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- Coxarthrosis (osteoarthrosis of the hip joint) and its treatment
01.11.2021 The article was checked by a traumatologist - orthopedist E.A. Baleskov. , is for general informational purposes only and does not replace specialist advice. For recommendations on diagnosis and treatment, consultation with a doctor is necessary.
Orthopedic traumatologists at the Yauza Clinical Hospital successfully treat coxarthrosis (osteoarthrosis of the hip joint), including surgery - they carry out all types of hip replacement, restoring the patient’s mobility and quality of life.
- Coxarthrosis (after arthrosis of the knee joint) ranks second in frequency among joint diseases.
- Loads ranging from 1.5 to 6 times the weight of a person are applied to the hip joint during walking and running.
- For 1-2 tbsp. coxarthrosis can be treated conservatively, at 3-4 stages. – surgery is indicated (usually hip replacement)
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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.
Causes of DOA of the hip joint
The causes and factors contributing to the occurrence of coxarthrosis may be:
- Injuries and long-term excessive loads on the hip joint (fractures, dislocations, fractures of the joint, as well as chronic permanent microtraumas in athletes, dancers).
- Congenital anomalies of the hip joint, dysplasia (up to 90% of cases), chondropathy.
- Past inflammatory process (autoimmune - rheumatoid arthritis and other systemic diseases, infectious - tuberculosis, etc.)
- Metabolic disorders
- Aseptic osteonecrosis
Most experts associate the development of coxarthrosis with impaired blood microcirculation in the joint area, caused by various reasons - sedentary work, low mobility, endocrine diseases, etc. The situation is aggravated by excess weight and curvature of the spine, which creates additional stress on the joints.
Without proper treatment, coxarthrosis leads to disability. The unbearable pain that appears at stage 4 of the disease is difficult to control even with strong painkillers. Don't let the disease change your life for the worse. Make an appointment with your doctor to get adequate treatment and stop the destruction of the joint.
Causes of coxarthrosis
Coxarthrosis is a secondary disease. It is provoked by primary pathologies that cause inflammatory processes and joint dystrophy:
- mechanical damage due to fractures and dislocations of the pelvic bones and femoral neck;
- congenital inferiority of the joint due to abnormal intrauterine development (dysplasia);
- aseptic tissue necrosis;
- bacterial infection causing arthritis, arthrosis, tendinitis, synovitis, bursitis;
- gout is a metabolic disorder of uric acid that accumulates in the joint;
- autoimmune lesions (rheumatoid arthritis);
- congenital dislocation of the hip.
Risk groups for developing the disease:
- low mobility or excessive physical activity;
- excessive body weight, obesity;
- metabolic diseases;
- hormonal imbalances;
- violation of the musculoskeletal system (scoliosis, kyphosis, flat feet).
Also at risk are patients whose parents or other close relatives suffer from severe diseases of the musculoskeletal system.
Degrees of coxarthrosis and symptoms of the disease
Symptoms of coxarthrosis usually appear in people over 40 years of age. Among them:
- Joint pain, often radiating to the groin or knee
- Gait disturbance
- Limitation of range of motion in a joint
- Muscle atrophy on the affected side
- In severe cases – disability
The severity of symptoms depends on the severity of changes in the joint.
With coxarthrosis of the 1st degree, patients feel intermittent minor pain in the joint area, occurring at the beginning of physical activity, quickly passing after a short rest. The process of going up and down the stairs is disrupted. The patient is able to work. The range of motion in the joint is fully preserved.
X-rays show minimal narrowing of the joint space, and minor bone growths are possible. The head and neck of the femur are unchanged.
Coxartosis 2nd degree . At the second stage, the pain intensifies, occurs with a slight load on the joint (when getting out of bed, standing, short walking), and radiates to the leg (hip, knee). The patient has a noticeable limp. The range of motion in the joint is noticeably limited, and the ability to work is impaired.
X-ray reveals a narrowing of the joint space by approximately 1/3, the head of the femur has an uneven contour, and the femoral neck thickens.
With grade 3 coxarthrosis, the joint hurts both during movement and at rest, sometimes preventing the patient from sleeping. Mobility is severely limited. The patient needs support when walking. In fact, he becomes disabled.
On the x-ray, the joint space is greatly narrowed, the joint is deformed - the head of the femur is irregularly shaped with an uneven contour, the neck is wide and short.
In the early stages, it is easy to miss the development of the disease. The symptoms are mild and are often taken without due seriousness. To check the condition of your joints and not miss the onset of the disease, make an appointment with your doctor and get examined at a time convenient for you.
Diagnosis of the disease
A detailed survey and clinical examination by an orthopedic traumatologist helps to identify the first signs of coxarthrosis.
The basis of diagnosis is radiography (computed tomography) of the joint. Already at the first degree of coxarthrosis, a slight narrowing of the joint space and proliferation of bone tissue are detected. Subsequently, deforming osteoarthritis of the hip joint is manifested by deformation of the head of the femur, thickening of its neck, the appearance of osteophytes (bone spines), and the narrowing of the joint space becomes more pronounced.
Magnetic resonance imaging (MRI) of the joint can reveal changes not only in bone structures, but also in cartilage tissue, ligaments, and synovium.
Laboratory tests can exclude the presence of an inflammatory process in the body and identify signs of metabolic disorders.
If necessary, a diagnostic puncture of the joint is performed followed by examination of the synovial fluid.
How to treat narrowing of joint spaces
There are several approaches to how to treat narrowing of joint spaces; for example, official medicine prefers to practice wait-and-see therapy. A patient with such a pathology is prescribed symptomatic therapy, which allows him to work fully despite the fact that the joints continue to rapidly deteriorate. At the moment when even intra-articular pain-relieving injections no longer help, an alternative method is proposed. This is endoprosthetics. During surgery, the destroyed joint is replaced with an artificial prosthesis. After a period of rehabilitation, the patient is again ready to return to his professional duties.
Manual therapy takes a completely different approach. Treatment of narrowing of the joint space with similar methods is possible only at the 1st and 2nd stages of the development of osteoarthritis. If the cartilage tissue inside the joint is already completely destroyed, then these conservative methods of therapy will no longer help you.
In our manual therapy clinic, treatment for narrowing of the joint space begins with restoring its normal lumen. Osteopathy, manual traction, etc. are used for this. Then the doctor develops an individual course for each patient aimed at restoring the normal height of the cartilaginous synovial layer.
Most often, we use osteopathy and massage to restore impaired processes of microcirculation of blood and lymphatic fluid, and restore the former elasticity of all tissues surrounding the joint. Therapeutic gymnastics and kinesiotherapy are also used - they improve the condition of the muscular frame of the body and provide adequate nutrition to all tissues of the joint. Physiotherapy, reflexology, laser therapy and much more are also used.
If you need qualified medical assistance in the treatment of narrowing of the joint space, we offer you to make an appointment right now for a free appointment with an orthopedist in our manual therapy clinic.
Treatment of coxarthrosis
Conservative therapy
In the initial stages, conservative treatment of osteoarthritis of the hip joint can be effective, individually selected depending on the specific situation: the severity of the process, age, and the presence of other diseases.
To relieve pain at any stage of DOA of the hip joint, non-steroidal anti-inflammatory drugs are prescribed. Unfortunately, they have side irritating effects on the gastrointestinal tract, and their effectiveness weakens over time.
Muscle relaxants can be used to relieve muscle tension and improve blood circulation in the joint area.
The restoration of cartilage tissue is facilitated by the use of chondroprotectors.
Hardware traction, physical therapy, physiotherapeutic treatment, manual therapy, post-isometric relaxation (the patient tenses and relaxes certain muscles, and the doctor stretches them during relaxation), osteopathy have a good effect.
Early diagnosis of the disease makes it possible to stop the development of coxarthrosis without resorting to surgical intervention. If you are worried about discomfort in your joints (even minor ones), immediately make an appointment with a specialist. This will allow you to detect the problem in a timely manner and select the most gentle treatment method.
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Surgery
Endoprosthesis replacement of hip joint
If conservative therapy is ineffective, surgical treatment of osteoarthritis of the hip joint is indicated.
The Clinical Hospital on Yauza performs the most common and effective operation today for severe coxarthrosis - hip replacement (replacing it with a modern prosthesis from the world's best manufacturers DePuy, Zimmer, Smith & Nephew, Biomet).
Other methods of surgical treatment of coxarthrosis (DOA of the hip joint):
Arthroplasty – restoration of altered bone and cartilage structures
Osteotomy - The bones that form the joint are cut and re-aligned in an anatomically correct position. This operation sometimes allows you to preserve the joint and mobility in it.
Arthrodesis is a rigid (fixed) fixation of bones in the joint area with metal staples and screws. Allows you to keep the leg as a support, but makes it motionless in the joint.
Arthrosis of the elbow joint
In the first degree, when a general narrowing of the joint space and compaction of the subchondral bone is detected, the doctor prescribes drugs to normalize blood circulation along with a vitamin complex. Along with drug therapy, the patient must perform therapeutic exercises and undergo a massage course.
In the second degree, bone growths (osteophytes) appear and a narrowing of the joint space is 2 times or more greater than normal; therefore, medications are prescribed that are injected directly into the joint, as well as drugs with analgesic, anti-inflammatory effects, and drugs for restoring cartilage tissue. Along with physical therapy and massage procedures, the doctor also recommends electrophoresis, magnetic or laser therapy. May also prescribe acupuncture.
In the third stage, medications and other treatment methods that are effective in the first two stages are used to stop the development of the disease. At this stage, the size of the joint space is so small that it is practically invisible. In addition, there is extensive proliferation of osteophytes with joint deformation, and mobility is almost completely absent. If the measures taken are ineffective for a long time, the only way out is surgical intervention.
Drug therapy includes the use of:
- drugs from the group of analgesics and antispasmodics that help relieve pain;
- non-steroidal anti-inflammatory drugs;
- topical drugs;
- drugs for intra-articular injections, which temporarily serve as a substitute for joint fluid. They are able to prevent the development of joint disease, block the destruction of cartilage tissue and ensure movement of the upper limb without feeling pain.
Carrying out a course of treatment allows you to ensure the most positive result. The treatment regimen for each patient is selected taking into account individual characteristics and the severity of the case. For some, one intra-articular injection is enough to ensure remission of the disease for a period of up to 6 months, while others require a course of 3-5 intra-articular injections, which are given once every 7 days to eliminate the patient’s problem with the elbow joint.
In the phase of exacerbation of arthrosis, any stress, massage procedures, and physiotherapy should be excluded, since they can increase the pain syndrome. Only after the severity has subsided, treatment with medications is supplemented with massage, physical therapy exercises, and the use of physiotherapeutic techniques.
Treatment should be carried out under the supervision of a physician. But in the patient’s area of responsibility, it is important to realize that therapy for a disease such as arthrosis of the elbow joint must be on an ongoing and systematic basis. Omissions, non-compliance with doctor’s recommendations, and violation of the medication regimen threaten the patient with undesirable consequences.