Coxarthrosis is a chronic progressive disease of the hip joint with damage to hyaline cartilage and subchondral bone as a result of a complex set of biomechanical, biochemical or genetic factors. With coxarthrosis, the patient's quality of life deteriorates significantly. Conservative therapy for coxarthrosis at the Yusupov Hospital is carried out by leading rheumatologists who specialize in the treatment of joint pathologies.
To diagnose the disease, the latest equipment from leading world manufacturers is used. Doctors use treatment regimens proposed by the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis and the Russian Association of Rheumatologists. Medicines with maximum effectiveness and minimal side effects are selected for each patient individually. Rehabilitation specialists use innovative methods of restorative therapy that accelerate the process of regeneration of joint tissue.
Severe cases of coxarthrosis (ICD10 code - M16) are discussed at a meeting of the Expert Council. Doctors and candidates of medical sciences, doctors of the highest category take part in its work. Leading specialists in the field of rheumatology collectively develop tactics for managing patients with coxarthrosis.
Causes of coxarthrosis
Coxarthrosis develops under the influence of various internal and external factors:
- Metabolic disorders;
- Genetic or hereditary predisposition;
- Age;
- Anomalies of vascular development;
- Overweight;
- Unfavorable working and environmental conditions;
- Concomitant diseases.
Significant causes of coxarthrosis are dysplasia (congenital developmental disorder) of the hip joint, which may not manifest itself until adulthood, premature wear of the joints resulting from intense stress, trauma and infection of the musculoskeletal system, diseases of the musculoskeletal system that lead to pathological redistribution of load on joints.
Factors that contribute to the development of the disease include a pathologically altered process of restoration of the structures of the hip joint in response to the influence of a damaging agent. If it is possible to identify a factor that played a key role in the development of the disease, they speak of the presence of “secondary” coxarthrosis (ICD code – M16.7). If the cause of the disease has not been established, determine the code in ICD No. M16.9 (coxarthrosis unspecified).
Attached files
| 1. (HS-014-Osteoarthrosis__polyarthrosis,_coxarthrosis,_gonarthrosis.pdf) | read/download file |
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Symptoms and diagnosis of coxarthrosis
At the onset of the disease, patients experience pain in the hip joint after physical activity. Often discomfort occurs in the groin area, hip and knee. Sometimes the first manifestation of coxarthrosis is pain in the knee joint, for which the patient consults a doctor. In the absence of sufficient experience, the doctor may diagnose gonarthrosis.
The pain is then accompanied by the following symptoms:
- Stiffness and crunching in the hip joint;
- Changes in gait (often, in order to avoid unpleasant sensations, patients turn their legs outward and waddle when walking from side to side, they develop a “duck” gait);
- Limping.
Over time, atrophy of the thigh muscles and shortening of the affected limb occurs. In the later stages, coxarthrosis transforms into ankylosis. Complete fusion of the femur with the pelvic bones occurs, causing the lower limb to be fixed in one position and perform only the function of support.
There are the following degrees of severity of coxarthrosis:
- The first degree is characterized by the presence of moderate pain and lack of stiffness in movements. Radiographs show a slight narrowing of the joint space and isolated bone outgrowths and osteophytes;
- The second degree of coxarthrosis is accompanied by the appearance of aching pain even at rest. Movement in the joint is difficult. The patient cannot lift or move his leg to the side. The pain intensifies when trying to turn the foot of the straightened leg to the left and right. The patient limps, and sometimes a crunching sound is heard in the hip joint. X-ray films reveal deformation of the femoral head, a narrowing of the joint space by 30% and numerous osteophytes;
- In the third degree of coxarthrosis, pain in the hip joint does not subside within 24 hours. Atrophy of the muscles of the thigh and buttocks develops. X-ray photographs reveal a deep deformation of the hip joint and a narrowing of the lumen of the gap until the bone surfaces are completely connected.
Bilateral coxarthrosis (ICD 10 code – M16.0, M16.6) is characterized by the presence of pathological changes in both hip joints. To diagnose coxarthrosis, rheumatologists at the Yusupov Hospital use an external examination, during which the doctor examines the mobility of the lower limb, evaluates the patient’s gait and appearance, and radiography. To clarify the diagnosis, magnetic resonance imaging of the hip joint is performed.
Active substances related to code M16
Below is a list of active substances related to ICD-10 code M16 (names of pharmacological groups and a list of trade names associated with this code).
- Active ingredients
- Hyaluronic acid
Pharmacological groups: Correctors of bone and cartilage tissue metabolism, Regenerants and reparants - Glycosaminoglycan-peptide complex
Pharmacological groups: Regenerants and reparants, Correctors of bone and cartilage tissue metabolism - Glucosamine
Pharmacological group: Correctors of bone and cartilage tissue metabolism - Glucosamine + Ibuprofen + Chondroitin sulfate
Pharmacological groups: NSAIDs - Propionic acid derivatives in combination with other drugs, Correctors of bone and cartilage tissue metabolism in combination with other drugs - Glucosamine sulfate
Pharmacological group: Correctors of bone and cartilage tissue metabolism - Diclofenac
Pharmacological groups: Ophthalmic drugs, NSAIDs - Acetic acid derivatives and related compounds - Diclofenac + Lansoprazole
Pharmacological groups: Proton pump inhibitors in combination with other drugs, NSAIDs - Acetic acid derivatives and related compounds in combination with other drugs - Diclofenac + Paracetamol
Pharmacological groups: Anilides in combination with other drugs, NSAIDs - Acetic acid derivatives and related compounds in combination with other drugs - Lidocaine + Tolperisone
Pharmacological group: n-cholinergics (muscle relaxants) in combination with other drugs - Tolperisone + Lidocaine
Pharmacological group: n-cholinergics (muscle relaxants) in combination with other drugs
Full Russian-language electronic version of the International Classification of Diseases, 10th revision, with changes and additions WHO 1990-2019. (current in 2021)
A temporary code for COVID-19 has been added to section U00-U49
- U07.1
Codes U00-U49 should be used to temporarily assign new diseases of unknown etiology. In emergency situations, codes are not always available in electronic systems. Category U07 specifications allow them to be used in every electronic system at any time on behalf of WHO immediately.
- Osteoarthrosis (polyarthrosis, coxarthrosis, gonarthrosis)
Drug treatment of coxarthrosis
With the help of drug therapy, rheumatologists at the Yusupov Hospital solve the following problems:
- Eliminate pain;
- Improves nutrition of articular cartilage and accelerates its recovery;
- Activate blood circulation in the area of the affected hip joint.
The goal of conservative treatment is to reduce pressure on the damaged articular head of the femur and increase the distance between it and the acetabulum, strengthen the muscles surrounding the diseased joint, and increase the mobility of the hip joint.
Rheumatologists at the Yusupov Hospital prescribe nonsteroidal anti-inflammatory drugs (NSAIDs) to patients with coxarthrosis to relieve pain and inflammation. This group of drugs includes the following drugs:
- Diclofenac;
- Ketoprofen;
- Indomethacin;
- Butadion;
- Movalis;
- Nimulid.
NSAIDs are good at reducing inflammation in the joint and eliminating pain, but they do not treat coxarthrosis itself. Scientists have proven that non-steroidal anti-inflammatory drugs, when used for a long time, can aggravate the process of destruction of cartilage tissue. There are contraindications for their use, since the drugs have side effects.
Chondroprotectors - glucosamine and chondroitin sulfate - improve the structure of the tissue and stop the destruction of the hip joint in coxarthrosis. These are substances that nourish cartilage tissue and restore the structure of damaged cartilage of the hip joint due to coxarthrosis. Unlike non-steroidal anti-inflammatory drugs, chondroprotectors do not so much eliminate the symptoms of the disease as act on the “base” of the disease.
Their use helps restore the cartilaginous surfaces of the hip joint, improve the synthesis of joint fluid and normalize its properties. Chondroprotectors are indispensable in the treatment of the initial stage of coxarthrosis, but are little effective in the third stage of the disease, when the cartilage is almost completely destroyed. To achieve the maximum therapeutic effect, rheumatologists at the Yusupov Hospital prescribe chondroprotectors in courses over a long period of time.
Rheumatologists prescribe muscle relaxants (mydocalm, sirdalud) to eliminate painful muscle spasms that often accompany coxarthrosis. These drugs eliminate muscle pain and somewhat improve blood circulation in the area of the affected hip joint. Their use requires some caution. Often, muscle spasm is a protective reaction of the body, which protects the hip joints from further destruction. If you relieve the protective muscle tension with the help of muscle relaxants, but do not take measures to save the joint from excessive pressure, the hip joint subsequently begins to deteriorate at an accelerated pace. Rheumatologists at the Yusupov Hospital use muscle relaxants in combination with chondroprotectors and joint traction. They are not used as an independent method of treatment.
The use of medicinal ointments and creams does not cure coxarthrosis. Their use sometimes significantly improves the patient's condition. For coxarthrosis, ointments that warm or irritate the skin are successfully used:
- Menovazin;
- Espol;
- Gevkamen;
- Nicoflex cream;
- Finalgon.
The irritation of skin receptors that occurs when they are rubbed stimulates the production of endorphins - our internal painkillers, which reduce pain and partially eliminate painful spasms of the periarticular muscles. Warming ointments increase blood circulation in the tissues and muscles around the affected hip joint.
Intra-articular injections of drugs for coxarthrosis are used quite rarely, since even a healthy hip joint has a narrow joint space and a small articular cavity. When, due to coxarthrosis, the gap of the hip joint narrows, it is quite problematic to introduce the medicine directly into its cavity. There is a risk of damaging the vascular and nerve trunks located along the intended needle insertion. Therefore, doctors prefer to inject drugs not into the hip joint, but into the periarticular area. Pain syndrome is eliminated with the help of periarticular injections of Kenalog, Diprospan, Flosterone, and Hydrocortisone.
Chondroprotectors (alflutop, chondrolone or homeopathic Target T) are injected into the periarticular tissues. They are used in courses over two or three years. During one course of treatment, from 5 to 15 periarticular injections of chondroprotectors are performed. These medications act on the cause of the disease, improve the condition of cartilage tissue and normalize metabolism in the hip joint. Sometimes doctors use intra-articular injections of hyaluronic acid (an artificial joint lubricant) to treat coxarthrosis. For this purpose, the drugs Ostenil, Synvisc, Fermatron, Duralan and the new domestic drug Giastat are used. Hyaluronic acid preparations are injected through the groin, directly into the hip joint itself. They are really useful, but there is a circumstance that significantly limits their use in coxarthrosis: it is quite difficult to administer the medicine exactly into the cavity of the hip joint affected by the pathological process. For this reason, rheumatologists at the Yusupov Hospital administer hyaluronic acid preparations under direct control using an X-ray machine or tomograph.
How does deforming osteoarthritis of the hip joint occur?
The hip (h/b) joint is the most powerful in the body, bearing the main load in human movement. It allows for greater mobility while maintaining stability under the pressure of the entire body weight. Such pressure is a serious test for articular cartilage, bone articulation - the acetabulum of the ilium and the articular head of the femur, which over the years leads to microdamage and degenerative changes in the joint.
Some diseases also play a role. Sometimes, for various reasons, the joint fluid changes its properties and no longer protects the cartilage well enough from friction. It becomes thinner, damaged and no longer protects the bones of the joint, which leads to their deformation. Pain appears.
This is how coxarthrosis develops. This is a severe progressive degenerative-dystrophic disease of the hip joints, often leading to loss of ability to work and disability.
Non-drug methods for treating coxarthrosis
An effective method of treating coxarthrosis is manual therapy. Doctors most often use two types of effects on the joint: mobilization and manipulation. Mobilization is a gentle traction of the hip joint, spreading the ends of the bones that articulate with each other. Manipulation is carried out in one sharp and short movement. If the manipulation is carried out in a timely manner and in the right place, it immediately brings relief to the patient, reducing pain and restoring range of motion in the hip joint. This happens during the initial manifestations of the disease.
Rehabilitation specialists at the Yusupov Hospital use hardware traction (traction of the hip joint) in the treatment of coxarthrosis to separate the articular ends of bones and reduce the load on the cartilaginous surfaces. A course of traction therapy consists of 10-12 procedures, which are carried out daily or every other day in combination with massage and other therapeutic measures. A patient with coxarthrosis is recommended to undergo 2 such courses of treatment per year.
Postisometric relaxation (stretching muscles and ligaments) is a relatively new treatment method that involves active interaction between the patient and the doctor. During the procedure, the patient tenses and relaxes certain muscles, and the doctor, while relaxing the patient, “stretches” the muscles, tendons and joints. In the treatment of coxarthrosis, post-isometric relaxation is used to eliminate painful spasmodic muscle contractions and as a procedure preceding a session of manual therapy or joint traction. Postisometric relaxation is one of the most useful procedures in the treatment of coxarthrosis of stages I and II. The method has almost no contraindications.
Rehabilitation specialists at the Yusupov Hospital use therapeutic massage as an additional method of therapy for coxarthrosis of stages I and II. Massage has the following effects on the hip joint:
- Improves blood circulation;
- Accelerates the delivery of nutrients to cartilage;
- Increases the elasticity of the joint capsule and ligaments;
- Restores the function of the synovial membrane.
Rehabilitation specialists at the Yusupov Hospital use massage for coxarthrosis in combination with post-isometric relaxation, manual therapy or traction of the hip joint.
Information
Sources and literature
- Protocols for the diagnosis and treatment of diseases of the Ministry of Health of the Republic of Kazakhstan (Order No. 764 of December 28, 2007) 1. Nasonova V.A., Osteoarthrosis. 2001; 2. Drozdov V.N., Osteoarthrosis, 2004; 3. Nasonova V.A., Muravyov Yu.V., Tsvetkova E.S., Belenkiy A.G., Osteoarthritis of the knee joint, 2003; 4. Nasonova V.A., Nasonov E.L., Alekseeva L.I., Muravyov Yu.V., Osteoarthrosis of the hip joint, 2004; 5. Nasonova V.A., Modern view of the problem of osteoarthritis, 2004; 6. Povoroznyuk V.V., Osteoarthrosis: modern principles of treatment, 2003.
Information
Physiotherapeutic treatment of coxarthrosis, diet and exercise therapy
Most physiotherapeutic procedures are unsuitable for the treatment of coxarthrosis. The hip joint lies deep, it is hidden under the thickness of the muscles, and physiotherapeutic procedures cannot radically affect the course of the disease. Physiotherapy can only bring some relief to the patient due to improved blood circulation and reflex analgesic effects.
With coxarthrosis, diseased joints lose moisture and become “dry”. Patients are advised to drink more water. To reduce the risk of edema in elderly patients, the liquid should be consumed in fractions. They are also prescribed treatment for the underlying disease that may be causing the swelling. If the patient is not prone to edema, he can drink up to two liters of non-carbonated purified water per day.
An important method of treating coxarthrosis is therapeutic exercises. Rehabilitation specialists at the Yusupov Hospital individually select for each patient those exercises that strengthen the muscles of the affected limb and the ligaments of the diseased joint, but do not force him to bend and unbend too much.
Instead of the usual fast dynamic exercises (active flexion-extension of the lower extremities), you need to do static exercises. You can lie on your stomach and slightly raise your leg, straightened at the knee, and keep it suspended. After 1-2 minutes, the patient will feel fatigue in the leg muscles, although the joints did not work in this case.
Also, the exercise therapy instructor suggests that patients very slowly raise their straightened leg to a height of 15-20 centimeters from the floor and slowly lower it. After 8-10 such slow exercises, the patient will feel tired. In case of coxarthrosis, loads on the hip joint and performing fast, energetic exercises with maximum amplitude are contraindicated. You should not swing your legs or actively squat, so as not to subject the hip joints to increased stress and to accelerate their destruction. When the first signs of coxarthrosis appear, make an appointment by phone with a rheumatologist at the Yusupov Hospital.
Hospitalization
Indications for hospitalization: severe pain, lack of effect of outpatient therapy, synovitis of the joint. The required scope of examinations before planned hospitalization: 1. X-ray of the affected segment and symmetrical joint in 2 projections. 2. General blood test (6 parameters). 3. General urine analysis. 4. Determination of C-reactive protein. 5. Reaction of Wright and Heddelson during joint production. 6. ECG. 7. Examination of stool for worm eggs. 8. Microreaction.
What is ICD?
ICD - 10 or the International Classification of Diseases, Tenth Revision, is a document accepted throughout the global medical community.
It characterizes the level of development of healthcare, which determines the comparability of diseases and medical norms of pathological processes.
This classification quickly allows you to identify the disease by group, class, type, type, nature of the course, allows you to describe the pathological process or condition so that it is clear to all doctors in the world, and accordingly it would be possible to consult with colleagues from different countries about the choice of treatment method .
The World Health Organization makes changes to the ICD every 10 years and approves the new edition.
At the moment, ICD 10, that is, the tenth edition, is relevant. With the help of ICD 10, you can very conveniently systematize and save data on all currently known pathologies, which allows you to quickly resolve the issue of treatment with doctors from all over the world.
Also, this classification allows us to combine all methodological approaches to the preparation and selection of treatment tactics.
Therefore, ICD 10 today can be called the main document of the modern healthcare system.
Classification
Coxarthrosis can affect only one or both hip joints
Coxarthrosis is classified according to the reason for its development and characteristics of the pathological process, as well as by location.
For this reason, there are three types of disease:
- post-traumatic – occurs against the background of a femoral neck fracture, bruises and other injuries of the hip joint;
- dysplastic (dysplasia) – is a consequence of congenital dysplasia of the hip joint;
- idiopathic or unspecified - a pathology the cause of which cannot be identified.
Also, dysplastic coxarthrosis can be unilateral or bilateral. There are primary and secondary coxarthrosis. Primary dysplastic coxarthrosis in ICD-10 is designated by code 16.0 (bilateral lesion) and 16.1 (only one joint is affected). The causes of primary or idiopathic coxarthrosis cannot be established; it is associated with age-related changes.
Dysplastic coxarthrosis, resulting from joint dysplasia, is designated by code M16.2. It should be noted that this form of pathology is always bilateral.
Secondary coxarthrosis is a disease that develops against the background of other pathologies, most often injuries, bruises or inflammation in the joint. In ICD-10 it was assigned codes M16.4 – M16.7.
Based on the localization of the degenerative-dystrophic process, three forms of the disease are distinguished:
- Damage to the upper structure of the joint is accompanied by acute pain, the main cause is repeated injury to the distal part of the joint.
- Damage to the central part of the joint is the most common type, in which there is a rapid increase in symptoms. Diagnosed in the early stages.
- Damage to the lower parts of the hip joint is the most severe form of pathology, since it is this part that takes part in adducting and abducting the hip back and to the side. This form is difficult to treat.
The classification of the disease according to the localization of the pathological process is not official, but is used to facilitate understanding of the essence of the pathology.
The main clinical manifestations of gonarthrosis
Osteoarthritis of the knee joint is often secondary in nature – it develops after injury. Women who suffer from varicose veins and are overweight are more susceptible to the disease. The process is often bilateral, but can also occur on one side. This, however, does not exclude initial degenerative processes in the second joint.
- The pain is felt on the inside or front of the knee.
- It makes itself felt most acutely when walking, especially on stairs.
- With active movements, a crunching sound is heard.
- Morning stiffness lasts no longer than 30 minutes.
- 30-40% experience a “drawer symptom” – weakening of the lateral ligaments of the knee joint.
Gonarthrosis develops more often in women who are overweight or have varicose veins.
Why does arthrosis cause pain?
With arthrosis of the knee joint or any other second or third degree, pain is always present. It is not associated with damage to cartilage, since there are no nerve endings in cartilage tissue. The cause of pain has a different origin:
- bone damage, for example due to the formation of osteophytes, due to osteoporosis or increased pressure in the medullary canal;
- synovitis or stretching of the joint capsule - a painful syndrome is always present against the background of secondary inflammation;
- damage to periarticular tissues - ligaments, muscles;
- anxiety, depression, other psycho-emotional factors.
Cartilage cannot hurt because it has no nerve endings.