Why does the hip joint hurt: about coxarthrosis and more

How does a femoral hernia manifest in women and men, symptoms and treatment methods

A femoral hernia is a protrusion of abdominal organs through the femoral canal under the skin in the groin area. This is one of the types of abdominal hernias (it accounts for 5–8% of all abdominal hernias); This type of hernia occurs mainly in women over 30 years of age. Compared to other types of hernias, femoral hernias more often cause difficulties in diagnosis, are more often strangulated, and generally have a more complex and insidious course.

At the initial stages of protrusion formation, it can be practically asymptomatic or manifest itself with nonspecific signs. Over time, the symptoms become more pronounced and cause serious inconvenience to patients: painful protrusion of noticeable size, constipation, nausea. After establishing the correct diagnosis, it is easy to get rid of the hernia through surgery.

Femoral hernia: features of manifestation

Worried about discomfort and pain between the groin and thigh?
Have you noticed a painful swelling on your thigh that appears with any load? All this may indicate a femoral hernia, so be sure to consult a doctor. The main danger of a hernia is the high risk of strangulation of the hernial sac. Compression of tissues, blood vessels and nerves is accompanied not only by pain, but also by disruption of their functioning, with further necrosis of the strangulated area, peritonitis and even sepsis. Timely surgery will help avoid complications and get rid of the hernia forever.

Diet

There is no diet as such for a femoral hernia, however, such patients need a diet correction that ensures normal daily bowel movements without constipation and flatulence , which contribute to increased pressure inside the abdominal cavity and an increase in protrusion. For this purpose, foods high in fiber (vegetables/fruits) that enhance intestinal motility are introduced into the diet: seaweed, beets, pumpkin, apricots, plums, peaches, figs, prunes, and the consumption of cabbage, yeast baked goods, kvass, and legumes that cause flatulence is reduced. (diet for constipation). If you are overweight, a rational diet for weight loss .

Types of femoral hernias

Based on location, unilateral and bilateral femoral hernias are distinguished. According to clinical signs they are divided into:

• Reducible - which can be easily adjusted in a lying position with gentle pressure on the protrusion with your hand.
• Irreducible - partially reducible or not completely reducible.
• Strangulated - sharp compression of the hernial sac, dangerous for the development of intestinal obstruction, with stagnation of feces, gangrene with tissue necrosis, sepsis.

There are the following stages of pathology development:

• Primary – the formation does not protrude beyond the femoral ring and does not manifest itself in any way.
• Canal (incomplete) – the protrusion is located in the femoral canal, but does not protrude beyond its boundaries.
• Complete - the hernial sac protrudes from beyond the boundaries of the femoral canal under the skin in the area of ​​the inguinal fold on the thigh.

More often, the disease is detected in the advanced (complete) stage.

What is a herniated thoracic spine?

The disease is characterized by deformation of the intervertebral disc in the form of bulging (protrusion) of its individual part beyond normal physiological boundaries. Herniation can occur at any of the vertebral levels Th1-Th12 between a pair of adjacent vertebral bodies. Most often, hernias are diagnosed along the spinal axis from the Th8 vertebra to the Th12. That is, the discs of the four lower segments are most susceptible to hernial pathogenesis: Th8-Th9, Th9-Th10, Th10-Th11, Th11-Th12. The high vulnerability of these levels to pathology is explained by their greater mobility and the high load-bearing load that they bear.

To understand the essence and complexity of the disease, let’s go through the main points, starting with the anatomical units that undergo damage. So, intervertebral discs. These are the most important structural elements of the spinal column, which are located between the vertebrae, ensuring their strong connection, shock absorption, smooth gliding, and normal mobility. Each disc is a fibrocartilaginous element, a kind of viscoelastic pad. It consists of a dense and elastic ring-shaped capsule (annulus fibrosus) and a gel-like mass enclosed inside it (nucleus pulposus).

The formation of disc protrusion is caused by wear and tear of disc tissue caused by local degenerative processes in the spine. They mainly mean advanced osteochondrosis. Its cause can be injuries, unbalanced physical activity (excessively high or, conversely, lack thereof), autoimmune pathologies.

1. Chronic osteochondrosis leads to metabolic depletion of the lining tissue between the vertebrae and to serious nutritional deficiency.
2. As a result, structure-forming components undergo destruction, which dominates the regeneration processes. The disk begins to deform irreversibly.
3. Subsequently, a rupture of the fibrous ring occurs with displacement of the nucleus pulposus and loss of part of it through the resulting defect into the spinal canal.

This is what advanced osteochondrosis looks like on MRI and CT images.

This prolapse, or protrusion in the thoracic region, is called a hernia. It can narrow the canal at the appropriate level, irritate and compress the nerve roots, compress the spinal cord, which causes painful phenomena, as well as various types of functional disorders.

Why surgery is needed

• A conservative approach to the treatment of femoral hernias is not effective.
• The hernial sac that slips through the femoral ring enlarges over time and ceases to be reduced.
• Even the smallest protrusion is often complicated by pinching.

At the GMS Hospital Hernia Treatment Center, treatment of femoral hernias is carried out using hernioplasty, which provides the following advantages:

• The use of microsurgical techniques and modern mesh devices allows minimizing trauma to the patient’s tissues.
• Stay in the hospital for no more than 1-3 days (depending on the scope of the intervention).
• Full recovery after surgery takes only 3-6 weeks.

Forecast

Femoral hernia

With a non-strangulated femoral hernia, in most cases the prognosis is favorable and after suturing the hernia the patient returns to his usual lifestyle. In the absence of timely treatment, there is a risk of the formation of an irreducible hernia, and in 80-90% of cases strangulation occurs.

Baker's hernia

Cysts that have formed recently (usually after excessive physical strain on the knee joints) are characterized by a benign outcome. In the presence of persistent synovitis of the joint, the cyst becomes chronic and its contents are joint fluid. In chronic cases, the fluid in the joint capsule is partially resorbed, which leads to its thickening. With a long course, daughter cysts, synechiae and septa can form. In cases of rapid accumulation of effusion, rupture of the cyst is possible with the spread of articular fluid through the interfascial spaces of the lower leg.

Causes of femoral hernia formation

The prerequisites for the development of a femoral hernia in men and women are weakness of the peritoneal muscles (rectus and oblique abdominal muscles). Sometimes it is congenital (in babies under one year old), but more often the defect occurs due to a regular increase in intra-abdominal pressure, due to:

• Rapid weight change
• Pregnancy
• Difficult birth
• Physical overexertion
• Abdominal wall injuries
• Severe, prolonged cough
• Regular constipation

Due to the specificity of the anatomy, hernial protrusion on the thigh is more often diagnosed in women and children.

Pathogenesis

Femoral hernia

The pathogenesis of a femoral hernia is based on the discrepancy between the strength of the muscular aponeurotic structures of the anterior abdominal wall and the pressure of the internal organs on it, that is, the main factor in hernia formation is the “anatomical prerequisites” that develop against the background of connective tissue pathology, manifested by quantitative changes in the ratio of mature collagen , which is the basis of strength various framework connective tissue elements (tendons, aponeuroses, ligaments).

Changes can occur in the process of collagen “maturation” in the form of slowing down the process or increasing the process/rate of its breakdown. Such processes lead to the prevalence of relatively thin/less strong collagen in connective tissue structures, which leads to a decrease in the resistance (resistance) of the abdominal wall structures. Such processes are the basis for the formation of a hernia. Increased collagen breakdown and a shift in balance towards immature forms can be facilitated by significant physical activity, alcohol, smoking and some toxins, and the process can also be congenital.

Becker's hernia

There are different views on the mechanism of cyst formation. Today, the most recognized by scientists is the valve mechanism of penetration of articular fluid from the cavity of the knee joint into the articular joint through the anastomosis, while the reverse flow of fluid into the joint cavity from the articular cavity is difficult. The immediate causes of unidirectional fluid flow can be:

• compression of the anastomosis directly by the enlarged knee joint itself or by the tendons of adjacent muscles at the moment of extension in the knee;
• compression of the anastomosis by a fold of the articular capsule, which can act as a valve flap;
• obstruction of the anastomosis with cellular detritus/fibrin masses;
• less often, the cause of obstruction of the anastomosis can be chondromic bodies that are located in the cyst cavity.

Cost of treatment for femoral hernia

The prices indicated in the price list may differ from the actual prices. Please check the current cost by calling +7 495 104 8605 (24 hours a day) or at the GMS Hospital clinic at the address: Moscow, st. Kalanchevskaya, 45.

Name	Price
Hernia repair for femoral hernia	100,002 rub.
Laparoscopic repair of inguinal, umbilical or femoral hernia	120,001 rub.

Dear Clients! Each case is individual and the final cost of your treatment can only be found out after an in-person visit to a GMS Hospital doctor. Prices for the most popular services are indicated with a 30% discount, which is valid when paying in cash or by credit card. You can be served under a VHI policy, pay separately for each visit, sign an agreement for an annual medical program, or make a deposit and receive services at a discount. On weekends and holidays, the clinic reserves the right to charge additional payments according to the current price list. Services are provided on the basis of a concluded contract.

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Make an appointment We will be happy to answer any questions Coordinator Oksana

Complications and consequences of thoracic hernia

What happens if you don’t treat a Th hernia or try to treat it, but incorrectly? Every sane person should understand that this will not end well. The patient risks losing the most valuable thing in his life in a short period of time - the ability to move. Poor quality treatment and its absence ultimately lead to extremely serious complications, leading among them:

• intercostal neuralgia (thoracic radiculitis);
• compression damage to the spinal cord, since the thoracic region has a very small intravertebral space;
• paresis, paralysis of arms and/or legs;
• immobilization of the entire half of the body, below the affected disc, or from the neck to the legs;
• failure of the functioning of the pelvic organs;
• critical dysfunction of the cardiovascular system and respiratory organs;
• progression of orthopedic disorders (scoliosis, kyphosis, dysplasia, etc.);
• active provocation of herniation at completely different levels of the spine.

Lesions in the chest area are one of the insidious consequences that can easily make a person disabled and incapable of self-care. The prognostic factor for a successful outcome is early diagnosis and correctly selected treatment tactics.

Signs and symptoms

In the first stages, the pathology has no visible clinical symptoms.
Occasionally, discomfort and pain in the inguinal-femoral fold may occur, aggravated by coughing, walking or other physical activity. The clinical picture of the full stage of the disease is expressed by the following symptoms:

• Visible protrusion in the inguinal-femoral fold.
• Disorder of urination (if parts of the bladder get into the hernial sac).
• Pain in the groin or lower abdomen.
• Flatulence, constipation, nausea, vomiting (if the hernia is formed by an intestinal loop).

If you have at least one of the above signs, do not delay your visit to the surgeon. The problem will not go away on its own, traditional and conservative methods will not help, the only solution is surgery.

Diagnostics

A muscle hernia on the thigh is differentiated from diseases that have similar symptoms (inguinal hernia, chronic lymphadenitis, varicose veins of the femoral vein, etc.). Diagnostics include:

• Collecting a detailed medical history.
• Surgical examination with palpation.
• Ultrasound of the protrusion and its contents.
• X-ray of the intestines.
• Ultrasound of the bladder and pelvis.
• Lab tests.
• Irrigoscopy.

The modern diagnostic base of GMS Hospital allows us to identify pathology at the initial stage, long before the appearance of pronounced symptoms.

You have questions? We will be happy to answer any questions Coordinator Tatyana

Hip diseases

Femoroacetabular impingement syndrome

Femoral-acetabular impingement syndrome (impingement syndrome) is one of the anomalies of the hip joint in which impingement or collision of articular structures occurs during movement. It is called femoroacetabular because impingement during movement is possible due to the collision of a part of the femur (usually the femoral neck or the edge of the femoral head) with the edge of the acetabulum (where the cartilaginous acetabulum is located).

Normally, impingement is impossible, but if a tubercle appears on the neck of the femur, or if the edge of the acetabulum and its lip are uneven, thickened, or stand too strong, then it is these tubercles or thickenings that will collide during movements in the joint. In this case, a vicious circle will arise: the impacting formations will become inflamed during movement, swell, become even larger in size and collide even more strongly. The exact reasons why these irregularities occur, leading to impingement syndrome, are unknown.

Some scientists believe that impingement syndrome is the cause of early arthrosis of the hip joint.

There are two mechanisms of impingement that can exist in the same hip joint at the same time:

1) eccentric impingement caused by the non-spherical shape of the head and the presence of deformation at its base on the femoral neck. This option is sometimes called cam impingement, from the English word cam - cam mechanism.

2) pincer impingement caused by excessive coverage of the acetabulum. The name comes from the English word pincer - tongs.

Diagnosis of femoroacetabular impingement syndrome (impingement syndrome)

The main symptom of hip impingement is pain that occurs in certain positions. With cam impingement, as a rule, this is flexion and external rotation (rotation around an axis). It is in this position that impingement most often occurs, i.e. collision. With pinser impingement, which is based on the deep position of the head in the acetabulum, the impact occurs in a wider range of movements (flexion, extension, abduction and their combinations).

An important role in diagnosis is played by an examination by a doctor, who will use tests to determine the position in which the pain occurs. It is worth noting that signs similar to the symptoms of hip impingement can occur with other injuries and diseases that cause pain in the hip joint, for example, a rupture of the acetabular labrum can give a similar picture.

To clarify the diagnosis, radiographs are taken, which must be taken not only in the standard anteroposterior projection, but also in the axial one, i.e. lateral. The fact is that a mild cam deformity is often not visible on a traditional anteroposterior radiograph, but it can be clearly seen on an axial radiograph. Bone changes in impingement syndrome are not always pronounced, so sometimes it is necessary to take control radiographs of the opposite, healthy hip joint.

Both computed tomography and magnetic resonance imaging can be helpful in diagnosis and can help identify other causes of hip pain that are not due to impingement.

Unfortunately, doctors are rarely aware of the problem of hip impingement syndrome and are often misdiagnosed, while the true cause of the pain remains unattended.

Treatment of femoroacetabular impingement syndrome (impingement syndrome)

Conservative treatment does not eliminate the cause of impingement, so it is rarely effective. However, with unexpressed pinser deformities, it can be useful in view of the vicious circle we have already mentioned: the impact causes inflammation, the pinched and inflamed acetabular lip swells, increases in size and is even more involved in impingement. In this case, unloading the joint, taking paracetamol, non-steroidal anti-inflammatory drugs (ibuprofen, ortfen, etc.), avoiding movements that lead to impingement can help cope with the exacerbation, but will not solve the problem in principle.

Conservative treatment for camp impingement does not affect the cause of the disease in principle, but one must remember that even in this case, with a mild impact, unloading the joint and painkillers can help survive the period of exacerbation of pain.

The only way to get rid of the cause of impingement is through surgery, but this does not mean that any impingement should be operated on. First of all, you should focus on the degree to which the existing impingement interferes with life, work, and sports. Mild cam and pincer deformities can be treated arthroscopically: a video camera and instruments are inserted into the joint cavity through 1-centimeter punctures. Using a special arthroscopic drill, the bony protrusion on the femoral neck at the base of the femoral head is resected (removed) in case of cam deformity and/or part of the acetabular labrum is resected in case of pinser impingement. As we have already noted, very often these two types of impingement exist simultaneously, so during the operation it is necessary to correct both the femoral neck and the acetabular labrum. It is worth noting that arthroscopic surgery for impingement is not always technically possible; moreover, the world's leading experts on this problem prefer to perform traditional open surgery rather than arthroscopic surgery.

Often, impingement is accompanied by ruptures of the acetabular labrum, which are treated according to the same principle as traditional ruptures due to trauma or degenerative changes.

Impingement syndrome is the cause of the development of arthrosis of the hip joint, which is a progressive disease. When the leading cause of pain and a significant decrease in quality of life becomes not impingement, but arthrosis itself, then hip replacement may be required.

Osteoarthritis of the hip joint

Osteoarthritis of the hip is a condition in which the smooth sliding surfaces of the joint (articular cartilage) become damaged. This usually results in pain, stiffness, and reduced range of motion in the joint.

The most common type of arthrosis is deforming osteoarthritis, which usually develops in older patients as a result of wear and tear of the cartilage.

The joint can also be affected as a result of inflammatory diseases (arthritis), such as rheumatoid arthritis and others, including those of an autoimmune nature.

Arthrosis can also develop if the hip joint has not developed as expected and has an abnormal structure (dysplastic coxarthrosis).

There is also post-traumatic arthrosis, which develops as a result of injury (a fracture in the hip joint that has not healed properly).

Arthrosis can occur as a result of osteonecrosis (aseptic or avascular necrosis), which is characterized by the death of part of the bone tissue.

Initial manifestations of arthrosis of the hip joint are treated conservatively; in later stages, endoprosthetics (replacement) of the hip joint is performed.

Osteoarthritis of the hip joint

Most people experience joint pain in their lives. The reasons may be monotonous or excessive physical activity, side effects of medications, etc. However, in some cases, pain can indicate the occurrence of serious joint diseases. The unambiguous causes of such diseases have not yet been established; we can certainly only talk about the adverse effects of bad habits, a sedentary lifestyle, and excess weight on the joints. Unfortunately, most patients suffering from this disease consult a doctor when the disease is in a deeply advanced form, which makes treatment much more difficult. Therefore, at the first signs of arthrosis, you should immediately contact a qualified specialist.

Symptoms and causes of hip arthrosis

The causes of arthrosis of the hip joint can be either a hereditary genetic predisposition to the disease, metabolic disorders or chronic injuries. Even such a factor as tight and uncomfortable clothing, which limits the freedom of movement of the hips, can lead to arthrosis.

How to recognize the symptoms of arthrosis in yourself? Most often, this diagnosis is observed in women after 40 years of age (70% of all patients). Men in adulthood are also susceptible to these types of diseases, but they are much less likely to get the disease than women.

First of all, you should be alert to aching pain in the groin and thighs, which worsens after physical exertion, when changing body position and sudden movements. Signs of the disease are also clicks and crunches in the joints, limited movement, and slight lameness. If a person has several of the above symptoms, then they should be examined as early as possible in order to identify the disease at an early stage and take measures for treatment.

Diagnosis of the disease

The diagnosis of arthrosis can be confirmed only after undergoing the necessary studies:

· a visual examination of the patient will help determine the direction for further action;

· taking a biochemical and general blood test will help identify inflammatory processes occurring in the body that accompany arthrosis;

· X-rays will allow you to investigate possible bone tissue disorders;

· MRI visualizes the slightest damage and changes in the cartilage tissue of the joints.

A set of measures to study cartilage tissue makes it possible to detect the disease in the early stages, which significantly simplifies treatment and makes it more effective.

Treatment

Arthrosis is accompanied by acute pain and limited movement, which can make treatment procedures difficult, so steroid painkillers are usually used to eliminate such symptoms. They have anti-inflammatory properties and effectively relieve pain. However, it should be borne in mind that these drugs only reduce symptoms and do not cure the disease. Medications such as chondroprotectors, on the contrary, nourish and restore damaged cartilage tissue and help improve the production of cartilage fluid. Complex therapy will achieve maximum effectiveness of treatment.

Experiencing constant pain, patients often forget about physical activity, but at least in minimal quantities, they are necessary. Massage will help improve blood circulation and absorption of necessary medications. Acupuncture, traditional and other types of massage have a beneficial effect not only on the sore joint, but also on the entire body as a whole. There are medicinal and painkillers in the form of ointments, balms, injections, etc., but their use must be agreed upon with the attending physician.

Failure to contact a specialist in a timely manner is guaranteed to lead to the development of a chronic form of the disease, which is extremely difficult to treat. Joint diseases inevitably change the patient’s quality of life for the worse, so it’s worth taking care of your health today.

Surgeries for femoral hernias

The essence of the intervention is that the surgeon excises the hernial sac, returns the displaced organs to their normal anatomical position and closes the hernial orifice. Femoral canal plastic surgery is performed using two techniques:

• The defect is sutured with a special material using the patient’s own tissue.
• The femoral canal is closed with a mesh implant (tension-free hernioplasty).

Specialists at the GMS Hospital Hernia Treatment Center prefer a low-traumatic, gentle surgical technology, which is tension-free hernioplasty.

Femoral hernia repair with mesh

The operation is carried out in two ways:

• Open hernioplasty is performed through a small incision in the inguinal-femoral fold. The surgeon opens the inguinal canal, isolates and drains the defect, and then strengthens the canal with a mesh endoprosthesis.
• Laparoscopic hernioplasty - the intervention is carried out using endoscopic equipment through small punctures into which surgical instruments are inserted.

The surgeon determines the method of intervention after examination. How the operation will be performed depends on the stage of the disease, the size of the hernial sac, the severity of clinical symptoms, the presence of complications and other factors.

Advantages of tension-free hernioplasty

Modern medicine has improved many surgical techniques for hernia repair, and one of the most minimally traumatic options is tension-free hernioplasty. This technique has undeniable advantages:

• Mild pain syndrome
• Fast rehabilitation (hospital stay is reduced to 1 day)
• No risk of relapse
• 2-3 weeks are enough for complete recovery

The entire operation lasts less than an hour and has an excellent cosmetic effect.

Preparing for surgery

During the consultation, the surgeon will prescribe a set of necessary examinations:

• ECG.
• X-ray of the lungs or fluorography.
• Blood and urine tests - general, biochemical.
• Blood tests for hepatitis, HIV, syphilis, coagulation, blood group and Rh factor.

You should definitely tell your doctor about the medications you are taking; you may have to stop them for a while. Your doctor will tell you more about preparing for surgery during your consultation. You can undergo a comprehensive examination at GMS Clinic in 1 day.

Treatment of femoral hernias at GMS Hospital

The minimally invasive surgery technologies used by surgeons at the Hernia Treatment Center at GMS Hospital will help quickly and safely eliminate the defect, eliminating the risk of postoperative complications. The use of mesh (including three-dimensional) endoprostheses from well-known manufacturers allows us to eliminate the risk of relapse of the disease, and the use of microsurgical techniques reduces the length of hospital stay to 1 day.

The rehabilitation period is easy, and full recovery takes only 3-6 weeks. You can learn more about the operation and the need for one or another diagnostic procedure at a consultation with a surgeon. You can make an appointment with a doctor by phone or by leaving an online application on the website.

List of sources

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• Styazhkina S.N. Abdominal hernia: textbook / comp. S.N. Styazhkina, V.A. Sitnikov, M.N. Klimentov et al. Izhevsk, 2011. 86 p.
• Makushin V.D., Danilova I.M. Backer cyst (review of the problem according to the literature) // Genius of Orthopedics. - 2000. - No. 1. - P. 110-113.
• Kamshilov B.V. Types of synovial cysts in the popliteal region // New Horizons: IV Trans-Ural. festival of scientific research, technical and applied creativity of youth: Abstracts. report region scientific-practical conf. - Kurgan, 2002. - Part 2. - P. 95-96.
• Mironov S.P., Orletsky A.K., Nikolaev K.A. Modern approaches to the diagnosis and treatment of popliteal cysts. Kremlin Medicine 2005; 2:33–6.