How to assign a disability group for coxarthrosis, where to go and what are the criteria for registration

The question of whether arthrosis gives disability is of interest to many. After all, the pathology is common, and the number of cases is steadily growing every year. Arthrosis or osteoarthrosis, or DOA, are non-inflammatory changes in the joints when they are destroyed as a result of dystrophy and degeneration. It is not uncommon, affecting 10–16% of the world's population over the age of 40. In women, the pathology occurs more often - after 60 years, the disease develops in 100% of cases.

The largest human joints are the hips; their arthrosis is called coxarthrosis. Affected by knee disease - gonarthrosis. The destruction process affects the joint, bones and ligaments. Causes of coxarthrosis:

• injuries, increased stress, age and obesity;
• joint dysplasia in childhood, rheumatism, hemophilia, osteoporosis.

Classification of pathology

The degrees of arthrosis of the hip joint are as follows:

1. Stiffness in the morning, tingling in the buttocks, intermittent crunching in the joint when bending over, fatigue. During the day everything disappears - on x-ray there are no symptoms. There is only a deterioration in the composition of the intra-articular fluid.
2. Coxarthrosis of the 2nd degree - the cartilage tissue becomes very thin due to destruction, the menisci are also destroyed. Bone spurs appear along the edges of the joint. There are signs of inflammation of the joint capsule, pain is already felt at rest, and the muscles begin to degenerate.
3. Coxarthrosis of the 3rd degree - weakening and hypotrophy of muscles, lameness, any movement causes sharp pain. With grade 3 DOA of the hip joint, contractures appear. Ankylosis may develop with complete immobility of the joint due to a sharp narrowing of the articular target and thickening of the femoral neck. Synovial fluid is no longer produced in the joint, and the bones constantly rub against each other.

It is no longer possible to cure coxarthrosis in the last 2 stages. Therefore, the patient is referred to the VC to receive a disability group. In these cases, 2 or 3 disability groups are considered working; only the first group is non-working for a given disease. Grade 3 knee joint gonarthrosis is similar in symptoms to coxarthrosis. The process of DOA can also affect other joints, but it is coxarthrosis that is severe in its course; with its third degree, disability is always given, the first time more often for a year.

When can disability be assigned?

If the examination reveals noticeable limitations in the mobility of the joint, the patient is unable to care for himself in everyday life, disability is assigned, but usually group 3, very rarely 2. The latter is given to patients who can hardly move, are unable to care for themselves and support themselves. This also applies to gonarthrosis: disability for arthrosis of the knee joint of the 3rd degree is given according to the same criteria, and this is group 3 for the year. Then, in order to extend it, people with disabilities must confirm it.

Within a year, the patient can undergo endoprosthetic surgery, restore and improve the condition of the joint, then disability due to coxarthrosis of the hip joint is often reduced or removed completely.

Despite all the indignation of patients and their relatives, the presence of even the most severe arthralgia does not give grounds for disability. Stiffness, arthralgia and crunching have diagnostic value, nothing more. In case of arthrosis of the knee joint of 2nd degree, disability during the initial examination is also determined only for a year and only group 3.

Disability is granted only if there are signs of life activity limitation.

This includes radiographically and arthroscopically confirmed joint and bone deformities. Severe degrees of DOA are more likely to fall under ACD, but not in clear direct proportion.

How is OZD determined?

If violations of static-dynamic functions (SDF) are present in grades 1 and 2 of DOA, they are not considered significant and disability is not due to them. Violations of SDF with DOA of the 3rd degree in Russia are also considered only moderate, and disability is not automatically issued for them (at best, count on group 3). Disability with gonarthrosis of the knee joint of the 2nd degree has the same criteria as coxarthrosis. SDF is the patient’s ability to move, self-care, work and adapt to society.

General Tips

The issue of assigning a disability to a person is decided by members of a commission from the state social service body. After considering the case, all members have the right to ask the patient the necessary clarifying questions.

To get a positive decision, you need to use several recommendations:

• the package of documents for submission to receive a group must be certified by the seals of 3 attending physicians and the head physician of the hospital;
• collect all documents, including records of ambulance calls, extracts from sanatoriums, etc.

Thus, it is not difficult to obtain a disability group for stages 2–4 of coxarthrosis; the main thing is to correctly approach the collection of the necessary documentation. At stage 1, there is no disability.

Degrees of statodynamic function (SDF)

There are only 4 of them:

• What disability group is given for grade 3 knee gonarthrosis?

1. Minor violation of SDF. The distance walked is 3–5 km, the pace is 90 steps/minute, aching pain. X-ray – stage 1 DOA.
2. Moderate violations of the SDF. A contracture of the joint is formed, movements are limited. The patient can walk with lameness and pain only 2 km, then rest so that the pain goes away. The leg is shortened to 4 cm. Muscle strength is 40% less. X-ray - stage 1-2 DOA. Later, arthralgia and lameness are constant, the patient can walk only 1 km with a cane, the walking pace is 45–50 steps/minute, the contracture is pronounced, shortening is 6 cm, the volume of the thighs on both legs differs by 4–5 cm and 1–2 cm on the legs , muscle strength is reduced by 70%. X-ray shows stage 2 DOA.
3. Pronounced violations of the SDF. Arthralgia in the lower back and both joints, shortening of 7 cm or more, lameness. A person walks only 0.5 km on crutches at a pace of 25 steps/minute. The difference in the hips is more than 6 cm, in the lower legs - more than 3 cm. The muscles are atrophied, the decrease in strength is more than 70%. X-ray – 2–3 degree DOA. Movement disorders are decompensated, radicular syndrome is observed.
4. The changes in the SDF are significant: any movement is impossible. The patient lies most of the time or moves only within the apartment and only with a walker.

Who is sent to ITU

These are those patients who have experienced progression of DOA with radiological signs of bone loss already in the first 3 years of the disease, synovitis worsens more often than once a quarter, and there are concomitant diagnoses that worsen the course of DOA. Disability in the 3rd degree of DOA is usually limited to working, i.e. 3rd group. To receive it, violations of the SDF must be moderate and persistent. The OZD includes:

1. Restriction of self-service 1st degree. This means that such a person spends more time on self-care; he is not able to perform the entire range of movements at once and splits them up, using orthopedic aids (cane, stick).
2. The ability to move 1st degree is more time spent on movement, it is partially due to the use of auxiliary orthopedic devices (cane, crutches).
3. Orientation ability 1st degree - the patient is oriented only in a familiar situation or with the help of auxiliary technical means.
4. Ability to communicate 1st degree - the information received is assimilated little and incompletely, auxiliary technical means are used.
5. Ability to control one’s behavior 1st degree: control becomes difficult in difficult situations, self-correction is partial.
6. Ability to learn 1st degree - there is a decrease in former qualifications, the possible amount of work performed is reduced, but the person can still work.

When conducting MSEC, the patient’s status is assessed by:

• X-ray according to Kosinskaya;
• functional diagnostics;
• according to the degree of violations of the SDF;
• according to the rate of progression of DOA.

If we talk about DOA degrees according to Kosinskaya, there are 3 of them:

1. 1 - everything is very minor: there are almost no restrictions in movement, the joint space is narrowed slightly, osteophytes are only at the stage of appearance;
2. 2 - joint movements are limited, it acts only in a certain direction. Any movement in the joint causes a crunching sound that can be heard from a distance. The joint gap is 2-3 times narrower than normal, bone spurs have become large, epiphyseal cysts have appeared, and the muscles are already moderately atrophied.
3. 3rd degree DOA - there is no synovial fluid, compaction and deformation of the joint are pronounced. Rocking movements are only up to 5–7, the joint space is overgrown and ankylosis occurs. There are many spurs throughout the joint, and fragments of cartilage and cysts in the bone may be visible on x-rays. Complete fusion of the joint is called ankylosis, and is actually grade 4 DOA.

Are such people given disability? There is a belief among some patients that level 2 disability already means disability, and this was the case before. Theoretically, at this degree, transfer to disability is possible, but only when independent movement is absent and the patient walks, for example, with a cane. But as surgeons advanced in terms of joint replacement, the issue of disability began to be viewed differently. Now the second disability group is given only if:

• there is ankylosis of the joints (hip, knee and ankle);
• violations of SDF of at least 2 degrees DOA, when they are moderate in nature;
• shortened leg 7 cm or more;
• after the operation, already existing disorders of the joint function in 2 or more joints remain stably, or if they appeared after operations, and even to a severe degree.

Group 1 disability is given only to the patient who can move exclusively in a wheelchair, he is absolutely incapable of self-care and always needs outside help and his complete disability is revealed. If endoprosthetics in a patient with stage 2 coxarthrosis improves the condition, doctors can completely remove the disability.

Relationship between disability and degree of process

The main principle for assigning disability remains violation of the SDF. The number of affected joints and the presence of concomitant joint disease are also taken into account. If after the operation there is no improvement in the static-dynamic state, no one has the right to remove the group or transfer to an easier one. In practice, unfortunately, it often happens that it is very difficult for a patient to prove his inconsistency in violations of the SDF.

Is disability automatically granted after endoprosthetic surgery? Many are deeply convinced of this. But this is a mistaken opinion. On the contrary, endoprosthesis replacement is recommended specifically to remove the disability group. The logic is this: a person agrees to endoprosthetics not because he wants to become disabled, but to recover and start working. Therefore, it is worth helping him with this and removing his disability completely.

A referral for re-examination of MSEC is given after surgery when moderate and severe motor dysfunction develops and the patient falls under OZH. This may be due to the lack of qualifications of the surgeon, or the prostheses turned out to be of low quality. Many other criteria are not given - this is the work of specialists.

Determining disability according to the above criteria is a scrupulous and capacious process. This classification is international; it was adopted by the World Health Assembly back in 1976.

Coxarthrosis is a serious type of disease in terms of the consequences of the musculoskeletal system. In most cases, the patient is unable to work for a long time, and the last stages of pathological changes raise the question of registering disability. It is recommended to find out in advance whether disability is given for coxarthrosis of the hip joint, who is eligible for the group and what grounds there should be for this. Having the necessary information will save time and effort during the procedure.

• Types of arthrosis and their degrees for which a disability group is given

Questions about registering a disability group

A diagnosis of joint coxarthrosis does not mean that with such a disease a person is automatically given disability status. To receive pension contributions and social benefits, a person must undergo an official procedure for recognizing a person’s disability status in the form of receiving the appropriate group.

The possibility of assigning a certain disability group and determining which group is assigned is determined on the basis of symptoms of pathological changes in the hip joint and restrictions in a person’s life (LR). A group confirming disability is given only in the presence of 2 or 3 degrees of joint destruction in the presence of pronounced impairments in the functional ability of the hip bones to move.

About the signs and symptoms of arthrosis >>

The possibility of assigning a certain disability group is determined by a medical commission. A medical examination is carried out for the following indications:

• arthrosis is characterized by rapid progress;
• the patient underwent surgery for indications of arthrosis;
• The patient experiences a clear restriction of joint movement, which is an obstacle to full life activity.

The severity of clinical symptoms must be observed for at least 3 years. The disease must occur with symptoms of exacerbation with a frequency of at least 3 times during the year. The referral to the commission is given by the attending physician, who may be an arthrologist or orthopedist.

Modern medicine shows good effectiveness, even if disability was previously diagnosed due to grade 3 coxarthrosis of the hip joint. In this regard, the issuance of a group does not mean obtaining status for the rest of your life.

Endoprosthetics today make it possible to almost completely restore the normal functioning of the joint, which leads to the removal of the disability group. In addition, according to Russian law, a disabled person must undergo a medical examination every year to confirm his disability.

How is the medical examination carried out?

To consider the case, the patient must go through a certain list of doctors, attach data from previous examinations in the form of X-rays, computed tomography, MRI of the hip joint and other results, and, if available, provide an extract from the hospital.

The attending physician informs the patient about the presence of severe functional disorders associated with the devastating consequences of coxarthrosis and the possibility of disability. In some cases, the initiative comes from the patient himself, who turns to the doctor with a request to be referred to a commission. Typically the patient undergoes the following specialists:

• At what degree of arthrosis can a disability group be issued?

• therapist;
• neurologist;
• arthrologist.

The passage procedure contains several stages:

• diagnostics, including recording the patient’s complaints and examination results;
• social diagnostics, which establishes the patient’s ability to provide independent care;
• determining the severity of the patient’s need for social support measures.

The doctors of the medical commission conduct a collegial assessment of the patient’s condition, discuss the results of studies and the conclusions of specialists. The final decision on the possibility of assigning disability is made by general voting.

Features of assignment of disability for coxarthrosis of 2nd degree

Disability with coxarthrosis of the hip joint of the 2nd degree is not required in all cases. If the patient experiences severe pain, but the functions of the joint are not impaired, then disability is in most cases denied.

The main criterion for the commission is the presence of acute respiratory distress, that is, a person, as a result of pathological changes, must find himself in a situation in which he is unable to move or stand without the use of a special device in the form of a stick, crutches, or wheelchair.

Disability is granted for 2nd degree pathology in the following cases:

• bilateral coxarthrosis, in which both joints are affected at once;
• the presence of grade 2 coxarthrosis, which is diagnosed in combination with gonarthrosis;
• shortening of the leg by 7 centimeters or more;
• rapid development of joint destruction, which should be confirmed by x-rays.

Destruction of a joint of the 2nd degree on an X-ray image is expressed in the form of a visually visible narrowing of the gap between the joints, the presence of osteophytes along the edges, and pronounced bone deformations.

In case of pathological changes in the hip joint of the 2nd degree, in the majority of cases they give the 3rd disability group, which for a person means the ability to work.

Under some circumstances, group 2 may be assigned, which more often occurs when destructive processes of the joint are combined with gonarthrosis or when the disease progresses significantly, which deprives a person of independent movement and self-care.

About methods of prevention for arthrosis >>

Features and stages of the disease

The main reason for the development of pathology is wear and tear of the joint, so coxarthrosis is usually diagnosed in older people

Coxarthrosis of the hip joint is a degenerative-dystrophic pathological process that leads to deformation of the joint. The disease is characterized by slow progression, but leads to severe and irreversible impairment of joint function.

The disease manifests itself over the age of 45; the main reason for its development is natural wear and tear of the joint. However, symptoms increase slowly, so the average age of people who consult a rheumatologist with suspected coxarthrosis is 50 years. Women suffer from this disease 4 times more often than men.

Disability due to coxarthrosis is not assigned to everyone. You can only get it if you have a severe form of the disease, due to which a person cannot move normally. There are three degrees of the disease.

First degree coxarthrosis

Coxarthrosis of the first degree is characterized by the onset of the pathological process. The symptoms are mild, most people do not pay attention to them, thereby delaying a visit to the doctor.

However, the first degree has the most favorable prognosis; it can be cured without surgery, with conservative therapy alone. If you pay attention to the initial symptoms in a timely manner and consult a specialist, the person will maintain the motor function of the joint.

Symptoms of the first degree of the disease are aching pain in the hip joint, which occurs only after exercise. Typically, a person notices discomfort at the end of the day, after long walks or sports. The pain goes away without medications, you just need to give the joint a rest.

Pronounced degenerative processes are not visible on x-rays. The joint space does not narrow, or narrows slightly, but the cartilage tissue is already beginning to thin out. There are no osteophytes, but thickening and stagnation of synovial fluid may be detected.

The progression of the disease can be stopped if therapy is started in a timely manner. For coxarthrosis of the 1st degree, disability is not given.

Second degree

In the second stage of the disease, pain may occur even at rest.

Coxarthrosis of the 2nd degree is a pathology of moderate severity. It is characterized by the following changes in the joint:

• uneven narrowing of the joint space by approximately 2-3 times;
• thinning and loss of elasticity of cartilage tissue;
• decrease in the amount of synovial fluid;
• joint nutritional disorder;
• single osteophytes.

Osteophytes are bone growths in a joint that interfere with the normal movement of the joint. Single osteophytes in grade 2 coxarthrosis are small in size, but it is because of them that the pain syndrome intensifies.

Symptoms of this degree of pathology:

• joint pain during exercise;
• periodic attacks of pain at rest;
• pain syndrome extends to the buttocks, groin and thigh;
• periodic muscle spasms of the thigh;
• crunch in the joint;
• lameness after exercise.

With coxarthrosis of the hip joint of 2nd degree, it is difficult to obtain disability. Theoretically, this form of pathology is a reason for applying for a medical and social examination, but in practice the patient is denied disability, since he can move independently.

At the second stage of the disease, predominantly conservative treatment is also practiced. A well-chosen therapy regimen can improve the quality of life and normalize movement in the joint, so disability is not required.

Third degree

The person begins to limp heavily and can no longer walk without a cane.

Coxarthrosis of the 3rd degree is characterized by severe and irreversible changes in the structure of the joint. The x-ray shows complete destruction of the cartilaginous layer, multiple bone growths, and almost complete narrowing of the joint space. The femoral head may also become displaced, leading to shortening of the limb.

The symptoms are as follows:

• constant pain that is difficult to relieve with medications;
• shortening of one leg;
• severe lameness;
• deterioration of the supporting function of the joint;
• atrophy of the leg muscles on the side of the affected limb.

Some patients are unable to put weight on the affected leg, while others experience only severe lameness and changes in leg length.

To obtain disability for grade 3 coxarthrosis of the hip joint, it is necessary to undergo a medical and social examination. There is no refusal, but the disability group depends on the severity of the joint deformity.

Fourth degree

Most doctors divide coxarthrosis into 3 degrees; this classification is quite simple to understand. However, in some sources you can find mention of the 4th degree of pathology. This is the most severe form, in which dislocation of the femoral head or its necrosis is added to degenerative-dystrophic processes. With this pathology, a person cannot lean on the affected limb. The leg is noticeably shortened, movement is only possible with a crutch.

It is impossible to cure grade 3 and 4 coxarthrosis with drugs. The only way to restore joint mobility is to replace it with a prosthesis.

Pain in grades 3 and 4 of pathology is severe and cannot be relieved with conventional analgesics; potent prescription drugs are used to relieve pain.

Features of assignment of disability for coxarthrosis of the 3rd degree

According to doctors, a therapeutic effect for grade 3 coxarthrosis and complete restoration of motor function is possible only through prosthetics. The last stages of the disease can make a person unable to move independently. To prevent irreversible changes, therapy is carried out using the following methods:

• drug treatment;
• therapeutic gymnastics;
• massage treatments;
• diet;
• physiotherapy.

In case of unfavorable development of events, grade 3 coxarthrosis of the hip joint is assigned to 2 or 1 disability groups. With such changes in the body, a person is often unable to perform work and in most cases cannot move. The patient may be immobilized and restoration of the functions of the hip joint in such circumstances is only possible through surgical intervention in which the joint is replaced with an endoprosthesis.

The first disability group is considered the most severe and is diagnosed when a person is unable to move and perform basic everyday activities. In most cases, such patients cannot live independently and need support from others.

Stages of development of the disease and their connection with disability

All arthrosis is a group of pathologies in which degenerative and deformational changes occur in tissues. Coxarthrosis is a fairly common pathology; in most cases it is diagnosed in women.

The mechanism of development of pathology is as follows:

1. The joint fluid thickens, causing the cartilage surface to dry out and become cracked.
2. Cracks provoke thinning of cartilage, which leads to pathological processes in tissues.
3. The bones are deformed, the mobility of the hip area is impaired, local metabolism deteriorates, and the muscles of the affected leg atrophy.

The development of coxarthrosis occurs in several stages:

1. The initial stage is difficult to notice even on x-rays, so the disease very quickly progresses to the next stage. But a person who is attentive to his health must pay attention to pain in the groin area and discomfort when walking. Disability at this stage is absolutely excluded.
2. The second stage the clinical picture is more obvious. Pain can appear not only during activity, but also at rest. The patient has difficulty lifting the affected limb, and discomfort in the knee area makes it difficult to bend it. If motor functions are lost to a significant extent at this stage of the disease, disability can be assigned, but this does not happen often.
3. The third stage of pain is very severe, as necrotic changes occur in the joint. As a rule, in this case, the patient is recommended to undergo surgery. At this stage of the disease, the patient is assigned a disability.
4. The fourth stage is the final stage in which the joint completely dies, causing severe pain and lameness when walking. In most cases, the patient requires a wheelchair and group 1 disability.

Read also: Procedure for registering disability after a heart attack and stenting

Disability was not granted: what to do?

In real life, obtaining a disability group for coxarthrosis turns out to be quite difficult and problems most often arise with a diagnosis of 2 degrees. According to statistics, about 60% of patients are refused, despite obvious signs of pathological changes, severity of pain discomfort and restrictions on normal life activities due to symptoms of the disease.

The refusal of medical commissions is often associated with the insufficiency, according to experts, of the grounds for assigning disability.

In this case, the limitation in the motor ability of the joint is considered insignificant, and recommendations are made to exclude heavy physical labor.

In such a situation, the patient can express disagreement and appeal to a higher authority in the form of the main MSEC bureau or a judicial body. In practice, such proceedings are time-consuming and require significant time and emotional investment. Those who have undergone a similar procedure recommend attaching all documents proving the seriousness of the disease and inability to function normally.

For a larger list of documents, it is better to contact doctors more often, so that in the future there is evidence that the disease actually periodically worsens. The more often a patient turns to a specialist regarding pain discomfort and problems with joint function, the more often he needs treatment in a hospital, the greater the likelihood of being assigned a disability group. In this case, each request for help at a medical institution must be recorded in the patient’s outpatient record.

Stages of disease development

Coxarthrosis was previously considered characteristic of the elderly, but recently cases of the disease appearing in younger people have become more frequent, since the root causes of the development of the disease are mutations in genes that arise under the influence of certain factors, as well as a person’s lifestyle. This may include immobility, frequent hypothermia of the joints, stress and indifference to the first symptoms in the early stages, when the disease is still curable.

If the second degree of coxarthrosis is diagnosed, then the process is irreversible. All that remains is to take measures to stop the development of the disease and prevent deterioration.

This disease is characterized by dysfunction of cartilage joints, a slow process of feeding the joint with useful substances and its deformation. The patient also experiences pain, discomfort and limitations in motor activity.

Coxarthrosis develops as a consequence of long-term osteoarthritis and is characterized by several stages:

1. First stage. At first the disease is unnoticeable. It cannot be determined even by x-rays, so, as a rule, it goes to the next stage. Nevertheless, there are symptoms, but they are often not noticed by patients or are attributed to other causes. There will be slight discomfort when walking, and slight nagging pain in the groin area. The assignment of disability for arthrosis of the hip joint of the first degree will not even be discussed by the commission.
2. Second degree. At this stage, the symptoms of the disease become more pronounced. Here the signs appear not only during activity, but also at rest. It becomes difficult for a person to lift the sore leg, discomfort reaches the knee, which contributes to the appearance of pain when bending the leg. This is when, in most cases, patients seek medical help. They can give 2nd degree disability for coxarthrosis, but this is done infrequently.
3. Third degree. Patients at this stage experience severe pain, and the joint is subject to severe changes in its anatomically correct position. As a rule, when diagnosed with third degree coxarthrosis, doctors recommend surgery, but not always. Sometimes they try to fight the disease using traditional methods. It becomes very difficult for a person to walk; he cannot perform many types of work. It is logical that he needs to be assigned a disability group to receive social assistance, but this process is very complex, lengthy and requires many tests, as well as collecting documentation for the commission. But in any case, disability is due to grade 3 coxarthrosis. The main thing is to approach all organizational issues with patience.
4. Fourth stage. At this stage, it is impossible to return to a normal lifestyle, and treatment can only be carried out using radical methods. Stage 4 is characterized by complete death of the joint and tissues around it. There is lameness and very severe pain. Often the patient cannot manage with only crutches and therefore needs a wheelchair. As a rule, they give 1st disability group for coxarthrosis of 4th degree.

What is the benefit of being assigned a disability for hip disease?

Assignment of a disability group gives a citizen the right to receive cash benefits and certain benefits, which today are determined at the regional and federal levels. The content and list of benefits may vary slightly, depending on what kind of assistance from the subject is provided in a given area.

To register, a patient diagnosed with coxarthrosis of the hip joint after undergoing MSEC must contact the PA. For registration you will need to provide the following list of documents:

• certificate from MSEC;
• passport;
• SNILS;
• passbook;
• certificates for minor children.

The list of benefits for destruction of the hip joint and diagnosis of coxarthrosis may include the following types of support:

• receiving benefits;
• 50% discount on medications;
• benefits on utility bills;
• a 50% reduction in the cost of sanatorium treatment, including travel costs;
• travel allowance.

Having a disability group of 3 means a person’s ability to work in certain types of work. Such citizens have labor benefits in the form of a shorter work week and additional vacation days. Young people with disabilities have priority rights when entering educational institutions.

The decision regarding which disability group can be assigned to a patient diagnosed with coxarthrosis is made by members of the medical and social examination based on the patient’s complaints and the results of previous examinations. In most cases, a positive decision is made and disability is given for coxarthrosis of the hip joint of the 3rd degree. The basis for the commission is the presence of limitations in the patient's life.

Today, pathologies of the musculoskeletal system are not a rare occurrence in medical practice. It is also noted that the disease affects increasingly younger people and becomes a cause of disability. Disability due to coxarthrosis is determined based on the decision of a medical commission. This usually happens when a person has already partially lost their ability to work. What is necessary to assign this status to a patient is described in detail below.

Pain in the hip area

Grounds for receiving disability

The question of whether a disability group for coxarthrosis of the 2nd degree is given is asked by patients suffering from this disease. It is possible to receive a group for damage to the hip joint under certain circumstances, since the disease itself is not a reason for disability. The need to use these privileges still needs to be proven. This process takes a lot of time and effort; a visit to a clinic and a special medical organization is required.

Disability can be assigned if the motor ability of the hip joint is impaired, causing the inability to move independently without a special device. This symptom is much more important for determining a patient’s disability group than the sensation of pain.

A disability group is assigned to a person if he has limitations that affect his ability to work. The second stage of deforming coxarthrosis is not characterized by severe symptoms and does not cause loss of motor ability in a person, therefore the degenerative process in the hip joint of the second degree itself is not an indication for registration.

A disability group can be assigned in the following cases:

• bilateral arthrosis of the hip joint, grade 2;
• bilateral coxarthrosis in combination with gonarthrosis - damage to the knee of 2 or 3 degrees;
• shortening of the leg by more than 6–7 cm;
• a rapidly progressing pathology, changes in which are recorded on x-rays.

The main reason for assigning disabled status to a patient with coxarthrosis is the need to use a crutch or stick to move.

But the established group can also be removed, since with the modern development of technology and medicine there is the possibility of a complete cure.

Coxarthrosis 2nd degree

Characteristics of the disease and ability to work

Coxarthrosis is characterized by a violation of the integrity of the surface of the articular apparatus against the background of slow metabolism. Pathology leads to the destruction of cartilage tissue, bone deformation, which weakens motor activity. If the disease is not treated, the patient becomes disabled.

There are many reasons for metabolic disorders - sedentary lifestyle, hypothermia, stress and much more. The peculiarity is the irreversibility of the processes. Disability for coxarthrosis can be assigned at 2, 3, 4 degrees of severity of the disease.

The 4th stage is characterized by complete immobilization, as a result of which a disability is clearly indicated, so attention should be paid to the other 2:

• The second degree is characterized by destructive processes due to which the patient experiences pain during movement and at rest. The pain is localized not only in the hip joint, but also in the groin, knees, legs, and lower back. The man begins to limp. As the pathology progresses, the muscles atrophy, the affected limb shortens, and a peculiar crunching sound is heard in the joint.
• With the 3rd degree, the cartilage is completely destroyed, pain is accompanied all the time. A person can no longer cope without a cane.

Where to go to apply for disability?

Let us consider in more detail the conditions for obtaining a disability group. This issue requires the greatest attention in the presence of the second degree of coxarthrosis, since the third stage itself is a reason for assigning this status.

The decision on the issue of disability due to arthrosis or not is made by MSEC - a medical and social expert commission. A referral to this organization is issued by the attending physician. This happens as follows:

1. Obtaining information about the existing grounds for obtaining disability from a doctor.
2. If there are grounds for this, the doctor gives the patient a card and a referral to undergo a local medical commission. It may include specialists:

• therapist;
• neurologist;
• arthrologist

For the walk, the card includes X-ray images, CT and MRI studies, and hospital discharge notes, if any. The person who received hospital treatment more often has the greatest chance of being assigned a disability.

1. After passing the doctors at the clinic, you can contact MSEC. To do this, you need a referral from a doctor, an outpatient card of the patient, hospital discharge and research results.

An expert commission evaluates the patient’s condition, discussing the data obtained and the doctors’ opinions, then a decision is made based on a general vote of doctors.

MSEC goals

Medical and social examination

A special medical commission assigns a disability group to a person. A patient with cascartrosis is referred for such an examination in the following cases:

To determine the disability group, the medical commission evaluates the patient’s condition in several stages:

1. Pay attention to the patient’s complaints and study the medical history.
2. Conduct social diagnostics.
3. Pay attention to the ability to work, the degree of movement and the patient’s ability to care for himself.

Based on this data, the medical and social commission assigns a disability group to the person.

What disability group is given for grade 2 coxarthrosis?

Any person suffering from second degree coxarthrosis can apply for disability. There are three groups in total, but for this diagnosis the third is most often prescribed. This is the easiest group, people for whom it is established can work and are considered to have limited ability to work.

The second group can be obtained very rarely - if a person simultaneously suffers from damage to the knee and hip joints, and motor function is depressed. Such people cannot work because their ability to move is limited. They need to undergo treatment, the results of which require a medical commission annually.

Of the three existing ones, the first disability group is considered the most serious and severe. In order for MSEC to diagnose it for hip coxarthrosis, certain factors must be present. The main one is the complete loss of a person’s ability to move independently and take care of himself, which entails a complete loss of ability to work. Due to limited mobility, a patient with coxarthrosis needs constant care, which includes trips to the store and other organizations, cooking and other everyday problems. The life of such patients becomes dependent on those around them.

Loss of ability to move freely

The first group is assigned to patients with grade 3 arthrosis of the hip joint, and it is a reason to think about joint replacement surgery. The second disability group for coxarthrosis is established with a slight limitation of the patient who needs the help of others to a lesser extent. In this case, the ability to work is partially preserved, but the employer is required to organize a workplace. Also, the second group is prescribed for ankylosis - this is a shortening of the leg by 7 cm. With a slight limitation of motor ability, a patient with coxarthrosis may be assigned a third disability group.

Diagnostics and therapeutic therapy

The following studies will help establish the diagnosis of coxarthrosis:

• Ultrasound diagnostics;
• CT;
• MRI;
• radiography;
• arthroscopy (examination of intra-articular fluid);
• blood tests.

Anamnesis is also collected and the affected joint is examined by a doctor.

Most often, only an x-ray is required to make a correct diagnosis.

Drug therapy is selected for patients individually, depending on the nature of the disease, its causes, and the degree of neglect. The general course of treatment is complex and lengthy. It includes drug therapy, physical therapy, and surgery (as a last resort).

Goals of traditional drug therapy:

• effective treatment without surgery;
• pain relief;
• reduction of inflammation;
• normalization of blood circulation;
• improvement of tissue nutrition.

Drug treatment involves the mandatory prescription of the following groups of drugs:

The method of administration and dosage are prescribed individually. The use of these medications is contraindicated during pregnancy, active inflammation, or allergies. Can be used with caution for gastrointestinal diseases, pathologies of the heart, kidneys, and liver.

Joint traction

The procedure is carried out using a special traction apparatus. Less often it is practiced manually. The goal is to reduce the load on the hip joint.

It is advisable to do stretching not only for the joints, but also for the spine.

Traction is a complex procedure that can only be performed by a specialist. It can be repeated several times a year, but only after the permission of the attending physician.

Surgical treatment

Surgery is prescribed when drug therapy no longer has an effect, and the joint is completely deformed.

The most effective operation is endoprosthetics. The essence of the procedure is to remove the affected joint and replace it with an artificial analogue - a prosthesis made of metal alloys or ceramics. The results of endoprosthetics are relief from pain, inflammation, and restoration of mobility. After surgery, the person will again be able to exert normal load on the hip joint. A high-quality endoprosthesis will last about twenty years, which is a good indicator.

Physiotherapy

Treatment with physiotherapy is mandatory when diagnosing coxarthrosis. With its help, you can effectively reduce pain, inflammation, relieve swelling, and enhance the effect of medications.

Sanatorium treatment will not cure the disease, but it can significantly alleviate the condition.

Before carrying out such treatment, it is important to make sure that the patient has no contraindications to physiotherapy (pregnancy and lactation, allergies, respiratory pathologies, vascular diseases, skin diseases).

The best physiotherapy for coxarthrosis:

Therapeutic exercises

A timely course of exercise therapy will help to successfully treat grade 2 coxarthrosis of the hip joint without surgery. Exercise strengthens muscles, improves blood circulation, relieves pain, and normalizes joint nutrition.

Exercise therapy should be carried out during periods of remission of the disease, when the patient does not suffer from acute pain. Active physical activity is contraindicated in case of hypertension, purulent lesions of the joints, pregnancy, and active inflammation.

A set of exercises for hip joints with arthrosis:

1. Sit down, stretch your legs. Slowly reach your feet with your hands, bending as much as possible so that the hip joint “works.” The same exercise can be performed in a standing position.
2. Stand straight and perform circular movements with your feet.
3. Lie on your back, perform swings with straight legs.
4. Lying on your stomach, raise your legs straight and hold them in this position for a few seconds. The same exercise should be performed while lying on your side.

Active physical exercise (running, squats or jumping) is strictly prohibited for patients with coxarthrosis: exercise will do more harm than good and will cause a new wave of inflammation.

The pool is an excellent place for gymnastics for hip joint disorders.

Exercise therapy can be supplemented with therapeutic massage, swimming, walking or skiing.

Medical Examination Criteria

Osteoarthritis, which does not manifest itself at first, can turn a person into a disabled person in a short time. If left untreated, the disease progresses rapidly and causes limited mobility and lameness. If these factors are present, a group is assigned to the patient, taking into account the following:

1. Examination – results of tests and instrumental diagnostic methods (X-ray, CT, MRI) over three years. The presence and frequency of relapses, the degree of joint destruction and the conclusions of other specialists play a role. The main criterion is to assess the loss of motor function of the joints of the pelvic area.
2. Progressive coxarthrosis, expressed by the absence of results from treatment for a long time.
3. Loss of ability to work, due to which the patient is unable to carry out his previous work activity, and is forced to remain on sick leave for long periods of time.
4. Coxarthrosis of the 4th degree – complete loss of the ability to move and the patient’s inability to take care of himself. This is the most severe case of coxarthrosis, in which the patient is assigned disability group 2 or 1.

Joint with arthrosis
When passing the commission, specialists take into account the degree of the patient’s need for social support. The fact of possible surgical intervention is also taken into account. Disability can be assigned for a certain period. For example, after completing the full course of treatment and restoring the functionality of the body, it may be canceled. If this is not the case, then it is necessary to re-pass the MSEC and extend the disability.

Main ITU criteria

Medical and social examination is based on the following criteria:

1. The commission carefully studies all the results of the patient’s examination over 3 years;
2. MSEC members pay attention to the number of patient visits, relapses, degree of joint damage and discharges from specialists. Particular emphasis is placed on the functionality of the hip joint;
3. The fact of the duration of the periods of therapeutic measures is established, as well as how much the patient’s condition worsens or improves;
4. Loss of permanent work skills - if the patient can no longer work in the same place due to coxarthrosis or excessively frequent and long sick leave is noted;
5. The degree of immobilization is if the patient needs outside and social assistance. For example, a person cannot take care of himself or work independently;
6. If surgery was performed, the commission examines the results of the operation. If the operation is successful, temporary disability may be assigned only for the period of rehabilitation.

What benefits does disability provide?

The main benefit when registering for disability is receiving a special benefit - a pension. In addition, there are other concessions for people with disabilities both at the state and regional levels.

To apply for a pension, you must provide all certificates and conclusions to the local Pension Fund department. For coxarthrosis of the hip, the third group is most often placed, in which a person receives:

• pension;
• 50% discount on prescription medications from a doctor;
• 50% discount on utilities;
• the same discount applies to spa treatment, including travel expenses;
• discount on public transport;
• assistance in finding a job;
• receiving additional leave and reducing working hours;
• discount on paid training.

In addition to this list, other benefits for people with disabilities may be established at the regional level. But when receiving the third group, it must be confirmed annually by passing a commission - MSEC.

How to apply for disability

Contents Referral for medical and social examination

Passing the examination

Disability groups

After disability has been established

If you do not agree with the expert's decision

The Federal Law “On Social Protection of Persons with Disabilities” gives the definition: “A disabled person is a person who has a health impairment with a persistent disorder of body functions, caused by diseases, consequences of injuries or defects, leading to a limitation of life activity and necessitating his social protection.” From a legal point of view, disability is a statement that a person, due to persistent disorders of body functions, has limited ability to carry out certain types of life activities, and he needs social protection measures, including rehabilitation.

The basic norms that regulate disability issues are set out in the Federal Law “On Social Protection of Disabled Persons” and in the Rules for Recognizing a Person as a Disabled Person. They concern registration of disability for both adults and children.

Only federal institutions of medical and social examination (MSE) can recognize a person as disabled: the Federal Bureau of MSE, the main bureaus in the constituent entities of the Russian Federation and their branches - MSE bureaus in cities and regions. They also develop an individual program for rehabilitation and habilitation of a disabled person (IPRA). It is important to understand that the ITU does not make a diagnosis, but determines how limited a person’s life activity is, and what rehabilitation measures are necessary to eliminate these limitations.

When determining disability, seven main categories of life activity are assessed: the ability to perform self-care, move independently, navigate, communicate, control one’s behavior, learn, and engage in work activities.

Important For the period from October 2, 2021, an exclusively absentee form of medical and social examination is provided. This procedure was approved by Decree of the Government of the Russian Federation of October 16, 2021 N 1697 “On the Temporary Procedure for Recognizing a Person as Disabled.”

The Government of the Russian Federation has extended the temporary procedure for establishing or confirming disability in Russia until March 1, 2022.

Disability is extended for a period of 6 months and is established from the date until which the disability was established during the previous examination.

Extension of disability is carried out without filing an application for a medical and social examination. The citizen's written consent to conduct the examination is also not required.

Example: If the previous certification date was October 20, 2021, then the disability is automatically extended until April 20, 2022. The decision to extend disability and develop a new IPRA must be made by the ITU Bureau no later than 3 days before the previously established period of disability.

Example: If the disability group was established before November 20, 2021, then the decision to extend it must be made by the ITU Bureau no later than November 17, 2021.

A certificate of disability determination and IPRA will be sent to the disabled person (his legal representative) by registered mail.

According to the Chairman of the Government of the Russian Federation Mikhail Mishustin: “The payment of disability pensions and the provision of people with technical means of rehabilitation will also be assigned and extended without personal appeal.”

Referral for medical and social examination

After a diagnosis has been made in a medical institution, you need to initiate the process of registering disability at the clinic at your place of residence. If you are facing a long-term hospitalization, you do not have to wait until you are discharged - you can apply for a referral for medical examination in the hospital. A referral for medical examination is issued by the medical organization where the patient is being observed - public or commercial. A branch of the Pension Fund or a social protection authority can also refer you to ITU. When completing the referral, the citizen (his authorized or legal representative) signs consent to conduct the examination. The referral and consent are transferred within 3 days by the medical organization, pension or social protection authority to the ITU office in the form of an electronic document or on paper. A citizen (his authorized or legal representative) is no longer required to submit an application to the bureau itself for an examination. You do not need to submit a referral to the ITU to obtain a duplicate of a disability certificate or to obtain a new certificate when the passport data of a disabled person (disabled child) is changed. In these cases, you need to submit an application to the ITU Bureau in person or through the government services portal. If you have contacted your attending physician or the head of a department of a medical organization, but the referral is refused, you must submit an application addressed to the chief physician.

Print the application or write it by hand in duplicate. Be sure to sign and submit one copy to the chief physician's office. On the second copy, ask for information about the registration of the application.

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If the medical organization does not see any indication for referral to ITU, you are required to issue a certificate of refusal, and then you have the right to independently contact the bureau. The Bureau will review your application and decide whether there are grounds for an examination and whether you need to undergo additional examination. If you do not agree with the bureau's decision, you have the right to appeal it to the Main Bureau or in court. You can appeal the decision of the Main Bureau to the Federal Bureau, as well as in court.

According to paragraph 4 of the Rules for recognizing a person as disabled, bureau specialists are obliged to familiarize you with the procedure and conditions for recognizing a citizen as disabled and provide explanations on the issues of establishing disability. If they tell you that “they don’t have to explain anything,” you can file a complaint with the head of the bureau and with the Ministry of Labor and Social Protection of the Population of the Russian Federation.

If you have any questions about passing the examination, you can ask them on the ITU Federal Bureau for Disability Issues hotline.

Passing the examination

A medical and social examination can be carried out at home if you cannot come to the ITU office for health reasons - you must have a medical report for confirmation. You can also undergo the examination in a hospital or in absentia according to the decision of the bureau. The expert commission itself will come for an inspection if such a need is indicated in the referral.

Section IV of the appendix to the Rules for recognizing a person as disabled contains a list of diseases for which disability is established during an absentee examination. In addition, if the patient lives in a remote or hard-to-reach area, the bureau can also make a decision to determine disability in absentia. The ITU Bureau will make a decision based on the results of reviewing medical documents received from the medical organization.

If the medical organization has not indicated in the referral to the ITU the need for an examination at home, and the ITU bureau refuses to allow the commission to visit your home or to conduct an examination in absentia, write an application addressed to the chief physician of the clinic. Ask for a conclusion for an examination at home or in absentia due to the patient’s serious condition and submit it to the ITU office.

You have the right to invite any specialist, with his consent, to participate in the MSE with the right of an advisory vote; his opinion must be included in the act drawn up based on the results of the examination.

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The Bureau can draw up a program for additional examination if the case requires special types of examination of the citizen. This program may include: an examination at a medical organization or at an organization engaged in the rehabilitation of disabled people, obtaining an opinion from the Main or Federal Bureau, or other activities.

If you refuse an additional examination, the bureau will make its decision based on the available data, but the ITU report will make a note about the refusal. This may affect the prescription of rehabilitation measures or technical means of rehabilitation.

The decision of the ITU is made by a majority vote of the specialists included in the commission and is announced in the presence of all participants. If a decision raises questions for you, you should be given the necessary clarification.

If you do not agree with the ITU’s decision, inform the bureau’s specialists that you are ready to appeal the decision, provide additional documents, examination results, doctors’ opinions, and will seek a different decision in a higher bureau or in court. In some cases, your active position may influence the specialists to make a decision in your favor.

When conducting an examination, a protocol is drawn up, and a report is drawn up based on the results of the examination. The citizen who underwent the examination (his legal or authorized representative) has the right to familiarize himself with the act and the protocol. Upon your written application, you must be given copies of the act and protocol on the same day. An application for a copy of the examination report and report can be submitted electronically through the public services portal from October 1, 2021. In this case, copies are issued in paper form or sent to you in electronic form (the applicant chooses the method of receiving copies when submitting an application) no later than the next business day.

Medical and social examination is carried out free of charge.

Disability groups

Disability groups are established depending on the degree of impairment of body functions that arose as a result of a disease, or as a consequence of injuries or defects. Adult patients are assigned one of three disability groups. A disability group is not assigned to children, only the category “disabled child.”

Disability group I is established for two years, groups II and III – for a year.

A disability group without specifying a period for re-examination (indefinite) is established on the basis of a list of diseases. In the appendix to the Rules for recognizing a person as disabled, you can familiarize yourself with the conditions for the indefinite determination of a disability group.

The category “disabled child” is established for a year, two years, five years until the age of 14 or 18 years.

The indications and conditions for establishing the category “disabled child” for a period of 5 and 14 years are listed in section II of the appendix, and up to 18 years of age - in sections I and III of the appendix to the Rules for recognizing a person as disabled.

After disability has been established

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A citizen recognized as disabled is issued a certificate confirming the fact of disability and an IPRA. The citizen himself or his legal representative can receive the certificate. The bureau sends an extract from the inspection report electronically to the Pension Fund within three days, and a referral from the IPRA to the branch of the Social Insurance Fund.

After the Pension Fund receives the certificate, you must write an application for a pension. The date of determination of disability is the day of admission to the referral bureau for MSA. That is, they cannot assign you a pension a month after your disability is established, citing the fact that the documents took a long time to arrive.

The Pension Fund is required to ask you whether you need a set of social services (SSS) in kind: free medications at the expense of the federal budget, free travel to the place of treatment, a voucher for sanatorium treatment. There is no need to take a certificate to the clinic confirming that you have not abandoned the NSU. The pension fund itself sends the document in electronic form.

If you do not agree with the expert's decision

If you do not agree with the refusal to register a disability, or a disability has been established, but you do not agree with the period for which it was given, or do not agree with the content of the IPRA, you can appeal the bureau’s decision to the ITU Main Bureau for your constituent entity of the Russian Federation within a month .

To appeal a decision, you must submit a written application to the bureau that conducted the examination, or directly to the Main Bureau. The Bureau that conducted the ITU, within 3 days from the date of receipt of the application, sends it with all available documents to the Main Bureau.

Let's say an orthopedist recommended orthopedic shoes for your child, but the commission did not include shoes in the IPRA, citing the fact that the child does not walk. You can submit an application to appeal the decision to the ITU Bureau regarding the content of the IPRA, namely, with a request to include the necessary technical means of rehabilitation. Attach to your application a report from an orthopedic doctor confirming the prescription of orthopedic shoes.

After your application is received by the Main Bureau, no later than a month later, the expert commission of the Main Bureau must conduct an examination and make a decision.

The decision of the Main Bureau can be appealed within a month to the Federal Bureau on the basis of an application submitted to the Main Bureau that conducted the examination, or directly to the Federal Bureau.

The Federal Bureau, no later than a month from the date of receipt of the application, conducts an examination and, based on the results obtained, makes an appropriate decision.

Decisions of the bureau, the main bureau, and the Federal Bureau can be appealed in court.

The material was prepared based on the Vera Foundation webinar “Procedure for registering disability”