosis of the hip joint?
- How to understand what the hip joint hurts?
- When is it necessary to consult specialists of other profiles?
- Treatment of arthrosis of the hip joint
- If the usual treatment does not help ...
The most common reason people turn to orthopedic surgeons is whether they are other manifestations of osteoarthritis. The share of arthrosis of the hip joint (coxarthrosis) accounts for about a third of all complaints, and these are tens and hundreds of patients per year.
What causes arthrosis of the hip joint?
According to statistics, coxarthrosis mostly occurs in women over 40 years of age, but by the age of 60, the number of men affected by this ailment has increased noticeably. Why is this disease primarily affected by women? It is known that the fair sex has other, than men, the structure and shape of the pelvic bones. The female pelvis is otherwise inclined, it is more horizontally positioned. This is due to the role of bearing 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: heavy physical labor, as well as work related to the constant stay "on your feet" (sellers, guides, teachers) and professional sports (weightlifters, jumpers, gymnasts).
- Injuries (falling, direct blow).
- Congenital anomalies of the hip joint (hypoplasia, dysplasia).
- Pain in the lower back. It is noticed that with one-sided pain in the lower back the body is slightly inclined towards the pain. So the body "protects" - relieves tension from the muscles. The protection of this is the wrong side: the load on the opposite hip joint is multiply increased. From this exorbitant load, wear it out much faster than it could be with a healthy back.
- Obesity. This is one of the most important risk factors for the development of osteoarthritis. At the end of the XX - beginning of the XXI century, excess body weight became literally "a scourge of civilization", causing a variety of health problems. That is why in recent decades, and osteoarthritis is diagnosed more often.
How to understand what the hip joint hurts?
Patients may be troubled by sharp pains that occur when walking around the hip, buttock, groin. These pains can irradiate (reflect) in the lower back, back, side or front surface of the thigh, knee. It is characteristic that at rest, especially when lying, this pain decreases. Each such case is individual, therefore visit to the orthopedist or the rheumatologist in any case should not be postponed, as well as it is not necessary to be engaged in a selftreatment.
Suspect the presence of a patient with coxarthrosis can be already at the stage of examination. The only available place where you can feel the structure related to the hip is the upper third of the lateral surface of the thigh. Here, the area of the so-called large trochanter (the femur section) is closely located. But the inflammation in the area of a large spit is not a coxarthrosis.
No matter how sick the hip joint, the appearance of the thigh of the patient does not change in any way - this structure is deeply hidden in the muscle mass. But it is perfectly clear that a person limps when walking or clicks his foot behind him. In order to diagnose coxarthrosis, certain tests (manipulations) must be carried out, which include flexion, extension of the legs in the hip joint, turns outward and inward, and several others. About the unpleasant sensations the patient informs the doctor, and on the basis of these data the preliminary diagnosis is put.
What else can hurt in the hip?
The reasons for the occurrence of painful sensations in this area are many. In addition to the pain caused by proper arthrosis, 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 joint bag). Articular bags, similar to pouches with fat and liquid, ensure the sliding of the tendons of muscles. Complaints of the patient with bursitis are usually associated with pulling, aching sensations, increasing in the prone position on the diseased side. The pain is intensified when the body's position changes (when standing up), and in a motionless state (sitting for a long time with one leg resting on one's leg), and with active movements (climbing stairs, running).
The second cause of pain, not related to bone structures, may be tendinitis (inflammation of the tendons themselves). Third, local (local) changes in surrounding tissues (eg, bruising after a bruise). Fourth, muscle ruptures, for example, the middle gluteus. This can occur due to injury or physical strain. Fifth, the deposition of crystals ("sand") of uric acid in the tendon area, if the patient has gout . Rarely, pain in the area of a large trochanter 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 onset, the connection with trauma or stress, to recall whether there was a hypothermia or an infectious disease. Finally, a formidable condition is aseptic (that is, non-purulent) necrosis (destruction) of the head of the femur. It manifests itself with the same signs as coxarthrosis, it is diagnosed only with the help of roentgenography and is treated, alas, only surgically. This condition usually occurs against the background of alcohol abuse or the constant intake of glucocorticosteroids (for example, with the same systemic inflammatory diseases).
Laboratory and instrumental examinations help the doctor to clarify the diagnosis and choose the treatment taking into account the characteristics of this particular patient.
- general and biochemical blood tests. These studies will help the doctor assess the severity of inflammation, confirm or disprove the presence of gout (this will "tell" the level of uric acid in the blood). The levels of cholesterol, bilirubin, liver enzymes will allow to choose a medicine taking into account its potential danger for this patient. If there is a suspicion of an inflammatory disease of the joints (rheumatoid arthritis, psoriatic arthritis), the doctor will prescribe the specifying tests - immunological.
- Radiography of the hip joints - the "gold standard" for diagnosing osteoarthritis. To make a diagnosis, it is enough to perform a so-called panoramic view of the pelvis in a direct projection. Radiologist will appreciate the evenness of the contours of bones, the width of the gap between them, determine the presence of osteophytes - tubercles and outgrowths that can cause painful sensations. In addition, the overview radiograph shows how symmetrical the pelvic bones are, because it is known that the "skew" of the pelvic ring, regardless of the reasons, can cause mechanical co-axirosis. Using an X-ray, you can roughly estimate the density of bone tissue, make a preliminary conclusion about the danger of fracture of the neck of the hip. If the introduction of any medications into the joint cavity is contemplated, radiography will help to determine the possibility of this action or contraindications to its implementation.
- Ultrasound of the hip joints. Can replace the roentgenogram? More likely no than yes. Ultrasound examination is more "subjective", that is, it depends on the qualification and experience of the diagnostician, on the sensitivity of the ultrasound machine, on the angle at which the sensor is positioned relative to the joint. In this type of study, the soft, non-bony structures of the joint itself, as well as the muscles surrounding the joint, are better seen. The amount of intraarticular fluid as well as uric acid crystals, the accumulation of which can cause pain in the hip joint, is also well defined, but is not directly related to the diagnosis of osteoarthritis.
- Magnetic resonance imaging (MRI). With the help of this study, you can consider literally every millimeter of the joint, determine the amount of intraarticular fluid, the state of the articular cartilage, menisci, near the cartilage (subchondral) bone. Well visible and extraarticular structures - muscles, vessels, subcutaneous fatty tissue. The method is accurate, fairly informative, and, most importantly, non-invasive, that is, no additional equipment penetrates into the joint.
When is it necessary to consult specialists of other profiles?
- The neurologist . According to statistics, more than 60% of patients with a diagnosis of coxarthrosis who have applied to a medical institution with complaints of pain in the groin and thigh are suspected initially of radicular symptoms and in some cases even suggest the presence of a herniated disc, 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 appendages of the uterus, adhesive process in the small pelvis, compression of surrounding structures with growing fibroid is the minimum list of causes that can cause pain in the groin, strengthen with walking and have signs that seem to be characteristic of arthrosis of the hip joint. 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 can be due to the pathology of the prostate. It makes sense to turn to this specialist when the diagnosis of coxarthrosis has not been confirmed.
Treatment of arthrosis of the hip joint
The main principle is an integrated approach to the treatment of this disease. This means a combination of medicinal methods with non-medicinal ones and a detailed elaboration of the "strategy" of treatment together with the patient.
It is important to convince the patient that compliance with recommendations is the main thing that he can do for his joints.
Therapeutic physical training in coxarthrosis includes a set of exercises, exercises on the stationary bike and swimming pool exercises with the instructor of exercise therapy.
The struggle with flatfoot should be carried out at any age and regardless of the type of foot changes: longitudinal, transverse or mixed. In either of these three cases, there is a serious danger of a "snowball": a phenomenon in which pain in the foot and ankle joint leads to painful sensations in the knees and meniscus lesion, and pain in the knee joints to an attempt to "spare" the leg, limp, and, ultimately, to the development of arthrosis of the hip joint!
The most important point of the whole treatment and rehabilitation program is the normalization of body weight. It should be remembered that the weight of a person in advance is "calculated" by nature based on heredity, bone density, elasticity of ligaments. Modern man does not need to guess what his ideal parameters are: everyone will calculate tables and calculators! There will be little - "negotiate" 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 the improvement of blood supply in the area of the damaged joint. Various methods are used: UHF, laser treatment, treatment with magnetic waves, short-term exposure to cold (cryotherapy), the impact of special electrical currents on the muscles surrounding the joint. These methods of treatment, on the one hand, are attractive for their relative cheapness, on the other - the lack of the need for taking medications. But one should never forget that absolutely harmless medicines do not exist, and absolutely harmless procedures do not happen either. For physiotherapy, there are a number of limitations and contraindications: oncological diseases (including those that were in the past) that can not be treated (this is called "uncompensated") arterial hypertension, thyroid diseases, gynecological diseases in women and prostate adenoma in men. Physiotherapy with caution prescribed for skin diseases, for example, with psoriasis and with pronounced signs of inflammation in the joints. In addition, the patient may have an inflammatory (systemic) rheumatological disease. And in this case physiotherapeutic procedures not only will not help, but also are quite capable to cause aggravation of illness.
1) Anesthesia. For arthrosis of the hip joint, so-called "simple" analgesics, for example, paracetamol, or non-steroidal 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 a wide range of side effects. Taking NSAIDs (non-steroidal anti-inflammatory drugs) for a long time, few people think about the potential harm of these medicines. They can cause erosive and ulcerative changes in the mucous membrane of the stomach and duodenum, damage to the kidneys, liver, and some even cause diseases of the cardiovascular system. In addition, there is evidence that some NSAIDs are capable of destroying articular cartilage.
2) It is generally accepted that preparations of glucosamine or chondroitin have a pronounced analgesic effect and a lesser risk of undesirable effects. Therefore, it is recommended to prescribe medications of this group (for example, arthrodarine) instead of usual NSAIDs (naid, aertal, arkoksia).
3) Chondroprotectors. These include combined preparations containing both chondroitin sulfate and glucosamine. The most famous of them are artra, don, structum. These medicines are taken for a long time, treatment courses last for several months with a mandatory break also in a few months. The form of the release is tablets, sachet (sachets) or capsules. It is noted that at a sufficiently high efficiency chondroprotectors are also well tolerated by patients, do not cause serious side effects. Along with the listed drugs in pharmacies are often sold biological supplements to food - dietary supplements. These funds are usually several times cheaper than chondroprotectors, but their effectiveness and safety have never been confirmed by anyone, and therefore, at their own risk, a person can face at best the complete uselessness of pseudo-drugs.
4) Recently conducted large-scale studies have shown the effectiveness of the preparation of strontium ranelate in osteoarthritis, affecting large joints. In the pharmacy chain, it is sold under the name "Bivalos". This tool slows the change in bone tissue and articular cartilage, that is, it not only helps reduce inflammation, but acts on a thin level, effectively eliminating the cause of the disease.
5) Preparations of hyaluronic acid. To undoubted advantages of this group of medicines is the long duration of the therapeutic effect. Developed drugs, the effect of which persists from four months to a year! In addition, this drug does not cause a change in the structure of the bone, in contrast to the hormonal means for intraarticular administration. The latter are rarely used, frequent introduction of steroids into the hip joint can cause aseptic necrosis of the femoral head, so now as a routine method of treatment is not recommended. Of course, the use of hyaluronates is also devoid of the risk of harmful effects on the gastrointestinal tract, liver and kidneys, as happens when taking NSAIDs inside.
Disadvantages of treatment:
- the need to insert a needle directly into the joint (there is a risk of infection);
- after the introduction of hyaluronic acid is rare, but there is still a short-term exacerbation of pain, which was called "pseudo-arthritis attack"
What is better - local treatment or regular intake of drugs inside?
Patients often ask this question. "If I have only a knee pain, so I need to treat my knee, hurts my thigh - let's treat the thigh, smear, take physiotherapy courses, if necessary, inject. ... Why should I swallow any chemistry, and even expensive?" The essence of the answer in that osteoarthritis can affect not only the large joints (knee, hip) that suffer in the first place, but also the joints of the feet, brushes, and spine. And taking medications to restore and strengthen 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 exertions unavailable?
Usually this issue worries athletes and young people with post-traumatic joint arthrosis. Considering the fact that osteoarthritis is a chronic process, that is, once started, it will slowly but surely progress, the answer arises by itself. This disease is treated for years. Reasonable approach to physical exertion, elimination of overloads, alternation of local and systemic courses (i.e. taking drugs inside) of anti-inflammatory therapy that supports treatment are the rules that must be observed in order to be mobile, physically or in 30-40 years who does not depend, and just keep an easy gait.
If the usual treatment does not help ...
In the case of persistent loss of function, severe pain syndrome, which is not stopped (not eliminated), or non-steroidal anti-inflammatory drugs, or steroids, the question of surgical treatment is raised.
How is coxarthrosis surgically treated? The operation is called endoprosthetics of the hip joint.
It looks like this. The surgeon removes the damaged articular structures, prepares a "site" for the installation of the endoprosthesis and places it so that the artificial joint "stands up" clearly to the same place where the patient's joint was previously. The wound is sewn up, and after a few days the patient is already offered to rise and take several independent steps. In the absence of complications and a smooth course of the postoperative period, after three weeks the patient completely independently moves, the function of the limb is restored.