Arthritis of the hip joint - cannot be ignored!

Wear of the hip joint occurs faster than wear of other joints due to the large loads it bears. Excess weight, illness, injury, and heavy physical activity accelerate the destruction process. At the initial stage of the disease, damage to cartilage tissue is manifested by periodic pain in the joint area; with the deterioration of the condition of the tendons and joint tissues, the pain syndrome increases, and restrictions in movement appear. If treatment is not started on time, the patient may require endoprosthetics.

The Yusupov Hospital provides care to patients with diseases of the musculoskeletal system. After a diagnostic study and clarification of the diagnosis, the doctor prescribes medication; in severe cases, surgery is performed. In the rehabilitation department of the Yusupov Hospital, the patient will be able to restore the motor activity of the joint using physiotherapeutic techniques, and develop the joint using physical therapy.

Causes of coxarthritis

The development of hip arthritis can be triggered by a wide range of factors, which include:

• injury to the pelvis, lower extremities, or specifically the hip joint (for example, dislocation or subluxation, fracture of the femoral head);
• congenital or acquired anomalies of the structure of the musculoskeletal system (hip dysplasia, flat feet, rickets, Perthes disease);
• hereditary predisposition (in particular, for rheumatoid and psoriatic arthritis);
• overload of the hip joint (in runners, heavyweights and other professional athletes, as well as overweight people and representatives of “standing” professions);
• diseases of the spine (lordosis, kyphosis, scoliosis and others);
• problems with blood circulation in the hip joint;
• infectious diseases (specific - for example, osteoarticular tuberculosis, brucellosis, borreliosis, gonorrhea, syphilis, hepatitis and general - for example, chlamydia, other genitourinary and intestinal infections, phlegmon, ostiomyelitis, furunculosis, otitis media, tonsillitis, pneumonia);
• hormonal changes and disorders associated with malfunctions of the endocrine system, menopause;
• age-related changes in joints;
• poor nutrition and other factors that cause a deficiency of vitamins and minerals in the body;
• metabolic disorders (diabetes mellitus, gout, hemochromatosis);
• autoimmune diseases (rheumatoid arthritis, systemic lupus erythematosus and others);
• alcohol and coffee abuse;
• unfavorable environmental or working conditions;
• frequent hypothermia (general or specifically in the pelvis and lower limbs);
• animal and insect bites;
• diseases of the nervous system, frequent or chronic stress.

Types of coxarthritis

Depending on the symptoms and causes, arthritis of the hip joint is usually classified as follows:

• Rheumatoid arthritis
  . This is a systemic disease in which the patient's own immune cells attack his cartilage and bone tissue. In RA, lesions of the hip joint are usually symmetrical (affecting both joints) and are often accompanied by inflammation of other joints. The disease sharply worsens under stress, allergies, overheating or hypothermia, physical and emotional overload. This is a chronic disease that requires lifelong treatment and management.
• Reactive arthritis
  . Always occurs as a result of infection - acute or chronic (for example, tonsillitis, cystitis, and so on). Most often, reactive arthritis of the hip joint causes ascending urinary tract infections, less often - descending intestinal infections. The causative agents of the disease include: ureaplasma, salmonella, chlamydia, mycoplasma, dysentery bacillus. Reactive arthritis is especially common among boys and men with reduced immunity and a history of recent infections. The acute phase of the disease must be stopped quickly - otherwise it can irreparably destroy the joint or part of it, and also become chronic.
• Post-traumatic arthritis
  . Injuries can be open or closed, single or repeated. Sports, household, and professional injuries, as well as disorders of the joint and soft tissues caused by surgery, require immediate treatment. This type of disease is the most unpredictable - changes and pain in arthritis of the hip joint due to injury can grow for years, or can progress quickly within 2-3 weeks.
• Gouty arthritis
  . A chronic form of arthritis associated with the deposition of uric acid salts in the joints. These crystals injure the cartilage lining and soft tissues when moving, causing constant irritation and inflammation. The disease requires lifelong treatment with diet.
• Psoriatic arthritis
  . It occurs as a secondary inflammatory disease against the background of psoriasis (usually advanced). It affects not only the hip, but also other joints (polyarthritis).
• Degenerative-dystrophic arthritis
  , which is also called
  arthrosis-arthritis
  . Appears due to wear and tear of synovial cartilage. In the absence of healthy gliding and shock absorption in the joint, chronic inflammation of the joint capsule occurs, which is accompanied by joint deformation and the appearance of osteophytes (bone outgrowths) that impede movement in the joint. Doctors associate it with disruption of healthy metabolic processes in cartilage tissue, as well as with endocrine pathologies.

Signs of hip arthritis

The symptoms of hip arthritis and arthrosis are very similar. To distinguish them, it is important to understand the mechanism of destructive changes in these diseases. With arthrosis, the joint fluid is produced in insufficient quantities, which is why the surface of the synovial cartilage begins to wear off, crack and lose its shock-absorbing properties. Symptoms of hip arthritis are caused by the fact that synovial fluid is produced in excess. This manifests itself in swelling, inflammation, poor blood circulation and nutrition of the cartilage. The type of disease also influences the nature of pain in hip arthritis and arthrosis. With arthrosis, they increase after physical activity, incl. static, dehydration, and with arthritis - at rest, especially in the morning.

It is important to consult a doctor when you notice the first signs of hip arthritis

The “classic” signs of hip arthritis include:

• acute pain when walking, sudden voluntary movements and pulsating, bursting or shooting pain - in a calm state;
• pain from hip arthritis may radiate to the hip, knee, outer thigh, buttock, or groin area;
• stiffness (as if the joint was “covered”), which persists until warm-up, deterioration of mobility in the joint, numbness, regular crunching during sudden movements;
• lameness, careful stepping and other gait disturbances;
• redness and warmth of the skin over the joint;
• muscle weakness (trembling legs, muscle twitching);
• later, noticeable swelling and deformation of the joint appears;
• muscular dystrophy and shortening of the diseased limb are observed in the later stages of the disease or with tuberculous arthritis.

It is impossible to ignore the symptoms and treatment of arthritis of the hip joint - this is fraught with necrotic processes in the bone with destruction of the joint, severe diseases of the knee joints, the load on which increases, and bursitis (inflammatory processes in the synovial bursae).

Methods for diagnosing coxarthrosis

An orthopedist, rheumatologist, and surgeon are involved in the diagnosis and treatment of pathology. A set of laboratory and instrumental methods is carried out to accurately determine the diagnosis.

Radiography

Thanks to the study, the stage of development of the pathological process is determined. The pictures show the changes:

• destruction of the hip joint;
• narrowing of the joint space;
• deformation of the articular surface of the bones;
• osteophytes.

The picture is taken only in 1 projection, so it is difficult to determine the full picture.

CT scan

Different projections of the articular cavity and surrounding tissues are determined. Changes are detected:

• degree of thickening of the bone structure;
• damage to hyaline cartilage;
• condition of the ligamentous apparatus, tendons;
• damage to nerves, muscles, blood vessels during extensive inflammatory processes and bone destruction.

CT is a method that simultaneously determines the condition of hard and soft tissues.

Magnetic resonance imaging

The affected area is scanned layer by layer. The doctor determines the condition of the joint, ligaments, muscles, nerves, blood vessels, and bones. This is the most informative method for diagnosing diseases of the musculoskeletal system. Violations are detected:

• difficulty in blood supply to tissues using MRI with the addition of a contrast agent;
• degree of damage to bones and ligaments;
• proliferation of fibrous tissue.

Doctors advise that if coxarthrosis is suspected, an MRI should be performed, but it is not available in all clinical institutions.

When to see a doctor

Coxarthrosis is a rather serious and, most importantly, irreversible disease of the hip joints; if not treated in a timely manner, it can threaten a person with complete disability.

The first manifestations of coxathrosis often do not cause concern in the patient. A slight pain in the joint after exercise is attributed to overexertion and fatigue. Usually, after rest, the unpleasant sensations go away and the person calms down, which is completely wrong. Already at this stage you should contact a specialist.

By catching the disease in the first stages and receiving qualified treatment, you can significantly extend the time of full functioning of the hip joints, maintain their performance and improve a person’s well-being.

Treatment of coxarthrosis

Only a doctor can determine whether a person has coxarthrosis. Home treatment requires the patient to fulfill the following requirements:

• Weight loss;
• Balanced diet;
• Maintaining a drinking regime (2 liters of water per day);
• Reducing the load on the joint (cane while walking);
• Performing a complex of exercise therapy.

With the second degree of the disease, the person should be sent to a hospital, since now the treatment methods will be more intensive. In addition to medications, laser therapy, ultrasound treatment and electrophoresis will be required. Physical therapy must be carried out under the supervision of a specialist. This stage of treatment is more long-term and relief does not come immediately.

If the disease is already diagnosed at the third stage, or despite the therapeutic measures taken, the patient’s condition has only worsened, more serious measures may be used. At this stage, they resort to surgical methods. The joint is completely replaced with a prosthesis. Endoprosthetics today is a fairly common way to get rid of coxarthrosis.

The dentures take root within one or two months. How quickly this happens is influenced by many factors, including the patient’s age, his physical condition at the time of surgery, and the correct implementation of all doctor’s recommendations. Usually, a prosthesis returns a person to his former mobility, relieves pain, and allows him to lead a normal life. The standard service life of a prosthesis is 15-20 years.

Recovery period

Such a serious operation as endoprosthetics requires patience from the patient during restorative procedures. Restrictions apply during this period:

• Complete cessation of sports activities;
• Elimination of physical stress on the joint;
• Walking only with crutches (2 months);
• Prohibition on dangerous exercises (sudden bending, squats).

In the first days after surgery, all movements should only be under the supervision of medical staff. For good wound healing and implantation of the prosthesis, you must follow all the doctor’s recommendations.

Usually, after full recovery, a person does not experience any particular pain, he can return to his usual lifestyle, play sports, and go hiking.

Advice from experts

Whatever degree of coxarthrosis a person has, it is worth following the general rules:

• After sitting for a long time, take a short walk;
• Do not lie in one position for a long time (on your side or back);
• Perform therapeutic exercises selected by specialists;
• Watch your weight.

Stages of hip arthritis

There are 3 stages of coxarthritis:

• Stage 1
  arthritis of the hip joint. There may be no pain; joint ill health can be noticed by minor manifestations - for example, discomfort when moving, crunching, morning stiffness. After warming up, the joint functions normally and does not cause problems during short walking. Discomfort with stage 1 arthritis of the hip joint can completely go away and recur after a long stay in one position, climbing stairs, etc.
• Stage 2
  arthritis of the hip joint. Pain in the joint appears or intensifies, which persists for a long time. The joint hurts at night and in the morning, which can affect the quality of sleep. With stage 2 arthritis of the hip joint, changes in gait appear (especially with fatigue), and the endurance of the affected limb decreases. Involuntary spasms may occur. Swelling is often observed.
• Stage 3
  arthritis of the hip joint. The pain plagues the patient almost constantly, and the pain syndrome covers the entire thigh. The range of motion in the joint is severely limited, the muscles become thinner. Lameness caused by inflammation and even shortening of the limb (in every 10th patient) due to joint deformation is noticeable. In this situation, treatment usually requires surgery.

Diagnosis and treatment of hip diseases at the Yusupov Hospital

Timely diagnosis of hip disease is an important component of successful therapy. To identify pathologies, the diagnostic center of the Yusupov Hospital uses European equipment, which ensures high accuracy of results.

For diseases of the hip joint, conservative treatment is a priority. The therapy program for these disorders includes massages, physical therapy classes with experienced instructors, and physiotherapeutic activities. These services are offered by physiotherapists and exercise therapy trainers at the rehabilitation clinic of the Yusupov Hospital.

To get rid of unpleasant symptoms, patients are prescribed painkillers. When using them, it is important for the patient to understand that painkillers do not affect the cause of the disorder, therefore, to eliminate it, chondroprotectors, intra-articular injections and means to normalize blood circulation are prescribed.

The clinic accepts patients in serious condition with intense symptoms around the clock. Each patient has the opportunity to receive a free consultation, for which it is necessary to make an appointment by calling the Yusupov Hospital.

Treatment of hip arthritis

Arthritis of the hip joint is treated comprehensively, and its chronic forms are treated consistently and for life. Treatment of hip arthritis involves pharmacotherapy and physiotherapy, the use of orthopedic devices, and physical therapy. In advanced cases, when drug treatment for hip arthritis does not help, the doctor may prescribe prosthetic surgery.

Drug treatment for hip arthritis

In the treatment of hip arthritis, medications are used to relieve pain, relieve inflammation, improve tissue nutrition, and improve tissue regeneration.

Drug treatment helps relieve inflammation and improve regeneration

Drugs for treating hip arthritis include:

• Nonsteroidal drugs (NSAIDs)
  - relieve pain and inflammation. These are nimesulide, paracetamol, meloxicam, ibuprofen, ketoprofen and others.
• Steroid (hormonal) drugs
  - radically reduce inflammation and pain if NSAIDs are ineffective. These are prednisolone and methylprednisolone, hydrocortisone, mazipredone, triamcinolone.
• Cytostatic and immunosuppressive agents
  . Although they have primarily an antitumor effect, they are used for rheumatoid arthritis. These are sulfasalazine, metypred, methotrexate, cyclosporine.
• Analgesics
  . Dexalgin, askofen, indomethacin, movalis are used for pain relief for arthritis of the hip joint. You can also use ointments and gels - Nicoflex, Voltaren, Diclofenac, Fastum-gel and others.
• Chondroprotectors
  - for better regeneration of cartilage tissue. These are artracam, artracam, alflutop, teraflex, arthra.

In case of infection, drugs for the treatment of arthritis of the hip joint are selected individually for the specific pathogen - this can be rovamycin, cephalosporins and others.

Physiotherapy for hip arthritis

In the early stages of hip arthritis (1st-2nd), physiotherapy plays a major role along with medications. The following methods for treating hip arthritis are most effective:

• phonophoresis;
• electrophoresis;
• ultrasound therapy;
• magnetic therapy;
• shock wave therapy;
• hirudotherapy;
• myostimulation;
• ozone therapy;
• radon and mud baths;
• paraffin applications.

Physiotherapy for hip arthritis is an effective treatment modality

After removing the disease from the acute phase, the following is used to eliminate the symptoms of arthritis of the hip joint:

• manual therapy;
• massage;
• physical therapy (physical therapy for arthritis of the hip joint)
• mechanical traction (stretching) of the joint, muscles and ligaments.

Surgical treatment of hip arthritis

In the treatment of hip arthritis, minimally invasive techniques are predominantly used - for example, puncture (a puncture in which excess fluid is removed from the joint capsule).

In later stages of the disease, synovectomy and endoprosthetics may be required. Synovectomy is a complete or partial excision of the joint membrane, which is performed for autoimmune, infectious and degenerative diseases of the hip joint. If necessary, the lost tissue is replaced with prostheses.

Joint endoprosthetics involves the complete or partial replacement of the head of the hip bone. Often this is the only way to restore mobility to the joint and the patient to be able to move painlessly again. Rehabilitation after surgical treatment of hip arthritis usually takes 3 months, during which time it is necessary to walk on crutches.

Treatment

Help before diagnosis

In case of severe injuries, it is necessary to fix the joint by applying a splint from the foot to the armpit. For minor traumatic injuries, it is enough to rest the leg. Cold is applied to the affected area. For intense pain, an analgesic is given. You cannot make active movements of the limb or put any weight on the leg. It is strictly forbidden to try to eliminate dislocation or displacement of bones.

Tactics for non-traumatic diseases are determined by symptoms. For minor manifestations, it is permissible to ensure limb rest and use local agents with analgesic and anti-inflammatory effects. In case of fever, weakness, severe pain, rapid increase in edema and hyperemia, it is recommended to immediately seek specialized help.

Conservative therapy

Dislocations are an indication for immediate reduction. For fractures, skeletal traction is usually applied, and patients are subsequently operated on or the limb is fixed in a plaster cast after signs of callus appear. In elderly patients with femoral neck fractures, immobilization with a derotational boot is allowed, preventing rotational movements in the joint.

Other patients are advised to unload the hip joint. According to indications, it is recommended to use orthoses or additional devices (crutches, canes). Prescribe massage, physical therapy, physiotherapeutic procedures:

• laser therapy;
• magnetic therapy;
• UHF;
• ultrasound;
• electrophoresis with drugs;
• UVT.

It is possible to use NSAIDs, chondroprotectors, and antibacterial drugs. Local agents are widely used. According to indications, joint punctures, intra- and periarticular blockades with hormones, intra-articular injections of chondroprotectors, and synovial fluid substitutes are performed.

Surgery

Surgeries on the hip joint are performed through open access and using arthroscopic equipment. Depending on the type of pathology, the following can be performed:

• Traumatic injuries
  : open reduction of hip dislocation, reconstruction of the acetabulum, osteosynthesis of the neck, trochanteric fractures.
• Degenerative processes
  : arthrotomy, arthroscopy, removal of loose intra-articular bodies.
• Tumors
  : removal of neoplasia, bone resection, disarticulation of the hip joint, interiliac-abdominal amputation, interiliac-abdominal resection.

For contractures, ankylosis, scarring of periarticular tissues, redressing, arthroplasty, and arthrodesis are performed. An effective way to restore limb function in diseases of various origins, accompanied by limitation of movements or destruction of the joint, is endoprosthetics.

Gymnastics for hip arthritis

Gymnastics for arthritis of the hip joint is performed mainly while lying on your back or stomach. At first, it is advisable to supervise the instructor. Here is an example of a short complex of exercise therapy for arthritis of the hip joint, which will help control the disease:

1. Stand up straight. Smoothly move your leg in a circular motion without overloading the joint. Repeat 8 times. Then make soft alternating leg swings from the same position.
2. Stand up straight and place your hands on a tabletop or other surface. Do a shallow half squat and straighten up. Up to 10 times. Perform exercises for arthritis of the hip joint without sudden movements.
3. Stand up straight and smoothly rise on your toes, feeling how your thigh muscles tighten. Gently lower your entire foot.
4. Lie on your back with your feet on the floor. Hold your leg under your knee with both hands and try to gradually pull your knee towards your stomach. 7-10 times.
5. Lying on your back, bend your knees and place them first to one side and then to the other. 7-10 times.
6. In a gentle mode, perform the “bicycle” exercise. Approximately 1 minute, until fatigue appears—gymnastics for arthritis of the hip joint do not need to be done through force.

We wish your joints health!

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