Coxarthrosis and hip surgery

Coxarthrosis is a complex degenerative disease of the hip joints (HJ), characterized by the progressive destruction of articular cartilage with subsequent deformation of the end elements of the articulating bones. The pathology is accompanied by severe pain, gait disturbance, and inhibition of motor and support functions of the lower extremities. In terms of incidence rate in the structure of all joint diseases, this pathology ranks 2nd after gonarthrosis of the knee joint. And in terms of its ability to cause disability, it leads.

This is the head of the hip joint affected by coxarthrosis of the 3rd degree.

According to international statistics, out of 100% of pathologies of the musculoskeletal system, 12% are coxarthrosis. Moreover, if previously it was customary to consider problems of this kind with hip joints mainly to be the lot of old people, now the disease is increasingly affecting young people. And what’s most disappointing is that with a diagnosis of coxarthrosis, surgery often becomes the only treatment option.

And this is a comparison of an absolutely healthy head of the femur (on the left) with one affected by coxarthrosis (on the right).

Surgery on the hip due to degenerative-dystrophic lesions is a necessary measure in advanced pathogenesis. Only through surgical intervention in the last stages of the disease is it possible to restore lost motor abilities and eliminate pain. In other words, to bring the quality of life of a person who has been suffering for years from unbearable pain and physical limitations as close as possible to normal.

What the boundaries of cartilage tissue look like in a healthy joint and one affected by coxarthrosis.

In various sources you can find different medical names for this pathology: arthrosis, osteoarthrosis, coxarthrosis, and the word “deforming” may be added. In fact, all these terms carry the same meaning - pathological degradation and destruction of the structural elements of the joint. But, if we are talking about hip joints, it would be more correct to call the disease coxarthrosis.

Anatomy of the hip joint

Before talking about the development of the disease and surgery, it is important to understand the anatomical features of the most important bone connection, on the health of which, one might say, the fate of a person depends. After all, failure of the hip joint negatively affects the biomechanics of not only the legs, but also the entire locomotor system, which often leads to disability. Having coxarthrosis of the hip joint, surgery is inevitable in some cases. And you yourself will understand a little later why. So, first things first, let's start with anatomy.

The joints are securely hidden behind the tendons; they are correctly called “joint capsules”.

The hip joint is the largest joint in the body. It is formed by two articulating bones - the femur and the acetabulum of the pelvis. The femoral head is located in the cup-shaped depression of the pelvic bone, where it moves freely in different directions. Thanks to this interaction of two bone elements, the following is ensured:

flexion and extension;
adduction and abduction;
hip rotation.

Rear part.

The surfaces of interacting bones are covered with a special elastic layer called hyaline cartilage. A special elastic coating allows the head to slide smoothly and unhindered, thanks to which a person moves freely and does not experience problems during physical activity. In addition, cartilage performs the functions of stabilizing the hip joint and cushioning every movement.

Attention! The main reason when surgery is recommended: coxarthrosis in an advanced state with persistent pain and critical impairment of motor abilities. Destroyed cartilage cannot be restored by special medications such as chondroprotectors, intensive physiotherapy, all kinds of intra-articular injections and expensive ointments. For pain syndrome, NSAIDs are also useless. All these remedies can have a positive effect only in the initial phase of the disease.

The joint structure is placed in a durable case - the joint capsule. Inside the capsule there is a synovial membrane that produces a specific fluid. It lubricates the cartilaginous covers of articular bones, moisturizes and enriches with nutrients, which maintains cartilage structures in excellent condition.

Outside the capsule lies a supra-articular group of femoral and pelvic muscles, thanks to which, in fact, the joint is set in motion. In addition, the largest joint covers a fan of various ligaments that perform a regulatory function, preventing excessive movement of the hip, more than the physiological norm.

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Goals of therapy and its effectiveness

Treatment of coxarthrosis without surgery has the following goals:

Relief of acute inflammatory process in the affected joint tissues.
Normalization of metabolism in cartilage tissue.
Improving overall mobility of the hip joint.
Strengthening the muscles of the sore joint.
Slowing down the progression of coxarthrosis.
Normalization of intra-articular fluid levels.
Relieving the patient of excruciating pain.

An integrated approach to therapy, including:

carrying out long-term drug therapy;
physiotherapeutic treatment;
therapeutic exercises;
massage;
diet therapy.

Drug treatment

Classical drug therapy is aimed at comprehensively improving the patient’s condition and ridding him of the characteristic signs of the development of the disease. The following medications are prescribed:

Drug group	Therapeutic effect	The most effective representatives of drugs
NSAIDs	Anti-inflammatory drugs are prescribed for active inflammation, accompanied by swelling, redness of tissue, high fever and pain. The advantage of these drugs is their rapid effect, but the disadvantage is their negative impact on the functioning of internal organs.	Diclofenac, Ketoprofen, Indomethacin, Piroxicam, etc.
Vasodilators	The drugs can relax and dilate blood vessels, which will improve blood circulation and relieve spasms. The downside of such medications is the high risk of allergies after treatment.	Trental, Teonicol
Chondroprotectors	Means for restoring cartilage tissue. Such drugs are especially effective in the initial stages of coxarthrosis. In advanced forms of the disease, they need to be taken for a long time	Chondroitin, Glucosamine, Rumalon
Muscle relaxants	The action of the drugs is aimed at relaxing muscle structures	Mydocalm
Hormonal steroids	Prescribed as injections into the diseased joint. The drugs act directly in the affected area, eliminate inflammation, relieve pain and normalize the structure of cartilage	Hydrocortisone, Kenalog
Local remedies	Ointments, gels and creams with anti-inflammatory and analgesic effects	Diclak, Diclofenac-gel

Physiotherapy

Therapeutic exercises are an effective method of treating coxarthrosis, however, with stage 3 of this disease, it can be difficult and very painful for the patient to perform even the simplest exercises. The attending physician must select an individual training set for the patient.

Gymnastics is useful even if it does not help heal the joint. By improving muscle tone, there is a greater chance of recovery after surgery.

Exercises for the treatment of coxarthrosis improve blood circulation, nutrition of cartilage and restore their overall structure. Do the following exercises:

The patient needs to lie on his back and put his legs straight. Next, slowly raise one leg and hold it in this position. Do the same with the other leg.
Contract the muscles of the thighs and buttocks.
Lie on your back and bend your leg at the knee.
Sit down and straighten your legs. Without getting up, you need to reach your feet with your hands.
Squeeze a large fitness ball with your feet while sitting and standing.

Therapeutic gymnastics has contraindications, so not all patients can perform it. Basic prohibitions:

period of menstruation in women;
hypertension in aggravated form;
elevated temperature;
the period after a recent stroke or heart attack;
acute heart failure;
period after recent surgery;
acute diseases of internal organs;
acute respiratory diseases;
severe pain;
high blood pressure.

Physiotherapy

Physiotherapy can be used during coxarthrosis as an auxiliary treatment. The most effective physiotherapeutic procedures:

Procedure name	Efficiency
Ultrasound treatment	Elimination of muscle tension, relief of pain and stiffness in the joint
Magnetotherapy	Slowing down the process of joint destruction, restoring cartilage, improving the immune system and blood circulation in the joint
Laser therapy	It has a powerful analgesic effect on the sore joint. The method helps improve metabolism and blood circulation in tissues
Mud therapy	Elimination of inflammation
Radio wave baths	Saturation of cells with nutrients and oxygen, increasing tissue permeability to microelements

Sanatorium treatment is an excellent way to slow down the destruction of the cartilage shell. But it requires regularity (at least 2 times a year).

Massage

Therapeutic massage is prescribed to patients at all stages of coxarthrosis. For stage 3 disease, massage treatment has the following features:

It is necessary to carry out massage with parallel drug therapy;
You can practice massage either on your own at home or with the help of a professional;
during the massage, a person should avoid putting stress on the sore leg;
massage should be combined with exercises in the pool, gymnastics;
During a massage, you need to rub not only the thigh, but also the lumbar region.

Massage allows you to relieve pain and accumulated tension in the hip area.

Properly performed massage improves blood circulation, joint mobility, and normalizes the condition of cartilage tissue.

Physiotherapeutic treatment should be practiced with caution in elderly patients and people who suffer from acute diseases. Direct contraindications to such procedures are the period of pregnancy and lactation, since these treatment methods negatively affect the process of bearing a child.

When is surgery necessary?

If a person has been admitted to a doctor with an already advanced type of coxarthrosis, and traditional drug therapy has proven ineffective, the patient is indicated for surgical treatment.

Stage 3 coxarthrosis - surgery cannot be avoided.

Indications for surgery are severe pain, loss of mobility, and development of bone necrosis.

Surgery is a way to completely get rid of pain, lameness and restore range of motion.

The main treatment method for coxarthrosis is total hip arthroplasty and long-term antibiotic therapy in the presence of an infectious process in the body.

Surgery can be avoided in most cases. To do this, a person should see a doctor in time if signs of illness appear.

Diet principles

The progression of coxarthrosis is directly related to metabolic disorders. The diet during such treatment should maximally saturate the body with all microelements useful for cartilage and bone tissue.

Recommended products for grade 3 coxarthrosis:

Fermented milk products (cottage cheese, kefir, milk, sour cream).
Cheese.
Jellies and jellied meats.
Boiled fish.
Dietary meat.
Fruits and vegetables.
Homemade juices.
Nuts.
Honey.
Greenery.
Cereals (buckwheat, oatmeal).
Dried fruits.

At the 3rd degree of the disease, it no longer matters what to eat; It's more important to lose weight.

Dishes in the diet should be served boiled or baked. The patient should forget about fatty, fried, salted and smoked foods for a long time. It is not recommended to consume the following foods for coxarthrosis:

sweets in the form of cakes, pastries, chocolate;
fresh bakery;
sweet carbonated drinks;
coffee;
salty fish;
semi-finished products;
fast food;
salt;
hot sauces;
sausages;
alcohol.

Drinking regime plays an important role in a restorative diet. A person needs to drink at least 2 liters of pure water per day without gas, compotes or dried fruit decoctions. White or green tea is considered very beneficial.

A sick person needs to eat 5-6 times a day, but the portions should be average. If a patient is overweight, his diet should be adjusted by a nutritionist or gastroenterologist.

What happens to the joint during coxarthrosis?

The hip joint bears the bulk of the loads, so it is easily injured and prone to rapid wear when unfavorable factors occur. This explains the high prevalence of the disease. Unfortunately, many patients turn to doctors in the late stages of arthrosis disorders, when functional capabilities have irreversibly dried up. Therefore, do not bring coxarthrosis of the hip joint to stage 3: the price of your carelessness, when surgery becomes the last chance, will result in disability.

Under the influence of negative phenomena, the synthesis of synovial fluid is disrupted. It is produced in catastrophically low quantities, and its composition changes. Thus, cartilage tissue constantly receives less nutrition and becomes dehydrated. The cartilage gradually loses its former strength and elasticity, exfoliates and decreases in volume, which makes unhindered and smooth gliding impossible.

Take a close look at the photo of the right joint; this is what happens to the joint when surgery is not done on time.

Thus, the interarticular gap narrows, increased pressure and increased friction are formed between the articulating surfaces of the thigh and pelvis, as a result of which the cartilage is even more injured and worn out. Which, naturally, significantly depresses the biomechanics of the joint: the joint becomes stiff, unstable, and uncontrollable. Every movement is given to a person with difficulty and pain.

Over time, the hyaline layer disappears altogether, the bone endings are exposed, and a colossal load is formed on the bone joint. During movements, bone structures interact in their pure form, without a protective coating. They press on each other, causing them to become deformed, in other words, flattened, touching muscle tissue and causing a pain reaction in the groin area and along the lower limb, sometimes radiating to the buttock. At a conscious level, a person, in order not to experience pain again, tries in every possible way to avoid movements of the joint, which negatively affects the condition of the muscles.

Image of the pelvic bone.

With such pathological changes, motor resources are eventually exhausted, problems with movement are further aggravated, and lameness appears. Surgery is required in the final stages, when coxarthrosis is accompanied by complete disappearance of the interarticular space.

Important! Delayed treatment is fraught with atrophy of the corresponding muscle group, serious deformations of the articulating bones and the formation of numerous marginal osteophytes. Osteophytic growths and extremely distorted forms of the hip joint lead to persistent pain and complete disability.

Preventive measures

The following recommendations will help reduce the progression of coxarthrosis:

You should keep your weight under control and follow a diet to correct it.
Regularly engage in therapeutic exercises and preventive sports (swimming, skiing, yoga).
Contact a doctor when the first pain in the hip appears in order to be able to promptly identify the disease and begin its treatment.
Timely stop inflammatory and infectious foci in the body, which may increase the risk of developing coxarthrosis.
Practice self-massage.
To refuse from bad habits.
Take chondroprotectors regularly (as prescribed by your doctor).
Strengthen the muscular system.
Avoid heavy lifting and other excessive physical activity.
Avoid hypothermia.

Causes of degenerative pathogenesis

The disease is of primary and secondary types. In the primary type, the circumstances of its occurrence are still unclear to medicine, that is, the lesion develops spontaneously and for no apparent reason. The secondary type of pathology becomes a consequence of injuries, poor lifestyle, and certain ailments. Various factors can influence the development of this disease and trigger a destructive mechanism, most often these are:

consequences of injuries - local fractures, dislocations, bruises, ligament damage, chronic microdamages, etc.;
excessive physical activity;
sedentary and sedentary lifestyle;
excess body weight;
long-term infections in the body;
rheumatoid arthritis;
smoking abuse;
age-related aging of the body;
hormonal imbalance and endocrine pathologies, especially diabetes;
metabolic diseases;
congenital anomalies of hip joint development (dysplasia, congenital dislocation);
any problems with the spine;
genetic predisposition.

There is a direct relationship between excess weight and the likelihood of joint problems.

Diagnostic measures

To establish an accurate diagnosis, the doctor prescribes the following differential diagnostic procedures:

MRI of the diseased joint or CT;
Ultrasound of the affected joint;
general clinical blood and urine tests;
radiography.

Based on the research results, the doctor will determine the changes that are characteristic of each individual stage of coxarthrosis. The doctor also needs to collect the patient’s life history and symptoms.

Sometimes, for complex joint deformities, MRI is used for diagnosis.

If complications are suspected, an abdominal ultrasound and detailed biochemical blood and urine tests may be prescribed. The attending physician can refer the patient for consultation to a therapist, surgeon, neurologist, or osteopath.

Treatment is selected for each patient individually, based on the severity of the pathology, the person’s age, the presence of complications and concomitant serious diseases.

What is offered to patients at stage 3 of coxarthrosis?

Traditionally, in advanced forms of coxarthrosis, patients are recommended to undergo hip replacement. This is a radical way to relieve a person from pain - expensive, lengthy, and requiring long rehabilitation. One of the surgical options is arthrodesis. The articular bones are fixed with metal staples to completely immobilize the supporting anatomical structure.

After total endoprosthetics, the patient undergoes long-term rehabilitation. During this period, it is very important to follow all recommendations, otherwise there will be a need for repeated intervention. If prosthetics are contraindicated, surgeons may recommend osteotomy - temporary fusion in the desired position of artificially broken hip bones. However, there are other, more gentle options.

Even at stage 3 of coxarthrosis, it makes sense to take a course of Noltrex intra-articular injections, which will help avoid complex surgery. The drug is injected into the joint, it expands the rubbing surfaces and restores the viscosity of the joint fluid. The hip joint is again able to absorb the load, so the pain during movement goes away. After 12-18 months, the course is repeated.

Noltrex is a good alternative to joint surgery in old age

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Degrees of coxarthrosis

Degenerative-dystrophic disease, like any other pathology, has degrees of development. Coxarthrosis has only three of them, each of which is characterized by the presence of certain changes.

Coxarthrosis 1st degree

With coxarthrosis of the 1st degree, a relatively moderate reduction in the joint space is observed, accompanied by the growth of bone tissue over the entire surface of the joint.

There are no pathological changes on the surfaces of the femur.

Coxarthrosis 2nd degree

With grade 2 coxarthrosis, the gap between the articular bones is significantly narrowed, which is more than 50% less than the generally accepted indicator. Pathological processes cause displacement of the femur, which is accompanied by deformation of its head, which significantly increases in size and becomes covered with numerous irregularities along the contour.

At this stage of development, bone growths appear on all surfaces of the acetabulum, not limited to cartilage.

Coxarthrosis grade 3

Coxarthrosis of the 3rd degree is characterized by a sharp deviation in functional indicators, as well as a strong reduction in the gap between the bones of the joint. In addition, there is a pronounced expansion of the femoral head, as well as numerous bone growths.

Prognosis and possible complications

Only stage 1 degenerative-dystrophic disease is amenable to successful conservative treatment. In other cases, there can be no talk of complete restoration of the functional activity of the hip joint, excluding cases of installation of an endoprosthesis.

In the absence of treatment, at the final stage of development of pathological processes, the patient develops limited mobility of the flexion type joint, which makes it impossible to move due to a constantly bent limb.

After complete fusion, the patient is unable to independently solve basic everyday issues and is assigned the status of a disabled person.

Symptoms of the disease

Symptoms of the second stage of coxarthrosis:

Pain that can be sharp, aching or stabbing. It often bothers a person when walking or even at rest at night.
Lameness due to joint deformation.
A sharp limitation of the motor functions of the hip joint due to narrowing of the joint space, the formation of osteophytes, and cartilage damage.
Atrophy of muscles, which, in the absence of load on the limb, quickly lose tone.
The photographs clearly show the deformation of the head of the joint and the unevenness of its outline.
Due to inflammation, high body temperature, swelling, and weakness are possible.

The main symptom is always the same - pain.

Disability with coxarthrosis in the second degree can occur in the event of complete loss of motor functions of the hip joint. This is a direct indication for surgery.

What therapeutic methods do most orthopedists prefer?

Orthopedists in different countries, with different experience and qualifications, make choices depending on the clinical picture of each patient. But there are also “favorite” treatment methods that are preferred in most cases. To quickly relieve pain, non-steroidal anti-inflammatory drugs are mainly used in a short course. Among chondroprotectors, the latest generation of drugs are in particular demand.

As a basic treatment method, orthopedists most often choose intra-articular injections of synovial fluid prosthesis. In the older age group, this is sometimes the only possible option, since the cardiovascular system in old age is not ready for general anesthesia, and not everyone agrees to undergo long-term rehabilitation. It is much easier, faster and safer to take a course of 2-4 injections - and get rid of pain for a year - than to undergo surgery.

Whatever therapeutic method the orthopedist chooses, he will always recommend reviewing the diet, as well as adding the right, complex carbohydrates to it, which will provide the body with energy. In the fight against chronic joint disease, it will never be superfluous!

Advantages and disadvantages of superficial endoprosthetics

This method is preferable because it allows you to save most of the hip joint. Therefore, it is practiced among young patients who have not yet experienced serious degenerative changes in bone tissue. But it also has disadvantages.

After the operation, an intensive accumulation of metal ions begins in the body, which enter the blood and gradually poison it. This poses a particular danger to patients with kidney disease, as well as young women.
Over time, metal surfaces rubbing against each other wear out and break down, causing new problems to arise.
People who have undergone superficial arthroplasty surgery are at risk for fractures of the upper third of the femur. This outcome occurs especially often with severe degenerative processes in tissues and against the background of osteoporosis, for example after menopause.

Metal joints often “jam” due to wear on the surfaces