Coxarthrosis of the hip, a complex pathology of joint diseases, leads to severe changes in the joints. Unfortunately, disability among adults with disabilities is common. In fact, hip pathology is almost half of all musculoskeletal system diseases. I will give an example from life of a case after surgical treatment and a rare complication during rehabilitation.
Coxarthrosis of the hip: a little about the disease
Osteoarthritis is a degenerative-dystrophic change that contributes to the complete destruction of cartilage resulting in loss of joint function.
Coxarthrosis - here the hip joints are destroyed, this is, in fact, the same joint disease.
In its mechanism, the articulation of the hip to the pelvis is similar to that of a door hinge. The head of the femur is connected to the ischium as a hinge. In it there is a special anatomical formation - acetabulum. This structure provides maximum joint mobility. This creates a full cycle of movements, or rather bending, stretching, rotating, etc. v.
Usually, the joint surfaces are smooth, with enough fluid inside, to ensure unhindered sliding. With the development of the disease, the mucus becomes thicker, more viscous, this is reflected in the condition of the cartilage. Joint translation no longer performs its full functions. For whatever reason, the shock-absorbing pads dry out, are covered with cracks, become rough.
- Firstly. As a result of the lack of the necessary slip, the friction of the bones increases, injuring them.
- Monday. As the process progresses, the deformation of the bony surfaces added to the cartilage tissue is altered. As a result, the body tries to compensate for the increased load.
- Tuesday. The increased load leads to complete atrophy of the thigh muscles and weakness of the ligaments.
Important: Osteoarthritis of the hip is a progressive disease. The changes can lead to a complete loss of a person's physical activity. Ultimately leading to disability. And completely disrupt the usual lifestyle. This disease and its treatment are of great significance not only in terms of medicine but also as a major social problem.
The reason for the development of coxarthrosis and its types of diseases
At least the exact cause of the occurrence of coxarthrosis, which destroys the hip joint, is not the exact cause. There are only assumptions. Most cases of pathological development of the hip are associated with congenital dislocation of the hip and dysplasia (hypoplasia) of the joint.
Therefore, there are 2 types of coxarthrosis;
- primary (arising from an unknown etiology);
- secondary (related to injury, illness).
Primary osteoarthritis is characterized by a combination of factors:
- the influence of biological and mechanical processes;
- excess weight;
- metabolic disorder;
- There is also a theory of pathological tissue repair in response to damaging agents (inflammation, friction, infection).
Often this type of coxarthrosis is associated with damage to the spine and arthritis of the knee (arthritis, dry joints).
In the secondary variant, the development reason is more obvious. Including:
- dysplasia. In half of congenital pathology cases, grade 1 dysplastic coxarthrosis of the hip occurs.
- Dislocation of the hip (congenital).
- Life trauma. Pelvic fracture, femoral neck, dislocation, lower dislocation.
- Legg-Calve-Perthes disease. Bone disease of the femoral head with the development of necrosis. This disease occurs in children with impaired blood and nutritional supply of the joints.
In addition, pathology can affect both formations at the same time or unidirectionally. Besides the direct causes, there are prognostic factors that stimulate the development of the disease. Often the disease occurs with increased load on the limbs of athletes. As well as those with difficult working conditions. Significantly increases the likelihood of joint overweight.
In addition, provoking factors include:
- Violation of metabolism, nutrition of joints, hormonal disorders.
- Posture disorder. Especially scoliosis, scoliosis leads to pelvic deformity.
- Age after 40 years. It is estimated that after this date, one in 10 patients is diagnosed with ''coxarthrosis of the hip 1. 2''. After 60, each third was observed. And by the time they turn 70 or older, almost 80% of those who sign up have this disease.
There is no specific gene responsible for the transmission of pathological changes in the joints. However, the genetic element is still traceable. A person can receive structural features of cartilage tissue, altered metabolism and bone pathology from relatives. It is a combination of genetic information that can cause the occurrence of hip disease.
The main division of the disease is by severity. There are 3 stages, differing not only in symptoms but also in the changes in radiographs. It is these indicators that are taken as the basis for diagnosis.
This division is the most common. There are also Kellgren classifications. It consists of 4 stages, plus zero - equivalent to a healthy joint.
The basis of all diseases of the musculoskeletal system is pain. Coxarthrosis of the hip joint grade 1-2 has less obvious symptoms than the late stage 3. Initially, it manifests as pain on exertion. Especially after long walks, climbing stairs. After that, pain becomes a constant companion, significantly reducing quality of life.
Coxarthrosis 1 degree
Discomfort is concentrated only in the joint area (groin, buttocks are practically not affected), rarely reflected in the thighs or knees. Pain relief at rest.
At this stage, no other manifestations are detected - gait is unchanged, there are no disturbances in movement. In contrast, in the dysplastic variant, an increase in mobility is observed due to changes in the connective tissue, often in the early stages of the disease, due to increased flexibility, the patient prefers to exercise. and yoga. The problem of motion comes only in 3 stages.
With symptoms of grade 1 spondyloarthritis, treatment can be carried out without surgical intervention. Reasonable therapy allows you to eliminate unpleasant symptoms, prevent progression.
2 levels of disease
The pain, although intermittent, manifests itself at rest. Irradiation becomes noticeable - thighs, groin, knees. Stiffness is observed - movement is limited when lifting, attempts to bend to the side, difficulty in circular movements of the legs (especially pain often increases). The lameness becomes noticeable, appearing after a lot of walking or running.
As you move, you will hear the characteristic crack of joints - rough, dry.
Osteoarthritis 3 degrees
The pain becomes constant, does not go away after rest and sleep. The discomfort does not leave the patient even at night. Having problems with walking, to facilitate movement, you have to use a cane. The lameness is permanent.
At this stage, atrophy of the muscles of the limb occurs, and the leg itself is shortened. These changes cause the patient to flex on the affected side, further increasing the load on the joint. Restricted movement is observed in most directions.
Bilateral coxarthrosis changes of the hip alter the patient's gait, thus all walking-related morphologies are affected. The appearance of pain in the lower back, the posture is disturbed, the axial position of the pelvis changes.
Examination by a chiropractor as well as a thorough analysis of complaints play an important role in the identification of the disease. The patient's activity should be assessed - ability to climb stairs, comfort in shoes and socks, walking activity, use of a cane.
It is recommended to check the general condition - blood, urine, biochemistry, electrocardiogram, identify signs of HIV and syphilis.
Grade 1 hip osteoarthritis has the faintest symptoms. That is why it is advisable to conduct radiographic examinations to visualize changes in the joint space. This method allows not only to establish the disease. And also often find out the cause of the occurrence - dysplasia, Perthes disease.
Knee pain is more common with grade 1 coxarthrosis of the hip, so it should be differentiated from gonarthrosis. In addition, the differential diagnosis includes examination of the spine to rule out lens syndrome (it causes diffuse pain in the thighs and knees).
In doubtful cases, MRI is used (allows you to examine the soft tissues in detail) and CT (to see bone formation).
This disease cannot be completely cured, but modern medicine can restore the lost mobility, helping you to live a full life.
The use of physical therapy, medication has an effect on the condition from 1-2 degrees. In the final stages, only surgery can help. In another, they work if the conservative treatments used do not bring remission.
Treatment level 1
Unfortunately, it is not possible to completely eliminate the pathology. In grade 1, treatment is aimed at stabilizing the condition.
During treatment, some general recommendations should be followed:
- Normalize physical activity - excessive loads should be reduced (hiking, running, jumping).
- The use of shoes with good shock-absorbing soles, special insoles.
- Weight loss.
- Compulsory exercise therapy.
Important: many patients completely refuse gymnastics and any load due to pain. Often this is related to an increased fear of pain, potentially making the situation worse. Practice proves this view wrong - regular exercise therapy strengthens muscles, protects them from atrophy, relieves pain, and improves joint function.
Do not provide a diet for patients with grade 1 hip osteoarthritis, only a moderate diet to lose weight. It is also helpful to add gelatinous foods, canned fish with bones, and dairy products to the diet.
Non-steroidal anti-inflammatory drugs are used as a medical method. Due to the large number of side effects, it is advisable to take intense pain relievers. You can combine their reception with gastroprotective drugs.
Persistent pain is relieved by steroid injections into the joint; Pain relief measures can also be taken.
For a support appointment:
- Muscle relaxants - relieve stress, relieve pain in the legs.
- Chondroprotectors - improve the recovery of cartilage tissue.
- Vasodilator (nicotinic acid) - helps to reduce vasospasm and also increases tissue microcirculation.
Warm compresses are also used in the complex (it is also possible to use folk remedies). They are not therapeutic, but they help relieve muscle spasms.
Make sure to use physiotherapy - UHF, acupuncture, electric current induction, massage.
Hip replacement surgery
To restore freedom of motion in stage 3, with severe pain relief, the patient is being prepared for a planned laparoscopic surgery. This is a special operation to replace a destroyed formation with an artificial formation. The interventions fully restored the patient's mobility. Helps to fully return to a normal lifestyle.
Depending on how common the process is, the prosthesis can be either unipolar (replacing only the worn end of the femur) or bipolar (the surface of the pad is also altered). After surgery, rehabilitation is imperative to return the patient to an active life as soon as possible.
For patients over 60 years of age, a rehabilitation period is established even before surgical treatment, so that recovery takes place in a shorter time. The service life of the artificial joint is about 20 years, but it is important to follow the recommendations:
- Exclude running, long walks, jumping.
- Avoid lifting heavy objects.
- Avoid being in an excessively static position (especially for those who work standing up).
My friend's husband had to undergo laparoscopic surgery. At diagnosis, he did not have coxarthrosis, but a lumbar herniated mass was successfully resected. His condition did not improve, the examination continued, and finally, when the problem was found, he was sent to a quota surgery.
After the replacement, everything developed safely, but the second hip also required surgical intervention. A year later, again the quota for the operation, was successfully completed. And then, from the first minutes after anesthesia, restore function and correctly follow the instructions of the doctor.
What about our friends? On the way home from the hospital, he began to put on a prosthetic joint (sitting for a long time, stepping on his feet). I forgot how careful I was the first time. As a result, the ligaments and muscles that had not yet adapted to the implant failed to hold and he jumped out.
Of course, they put it in, put a plaster on, and then everything seemed to be fine. But she complains that she can't move her leg to the side, it's very painful, it's uncomfortable to walk. Although he does different exercises and exercises to develop both joints, this is also work and desire to move independently.
The symptoms and treatment of coxarthrosis of the hip joint, as well as their stages, we have analyzed.
- Only daily physical education will help avoid serious complications and live to old age without needing crutches. In Soviet times, serious work was done to prevent diseases of the musculoskeletal system and strengthen the immune system. Now the lost experience is hard to renew, that's clear to the mind, but too lazy to do it.
- Excess weight wears down joints to disgrace, joint disease gets better, but doesn't cause further weight loss. My friend is sure of this, even without trying to eat foods that are less sweet and high in starch. Proper nutrition is very important.
- I consider lifting weights no less evil for the entire skeleton.
- Bad habits (alcohol, smoking) remove calcium, magnesium and other beneficial substances from the body.
Just digging, everything is connected to each other.
Take care of yourself and your joints by exercising every day!