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Coxarthrosis is a pathology of the hip joint caused by a violation of local blood circulation. A dystrophic process of the articular cavity is formed, leading to degeneration. Other names for the disease are deforming arthrosis, osteoarthritis. With the disease, the synovial fluid in the joint cavity becomes thick and ceases to lubricate the hyaline cartilage. Its tissues dry out and microcracks appear. Due to the reduced functionality of cartilage, bones rub against each other and become damaged. An inflammatory process occurs.
Degrees of coxarthrosis
The pathology is multi-stage in nature. Each degree has its own clinical symptoms. The joint space gradually decreases and bone growths form.
First degree coxarthrosis
Slight narrowing of the joint space, the initial stage of the inflammatory process. Symptoms:
- absence of pain syndrome;
- clicks, crunching, crackling sounds when moving.
Extraneous sounds appear when walking and bending a limb due to the friction of bones against each other. It is necessary to carry out differential diagnosis, since the symptom may indicate the collapse of bubbles inside the joint (physiological norm).
Second degree coxarthrosis
Morphological changes occur:
- narrowing of the articular cavity by half;
- defects and displacement of the articular part of the femur;
- bone growths extending beyond the cartilaginous lip.
Patients complain of chronic, dull pain. With active movements they become sharp. Mobility is limited.
Third degree coxarthrosis
The joint gap disappears due to tissue fusion. Extensive bone growth and expansion of the head of the hip bone. Symptoms:
- persistence of pain at any time of the day, causing insomnia;
- spread of pain from the hip joint to the lower leg.
The patient's movements are limited. When walking, a crutch or cane is required.
Attention! Specialist consultation required!
Causes and risk factors
The normal functioning of cartilage tissue cells is impossible without adequate nutrition and removal of metabolic products.
Cartilage does not have its own blood vessels, so it receives oxygen and other nutritional components from bones and synovial fluid, which fills the joint capsule and washes the cartilage. The nutrition of cartilage tissue in the joint must pass continuously along a chain: the walls of the joint capsule secrete synovial fluid, and from it nutritional components already enter the cartilage. If at least one link in this chain is disrupted, the disease develops.
The cartilage of the hip joint experiences serious loads, and under certain pathological conditions they begin to collapse. The catalyst for degenerative-dystrophic changes in cartilaginous tissues can be disorders that reduce their regenerative abilities. Destruction is facilitated by age, injury, genetic predisposition, excess weight, as well as infectious and autoimmune pathologies.
Coxarthrosis can be primary or secondary . Primary coxarthrosis occurs against the background of changes in cartilage; secondary coxarthrosis is often associated with congenital or acquired anatomical features.
The causes of coxarthrosis are:
- External influences, including injuries, fractures for which osteosynthesis is performed (postoperative and post-traumatic coxarthrosis) - Internal causes - congenital anomalies of the hip joint (dysplasia), epiphysiolysis. - Systemic pathologies in which coxarthrosis is only one of the symptoms - gout, rheumatism, metabolic disorders (diabetes mellitus), hormonal diseases, allergic reactions, collagenosis.
— Involutive processes are physiological metabolic-dystrophic, sluggish pathologies that often manifest themselves against the background of chronic infections.
However, often completely different disorders, which at first glance are not related to the hip joint, lead to the development of the disease. It can be:
— dysfunction of the TMJ; — scoliosis of the cervical and thoracic spine; - visceral and psychosomatic problems; — surgical interventions, consequences of difficult childbirth in women; — cicatricial adhesive processes.
Even ordinary abdominal surgery on the anterior abdominal wall (for example, appendectomy) can cause distortion of the groin area and significantly change the biomechanics of the hip joint. Therefore, only an integrated approach to the body as a whole, which is the main principle of osteopathy, will help to detect and eliminate the disorder.
Risk factors for coxarthrosis include: - Previous hip injuries. They usually cause unilateral coxarthrosis. - Arthritis or ankylosing spondylitis. — Anatomical defects of the hip joint and hereditary predisposition. — Pathologies of the hip joint. Coxarthrosis can be caused by congenital dislocations of the femur, Perthes disease, or epiphysiolysis.
- Excess weight. Often, excess body weight causes bilateral osteoarthritis. — Type of activity and characteristics of physical activity, which are accompanied by excessive stress on the joint.
— Age over 70 years, female. — Metabolic disorders and acromegaly. — Amateur or professional sports that can lead to hip injuries or wear of cartilage tissue.
- Menopause period. — Femoroacetabular conflict. - Sedentary lifestyle. — Unbalanced diet – insufficient intake of vitamins D, C and K.
Ethnicity is also an important risk factor - Asians suffer from deforming arthrosis of the hip joint 70-85% less often than Americans and Europeans.
If there are no congenital pathologies, the hip joint suffers from stress, especially when the center of gravity of the body is shifted or emphasized on one leg. This can be related to childbirth, surgery, the stomach, and even the jaw. When the joint surfaces are skewed, they experience constant overload, which leads to disruption of their nutrition and metabolic processes. This changes the shock-absorbing properties of cartilage, disrupts the production of synovial fluid and ultimately leads to coxarthrosis.
Preventive actions
Preventive measures can be used to prevent the occurrence of pathological processes, as well as during remission, preventing the progression of the disease.
Prevention of coxarthrosis involves:
- maintaining a balanced diet;
- systematic sports;
- maintaining a healthy lifestyle, which includes giving up bad habits;
- body weight control;
- systematic preventive examination and timely treatment of various diseases.
Remember that your health is only in your hands. Keep him in optimal condition and enjoy a full life!
Symptoms of coxarthrosis
The bones in the hip joint are covered with cartilage, which provides soft gliding and helps distribute the load when walking. The joint fluid performs nutritional and shock-absorbing functions. With the development of coxarthrosis, the properties of the synovial fluid change, and it becomes unable to lubricate the cartilage well. As a result, the cartilage tissue dries out and becomes thinner - the bones of the hip joint begin to rub against each other and become deformed.
Since cartilage is not innervated, signs of its destruction do not begin to appear immediately. The first manifestations of degeneration of cartilage tissue and changes in the properties of intra-articular fluid are crunching and clicking sounds when moving.
More severe symptoms occur when the disease begins to affect surrounding tissue.
Painful sensations: - gradually increase; - increase with physical activity, uneven distribution of loads on the joint; - may intensify in winter and autumn - subside after movement; - often concentrated in the groin area or leg, but sometimes can radiate to the buttocks or knee joint; - in the terminal stages they become constant and intensify at night.
By the way, often with osteoarthritis of the hip joint, pain can radiate to the knee, so the patient turns to specialists with this particular complaint. The doctor orders an x-ray of the knee joint and, if there are minor changes, makes an erroneous diagnosis – gonarthrosis. Because of this, the patient wastes time. If there is no timely treatment, the disease is fraught with serious complications.
Stiffness in the joint: at stages 2-3 of coxarthrosis, morning stiffness lasts no more than an hour, but it disappears after the person walks a little; Often the result of limited mobility is joint contractures and muscle atrophy.
In addition, the disease is often manifested by crepitus during walking, shortening of the limb and local inflammatory processes.
If timely treatment is not started, the pain may be accompanied by other unpleasant symptoms. The most common of these is a crunching sound, then the gait changes and lameness appears. Gradually, the development of pathological processes leads to atrophy of the muscular-ligamentous apparatus of the thigh and visual shortening of the diseased limb. In the last stages of coxarthrosis, the development of ankylosis (immobility of joints) is possible - bone, cartilaginous or fibrous fusion of the articular ends of articulating bones.
Most often, the disease manifests itself as pain and limited mobility of the leg at its junction with the pelvic ring.
This condition can cause significant discomfort in the joint and significantly reduce the quality of life, limiting areas of movement and negatively affecting the psycho-emotional state.
As a rule, the diagnosis is made by an orthopedist or surgeon, and confirmed by x-ray, CT or MRI. But it is noteworthy that often the severity of joint pain does not always correspond to the research results.
Thus, at initial or moderate radiographic signs of the disease (stages 1-2), pain can be very intense, and with almost complete degeneration of cartilage in the joint (grade 3), the pathology only slightly limits mobility.
This means that the degree of the process is not always the determining factor in the severity of pain. Therefore, patients often delay treatment, in vain believing that the pain has gone away forever.
Diagnosis of arthrosis of the hip joint
The first degree of joint arthrosis is difficult to diagnose due to the lack of obvious symptoms. Diagnosis of stage 1 coxarthrosis includes the following types of examination:
- Consultation and examination by a traumatologist and doctors of related specialties.
- To exclude disorders of endocrine origin - laboratory tests of blood and urine.
- Magnetic resonance imaging.
- Computer types of diagnostics.
- Ultrasonography.
- X-ray examination.
All types of diagnostic examinations are carried out as prescribed by a doctor. Certain types of diagnostic examinations require preparation, which the doctor will explain in detail.
Stages
For ease of diagnosis, there are three main stages (degrees) of coxarthrosis: Stage I. The first stage of coxarthrosis is manifested by minor pain in the hip area. The pain often goes away after a little rest. Problems while walking have not yet appeared, there are no changes in posture and gait. The radiograph visualizes a slight narrowing of the joint space. Stage II. At the second stage of coxarthrosis, pain noticeably intensifies and can be felt even at rest, radiating to the knees or groin area. Violation of the biomechanics of the joint leads to lameness, and characteristic clicks are heard during movements. The pelvis warps, so one leg becomes visually shorter. X-rays allow you to see the growth of osteophytes and changes in the shape of the femoral head. The narrowing of the joint space reaches 30%, and the articular head moves upward. Stage III coxarthrosis. Severe muscle atrophy is accompanied by an increase in pelvic distortion, and the gait begins to resemble a “duck” one. X-ray confirms the last degree of coxarthrosis, as evidenced by multiple bone growths - osteophytes, and also shows a significant narrowing of the joint space until its complete fusion. The femoral neck thickens significantly.
At stages I-II, the muscles that are responsible for the movement of the hip joint weaken. At the second stage, their functions are already partially impaired, since changes are observed in the mechanism of reflex neurotrophic regulation.
In the third stage, the motor activity of the hip joint is sharply disrupted, contractures and changes in the axis of the limb change the amplitude of muscle contraction, as well as the location of the attachment points of muscles and tendons.
This leads to shortening or stretching of the muscles, they are not able to fully contract. Trophic changes are observed not only in the muscles, but throughout the diseased limb.
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Features of treatment
Basic principles of treatment:
1. Restoring blood supply to the joints. Swelling and muscle spasms form around the diseased joint, which impairs blood circulation in the bursa, impairing the production of synovial fluid. That is why, with coxarthrosis, it is important to first relieve swelling and restore blood flow. Manual osteopathic techniques can successfully cope with this.
2. Increase in physical activity. Only in such cases will the synovial fluid be able to properly wash the cartilage, the cells will receive normal nutrition and be able to regenerate. Exercises should be careful and careful. Performing exercises through force and pain is prohibited, otherwise the joint will be further destroyed and the rate of development of coxarthrosis will increase. For this purpose, our clinic successfully uses methods of physical therapy and kinesiotherapy in general.
3. Lifestyle changes in general. It is not recommended to lift weights, sit or stand for long periods of time. The diet should contain products that provide the cartilage tissue of the hip joint with the necessary elements - fluorine, magnesium, phosphorus.
By following these rules, you can achieve cartilage restoration and slow down the progression of grade I and II coxarthrosis. With grade III coxarthrosis, the chances of treatment success largely depend on the patient’s perseverance: good results are quite achievable if the patient himself is committed to serious work. The main task is to preserve the original hip joint. Osteopathy and exercise therapy successfully cope with it.
The most common reason for visiting a doctor is pain in the hip joint, as well as a feeling of stiffness.
In such cases, an examination by an osteopathic doctor will be mandatory. Osteopathy has been included in the list of medical specialties since 2015 as the highest degree of training for a specialist in manual therapy.
The need to start treatment with an osteopath is due to the fact that pain, and the disease itself in principle (especially in the initial stages) is often caused by chronic overload of the hip joint due to an imbalance in the axial balance of the body in combination with tension in the periarticular tissues and muscles. As a result, the hip takes a physiologically incorrect position or is compressed, and the articular elements are overloaded. Pain occurs.
During the examination, the osteopath will determine a shift in the center of gravity to one of the legs, areas of bone overload in the hip joint, impaired mobility in the joint and the location of anatomical structures, which are often the true causes of coxarthrosis.
Disease prevention
Measures to prevent the development of coxarthrosis include maintaining a healthy, active and active lifestyle, regular exercise to strengthen muscles and joints, and weight control.
As a preventive measure for older people, doctors recommend:
- follow the principles of healthy eating;
- exercise;
- take a course of massage treatments;
- visit the pool;
- do Norwegian walking or skiing;
- undergo sanatorium-resort treatment;
- take chondroprotective drugs once a year.