Facts about hip arthritis: symptoms and treatment of the disease

Arthritis of the hip joint (coxitis) is an inflammatory process of various etiologies, which involves the connective tissue in the area of ​​​​the articulation of the pelvic and femoral bones. In arthritis, inflammation develops in the synovial membrane lining the joint cavity. However, without timely and adequate treatment, coxitis quickly transforms into osteoarthritis of the hip joint, in which degenerative and destructive changes occur in the articular cartilage and subchondral bone.

Chronic pain syndrome and dysfunction of the hip joint in arthritis not only limits the physical activity of patients, but can also cause acquired disability. Because hip arthritis can be part of joint syndromes of various etiologies, the true prevalence of the disease remains unknown. It is believed that in terms of frequency of development, coxitis is second only to arthritis of the knee joint.

According to the clinical course, arthritis of the hip joint can be acute (with a duration of primary joint attack of less than 2 months), prolonged (up to 1 year), chronic (longer than 1 year), recurrent (if a repeated joint attack occurs after a period of remission lasting at least 6 months).

Coxites can be primary bone or primary synovial. Examples of primary synovial arthritis of the hip joint are rheumatoid and reactive arthritis. Primary bone arthritis is spoken of when the bone tissue is initially affected, and then the synovial membrane (for example, with tuberculous arthritis).

General information about the disease

Arthritis of the hip joint (coxitis) is a polyetiological disease in the development of which many factors take part. There are several clinical forms of the disease, during which there are both similar and different symptoms. ICD-10 code M00 – M99.

The hip joint (HJ) is formed by the acetabulum of the pelvic bone and the head of the femur. The spherical shape makes it mobile; a ligament fits from the head of the femur to the acetabulum, holding the articular parts in a normal position. Externally, the hip joint is also strengthened by ligaments and a thick layer of soft tissue. This is the leading supporting joint, located deep in the tissues, so it is not so easy to identify a slow inflammatory process with mild symptoms in it.

Arthritis of the hip joint develops at any age, since the disease can have different origins. The most relevant clinical forms are lesions in childhood and adolescence, as well as tuberculous arthritis.

Etiology and list of the most likely causes of joint arthropathy

Arthropathy of the knee joint or other joints of the musculoskeletal system (MSA) of the human body can be diagnosed in people of different ages, in particular in children.

Considering the stages of the course of secondary pathology, we can distinguish:

• acute period, the duration of which can reach two months;
• a protracted form is observed throughout the year;
• The chronic form involves a long course with remission and the occurrence of periodic relapses.

It is important to note that regardless of the type or form of the disease being considered, there is a list of the most likely causes of its development. Each cause has certain consequences, which largely determine the form of the disease being diagnosed.

Among the most common causes of secondary pathology of this type are:

• allergic reactions;
• associated painful conditions;
• infectious and parasitic lesions;
• inflammation of blood vessels;
• overweight;
• disruption of internal organs.

Causes

The etiology of arthritis of the hip joint is very different. A special group of diseases consists of lesions of various origins in childhood and adolescence. They are united under the common name “juvenile idiopathic arthritis” (JIA), where the term “idiopittic” means unspecified origin. This includes both truly unspecified arthritis and rheumatoid, psoriatic and other arthritis in children under 16 years of age. Very often at this age the disease occurs with the development of hip arthritis.

Another reason for the development of hip arthritis is a specific infection - tuberculosis, gonorrhea, syphilis, brucellosis. Infectious hip arthritis in adults most often develops with gonorrhea, in children and adolescents - with tuberculosis.

Nonspecific infection (mostly coccal) can also cause arthritis of the hip joint. The inflammatory process usually develops against the background of open injuries during wounds, surgical interventions and intra-articular manipulations. The process often becomes purulent and requires surgical treatment.

In rheumatoid arthritis, coxitis rarely develops, but it is often one of the symptoms of ankylosing spondylitis, an autoimmune disease that affects the spine and large joints.

Quite often, the cause of the development of hip arthritis is chronic intestinal diseases and some other diseases of the internal organs. Reactive hip arthritis is quite rare.

Read more about which joints are affected by reactive arthritis here.

Very often, patients with coxitis have a hereditary burden - close relatives suffering from similar diseases. Triggering factors for the onset of the disease are: past infections, hypothermia, stress, heavy physical activity, bad habits.

Varieties

Today, it is customary to distinguish several types of secondary diseases. Arthropathy of the knee, hip, elbow, etc. can be:

• reactive - occurs against the background of a specific tissue reaction to the development of systemic pathologies of the body. Occurs in leukemia and endocrine system disorders;
• dystrophic - progression is due to insufficient nutrition of cartilage tissue. Occurs in people over 55 years of age when natural disorders affecting the functioning of the entire body are detected;
• pyrophosphoric (chodrocalcinosis) - has a connection with metabolic disorders, namely, the exchange of salts and calcium in the tissues of the human body. Often, the provocateurs of this type of illness are injuries to large joints;
• allergic – provoked by allergic reactions;
• psoriatic – occurs with psoriasis;
• idiopathic - defined in a situation where it is impossible to establish reliable causes for the development of a pathological condition of a secondary type;
• hereditary form - transmitted at the genetic level, established on the basis of the collected anamnesis.

Symptoms of hip arthritis

Arthritis of the hip joint can be acute or chronic. The main manifestations of the disease will be different. It is worth knowing these manifestations in order to consult a doctor in a timely manner.

Joint pain and inability to stand on your leg are some of the first symptoms of hip arthritis

First signs

Symptoms of arthritis of the hip joint in the acute course of the disease: high body temperature, chills, malaise, joint pain, inability to stand on the leg due to pain. The symptoms are characteristic, so the diagnosis is usually not in doubt.

The signs of chronic hip arthritis are difficult to notice. It begins unnoticed with slight pain when moving, morning stiffness, which quickly passes. Sometimes pain appears when the leg is in a certain position, for example, when straightening. Special attention should be paid to such vague symptoms.

Obvious symptoms

In acute hip arthritis, this is increasing joint pain and fever that lasts more than 5 days. This usually indicates the development of a suppurative process.

But more often, hip arthritis develops gradually and the obvious symptoms are a slow increase in stiffness and pain. Since the patient begins to spare his leg, he develops muscle atrophy, the diseased leg becomes thinner than the healthy one, and gait and posture are disturbed. It will be easier to bend your leg at the hip than to straighten it.

Dangerous symptoms

If these symptoms appear, you should immediately consult a doctor:

• pain accompanied by high fever after injury, surgery or manipulation of the hip joint;
• the appearance of joint pain 1 to 4 weeks after the infection;
• pain in the hip joint is accompanied by morning stiffness of movement.

When is it time to seek medical help?

Despite the extensive symptomatic picture and seemingly obvious signs of a secondary disease, identifying it in the initial stages is not an easy task.

Only over time does a feeling of a sharp deterioration in health begin, which makes it possible to track vivid symptoms.

You should visit a traumatologist or orthopedist in a situation where:

• swelling of the periarticular tissues is observed;
• body temperature rises “unreasonably”;
• there is a feeling of extreme fatigue, weakness is present;
• lymph nodes increase in size;
• movements are severely limited or completely impossible.

Self-medication in such a situation is not the best solution. Wasting time reduces your chances of recovery.

Why is hip arthritis dangerous?

The hip joint is the largest joint in the body. It is the support of the human body. However, arthritis of the hip joint often goes unnoticed and leads to disability. The stages of the inflammatory process transform into one another and along with them the function of the hip joint is gradually lost. Therefore, during examination and diagnosis, the stage of the disease, possible complications and the tendency to relapse are identified.

Stages of hip arthritis

According to the degree of activity of the inflammatory process and its progression, there are 3 stages of arthritis of the hip joint:

1. Initial
   – inflammation of the synovial membrane, increased content of inflammatory exudate. At this stage, the restriction of movement is insignificant and occurs mainly due to pain and muscle spasm. On ultrasound, you can see an increased volume of exudate in the joint capsule.
2. Expanded
   . The degree of inflammation activity is high, and the first signs of a destructive process in the hip joint also appear. An X-ray can show narrowing of the joint space and bone loss (osteoporosis), and an MRI can show erosive damage to the cartilage tissue covering the articular surface. The pain is constant, movements are limited, mainly when extending the leg and turning it inward (rotation).
3. Advanced
   - formation of immobility (ankylosis). The bone tissue of the joint grows and fusion occurs into a single conglomerate. Often this fusion occurs in an incorrect position, which seriously limits movement. Complete disability occurs.

Possible complications

Arthritis of the hip joint can be complicated by:

• abscesses and fistulas (breakthrough of purulent exudate to the surface of the body) - with purulent and tuberculous hip arthritis;
• complete immobility of the joint;
• dislocations and subluxations of the hip joint;
• deformation of the entire skeleton against the background of pronounced changes in the hip joint.

To prevent this from happening, you should consult a specialist at the first signs of hip arthritis.

What to do if the disease relapses

Healthy and arthritic hip joint

Some clinical forms of this pathology occur in waves, with exacerbations and remissions. Exacerbations are rarely pronounced, but are still accompanied by pain. To eliminate pain before consulting a doctor, you can take the following measures:

• take any sedative (calming) agent - tincture of valerian or motherwort, Corvalol, etc.;
• take a tablet of medication from the group of NSAIDs (non-steroidal anti-inflammatory drugs) - Diclofenac, Nise, Indomethacin, etc.;
• apply ointment, gel or cream with NSAIDs to the skin over the sore spot (Voltaren, Pentalgin);
• call a doctor at home;
• lie down and take the least painful position.

How is arthropathy treated?

By analogy with the treatment of osteoarthritis, the therapy of arthropathy is complex. It combines physiotherapeutic and medicinal methods, and physical therapy is included at the rehabilitation stage. It is important for the patient to follow simple rules:

• to refuse from bad habits;
• balance your diet;
• monitor body weight;
• take prescribed medications.

For arthropathy, radon baths, electric shock and climatotherapy are most often prescribed. Among the pharmaceutical drugs that are relevant are antibiotics that eliminate the provoking agent, non-steroidal anti-inflammatory drugs that fight visual manifestations and chondroprotectors. The latter promote tissue regeneration, as they enrich the joint with building material.

In advanced cases, surgery may be necessary

The most common clinical forms of coxitis

Depending on the cause of occurrence, hip arthritis can have a different course. Symptoms of the disease may also vary slightly.

Any form of arthritis has serious complications, so you should not delay treatment.
See how easily the disease can be cured in 10-12 sessions.

Acute purulent coxitis

The hip joint is protected from external influences by a thick layer of soft tissue, so infection enters it mainly during injuries and surgical procedures. Much less often, it enters with blood from other infectious and inflammatory foci, for example, with sinusitis, otitis, tonsillitis, etc.

A sign of purulent arthritis is a sharp rise in body temperature, chills, malaise combined with severe joint pain. Such a patient requires emergency surgical care. If it is not provided, the purulent process can spread to the surrounding soft tissues with the formation of abscesses and phlegmons or with blood flow throughout the body (sepsis).

Juvenile idiopathic arthritis (JIA)

Juvenile idiopathic arthritis occurs mainly in children under 16 years of age

This is a large group of diseases that includes all hip arthritis in children and adolescents under the age of 16. It is not always possible to determine the origin (etiology) of this disease. The disease is dangerous because it can quickly lead to complete destruction of the hip joint and early disability.

The disease arises and proceeds unnoticed with a gradual increase in pain and loss of normal function. Quite quickly, the affected leg loses volume and begins to look thinner in appearance. Bone growth also lags behind, one limb becomes shorter than the other. It is difficult for the child to straighten the leg and especially turn the knee inward. Identifying JIA at an early stage and carrying out adequate therapy prescribed by a rheumatologist allows you to avoid disability.

Tuberculous coxitis

Tuberculous arthritis of the hip joint is a severe progressive disease. The source of infection first forms in the bone tissue and only after some time breaks into the joint cavity. Tuberculous arthritis of the hip joint occurs in three stages:

• Prearthritic
  - the tuberculous focus is located inside the joint-forming bones, most often in the area of ​​the acetabulum of the pelvic bone. It proceeds unnoticed in the form of minor pain and periodically developing lameness. At this stage, coxitis is rarely detected.
• Arthritic
  associated with the breakthrough of a tuberculosis focus into the joint cavity:
  beginning - the pain intensifies, the tissues swell, the skin turns red; impaired movement due to muscle spasms; low-grade fever, weakness, lack of appetite;
• height – inflammation progresses, cartilage is destroyed; the pain is very strong, inflammation increases, gait is disturbed, it is difficult to stand on the leg, it moves with difficulty; intoxication increases;
• subsidence of the process - inflammation gradually subsides, connective tissue grows in the articular cavity.
• Postarthritis
  - inflammation goes away, but its consequences remain in the form of shortening of the limb, muscle atrophy and incorrect placement of the limb, as a result of which the configuration of the whole body can change. Ankylosis is most often connective tissue, but bone ankylosis also occurs. Disability.

Chondroprotectors: what are they, how to choose, how effective are they?

Joint pain at rest

Coxitis in chronic inflammatory bowel lesions

Arthritis of the hip joint often begins against the background of chronic ulcerative colitis and Crohn's disease (a pathological process affecting all layers of the intestinal wall). The disease begins suddenly, accompanied by severe inflammation and joint pain. It lasts for several months, then the process subsides without causing any changes in the joint. Relapses of the disease are also possible.

Diagnostics

To identify symptoms of hip arthritis and its treatment, special questionnaires have been developed for patients, clinical tests for specialists, and various laboratory and instrumental studies. It is not easy to detect this disease at an early stage, but it is most treatable when it starts. Algorithm for examining a patient with suspected coxitis:

• Laboratory methods:
  general, biochemical, immunological blood tests
  - the degree of activity of the inflammatory process and the presence of autoimmune processes are revealed;
• examination of intra-articular fluid under a microscope and by inoculating on nutrient media
  - the nature of the inflammatory process, infection and its sensitivity to antibiotics are revealed.
• Instrumental methods:
  Ultrasound
  - you can detect a large volume of exudate and an increase in the synovium;
• radiography of the hip joint
  - bone changes in the joint;
• MRI or CT
  – changes in articular and periarticular tissues;
• arthroscopy
  – examination of the inner surface of the joint cavity; if necessary, exudate or a piece of tissue is taken for examination;
• aspiration biopsy of the joint
  - sampling of exudate for examination using a puncture method (if arthroscopy is not possible).

A full examination can only be carried out in a clinic.

Risk factors for joint arthropathy

There are certain factors that indicate an increased risk of secondary pathological disease. These include:

• autoimmune diseases;
• hemophilia;
• excessive stress on the joints;
• genetic predisposition;
• alcohol abuse;
• tendency to allergic reactions;
• chlamydia infection;
• impaired metabolism;
• accumulation of uric acid in joint tissues.

Treatment of hip arthritis

Treatment measures can be conservative or surgical. The main goal of treating hip arthritis is to relieve pain and suppress the progression of the disease. The patient is prescribed individually selected complex treatment.

Drug therapy

Treatment of hip arthritis begins with drug therapy. All medications are selected individually for each patient:

Crunching in joints - when to worry

Intra-articular injections of hyaluronic acid

Non-drug methods

These treatments for hip arthritis include:

• Immobilization is carried out mainly for tuberculous coxitis and ankylosing spondylitis at the stage of acute inflammatory process. A large coxite plaster cast is applied, covering the affected leg, pelvic girdle and torso to the nipples. When the process subsides, the bandage is replaced with crutches and the load on the leg is gradually increased by incorporating therapeutic exercises.
• Massage – performed after acute inflammation subsides, helps improve blood circulation, activate metabolism and restore joint function.
• Therapeutic exercise (physical therapy) - for some types of hip arthritis, especially in childhood and adolescence, exercise therapy is prescribed as early as possible - this prevents the development of ankylosis. The load should be constant and gradually increasing. Monitoring by a doctor is required.
• Physiotherapeutic procedures - different types of procedures can be prescribed at any stage. At the acute stage, this is electrophoresis with anti-inflammatory and painkillers; when the process subsides, UHF, paraffin, laser and magnetic therapy.
• Reflexology is an effect on points on the human body reflexively associated with the hip joint.
• Sanatorium-resort treatment is carried out in a state of remission, no earlier than six months after the last exacerbation. Resorts shown:
  with sodium chloride waters and mud - Anapa, Pyatigorsk, Evpatoria;
• with hydrogen sulfide waters - Sochi-Matsesta;
• with radon waters - Belokurikha, Tskhaltubo.

Traditional methods of treatment

Traditional medicine can be used as an auxiliary therapy for hip arthritis only as directed and under the supervision of a physician. For swelling and joint pain, the following folk remedies are suitable:

• decoction of bay tree leaves; 20 g of crushed raw materials pour 500 ml of hot water, boil over low heat for 5 minutes, cool, strain and take 150 ml three times a day before meals; has anti-inflammatory and analgesic effects; course – 3 days with a week break, then repeat everything;
• ointment for joint pain; mix the yolk of a chicken egg, 20 ml each of apple cider vinegar and turpentine; store in the refrigerator and use as a pain reliever, applying to the skin over the sore spot at night.

Read more about the most effective methods of treating arthritis in this article.

Surgical methods of treatment

In severe cases of arthritis of the hip joint, endoprosthetics is performed

Surgical assistance is required for purulent hip arthritis. Punctures are performed, pus is removed from the joint cavity, then it is washed with an aseptic solution. When abscesses and phlegmons appear, they are opened and the pus is removed. In case of significant destruction of the hip joint, especially in cases of trauma, resection of the most affected bone areas is performed.

In case of complete loss of joint function, the operation of choice is endoprosthetics - replacement of the destroyed joint with an artificial implant.

Symptomatic picture

Among the general symptoms of arthropathy (regardless of its type), it is customary to highlight pain of a paroxysmal nature, as well as inflammation and swelling of the affected joint, which are not accompanied by visual changes.

In addition, there are:

• soreness;
• disorders of the genitourinary system;
• noticeable stiffness of movement;
• increase in body temperature.

There are also specific symptoms that are observed exclusively in women. For example, nagging pain in the lower abdomen, intermenstrual bleeding, purulent discharge, etc.

It is also important to pay attention to the fact that symptoms of arthropathy may also include signs of secondary damage, which usually include:

• pain of varying intensity (dull/aching);
• limited mobility;
• painful palpation.

Approach to treating the disease at the Paramita clinic, Moscow

Patients with suspected hip arthritis are always carefully examined by specialists at our clinic using modern laboratory and instrumental methods, including MRI. During the examination, the main and concomitant diseases are identified and only after that individually selected treatment is prescribed.

Our doctors are trained in all existing methods of treating this disease. The Western techniques they use allow them to act directly on the source of inflammation, while the Eastern ones – on the body as a whole, restoring the proper functioning of all organs and systems, including the hip joint.

This approach to treatment allows you to quickly eliminate the pain syndrome and stimulate the patient’s desire for recovery. Then the main course of treatment is carried out, aimed at suppressing inflammation and progression of the disease. The final stage is the restoration of lost joint function. Treatment allows patients to forget about pain and lead a normal life. More information about treatment methods for hip arthritis can be found on our website.

We combine proven techniques of the East and innovative methods of Western medicine.
Read more about our unique method of treating arthritis

Main events

In order to make a correct diagnosis, everyone who seeks medical help must be prepared for such manipulations as:

Additionally, if signs of inflammation in the joints are detected, the patient is referred for examination to an ophthalmologist.

As a result of passing all diagnostic measures, the attending physician determines further treatment, taking into account the degree of damage, the presence of concomitant diseases, age and other characteristics.

General clinical recommendations

To avoid relapses of hip arthritis and forget about pain, patients are recommended to:

• lead an active healthy lifestyle;
• Healthy food;
• get rid of excess weight and bad habits - smoking and alcohol abuse;
• do exercise therapy every day; Swimming is especially beneficial;
• avoid heavy physical activity, hypothermia and stress;
• carefully treat all acute and chronic diseases;
• take courses of anti-relapse therapy several times a year as prescribed by a doctor.

How not to get sick

The hip joints should be especially taken care of by persons with a family history and who have relatives with a similar pathology. To do this, you need to avoid any factors that provoke the disease: infections, hypothermia, stress. It is also necessary to move more, engage in feasible sports to strengthen the muscles of the back and lower extremities, and also maintain normal body weight.

What to eat

Meals should be varied and regular. It is worth limiting: spicy seasonings, fried, fatty, smoked foods, alcohol, sweets - all this can provoke inflammatory processes in the joints.

Anti-arthritic prevention measures

To avoid the recurrence of arthritis after successful therapy, as well as to prevent the disease if a person has not yet encountered it, please familiarize yourself with the general principles of prevention and adhere to them. Recommended rules for carrying out preventive control are as follows:

• avoid hypothermia of the body and joints in particular, dress appropriately in cold weather;
• maintain the correct daily routine - balanced and normal frequency of meals, reasonable hours for rest and work, daily exercise and healthy physical activity;
• adding foods containing B vitamins to your diet if there are not enough of them on your table;
• wash vegetables and fruits before eating, and cook foods that require mandatory heat treatment until fully cooked;
• drink enough clean water daily (2-2.5 liters);
• avoid stress and nervous situations;
• watch your weight, high body weight is an enemy for bones and joints;
• promptly and efficiently treat any bacterial, infectious and viral diseases, including even common colds and caries;
• completely give up smoking, eliminate alcohol or minimize its consumption as much as possible (a little bit and only on holidays);
• do not sit for a long time in a monotonous position, eradicate habits such as crossing “legs over legs” and tucking your limbs in a bent position under you;
• maintain general and intimate hygiene;
• be vigilant about casual sex (increased risk of catching an STI), so if you are not sure about your partner, use a condom for the entire session, and then be examined for sexually transmitted infections;
• at the first unpleasant sensation localized in the joint, immediately go to the doctor (self-medication will not be without consequences);
• carry out all treatment measures and prevention of all existing chronic diseases in a timely manner, according to the instructions of a specialized doctor.

Frequently asked questions about the disease

Which doctor should I contact?

It’s better to start with a therapist, he will advise who to contact. A surgeon treats purulent processes, a rheumatologist - everything else, except for tuberculosis, you need to contact a phthisiatrician.

Can juvenile arthritis be cured without surgery?

With adequate treatment, you can get rid of relapses of the disease and its progression. Modern methods of conservative treatment allow patients to forget about exacerbations forever during maintenance treatment. Surgery is a last resort, but sometimes it is still necessary.

Literature:

1. Yablokova E. A. Clinical features and impaired mineralization of bone tissue in children with inflammatory bowel diseases. Diss. Ph.D. honey. Sci. M., 2006. 185.
2. Dzyuba G.G., Reznik L.B., Erofeev S.A., Stasenko I.V. Modern methods of treating surgical infection of the hip joint // Modern problems of science and education. – 2021. – No. 5.
3. D'Incà R., Podswiadek M., Ferronato A., Punzi L., Salvagnini M., Sturniolo GC Articular manifestation in inflammatory bowel disease patients. A prospective study // Dig Liver Dis. 2009, Mar 9.
4. Rodriguez VE, Costas PJ, Vazquez M., Alvarez G., Perez-Kraft G., Climent C., Nazario CM Prevalence of spondyloarthropathy in Puerto Rican patients with inflammatory bowel disease/Ethn Dis. 2008, Spring; 18(2 Suppl 2):S2–225–9.

Themes

Arthritis, Joints, Pain, Treatment without surgery Date of publication: 12/09/2020 Date of update: 03/12/2021

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