Every year, diseases of the musculoskeletal system increasingly concern people, and their development at a young age is increasingly observed. This is facilitated not only by a change in lifestyle, but also by an increase in the level of injuries, which is largely interconnected. One of the most common pathologies of the musculoskeletal system is arthrosis of the hip joint, characterized by the occurrence of progressive pain and limited mobility. Ultimately, the disease can lead to complete immobility of the joint and disability. To avoid the occurrence of such undesirable consequences, it is important to start the treatment of arthrosis as early as possible. And if in the early stages of development it can be stopped by conservative methods, in case of serious changes it is possible to restore the functions of the hip joint and eliminate unbearable pain only with the help of a high-tech operation.
What is osteoarthritis of the hip joint
Osteoarthritis of the hip joint is a chronic degenerative dystrophic disease in which the gradual destruction of the hip joint occurs. At the same time, all its components are gradually involved in the pathological process, but hyaline cartilage is especially affected, which leads to a narrowing of the joint space and deformation of its other components. More often, pathological changes occur in only one hip joint, although both can also be affected simultaneously.
The hip joints are the largest in the human body as they bear the greatest load during the day. Each is formed by the head of the femur and the acetabulum, which is a bowl-shaped depression in the pelvis. Both surfaces are covered by smooth, moderately elastic hyaline cartilage. It is he who guarantees the smoothness and the unimpeded sliding of the femoral head in a natural depression and, thus, makes it possible to carry out movements in various planes.
Movement of the hip joint is provided by a group of muscles connected to it by fascia. It is also surrounded by ligaments, whose tasks are to limit its mobility within physiological limits and ensure the stability of its position.
The entire joint is surrounded by a joint capsule covered by a synovial membrane. Its main task is the synthesis of synovial fluid, which lubricates the contiguous parts of the hip joint and at the same time acts as a carrier of nutrients for it. It is from the synovial fluid that the hyaline cartilage that lines the femoral head and the surface of the acetabulum constantly receives components for the formation of new cells, that is, regeneration. This is extremely important for this cartilaginous formation, as with each movement of the hip it wears out, but is normally restored immediately. But when injured or under the influence of other factors, this does not happen, which leads to the development of arthrosis of the hip joint, that is, thinning and destruction of its hyaline cartilage.
As a result, deformed areas are formed in ideally smooth cartilage, which increase as the pathology progresses. As it wears away, the surfaces of the bones that form the joint are exposed. When they come into contact, there is a characteristic flare-up and intense pain. This causes osteophytes to form and, in the final stages of development, the femoral head completely fuses with the acetabulum, making any movement in the hip joint impossible.
At the same time, osteoarthritis of the hip joint can provoke the development of various inflammatory processes within the joint, including:
- bursitis - inflammation of the synovial bursa;
- tendovaginitis - an inflammatory process in the sheath of the tendon sheath of muscles;
- tunnel syndrome - compression of the nerves, causing pain radiating along the strangled nerve.
The reasons
One of the common causes of the development of arthrosis of the hip joint is mechanical damage, not only direct injuries, but also microdamage caused by the destructive effect of excessive loads on it. One of the most common causes of the development of the disease is a fracture of the femoral neck.
It starts from the femur at a 120° angle and connects it to the head. The presence of osteoporosis significantly increases the likelihood of hip fracture, but this type of injury can also be the result of a traffic accident, a fall from a foot from a height, impact, etc.
Femoral neck fracture may be accompanied by aseptic necrosis of the femoral head, which will become a trigger for the development of degenerative-dystrophic changes in the joint. The presence of dysplasia or subluxation of the hip joint, ruptures of its ligaments, transcondylar fractures or fractures of the acetabulum also create favorable conditions for damage to its structures. In these situations, post-traumatic osteoarthritis of the hip joint is diagnosed.
Post-traumatic osteoarthritis of the hip often occurs in professional weight and light lifters, skydivers, porters, and skaters.
The development of arthrosis of the hip joint after injury is due to a violation of the congruence (comparability) of joint surfaces, decreased quality of blood supply to joint components, and prolonged immobilization. As a result of prolonged immobility, there is not only a deterioration of blood circulation in the fixed area, but also a shortening of the muscles, a decrease in their tone. The probability of post-traumatic osteoarthritis significantly increases when an inappropriate situation or untimely treatment is performed, which leads to the preservation of defects of varying severity. In addition, the risks of its development increase with excessively early loading of the joint and inadequate exercise therapy, including very intense, initiated late or vice versa early.
Sometimes the disease occurs after surgical interventions on the hip joint due to scarring and additional tissue trauma. Although in some cases, surgery is the only way to eliminate the consequences of the injury.
Excessive loads can also cause changes in the hip joint, as they lead to microtraumas. Regular tissue damage activates the division process of chondrocytes (cartilaginous tissue cells). This is accompanied by an increase in the intensity of cytokine production, which are normally produced in small amounts. Cytokines are mediators of inflammation, in particular, the cytokine IL-1 leads to the synthesis of specific enzymes that destroy the hyaline cartilage of the hip joint.
In addition, high loads can cause microfractures of the subchondral plate. This leads to their gradual compaction and the formation of bony growths on the surface, called osteophytes. They can have sharp edges and cause further damage to the joint as well as damage to the surrounding tissue.
The subchondral plate is the extreme part of the bone that is in direct contact with the hyaline cartilage.
In some cases, it is not possible to determine exactly what provoked the development of degenerative-dystrophic changes in the hyaline cartilage of the femoral head and acetabulum. In these situations, idiopathic or primary arthrosis of the hip joint is diagnosed.
Today it has been established that the tendency to develop it can be inherited, that is, the presence of this pathology in close relatives significantly increases the chances of developing arthrosis of the hip joint. Presumably, it has a polygenic inheritance, that is, its development depends on the presence of many genes. Each of them individually creates mild prerequisites for the development of the disease, but when combined, they become a matter of time, especially when leading a sedentary lifestyle and obesity, or vice versa, strenuous physical work.
There is a theory that osteoarthritis of the hip joints is the result of a congenital or acquired mutation of the type II procollagen gene.
There is also secondary arthrosis of the hip joint, which develops against the background of the presence of concomitant diseases and age-related changes.
Symptoms
The disease is characterized by the occurrence of pain, limited mobility and crisis in the hip joint, the severity of which directly depends on the degree of neglect of pathological changes. In the final stages of development, shortening of the affected leg and complete immobility of the hip joint can be observed, due to complete fusion of the bony structures that form it.
Initially, the disease may proceed without pronounced signs and cause mild, short-term pain. As a rule, they appear after physical exertion, in particular walking, carrying heavy loads, squatting, bending over. But as the degenerative-dystrophic changes in the joint progress, the pain intensifies. Over time, they become not only more intense, but also last longer, and the interval between the start of physical activity and its appearance is also reduced. At the same time, even long rest may not bring relief. Subsequently, pain can torment a person even with prolonged immobility of the hip joint, for example, after a night's sleep.
If intra-articular structures impinge on nearby nerves, pain can radiate to the groin, buttocks, thigh, and knee. However, they tend to intensify with hypothermia. In the last stage of the development of the disease, the pain becomes unbearable. This causes an unconscious desire to feel sorry for the leg and put less stress on it, which leads to lameness.
Another symptom of osteoarthritis of the hip joint is decreased range of motion. Most of the time, there is a limitation in the ability to turn the leg in and out to lift the bent leg at the knee to the chest. Over time, the so-called morning stiffness occurs, which disappears after the patient "diverges". Subsequently, a compensatory curvature of the pelvis is possible, which leads to a change in gait. In the future, patients completely lose the ability to make certain movements with the affected leg.
If osteoarthritis of both hip joints develops at the same time, the so-called duck gait develops with the pelvis retracted and the body shifted forward.
All this can be accompanied by the formation of edema in the hip joint. But in the presence of excess weight, they can go unnoticed.
Often during movements, especially extensors, a crisis occurs in the affected joint. It is a consequence of the exposure of the bony surfaces of the femoral head and acetabulum and their friction with each other. In this case, there is a sharp increase in pain.
Also, with arthrosis of the hip joint, painful spasms of the femoral muscles may occur. With extremely advanced degenerative-dystrophic diseases, when the joint space almost completely disappears and the femoral head begins to flatten, shortening of the affected limb by 1 cm or more is observed.
In general, there are 3 degrees of osteoarthritis of the hip joint:
- Grade 1 - the joint space of the hip joint is narrow and the edges of the bony structures are slightly pointed, which indicates the beginning of the formation of osteophytes. Clinically, there is a mildly pronounced pain syndrome and some movement restrictions.
- Grade 2 - joint space is reduced by more than 50% but less than 60%. Significant osteophytes are observed, as well as signs of cysts in the epiphyses of the bones. Patients observe significant limitations of movement in the hip joint, the presence of a crisis during movements, pain and atrophy of the thigh muscles of varying severity can be traced.
- Grade 3 - joint space is reduced by more than 60% or is completely absent, and osteophytes occupy a large surface and are large, subchondral cysts are observed. The hip joint is stiff, the pain can become unbearable.
Diagnosis
The appearance of pain and other symptoms characteristic of osteoarthritis of the hip joints is the reason to contact an orthopedist. The doctor may suspect your presence, especially if you have had hip or pelvic injuries in the past, based on the data obtained during the interview and examination.
The presence of osteoarthritis of the hip joint is indicated by pain, the intensity of which increases over several years. Much less frequently, there is a rapid development of degenerative-dystrophic changes, when several months pass from the appearance of the first signs to a powerful permanent pain syndrome. This is characterized by increased pain while standing or performing physical work. In addition, for osteoarthritis, the presence of morning stiffness, lasting up to half an hour, is typical, and also occurs after prolonged immobility. Gradually, there is an increase in mobility restrictions and deformation of the hip joint, which in the later stages of development, the orthopedist may notice during the examination.
However, all patients necessarily receive instrumental research methods, with the help of which it will be possible to confirm the presence of hip arthrosis and establish its degree, as well as to differentiate it from some other diseases accompanied by similar symptoms. As a rule, diagnosis is carried out using:
- Radiography - allows detecting the main signs of arthrosis, in particular the narrowing of the joint space and the presence of osteophytes. But recently, CT has become a more informative research method, which makes it possible to assess the condition of the hip joint with greater precision.
- Magnetic resonance imaging is a highly informative method for diagnosing various changes in the state of soft tissue structures, including cartilaginous tissue, which allows detecting the slightest signs of hyaline cartilage degeneration.
In addition, patients may receive laboratory tests including KLA, OAM, a biochemical blood test, etc. They are required to establish concomitant diseases that created prerequisites for the development of secondary arthrosis of the hip joint.
Treatment of osteoarthritis of the hip joint without surgery
Treatment of degenerative-dystrophic changes of the hip joint through conservative therapy methods is only possible with 1st and 2nd degree arthrosis. The prescribed measures can improve the patient's condition, stop or at least slow down the progression of the pathology, and thus maintain the ability to work. But they are not able to lead to a complete regression of the changes that have already occurred in the joint.
Today, as part of the conservative treatment of arthrosis of the hip joint, are prescribed:
- drug therapy;
- exercise therapy;
- physiotherapy.
In addition, patients are advised to make some adjustments to their lifestyle. Therefore, in the presence of excess weight, it is worth taking measures to reduce it, that is, increasing the level of physical activity and reconsidering the nature of nutrition. If the patient is actively involved in sports and overloads the joint, which causes microtrauma to the joint, it is recommended to reduce the training intensity.
medical therapy
Drug therapy for osteoarthritis of the hip joint is always complex and includes drugs from different groups that aim to reduce the severity of the symptoms of the disease and improve the flow of metabolic and other processes in the joint. This:
- NSAIDs - drugs with anti-inflammatory and analgesic effects, produced both in oral form and in the form of local agents, which allows choosing the most effective and convenient option for use;
- corticosteroids - drugs that have powerful anti-inflammatory properties and are used in most cases in the form of a solution for injection, as when choosing systemic therapy they cause the development of unwanted side effects;
- chondroprotectors - drugs synthesized on the basis of natural components of cartilage tissue used by the body to restore it (prescribed for long courses);
- muscle relaxants - drugs indicated for muscle spasm, which causes pain of varying severity;
- B vitamins - help improve nerve conduction, which is necessary for the development of carpal tunnel syndrome;
- preparations that improve microcirculation - help to increase the intensity of blood circulation in the affected area, which leads to an increase in the rate of metabolic processes and helps to restore damaged cartilage.
If concomitant diseases are detected, consultation with related specialists and appropriate treatment is indicated.
With very severe and debilitating pain syndrome that cannot be eliminated with the help of prescribed NSAIDs, intra-articular or periarticular blocks may be performed. They involve injecting a local anesthetic in combination with a corticosteroid directly into the joint cavity, which quickly leads to an improvement in well-being. But procedures of this type can only be carried out in a medical institution by a qualified specialist, otherwise there is a high risk of complications.
exercise therapy
Physiotherapy exercises play one of the main roles in the non-surgical treatment of arthrosis of the hip joint, both in idiopathic and post-traumatic forms. But a set of exercises must be selected individually, taking into account the nature of the previous injury, the patient's level of physical development and existing concomitant diseases.
Exercise therapy should be done daily in comfortable, unhurried conditions. All movements must be performed smoothly, without jerks, so as not to harm the already deformed hip joint. This will allow:
- reduce the intensity of the pain syndrome;
- increase joint mobility;
- reduce the risk of muscle atrophy;
- increase the intensity of blood circulation and metabolic processes.
Physiotherapy
To increase the effectiveness of the prescribed measures, it is often recommended that patients with osteoarthritis of the hip joint undergo a course of physical therapy procedures. Traditionally, those that have anti-inflammatory, anti-edematous and analgesic effects are chosen. This:
- ultrasound therapy;
- electrophoresis;
- magnetotherapy;
- laser therapy;
- shock wave therapy, etc.
In some cases, plasmolifting is indicated, that is, the introduction of the patient's own blood plasma, purified and saturated with platelets. To obtain it, venous blood is taken, which is then subjected to centrifugation. As a result, it is divided into erythrocyte mass and plasma, which is used to treat degenerative-dystrophic changes in the hip joint.
Surgery for osteoarthritis of the hip joint
When diagnosing 3rd degree hip joint arthrosis, surgical intervention is indicated for patients. It can also be performed with the ineffectiveness of conservative therapy and persistent pain and mobility restrictions already in the 2nd stage of disease development.
In general, indications for hip surgery are:
- a significant decrease in the size of the joint space;
- the presence of persistent and intense pain;
- significant mobility restrictions.
The most effective and safest operation for arthrosis of the hip joint is arthroplasty. Today it is recognized as the gold standard for the treatment of this pathology, regardless of the reasons for its development. The essence of this type of surgical intervention is to replace part or all of the components of the hip joint with artificially created endoprostheses. The prostheses themselves are made of biocompatible and durable materials.
Its installation allows you to completely restore the normal mobility of the pathologically altered hip joint, eliminate pain and provide the patient with the opportunity to lead a full life. For each patient, the type of arthroplasty is selected individually based on the degree of destruction of various components of the joint.
The most effective is total or total hip arthroplasty. It involves the replacement of the entire joint with an artificial endoprosthesis, that is, the acetabulum, the femoral head and its neck. These prostheses are able to serve uninterruptedly for 15 to 30 years and guarantee the restoration of the entire volume of joint functioning.
They are installed without cement or with the help of special cement. The first method is more suitable for young patients, as it involves attaching the prosthesis to the pelvis, growing into the spongy layer of its own bone. For the elderly, the endoprosthesis installation method with cement is more suitable, which firmly holds the artificial material on the bone surfaces even in the presence of osteoporosis.
If the normal hyaline cartilage that lines the surface of the acetabulum is preserved, patients can receive partial arthroplasty. Its essence is to replace only the head and neck of the femur with an endoprosthesis. Today, there are 2 types of structures of this type: monopolar and bipolar.
The former are less reliable, after their installation, the need for total arthroplasty becomes later. This is due to the fact that the replaced artificial femoral head, when making movements, rubs directly against the cartilage of the acetabulum, which causes it to wear out faster.
Bipolar endoprostheses do not have such a disadvantage, as the artificial femoral head is already enclosed in a special capsule, adjacent to the acetabulum. Therefore, the cartilage that covers it is not deformed, as the capsule serves as a kind of plug and artificial substitute for the natural hyaline cartilage of the femoral head.
However, regardless of the type of endoprosthesis performed, postoperative rehabilitation is indicated for all patients. It consists of the appointment of drug therapy, exercise therapy and massage therapy. Recovery time depends on individual characteristics. But it is important to remember that the effectiveness of the operation directly depends on the quality of compliance with the doctor's recommendations during the rehabilitation period.
Thus, arthrosis of the hip joint is a common disease of the musculoskeletal system, which can occur even in the absence of direct prerequisites for its development. This pathology can lead not only to intense pain, but also to disability, so it is important to diagnose and take measures to stop its progression even at the first signs. However, the current level of development of medicine makes it possible to deal with advanced cases of arthrosis of the hip joint and restore full range of motion, as well as permanently get rid of severe pain.