Arthritis (deformed joints, coxarthrosis, osteoarthritis) is a slow progressive degenerative-dystrophic disease that ultimately leads to destruction of the affected joint, persistent pain, and limitedmovement.
The disease affects people over 40 years old. Women are infected several times more than men.
In the general structure of joint disease, dry joint disease of the hip joint plays a key role. This is due to the extensive congenital pathology of the hip joint (dysplasia), as well as the considerable physical activity that these joints suffer.
Risk factors and causes of dry hip disease
In the pathological mechanism of the development of hip arthritis, the main role belongs to changing the physicochemical properties of the synovial fluid (in the joint), so it becomes denser and viscous. than. This reduces its lubricating properties. As they move, the cartilage surfaces start rubbing together, becoming rough, and cracks appear. The small particles of the hyalin cartilage break apart and enter the joint cavity, causing aseptic (non-infectious) inflammation in it. As the disease progresses, bone tissue is attracted to the inflammatory process, resulting in aseptic necrosis of areas of the femoral cap and the surface of the tibia, the formation of osteoporosis (bone growth), which increases the condition. inflammation and intense pain during exercise.
At the level of late hip osteoarthritis, inflammation spreads to the surrounding tissues of the joint (vessels, nerves, ligaments, muscles) leading to signs of periarthritis. As a result, the hip joint is completely destroyed, loss of function, movement in it stops. This condition is called adhesions.
Causes of hip arthritis:
- congenital hip dislocation;
- hip dysplasia;
- aseptic necrosis of femoral head;
- Peters' disease;
- hip injury;
- inflammatory arthritis of the hip joint;
- gonarthrosis (degenerative deformity of the knee);
- bone necrosis;
- overweight;
- professional sports;
- flat feet;
- curvature of the spine;
- sedentary lifestyle.
The condition is not inherited, but the child inherits from his parents the structural features of the musculoskeletal system, which can cause hip dryness under conditions conducive to this. This explains the fact of the survival of families, the rate of disease is higher than the general population.
Types of diseases
Depending on the etiology, degenerative hip disease is divided into primary and secondary. Secondary joint disease develops against the background of other diseases of the hip or joint injuries. The primary form is not related to the previous pathology, the cause of its development is often not determined, in this case they talk about idiopathic arthritis.
Coxarthrosis is one side or two sides.
Stages
During hip degeneration there are three stages (degrees):
- Initial changes - pathology is not noticeable, as long as they are promptly and appropriately treated, they are reversible.
- Progressive coxarthrosis is characterized by a gradual increase in symptoms (joint pain and impaired mobility), changes in joint tissue that have been irreversible, but therapy can delaydegenerative process.
- Eventually - movement in the joint is lost, forming the ankle joint. Can only be treated with surgery (replacing a joint with an artificial joint).
Orthopedic surgery in 95% of cases helps to completely restore the mobility of the limbs, restore the working capacity of the patient.
Symptoms of hip arthritis
The main signs of hip arthritis:
- pain in the groin, hips, and knees;
- feeling stiffness in the affected joint and limited mobility; lame
- ; lead limit
- ;
- changes atrophy of the muscles of the thigh.
The presence of several symptoms of hip arthritis, as well as their severity, depends on the severity of the disease.
In grade I degenerative hip disease, the patient complains of pain arising under the influence of physical activity (walking, running long) in the affected joint. In some cases, pain is localized in the knee or thigh. After a short rest, the pain should go away on its own. The range of movements of the limbs is completely preserved, the gait is not disturbed. The radiograph shows the following changes:
- slightly uneven decrease in the lumen of the joint cavity;
- osteogenic cells are located along the inner edge of the acetabulum.
No changes were detected in the neck and top of the femur.
With degree II hip degeneration, pain occurs at rest, even at night. After exertion, the patient begins to limp, forming a characteristic "duck" gait. So-called pain begins to appear - after a long period of inactivity, the first few steps cause pain and discomfort, then go away, then come back after a long time. The range of motion of the affected joint is limited (kidnapping, inner rotation). X-rays showed that the joint cavity was not evenly narrowed and its lumen was 50% of normal. The bone cells are located along both the inner and outer edges of the arachnoid cavity, beyond the border of the cartilage lip. The contours of the femur cap become uneven due to deformation.
With grade III degeneration of the hip joints, the pain is constant and intense, and doesn't stop at night. Walking was significantly difficult, the patient was forced to use a cane. The range of motion in the affected joint is sharply limited, after which it is completely stopped. Due to atrophy of the thigh muscles, the pelvis is deflected in the anterior plane and the limbs shorten. Trying to compensate for this shortening, when walking, the patient is forced to deviate from the body towards the injury, which increases the load on the diseased joint. X-rays revealed more bone development, significantly narrowed joint space, and a marked increase in the femur tip.
Diagnosis
The diagnosis of osteoarthritis is based on data on clinical images of the disease, physical examination results and instrumental studies, of which the most important are imaging-imaging methods. X-ray, computer or magnetic resonance. They not only allow to determine the presence of fibrosis of the hip joints and evaluate its extent, but also to identify the possible cause of the disease (trauma, juvenile diarrhea, Peters disease). .
Differential diagnosis of hip degeneration from other diseases of the musculoskeletal system is difficult. In grades II and III of hip arthritis, muscle atrophy develops, which can cause severe pain in the knee joint, characteristic of gonitis or gonarthrosis (knee diseases). To make the differential diagnosis of these conditions, knee and hip joint palpation is carried out, their motion mass is determined, and they are also examined by X-ray.
In spinal pathologies, in some cases, compression of the nerve roots of the spinal cord occurs with the development of pain syndrome. Pain can spread to the area of the hip joint and mimic the clinical picture of the injury. However, the nature of pain in lens syndrome is slightly different from that of hip arthritis:
- Pain
- occurs from lifting heavy objects or sudden sudden movement and not being affected by exertion;
- The pain is localized in the buttock area, not the groin.
With lens syndrome, the patient can safely move the leg to the side, while with degenerative hip disease, kidnapping is limited. A characteristic sign of lens syndrome is a positive symptom of stress - sharp pain when the patient lies on his back to lift his legs straight.
Osteoarthritis affects people over 40 years old, women several times more sick than men.
Synovial bursitis should be differentiated from trochanteritis. Trochanteric bursitis develops faster, over a few weeks. Usually, it precedes physical activity or significant trauma. The pain of this disease is much more obvious than that of hip arthritis. At the same time, the limbs are short and limited in its motor ability to be detected.
The clinical picture of atypical reactive arthritis and ankylosing spondylitis may resemble the clinical manifestations of hip arthritis. However, the pain occurs in patients mainly at night or at rest, while walking does not increase but decrease. In the morning, the patient noticed the stiffness of the joints, which disappeared after a few hours.
Treatment of degenerative hip joints
Orthopedists treating hip arthritis. With degrees I and II of the disease, conservative treatment is indicated. With severe pain syndrome, patients are prescribed nonsteroidal anti-inflammatory drugs in a short course. Do not take them for a long time, as they not only have the ability to adversely affect the organs of the digestive tract but also prevent the regeneration of hyalinic cartilage.
The fibrosis of the hip joints includes protective drugs and vasodilators, providing optimal opportunities for repair of damaged cartilage tissue. With severe muscle spasms, central muscle relaxants may be required.
In case pain syndrome cannot be ended with nonsteroidal anti-inflammatory drugs, they must resort to corticosteroid injections in the joints.
Local treatment of the hip joint using warming ointment can reduce muscle spasm and partly alleviate the pain with its distracting effect.
Physical therapies are also used in the complex treatment of hip arthritis:
- magnetotherapy;
- induction heat;
- UHF; laser therapy
- ;
- ultrasound treatment;
- massage;
- medical gymnastics;
- manual therapy.
Dietary food for hip arthritis that aims to regulate body weight and normalize metabolism. Losing weight reduces stress on the hip joints and thus slows the progression of the disease.
To relieve stress on the affected joint, the doctor may recommend the patient to go on crutches or a cane.
In the case of grade III hip joints, conservative treatment is ineffective. In this case, improving the patient's condition and returning the patient to normal mobility is only possible through surgical intervention - replacing the damaged joint with an artificial joint (joint replacement).
Potential consequences and complications
The most serious complication of progressive degenerative hip joint disease is disability due to loss of joint mobility. With bilateral coxarthrosis, the patient loses the ability to move independently and requires constant external care. Long lying in bed in a position that sets the stage for the emergence of congestive pneumonia (decreased veins), is difficult to treat and can lead to death.
The condition is not inherited but the child inherits from the parents the structural features of the musculoskeletal system, which can cause dryness of the hip joints.
Forecast
Osteoarthritis is a progressive, chronic disease that can only be completely cured in the early stages, as long as the cause is eliminated. In other cases, therapy may slow its course; however, over time, it is necessary to implant a hiposcopy. Such surgeries in 95% of cases help to completely restore the limb motor ability, restore the working capacity of the patient. The lifespan of modern restorations is 15-20 years, after which they must be replaced.
Precautions
Prevention of osteoarthritis aims to eliminate the possible causes of the development of this disease, and includes:
- promptly detect and treat diseases and injuries of the hip joints;
- refuses a sedentary lifestyle, regular but not excessive physical activity;
- controls body weight;
- reasonable nutrition;
- give up bad habits.