Treatment of coxarthrosis (arthrosis of the hip joint)

Treatment of coxarthrosis (arthrosis of the hip joint)

Coxarthrosis, or arthrosis of the hip joint, is a degenerative-dystrophic disease, often starting with damage to the cartilage and accompanied by the development of an inflammatory process, which over time leads to varying degrees of deformation of the joint, which is why it is also called deforming arthrosis.

Coxarthrosis can occur at any age, but is more common in the elderly. There may be significant damage to one or both hip joints, which often leads to disability and/or surgical treatment. The disease is more common in women than men.

Causes of frequent damage to the hip joint

This is due to some features of its structure and function:

• As you know, the entire weight of a person’s body is transferred directly through the hip joints to the lower limbs, and in old age it is often excessive.
• Throughout life, this organ periodically experiences severe overload - lifting weights, playing sports, running and multiple microtraumas from small jumps, bruises, falls and after car accidents.
• The deep position of the articular head in the articular cavity and the fact that most of it is covered with hyaline cartilage affects its blood supply - it is often insufficient. This leads to disruption of its “nutrition,” premature “wear and tear” of the articular parts, and the development of degenerative-dystrophic changes with compensatory involvement of periarticular (para-articular) soft tissues in the process.
• Heredity and congenital anomaly of the femoral head
• The joint is also susceptible to the development of osteoporosis, and this leads to a decrease in its strength and frequent injury; and a sedentary lifestyle exacerbates this process.
• Often there are developmental disorders (dysplasia) and congenital deformities of one or two hip joints, pelvic bones, which the patient first learns about only after undergoing an X-ray examination, examination by an orthopedist, and often already as an adult.

Mechanism of formation of joint coxarthrosis

The process, as a rule, begins with the articular cartilage: it dehydrates, becomes less elastic, gradually becomes thinner and loses its strength and shock-absorbing properties. Therefore, the bone tissue adjacent to it becomes denser - osteosclerosis develops in it, and the articular surface gradually flattens, and small outgrowths - osteophytes - form along its edges.

At the same time, single small cysts appear in the bone tissue of the articular cavity, and osteoporosis develops. All this is often accompanied by inflammation in the synovium. Gradually, the range of motion in the joint decreases, the adjacent tendons and muscles are involved in the process, they are often tense, spasmodic and painful.

As the process progresses, the articular cartilage is gradually destroyed, the bone tissue of the articular head and articular cavity is “exposed”, their surfaces come closer and gradually grow together, a bone block is formed - bone ankylosis. At the same time, the limb is shortened, the pelvis is distorted, and the load on the other joint increases significantly, which will accelerate the development of similar changes in it.

The most common symptoms of coxarthrosis

At first, patients begin to be bothered by stiffness when moving the joint, then a slight pain when walking, over time it intensifies, becomes longer and more intense, and then permanent, this leads to “sparing” the sore limb, the desire to reduce the load on it and the appearance of lameness , and over time, muscle wasting of the diseased limb.

At the same time, the pain begins to bother me more at night, when the weather changes (meteosensitivity appears). Often the pain radiates to the knee, buttock and along the outer surface of the thigh - trochanteritis and bursitis (inflammation of the periarticular bursae) develop there; very often patients are bothered by severe pain in the groin area.

In addition, asymmetrical load on the legs and pelvis leads to a redistribution of the load on the entire musculoskeletal system and is often accompanied by pain in the back, lower back, radiating along the back of the thigh (along the sciatic nerve). Patients tend to move less, complain of increased fatigue, irritability, sleep disturbances, and decreased mood.

What should you do if such signs appear?

You must first consult a doctor (preferably an orthopedic traumatologist or rheumatologist) and undergo the examination prescribed by him. Usually this:

• radiography, computed tomography of the hip joints and pelvic bones or magnetic resonance imaging,
• Ultrasound of the hip area and vessels of the lower extremities,
• ultrasound or x-ray densitometry to determine bone density and determine the severity of osteoporosis,
• clinical blood test,
• biochemical blood test (creatinine, urea, total and direct bilirubin, ALAT, ASAT, alkaline phosphatase, total protein, C-reactive protein, rheumatoid factor, antistreptolysin-O, uric acid, total calcium, phosphorus, calcitonin, parathyroid hormone and others),
• consultations with related specialists (neurologist, endocrinologist and others),
• electroneuromyography and other studies.

You should consult a doctor when the first symptoms appear, while the joint is still preserved and you can stop the development of inflammation, prevent complications, without bringing the process to surgical treatment and its replacement with an artificial implant (endoprosthetics).

Trying to treat pathology on your own leads to an increased risk of disability. By self-medicating, patients only waste time, since taking dietary supplements, rubbing with ointments, compresses, therapy with various home physiotherapeutic devices, etc. cannot stop this process, but only muffles the pain and other symptoms.

Treatment of coxarthrosis of the hip joint

Treatment of the pathology depends on the stage of development of the pathological process, among which are coxarthrosis of the hip joint of degrees 1, 2 and 3. First of all, therapy is aimed at reducing pain, relieving muscle spasms, improving tissue trophism and blood circulation in the organ, improving nutrition and restoring the structure of damaged cartilage tissue, increasing joint mobility and strengthening the muscles of the limb.

Conservative therapy includes a combination of medications and physiotherapeutic methods. Various groups of drugs are prescribed:

• analgesics,
• NSAIDs (Voltaren, Arcoxia, Movalis, Xefocam, etc.),
• muscle relaxants (mydocalm, sirdalud) – to relieve muscle spasms and improve blood circulation,
• chondroprotectors (glucosamine, chondroitin sulfate, alflutop, rumalon, structum, etc.) – to restore the structure of damaged cartilage tissue,
• vascular drugs to improve blood supply to the joint area, which restores metabolism and oxygen delivery to tissues.

In particularly difficult cases, intra-articular injections are performed:

• anti-inflammatory drugs are used in the acute stage of the disease to reduce inflammation in the joints, manifested by edema and swelling; in such cases, intra-articular injection is quite effective and alleviates the patient’s suffering. More than three injections are not given into one joint, and the interval between injections should be 5-7 days;
• drugs from the chondroprotector group, these drugs are used not only at the early stage of the disease, which occurs without tumor and edema. They contribute to the partial restoration of articular cartilage tissue, promote the production of joint fluid and improve its properties. This is a fairly effective group of drugs, since they directly affect the cause of the disease and stop the process of destruction of articular cartilage;
• hyaluronic acid preparations - to reduce friction of damaged articular surfaces, which improves joint mobility and protects cartilage surfaces from further destruction;
• intra-articular injections of autologous platelet-rich plasma isolated from the patient’s blood – PRP therapy. Platelets contain growth factors that stimulate regeneration processes.

Along with drug therapy, the attending physician prescribes a course of physiotherapy (SWT, laser therapy, ultrasound), therapeutic massage, kinesio taping, manual and other types of therapy methods. They are necessary not only to reduce tension and spasms of muscles and ligaments, but also to improve blood supply and innervation, also help to activate metabolic processes, reduce swelling and inflammation, and subsequently help restore range of motion in the joint and prevent the development of contractures .

Surgical methods are resorted to when conservative therapy does not bring results.

You can find out more about the treatment and prevention of coxarthrosis, and make an appointment for a consultation and appointment with our specialists by calling us in the Contacts section.

Diagnosis and treatment of bacterial skin infections

What is the best way to manage a patient with a staphylococcal skin infection? How can a general practitioner diagnose and treat erysipelas? What treatment is effective for erythrasma?

Normally, human skin is populated by a huge number of bacteria that peacefully coexist on its surface or in the hair follicles.

However, the skin has certain properties that protect it from infection by pathogens. These include a dense and dry stratum corneum, practically impenetrable to microorganisms, and an adhesive intercellular substance - a complex mixture of lipids that tightly connects the cells of the malpighian layer and also protects the skin by clogging the entrance to the hair follicles.

Other factors that stop the penetration of pathogenic microorganisms include the constant turnover of skin cells, acidic pH, the presence of immunoglobulins in sweat and various types of skin flora.

Skin infections typically develop only when injury, overhydration, or inflammatory skin conditions compromise these protective properties. Organisms that cause skin infections may be part of the resident flora of the skin or nearby mucous membranes, or may come from external sources such as another person, the environment, or contaminated objects.

Impetigo is the most superficial skin infection caused by S. aulreuls and S. pyogenes. There are two main clinical variants: bullous impetigo, considered a staphyloccal disease, and nonbullous impetigo, caused by S. aulreuls or S. pyogenes or both organisms.

The disease occurs in children much more often than in adults, developing on exposed parts of the body, face and limbs, in places of scratches, abrasions and insect bites.

Initially, red spots appear, which turn into blisters and pustules, which open easily and form thick, adherent yellowish-brown scales on an erythematous base (see Fig. 1). They are often numerous and may be itchy, but are usually painless.

With the bullous form, large vesicles and blisters with a diameter of 1-2 cm can develop. They open more slowly and persist for two to three days. Pathogens are usually identified by culture, but this is not necessary in clinically obvious cases.

The most serious complication of impetigo is post-streptococcal acute glomerulonephritis, the overall incidence of which has decreased in recent years.

Bullous impetigo is caused exclusively by S. aulreuls, which secretes the toxin exfoliatin, which causes breakdown of the intercellular substance in the superficial layers of the epidermis. Absorbed in large quantities into the bloodstream, this toxin causes staphylococcal scalded skin syndrome, which is fatal in 5% of cases.

For moderate and localized infections, a topical antibiotic such as mupirocin or fusidic acid is used, and topical neomycin and bacitracin are also effective. The use of licacin gel is very effective.

For severe and widespread forms, a systemic antibiotic is prescribed. Erythromycin or a first-generation cephalosporin such as cephalexin is usually sufficient.

Ecthyma refers to infections that resemble impetigo, but affect the deeper layers of the skin. It is characterized by the formation of thick, adherent scales (see Fig. 2) covering areas of skin ulceration, preceded by the formation of pustules and blisters. The buttocks, thighs and legs are most often affected. The disease is common in the tropics, where poor hygiene and inadequate nutrition contribute to its development. The causative agents may be S aulreuls or S pyogenes, or both microorganisms, but the ulcerations they cause reach the dermis and heal with scarring, which is not characteristic of impetigo. Treatment is with systemic antibiotics targeting S. aulreuls and S. pyogenes.

Superficial folliculitis, boils and carbuncles. Folliculitis (inflammation of the epithelium of hair follicles) is a common dermatological disease, not always primarily of an infectious nature. Physical or chemical trauma, as well as occupational exposure to tar products also used for medicinal purposes, all cause folliculitis.

When staphylococci penetrate into the deeper layers of hair follicles, inflammation seizes the dermis, causing the formation of boils and carbuncles. An inflammatory vesicle with a purulent head (furuncle) develops or the infection covers several nearby hair follicles and an inflammatory conglomerate is formed, from which pus is released (carbuncle).

Boils are most often found on the face and legs, and the typical location of carbuncles is the back of the neck; as a rule, they accompany diabetes mellitus. Large boils and carbuncles are opened and drained, prescribing a penicillinase-resistant antibiotic.

Recurrent staphylococcal skin infections. Some patients are susceptible to recurrent staph skin infections.

Predisposing factors here are diabetes mellitus, chronic renal failure and some immunodeficiency conditions, but most patients do not have the diseases listed above: these patients are probably chronic carriers of staphylococci, and with the slightest injury to the skin, pathogens cause infection.

They try to prevent recurrences of such infections in various ways: by washing the skin with various antiseptics, treating other family members with antistaphylococcal antibiotics and prolonged therapy with other local or systemic antibacterial drugs. All these methods are aimed at destroying the staphylococcal “trail”.

Unfortunately, these measures are usually nonspecific and ineffective, since bacteria reappear soon after the antimicrobial drug is discontinued. Therefore, long-term use of local antiseptics is preferable.

Erysipelas and cellulitis are acute, rapidly spreading infections of the skin and underlying tissues.

The hallmark of erysipelas is a well-defined, raised edge, reflecting involvement of the more superficial (dermal) layers (see Fig. 3). However, cellulite can be located superficially, and erysipelas deeper, so that in many cases these two processes coexist and it is almost impossible to distinguish them.

It is believed that erysipelas is caused by streptococci, usually group A and sometimes groups G and C. For cellulitis, either S. aulreuls alone or together with streptococcus is cultured. H. influlenzae type b is an important etiological factor for facial cellulitis in children under two years of age.

Erysipelas, which typically affects the face, is a disease of the elderly that develops for no apparent reason or sometimes after facial trauma.

Cellulite affects the lower extremities, especially the calf area. It is often preceded by an injury, ulcer or other damage to the skin, where the infection originates.

As with erysipelas, cellulitis may be accompanied or preceded by fever and chills, but many patients do not develop a fever and do not appear seriously ill.

The skin is red, hot and swollen, the edges of the inflamed area are uneven, and bubbles and blisters may develop on the surface (see Fig. 4). In rare cases, lymphangitis and regional lymphadenitis are detected.

Without treatment, complications such as fasciitis, myositis, subcutaneous abscess and septicopyemia may develop. Periorbital cellulitis, usually caused by trauma, may be complicated by cavernous sinus thrombosis, orbital, subperiosteal or cerebral abscess formation, or meningitis.

Patients with these conditions must be hospitalized.

The staphylococcal and streptococcal pyodermas described here make up the majority of skin bacterial infections. You need to be able to distinguish between infectious processes inherent in three clinical situations:

• the infection does not fit into the typical clinical picture of pyoderma or does not respond completely to standard therapy;
• the patient’s body is weakened and cannot withstand the fight against infection;
• There is a history of exposure to unusual skin pathogens.

• Infections caused by resident corynebacteria

Erythrasma is characterized by red-brown scaly areas of skin located in the groin, armpits and interdigital spaces (see Fig. 5).

Corynebacteriulm minultissimulm is considered the etiological factor of this disease, which is asymptomatic and develops, as a rule, in diabetics, obese and elderly people, as well as in those living in tropical climates.

Due to the fact that these microorganisms produce porphyrins, in the ultraviolet light of a Wood lamp, the affected areas fluoresce from coral pink to orange-red, which confirms the diagnosis. Typically, no cultivation is required.

Sometimes vigorous washing with soap is enough to cure. Another approach is topical treatment with erythromycin and clindamycin or topical azoles such as clotrimazole, which are active against some Gram-positive bacteria and fungi. For extensive lesions, erythromycin is probably most effective.

Pockmark keratolysis is a superficial skin infection apparently caused by strains of Corynebacteriulm and characterized by the presence of pockmarks 1–7 mm in diameter on the soles of the feet. Pockmarks, merging, can form surface erosions.

The disease is usually asymptomatic, but sometimes patients complain of itchy, burn-like pain or a cheesy smell.

Pockmark keratolysis appears to be associated with excessive wetness of the feet due to tight shoes, frequent contact with water, or excessive sweating.

Treatment of hyperhidrosis, combined with the methods described for erythrasma, is usually effective.

Axillary trichomycosis is characterized by waxy nodules that form in the hair of the armpit. Yellow, red or black, they are formed by large colonies of coryneform bacteria covering the hair cuticle.

First of all, the disease affects patients who pay little attention to personal hygiene and suffer from excessive sweating.

For successful treatment, as a rule, it is enough to shave your hair and use deodorants for your armpits. Topical application of erythromycin and clindamycin is also effective.

References
1. Noble WC Microbal Skin Disease: its Epidemiology. Arnold, London, 1983. 2. Hoor EW, Hooton TM, Horton CA et al. Mircroscopic evaluation of cultaneouls cellulitis in adults // Arch. Intern. Med. 1986; 146: 295-297.

Note!

• For moderate and localized forms of impetigo, both streptococcal and staphylococcal etiologies, a local antibiotic, such as mupirocin or fusidic acid, is sufficient. Topical forms of neomycin and bacitracin are also effective and are often used in combination. For widespread and severe forms of infection accompanied by lymphadenopathy or if there is reason to suspect nephritogenic streptococcal infection, oral antibacterial drugs that act on both microorganisms, such as erythromycin, are indicated
• Some patients are susceptible to recurrent staphylococcal skin infections. Predisposing factors such as diabetes mellitus, chronic renal failure and some immunodeficiency conditions are absent in most patients. The method of choice is long-term use of local antiseptics
• Erysipelas, usually localized on the cheeks, is streptococcal in nature. It is most common among older patients and develops either for no apparent reason or, in rare cases, sometimes after facial trauma. The drug of choice is penicillin; in more severe cases, benzylpenicillin is prescribed intravenously at 600-1200 mg.
• Erythrasma appears as red-brown patches of skin covered with scales in areas of diaper rash, such as the groin, armpits and interdigital spaces. Intensive washing with soap is sometimes enough to cure. Another approach is topical treatment with erythromycin and clindamycin or topical azoles such as clotrimazole, which are active against some Gram-positive bacteria and fungi. For extensive lesions, erythromycin is probably most effective.