Osteochondrosis of the hip joint

The hip joint (HJ) is one of the largest and most important joints in the body. It supports the body and allows you to maintain mobility. Unfortunately, problems with it are not always recognized in time. Very often the pain radiates to the groin, lower back, knees and other areas, which is why people do not associate the discomfort with joint diseases. But not only the elderly are at risk, but all young people who are overweight, lead a sedentary or overly active lifestyle. As a rule, osteochondrosis of the hip joint occurs in 7% of the population under 30 years of age. After 40 years, the indicator triples, and after 55 – 7 times!

Ignoring the pain signal may result in disability, but osteochondrosis of the hip joint is not a death sentence. The sooner you start treatment, the easier and faster the rehabilitation will be. So how to prevent the disease and cure it if the first pain sensations are already making themselves felt?

What is osteochondrosis of the hip joint?

Osteochondrosis of the hip joint (HJ) is a degenerative-dystrophic disease, the pathological processes of which are localized in bone and cartilage tissues and cause limited mobility of the lower extremities.

Depending on the etiology of origin, osteochondrosis of the hip joint is classified into several types:

primary – develops mainly in old age (after 45 years), is characterized by symmetry of the lesion and an extremely unfavorable prognosis;
secondary – occurs against the background of diseases and a number of external factors.

Degenerative changes are most often diagnosed in women, mainly after 40 years.

Types and causes of coxarthrosis development

The reasons for the formation of primary coxarthrosis have not been reliably established. This form of the disease is most often accompanied by concomitant lesions of the spine and knee joint, osteochondrosis and gonarthrosis.

Secondary coxarthrosis of the hip joint is a direct consequence of the following diseases:

Congenital hip dislocation;
Necrosis of the femoral head;
Hip dysplasia;
Perthes disease;
Inflammation and infections in the joints;
Injuries or fractures.

Osteochondrosis of the hip joint: causes

The head of the femur and the pelvic bone are connected to each other by cartilaginous structures, the destruction of which can cause a complete loss of human mobility.

Osteochondrosis of the hip joint is a complex pathological disease that involves the development of degenerative processes in the articular tissues. The probable causes of the development of this type of pathology are usually identified as:

genetic predisposition – a diagnosed disease in close relatives increases the risk of its manifestation;
excess body weight - obesity negatively affects not only a person’s appearance, but also the functionality of the musculoskeletal system;
metabolic disorder – metabolic failure provokes stability of nutrition of tissues of various types;
incorrect shoes - the inconvenience experienced when wearing shoes every day causes excessive stress on the parts of the musculoskeletal system;
infectious diseases – the presence of an infection in the body can provoke inflammation of various types of tissues;
congenital pathologies - dysplasia is usually classified as such;
previous injuries - any violation (bruise, fracture, dislocation, etc.) causes weakening of the joint and increases the risk of their deformation.

Causes and mechanisms of disease development

The diagnosis of osteoarthritis of the hip joint is established on the basis of clinical symptoms or pathological manifestations of the disease. With osteochondrosis, there is a progressive loss of hyaline articular cartilage of the hip joint with accompanying changes in the subchondral bone, marginal growths (osteophytes) develop and the endplate of bone thickens. The soft tissue structures in and around the hip joint are also affected. Moderate inflammatory infiltrates are observed in the synovium, muscles and ligaments become weak. Often, patients with radiographic signs of osteoarthritis have no clinical signs of the disease.

The cause of primary idiopathic osteoarthritis of the hip is unknown. Secondary osteoarthritis is caused by disorders in the hip joint, which are caused by the following etiological factors:

Injuries;
Inflammatory diseases;
Congenital or acquired anatomical deformities;
Metabolic shifts.

The leading role in the development of osteochondrosis is played by microtraumas, physical activity, microtraumas, oxygen starvation, and decreased blood supply. Age, low physical activity, hormonal changes, metabolic disorders and infectious and allergic factors can provoke the development of the pathological process.

The basis of the lesions in osteoarthritis of the hip joints are changes in the cartilage tissue, which adapts the joint to mechanical load. With osteoarthritis, degeneration and death of chondrocytes occurs, depolymerization of the main substance that they regulate, and the number of glycosaminoglycans decreases. Due to the loss of proteoglycans, the strength of cartilage decreases and degeneration occurs. The response of bone tissue is expressed in its growth and the formation of bone protrusions.

Degrees of osteochondrosis of the hip joint

Today, it is customary to distinguish three degrees of development of osteochondrosis of the hip joint. Each of them has its own characteristics and requires a specific treatment plan, which can only be determined by the attending physician, taking into account the individual characteristics of the patient and the clinical picture of the disease.

Osteochondrosis of the hip joint 1st degree

Osteochondrosis of the hip joint of the 1st degree is quite difficult to diagnose due to mild or absent symptoms.

During this period, dystrophic changes begin, which can be determined using x-ray examination (visually noticeable minor growths along the edge of the pelvic cavity).

Osteochondrosis of the hip joint 2nd degree

With osteochondrosis of the hip joint of 2nd degree, dystrophic changes expand in area and affect bone tissue.

The head of the femur undergoes deformation, the cartilage tissue becomes thinner, bone growths form, and the area of inflammation expands its boundaries.

The patient experiences a change in gait and lameness.

Osteochondrosis of the hip joint, grade 3

With osteochondrosis of the hip joint of the 3rd degree, degenerative-dystrophic changes lead to the complete destruction of the cartilage tissue of the joint; individual cartilaginous remains are observed between the tibia and pelvic bone.

During the examination, replacement of cartilaginous tissue with bone growths is noted. Inflammation and visually noticeable swelling are diagnosed.

Symptoms of coxarthrosis

Symptoms increase gradually. The higher the degree, the more new signs there are.

Limited movement

With an active inflammatory process and rubbing of bones, bone tissue grows compensatory. The range of movements decreases. In the later stages, the symptom provokes deviations:

transition of inflammation to the synovium;
growth of fibrous tissue into the joint.

Stiffness of movement appears at each stage. With stage 1 disease, rotational movements are limited. At 4 – a person cannot walk, squat, stand up, or turn his leg to the side.

Pain syndrome

At stage 1, there is practically no pain, the person may feel discomfort. Arthralgia occurs in grade 2. If a person rests for a long time, it decreases. Acute pain is provoked by the following factors:

active mobility;
lifting heavy objects;
hypothermia;
viral, bacterial infections of systemic type;
exacerbation of chronic pathologies of the musculoskeletal system (synovitis).

Periodically, a stage of remission occurs. The person stops feeling pain. But exacerbation occurs immediately after the influence of negative factors.

Crunch

Joints crunch when moving:

flexion, extension;
walking;
rotation of the hip joint.

When moving, crunching, clicking, and crackling sounds appear. The sign occurs when bone processes and osteophytes interact. The more they rub, the greater the inflammation and damage. Usually the crunch is accompanied by pain.

Lameness

Develops at stages 3-4. The man has a strong limp and requires a cane to walk steadily. Cause of condition:

flexion contractures;
extensive damage to the bone surfaces inside the joints;
deformation of the articular cavity.

The patient's leg does not straighten completely; each step causes lameness combined with pain. When walking, he tries to lean on his healthy leg, this changes the center of gravity.

Shortening of the lower limb

The symptom develops no earlier than stage 3. The leg is shortened by 1 cm. If the disease is not treated in a timely manner, the reduction of the lower limb will be stronger. Reasons for shortening:

atrophic processes in muscles;
abrasion of cartilage;
reduction in the volume of the articular cavity;
damage, deformation of the femoral head.

The greater the shortening, the more severe the lameness.

Muscle spasms

With coxarthrosis, the patient periodically experiences muscle spasms. Causes:

weakness of the ligamentous apparatus - the muscles go into a state of spasm to maintain the integrity of the hip joint;
inflammation of the synovial membrane;
damage to nerve endings by osteophytes for compensatory pain suppression.

The symptom does not persist throughout the course of the disease. He appears periodically.

Symptoms of osteochondrosis of the hip joint

The symptoms of the pathology are directly related to the degree of development of the disease.

With osteochondrosis of the hip joint of 1 degree, the following symptoms are observed:

pain after physical activity of varying intensity, dull or aching;
pain disappears after a short rest.

With osteochondrosis of the hip joint of the 2nd degree, it is customary to distinguish the following symptoms:

increased pain, even at rest;
the occurrence of lameness after lifting heavy objects;
difficulties in flexion/abduction of the lower limb;
discomfort after a long stay in the same position;
slight shortening of the limb.

Osteochondrosis of the hip joint grade 3 has pronounced symptoms and involves:

regular pain of severe intensity;
the need to use a cane for walking;
insomnia;
depression;
increased irritability;
atrophy of the muscles of the lower extremities.

Diagnostics

The diagnosis is made based on patient complaints, external examination, and test results that determine the range of motion in the hip joint. The most informative is radiography.

X-ray of the hip joint for osteochondrosis.

But sometimes it is necessary to conduct other instrumental studies to identify developed complications or differentiate osteochondrosis from inflammatory pathologies:

MRI allows you to assess the condition of nerves and blood vessels localized in the hip joint area;
CT helps to quickly detect an inflammatory process, benign or malignant neoplasm;
Ultrasound is used to detect damage to muscles and the ligamentous-tendon apparatus of the hip joint.

In some cases, it is impossible to do without arthroscopy - examination of the articular cavity using a device equipped with a miniature video camera. If aseptic or infectious inflammation is suspected, a biochemical study of a sample of synovial fluid is performed.

Synovectomy of the hip joint.

Features of diagnostic measures

Anyone can seek qualified medical help if one or more symptoms of the disease develop.

To make a diagnosis, you must first consult a therapist. Who will give a referral to a highly specialized specialist (rheumatologist/orthopedist/surgeon).

The first stage of diagnosis is the collection of anamnesis and medical history of the patient. After this, instrumental research methods are prescribed, which include such medical procedures as:

radiography;
ultrasonography;
computed/magnetic resonance imaging.

In order to exclude the possibility of concomitant diseases, the patient is also prescribed laboratory tests of blood and urine.

In addition, it is worth noting that to determine the existing degree of development of pathological processes, diagnostic methods such as an immunogram and a test for rheumatoid factor are used.

Treatment of osteochondrosis of the hip joint

Treatment of osteochondrosis of the hip joint involves complex therapy, the key purpose of which is to restore mobility, as well as relieve symptoms while simultaneously preventing the development of complications.

Regardless of the diagnosed degree of development of a degenerative-dystrophic disease, treatment necessarily includes the following areas:

use of medications;
physiotherapeutic treatment;
massage;
use of therapeutic physical training techniques;
nutrition correction.

Physiotherapeutic treatment

Physiotherapy helps reduce swelling and also triggers regeneration, accelerating blood circulation in the tissues.

For osteochondrosis of the hip joint, the following types of physiotherapeutic treatment can be prescribed:

myostimulation - the use of electric current pulses;
magnetotherapy - heating tissues using magnetic field;
phonophoresis – a combination of ultrasound and medicinal effects;
shock wave therapy – tissue stimulation using sound waves.

The list of procedures is selected taking into account the degree of osteochondrosis and the general health of the patient.

Massage

The purpose of massage can improve blood circulation in the affected tissues and stimulate acceleration and increase in the volume of fluid released, which improves joint mobility.

The procedure is prescribed exclusively by the attending physician. The implementation of procedures should only be entrusted to an experienced specialist.

The course is determined by individual indicators.

Therapeutic exercise (physical therapy)

Exercise therapy plays a special role, because it helps restore joint stability and relieve muscle tension.

If the hip joint is affected, it is recommended to regularly engage in gymnastic exercises. The complex is determined individually by a physical therapy instructor based on the recommendations of the attending physician.

All movements when performing exercises should be smooth and performed with caution. After completing a set of exercises, self-massage of the muscles of the buttocks and thighs is allowed.

Drugs for the treatment of osteochondrosis of the hip joint

The use of drugs of various groups involves achieving such goals as:

elimination of pain syndrome;
normalization of providing tissues with an optimal amount of nutrients;
launch of regenerative processes;
improved blood flow;
reducing the load on the affected joint.

When treating with drugs, the following groups of drugs are prescribed:

muscle relaxants;
vasodilators;
painkillers;
chondroprotectors;
NSAIDs (non-steroidal anti-inflammatory drugs).

Particularly important in treatment are considered to be drugs from the NSAID group, one of the most effective of which is Artradol.

Surgical intervention

A radical treatment method is indicated in a situation where the patient has:

high intensity pain syndrome;
significant destruction of articular tissues;
low rates of effectiveness of conservative techniques.

Blog

Coxarthrosis is a degenerative disease of the hip joint, characterized by a progressive course and disruption of the static-dynamic function of the musculoskeletal system. Since the hip joint is the most powerful in the human body and experiences heavy loads during life, it is not surprising that diseases of this joint take 2nd place after back pain.

There are primary coxarthrosis (idiopathic, i.e., of unknown etiology) and secondary coxarthrosis, which occurs against the background of hip dysplasia or congenital hip dislocation, as a result of injury, or an inflammatory process in the joint.

The reasons are different in all cases - the clinic is the same.

The main complaint of patients with coxarthrosis is pain. But the nature, intensity, duration and localization of this pain depend on the severity of the degenerative process in the joint, i.e. from the stage of coxarthrosis. There are three stages of coxarthrosis.

In the first stage , periodically after physical activity (long walking, running), pain occurs in the hip joint, less often in the hip or knee joint. As a rule, the pain goes away after rest. The range of motion in the joint is not limited, muscle strength is not changed, and gait is not impaired. Radiographs show minor bone growths that do not extend beyond the labrum. They are usually located around the outer or inner edge of the articular surface of the acetabulum. The head and neck of the femur are practically unchanged. The joint gap is unevenly slightly narrowed.

In the second stage , the pain is more intense, radiates to the thigh, groin area, and occurs at rest. The function of the joint is impaired. First of all, internal rotation and abduction of the hip are limited, i.e. flexion and adduction contracture is formed. The strength of the muscles that abduct and extend the hip decreases, and their hypotonia and hypotrophy are determined. Therefore, lameness begins to appear when walking. The radiograph shows significant bone growths along the outer and inner edges of the acetabulum, extending beyond the cartilaginous lip. Deformation of the femoral head, its enlargement and uneven contour are noted. Cysts can form in the most loaded part of the head and acetabulum. The neck of the femur is thickened and widened. The joint space is unevenly narrowed (up to 1/3-1/4 of the original height). A tendency to displacement of the femoral head is determined.

In the third stage , the pain is constant and occurs even at night. When walking, patients are forced to use a cane. There is a sharp limitation of all movements in the joint (flexion-adduction contracture) and hypotrophy of the gluteal muscles, as well as the muscles of the thigh and lower leg. There is a tilt of the pelvis in the frontal plane, which leads to functional shortening of the limb on the affected side. The patient is forced to step on his toes to reach the floor and tilt his torso to the affected side when walking to compensate for the tilt of the pelvis and shortening of the limb. This compensation mechanism leads to a shift in the center of gravity and overload of the joint. Radiographs reveal extensive bone growths on the side of the roof of the acetabulum and the head of the femur, and a sharp narrowing of the joint space. The neck of the femur is significantly expanded and shortened.

Unfortunately, there is still no unified theory of the pathogenesis of coxarthrosis. Most scientists believe that the trigger point is a violation of blood circulation in the joint due to both deterioration of venous outflow and disruption of arterial inflow. As a result of tissue hypoxia, underoxidized metabolic products accumulate, activating proteolytic enzymes and hyaluronidase in the synovial fluid, which destroy cartilage proteoglycans. It becomes thinner, loosens, fragments, and its shock-absorbing properties are lost. As a compensatory reaction of the articular surfaces of the hip joint, marginal bone growths are formed. Subsequently, sclerosis develops and cysts form in the articulating parts of the femoral head and acetabulum.

Treatment of coxarthrosis due to the lack of a single pathogenetic mechanism for the development of the disease is symptomatic. Its goal is to reduce pain, for which analgesic and anti-inflammatory drugs are used (analgin, indomethacin, ortofen, etc.). To improve redox processes in cartilage tissue, chondroprotectors, vitamins, rumalon and other drugs are prescribed. In a clinic setting, electrophoresis of a solution of novocaine, dimexide, as well as ultrasound therapy, magnetic therapy, and laser therapy are used. After reducing the pain, manual massage of the lumbar region, hip joint, thigh and therapeutic exercises (kinesitherapy) are recommended.

Here we come to the most interesting question of this article. For us, kinesitherapists, it is obvious that therapeutic exercises in the treatment of coxarthrosis should not occupy the last, but the first, or rather, the leading place. Is it possible to consider a joint disease in isolation from its inseparable component - muscles and ligaments? After all, without their direct action, a joint is a set of bone structures, and nothing more. The ancient Greeks said: “The body is a single whole, treat the patient, not the disease.” The human body is perfect, there is nothing superfluous in it. And just as in nature the death of a mosquito leads to the death of entire populations of birds, so in the human body the loss of the quality of any muscle group, for example, hypotrophy of the adductor and abductor muscles of the thigh in coxarthrosis, leads to the loss of a large section of the vascular network feeding the joint (for reference : there are 3-4 capillaries in one muscle fiber). So what can we expect from drug therapy then? After all, anyone understands that the drug is delivered to the point of action through the bloodstream. And in our joint area there is ischemia and dystrophy. How much of the drug gets into the joint in this position? Minor...

Therefore, in the first place in the treatment of coxarthrosis, we must place physical therapy (kinesitherapy), which will allow us to influence the joint at the level of the pathogenesis of the disease, thus ensuring maximum effectiveness of the drug treatment carried out in parallel. After all, the “pumping” function of muscles cannot be replaced by any other procedures. And only by restoring the trophism of the joint can we count on regeneration processes in it. And if there are already existing defects in the structure of the joint, it is necessary to ensure the maximum level of safety for physical work with it.

For this purpose, strength training equipment with a strictly specified movement geometry is used.

Modern kinesitherapy centers use the MTB (Bubnovsky multifunctional simulator), which received a certificate in July 2011 as a means of medical rehabilitation. The main advantage of MTB is the possibility of decompression work on the affected joint under conditions of individual selection of load when performing each exercise. The treatment program for each patient is drawn up individually, based on the results of myofascial testing. During testing, the functionality of the musculoskeletal system is determined, i.e. the strength of individual muscle groups, the ability to move joints, the condition of the muscles of the upper limbs and back. In addition, the motor reaction of the muscles is determined, that is, the time spent on the ability to perform the next exercise; learning the technique of movements and diaphragmatic breathing, which is necessary to reduce intra-abdominal pressure when performing strength exercises.

The prescribed treatment program is carried out individually, under the supervision of an exercise therapy instructor. Our work experience shows that a well-trained muscular system helps to develop compensatory mechanisms even with severe disorders in the joint. But it would be better not to let them know...

Recently, a patient asked me a question that I could not answer. For several years she wandered around to different doctors (rheumatologists, surgeons, orthopedists) with one diagnosis - coxarthrosis of the second degree. Treatment was prescribed but there was no improvement in health. After studying at our center for a month, she noticed a clear positive trend and asked: “Why wasn’t I referred to you for treatment earlier? Aren’t our doctors interested in seeing the patient get better?”

No, I do not believe that our doctors do not want the best for their patients. Probably, the role of reasonable physical training for the treatment of joint diseases is simply underestimated. But in vain... After all, back in 1786, Professor N. M. Maksimovich-Ambodik said: “A body without movement is like stagnant water, which molds, deteriorates, rots .

So let's not let it come to this!

Physiotherapy and sports medicine doctor

E.I.Vlasova

Nutritional Features

Compliance with the basics of dietary nutrition during complex treatment helps to reduce the load on the affected lower limb and relieve inflammation, improving the nutrition of the affected tissues.

It is recommended to expand the daily diet and enrich it with such foods as:

nuts and seeds;
Fish and seafood;
dairy and fermented milk products;
citrus;
whole grain food products.

If you want to achieve the most positive result in the treatment of osteochondrosis of the hip joint, you should limit the consumption of strong tea/coffee, as well as instant foods and bakery products. Bad habits (drinking alcohol and smoking) should be abandoned altogether.

Prevention

Preventive measures to prevent the occurrence of the disease or reduce the likelihood of its complications include:

balanced diet;
systematic performance of gymnastic exercises;
rejection of bad habits;
eliminating the possibility of hypothermia;
control of optimal body weight indicators;
timely treatment of various types of diseases;
systematic preventive medical examinations.

A long course of degenerative-dystrophic processes without proper treatment can lead to the development of lameness and disability of the patient.

Remember, maintaining a healthy lifestyle, adjusting your daily diet and systematically visiting your doctor is the key to effective prevention of the development of the disease.

Risk factors leading to the onset of the disease

The likelihood of developing the disease increases if:

Increased stress during sports, lifting weights, excess body weight;
Hormonal or metabolic disorders in the body, circulatory problems;
Anatomical problems of the musculoskeletal system: kyphosis, scoliosis, flat feet;
Age;
Passive lifestyle.

The disease is not inherited; risks, predisposing factors, and anatomical features are inherited. If among a person’s closest relatives there are people with severe forms of arthrosis, then visiting specialists and preventing diseases is vital.