Partial hip subluxation can occur at any age. Previously, it was believed that this condition is characteristic only of infants in the first year of life and is provoked by dysplasia of cartilage tissue. In the last decade, doctors have reconsidered their attitude to this problem. It turned out that subluxation of the femoral head occurs long before the destruction of the cartilage fiber begins. And this is precisely what causes the development of deforming osteoarthritis in 28% of clinical cases.
What is hip subluxation and how does it manifest? To understand the essence of the problem, you must first become familiar with some aspects of the anatomy of this bone articulation. The hip joint is formed by the head of the femur, located on a small neck. The head fits into the acetabulum of the ilium. The ilium is attached to the sacrum by means of a joint. Thus, there is always mechanical and shock-absorbing tension between the iliosacral and hip joints.
The hip joint has a wide range of mobility: abduction and adduction of the leg, flexion and extension, rotation, etc. Due to this, a stretch of the articular capsule is created, resulting in instability of the position of the femoral head in the acetabulum. Free movement of this structural part entails weakening of the surrounding ligamentous apparatus and provokes secondary destruction of the cartilaginous synovial layer. With sudden movements with excessive amplitude, a change in the position of the femoral head in the articular cavity may occur. This is what subluxation is. It differs from a full dislocation in that the integrity of the articular capsule is preserved and the head of the femur does not completely leave the cavity of the acetabulum.
Hip subluxation can be stable, fixed or habitual. In the first case, after displacement, the head of the femur retains its new position and is fixed by the formation of scar deformations in the cartilaginous and ligamentous tissue. She cannot return to her physiological place on her own. With habitual or unfixed subluxation, constant rotation of the femoral head occurs, it moves and returns to its place. This situation is much more dangerous for the condition of the entire bone articulation. The joint capsule is stretched and the supply of synovial fluid to the cartilage tissue decreases. Due to mechanical friction, the cartilaginous synovial membrane disintegrates and the bone surfaces begin to crack.
When the first signs of incorrect position of the femoral head in the cavity of the acetabulum appear, you should consult an orthopedist or chiropractor as soon as possible. These doctors will be able to provide conservative care and restore the functionality of the bone articulation.
In Moscow, you can make an appointment for a free appointment with an orthopedist at our manual therapy clinic. An experienced doctor will make an accurate diagnosis and tell you about the possibilities of treatment without surgery.
Causes of hip subluxation
In early infancy, hip dysplasia most often causes subluxation of the femoral head. But you should not think that if such an injury did not occur in childhood, then in adulthood a person is reliably insured against this. Not at all. If he had congenital or acquired dysplasia of the cartilage tissue of the hip joint in infancy, then he is at risk for various pathological changes in this bone joint.
First of all, it is worth understanding that dysplasia does not go away without a trace. The thinned synovial cartilaginous layer in the affected areas persists throughout life. Such people have incorrect foot placement, non-physiological position of the femoral heads in the acetabulum, and often there is compensatory torsion and rotation of the pelvic bones.
All these pathologies do not attract much attention, since they practically do not manifest themselves externally. Therefore, even during medical examinations, doctors do not pay attention to existing risk factors.
In old age, subluxation of the hip joint often occurs due to coxarthrosis, since not only cartilaginous synovial tissue is destroyed, but also bone tissue. The level of fixation decreases and deformation of the ligamentous and tendon apparatus occurs.
Other potential causes of hip subluxation include:
- excess body weight, which provokes increased pressure on the articular surfaces and provokes their displacement relative to each other;
- incorrect positioning of the foot in the form of flat feet and clubfoot;
- valgus or varus curvature of the legs, femur;
- femoral neck deformity;
- heavy physical labor with constant stress on the muscles of the back and lower extremities;
- deforming osteoarthritis of the knee joint;
- curvature of the spinal column and poor posture;
- osteochondrosis of the lumbosacral spine, in which the patient is forced to spend a long time in an unnatural forced position;
- dystrophy or atrophy of muscle fiber;
- cicatricial deformations of ligamentous and tendon fibers after sprains and ruptures;
- hip replacement surgery;
- stretching of the joint capsule;
- fractures and cracks of the femoral head, its neck or articular acetabulum.
All these reasons should be excluded. Also, one should not discount the possibility of developing rheumatoid damage to cartilage tissue in the articular form of ankylosing spondylitis, systemic lupus erythematosus, scleroderma, polyarthritis, etc. Rare causes of subluxation of the femoral head are tumors and infectious lesions of the soft tissues of the bone articulation.
General information about the disease
Degenerative-dystrophic degeneration of the hip joint, called coxarthrosis, develops more often in people aged 40 years and older. Injuries, specific joint diseases, and systematic physical overload lead to earlier development of the disease. According to statistics, a more frequent development of pathology in women is noted, which is due to serious anatomical stress during pregnancy and childbirth.
Coxarthrosis is characterized by a gradual course. At an early stage of the disease, the joint can be completely restored only by conservative methods. In advanced stages, recovery is impossible; the result of treatment is to slow down or stop the destruction of the joint capsule, maintain mobility, and relieve pain.
How to Identify Hip Subluxation (Signs and Symptoms)
The first signs of hip subluxation are a feeling of stiffness, limited mobility and pain that occurs when performing certain movements. For example, a characteristic symptom of hip subluxation may be the inability to sit down without support from foreign objects. A person cannot pull his leg towards his body. Or, on the contrary, it is impossible to move your leg to the side. Any restrictions in mobility are symptoms of hip subluxation.
It is quite false to isolate the clinical symptoms of subluxation of the hip joint against the background of traumatic exposure. Characteristic signs of sprain or rupture of ligament and tendon fibers, bone fractures, etc. come to the fore. But it is important to remember that any injury can negatively affect the condition of the joint capsule. It is characteristic that with traumatic etiology, subluxation is almost always not fixed. This is an unstable condition that is very difficult to diagnose. But at the same time, instability of the position of the femoral head is a very dangerous condition.
How to determine hip subluxation at home:
- sit on a chair with your knees apart; if you feel like something is bothering you, consult a doctor;
- do a squat, if this is not possible, then you need help;
- lie on your back and bring your legs, bent at the knees, to your chest, if you can do this, there is no subluxation in this plane.
This is only part of the diagnostic functional tests. The rest you can go through with an orthopedist in our manual therapy clinic during a free initial appointment.
We strongly recommend that you consult an orthopedist if you periodically experience clicking in the hip joint area, tension in the surrounding muscles, your legs get tired quickly, you are unable to perform certain movements, if a feeling of stiffness and mobility provokes pain.
All these signs may indicate some pathology in the area of this bone articulation. It is better to start treating it at an early stage. Therefore, do not wait until the pain becomes unbearable and you lose the ability to move independently. Seek help in the early stages of the disease.
Symptoms of hip replacement instability
Even during the consultation with the attending physician, the patient should be explained possible side effects and complications after surgery. The surgeon himself must foresee such negative consequences based on diagnostic data during the examination of the patient. Incorrect selection of an individual prosthesis can lead to its failure within five years after installation. Repeated endoprosthesis surgery can be avoided if all precautions are followed and actions that could damage the stability of the implant are not performed.
The following signs of instability of the hip joint endoprosthesis can be identified:
- The occurrence of permanent aching pain in the joint both during walking and at rest. Often the pain intensifies closer to night (during sleep).
- Loss of support for the artificial joint.
- General weakness in the lower extremities, fatigue when walking.
Most patients are mistaken in believing that the symptoms listed above are the result of the effects of surgery, which will go away on their own within a short time. in fact, everything is much more complicated. It is advisable to consult a specialist as soon as possible and undergo diagnostic procedures that will show whether repeated surgery is required.
The thing is that the installed implant affects the movements of the hip joint, both during total endoprosthetics and when replacing only part of the damaged joint. As a result, the process of bone tissue restoration may slow down. Loosening of the prosthetic leg in most cases leads to the development of local osteoporosis. Thus, the mobility of the endoprosthesis itself is limited.
Unfortunately, modern scientific and laboratory research has not been able to identify a material for prostheses that would cause absolutely no harm to human health. As a result of friction of the implant components against each other, tiny particles settle in the surrounding tissues, causing infectious processes and tissue death. Local blood circulation may also be impaired. Therefore, when the first signs of loosening of the hip joint endoprosthesis appear, you should immediately seek help from your doctor.
Before treating hip subluxation
It is very important to conduct a high-quality differential diagnosis before treating hip subluxation. During this procedure, the doctor must determine the plane of displacement of the femoral head and the degree of its instability. It is also very important to establish the exact cause of this condition. If the cause is not eliminated, then any, even the most effective treatment, will not give a positive and lasting result.
Diagnosis begins with an examination by a doctor. The orthopedic surgeon performs a manual examination and a series of diagnostic functional tests. This allows you to understand how unstable the articulation of the bones is. Then a dynamic x-ray is prescribed. It is very important to carry out radiographic examination with changes in the position of the lower limb. As mentioned above, a subluxation can be unstable, so displacement of the femoral head can only be detected dynamically.
An MRI examination may be required to establish the exact condition of all tissues of the hip joint. Ultrasound, electromyography, and a number of blood tests may also be indicated. A precise plan for a diagnostic examination is drawn up by a doctor based on data obtained during the initial examination of the patient.
Methods for treating joint implant instability
Timely diagnosis and treatment will help to avoid serious consequences. In this case, it will be possible to quickly normalize and stabilize the process of bone tissue restoration. This will also have a positive effect on the process of integration of the prosthesis into the human body.
Temporary walking with crutches may be prescribed as a preventative measure. At the same time, a course of taking appropriate medications is prescribed. In some cases, the patient will be recommended certain physical exercises for the lower extremities.
Treatment of hip subluxation
Before adjusting a subluxated hip joint, the doctor must make sure that there are no contraindications for this manipulation. You should not perform the reduction yourself. Cartilage and bone tissue can be damaged. When reducing an old subluxation, severe pain is possible and anesthesia is required.
Treatment for hip subluxation involves complete restoration of all damaged tissues:
- it is necessary to restore the elasticity of the joint capsule and thereby prevent the possibility of re-injury in the future;
- it is necessary to increase the performance of the ligamentous apparatus and, if necessary, remove cicatricial deformities;
- it is recommended to increase the tone of the surrounding muscle tissue to securely fix the head of the femur in the cavity of the acetabulum and ensure complete diffuse nutrition of the cartilage tissue;
- it is important to restore the functionality of damaged areas of synovial cartilage tissue covering the articular surfaces of bones to eliminate the risk of developing deforming osteoarthritis.
Our manual therapy clinic uses effective and safe techniques. When reducing a subluxation, the osteopath first gently prepares all the tissues. Relaxes overly tense muscle fibers, increases the elasticity of the ligamentous and tendon apparatus. After reduction, an individual course of treatment is developed. It may include:
- osteopathy to completely restore the process of blood supply to tissues and the movement of lymphatic fluid;
- massage to increase muscle tone and improve the elasticity of all tissues;
- therapeutic exercises and kinesiotherapy to restore the performance of muscles, ligaments and tendons;
- physiotherapy, reflexology and much more.
The course of treatment is developed for each patient individually. If you suspect a hip subluxation, schedule a free appointment with an orthopedist at our chiropractic clinic.
Diagnosis of prosthesis instability
When the first symptoms of instability of the hip joint endoprosthesis occur or before they appear, it will not be superfluous to undergo a course of diagnostic measures. The doctor will prescribe the following types of examination:
- X-ray examination of the hip joint;
- analysis of the state of bone tissue and its density using the densitometry method;
- analysis of metabolic processes in bone tissue.
In some cases, the appointment of the above measures occurs immediately after surgery. Of particular danger is the initial presence of osteoporosis in the patient, since it is this feature of the bone tissue that can provoke instability of the prosthesis after installation.
Minimally invasive endoprosthetics in the Czech Republic: doctors, rehabilitation, terms and prices.
Find out more
Non-surgical therapy
As part of the treatment of cystic formations, patients are prescribed NSAIDs to relieve pain and inflammation, as well as puncture. The latter are therapeutic manipulations, the essence of which is to insert a puncture needle into the cavity of the cyst under local anesthesia and CT control. Through it, the liquid contents of the neoplasm are removed, and then the cavity is washed with saline and aminocaproic acid, anti-enzyme agents and corticosteroids are administered.
The number of punctures is determined in each case individually based on the size of the hip cyst and its response to the treatment. Usually, 6-10 procedures are enough to regress the formation.
To increase the effectiveness of conservative therapy, patients may be prescribed physiotherapy and exercise therapy. Treatment of the disease that provoked the development of a hip joint cyst is mandatory.