Osteoarthritis of the hip is a progressive dystrophic-degenerative disease. Most often, it develops in old age, when provocative factors arise - infectious, non-inflammatory diseases of the joints, trauma, genetic predisposition, curvature of the back.
Coxarthrosis is another name for hip arthrosis, the treatment of which is very complex, long-term, first conservative, then surgical. The main symptom of the disease is pain, restriction of movement; in later stages, shortening of the diseased limb and atrophy of the femoral muscles occurs.
However, the term osteoarthritis has recently been removed and now the disease is referred to as joint osteoarthritis. Previously, osteoarthritis was considered not an inflammatory process, but now inflammation is also recognized in osteoarthritis. As in all the theory of aging, interleukins are secreted by various cartilage structures and cause inflammation, which results in its degeneration, i. e. , cracking and breakdown. And therefore, there is no osteoarthritis now, there is only osteoarthritis.
The disease itself is not inherited, but such characteristics provoke its development as weakness of cartilage tissue, various metabolic disorders, genetic features of skeletal structure can be transmitted from parents to children. Therefore, the risk of developing osteoarthritis of the joints in the presence of this disease in the other family increases.
However, the main causes of hip arthrosis are concomitant diseases:
As the disease progresses slowly, it can be unilateral and bilateral. Factors contributing to osteoarthritis:
The main diagnostic methods are MRI and CT, radiography. MRI data give a more accurate picture of the soft tissue condition, and CT scan of bone tissue pathology, clinical signs, and symptoms of hip arthrosis are also considered. It is very important to determine not only the presence of pathology, but also the degree of osteoarthritis and the reasons for its occurrence.
For example, if the changes in the images are related to the proximal femur, then this is a consequence of Perthes disease, if the cervico-diaphyseal angle increases and the acetabulum flattens significantly, this is hip dysplasia. You can also learn about x-ray injuries.
The main symptoms of osteoarthritis of the thigh joints are as follows:
At this stage of the disease, a person experiences pain only during and after a physical exertion, from running or prolonged walking, while the joint itself aches mainly, very rarely the pain radiates to the hip or knee. Also, a person's gait is normal, no lameness is noticed, the thigh muscles are not atrophied. When diagnosed, bone growths are seen on images, which are located around the inner and outer edges of the acetabulum, other pathological disorders in the neck and femoral head are not noticed.
In the case of grade 2 arthritis of the hip joints, the symptoms become significant and the pain already becomes more constant and stronger, both at rest and during movement, it radiates to the groin and thighs, with the loadthat the patient is already lame. There is also a limit to hip abduction, the range of motion of the hip is reduced. In the photograph, the narrowing of the gap becomes half the norm, bone growths are found on both the outer and inner edges, the femoral bone head begins to grow, deform and shift upwards, its edges becoming uneven.
At this stage of the disease, the pain is painful and constant, day and night, it becomes difficult for the patient to move independently, so a cane or crutch is used, the range of motion of the joint is severely limited, atrophy of the muscles of the lower leg, thigh and buttocks. The leg is shortened and the person is forced to tilt the body as he walks towards the injured leg. Shifting to the center of gravity increases the load on the damaged joint. X-ray images show multiple bone growths, the femoral head widens, and the joint space is significantly narrowed.
To avoid surgical intervention, it is very important to make the correct diagnosis at the right time, to differentiate osteoarthritis from other diseases of the musculoskeletal system - reactive arthritis, trochanteric bursitis, etc. In 1 and 2 degrees of osteoarthritis, treatment should be carried out in a complex, conservative medicine, meduke using manual therapy, therapeutic massage, therapeutic exercises, but only under the supervision of a qualified orthopedist.
Combining all treatment measures should solve several problems at once:
For this today there is a large selection of different NSAIDs - non-steroidal anti-inflammatory drugs, which, although relieving pain, but do not affect the development of the disease, can not stop the process of tissue destructionto cartilage. They have a number of serious side effects, the long-term use of which is also unacceptable for the fact that these agents affect the synthesis of proteoglycans, contributing to the dehydration of cartilage tissue, which only worsens the condition. Of course, it is unacceptable to endure pain, but pain relievers should be used with caution, under the supervision of a physician, only during periods of disease exacerbation.NSAIDs include: celecoxib, etoricoxib, texamen, nimesulide, naproxen sodium, meloxicam, ketorolac tromethamine, ketoprofen lysine, ketoprofen, ibuprofen, diclofenac.
Local remedies for osteoarthritis deformity such as warming oils are not very therapeutic, but they reduce pain by acting as a distraction and partially relieving muscle spasm.
Chondroprotective agents such as glucosamine and chondroitin sulfate are important drugs that can improve cartilage condition, but only in the early stages of the disease. A complete description of these drugs in tablets, injections, lotions, at average prices and treatment courses in the article arthrosis of the knee joints. To improve blood circulation, to reduce the spasm of small vessels, vasodilators are usually recommended - cinnarizine, pentoxifylline, xanthinol nicotinate.
Muscle relaxants, such as tizanidine and tolperizone hydrochloride, can only be prescribed for strict indications. Using them can have both positive and negative effects, muscle relaxation on the one hand reduces pain, improves blood circulation, but on the other hand, muscle spasm and tension - there is a protective reaction of the body and its removal can accelerate the destructionof joint tissue.
Hormonal injections are performed only with synovium, ie the accumulation of fluid in the joint cavity. Once, and no more than 3 times a year (methylprednisolone, hydrocortisone acetate). Hormonal agents relieve pain and inflammation, but have a pronounced immunosuppressive effect and their use is not always justified. More is more convenient to inject into the thighs with chondroprotectors - chondroitin sulfate, 5-15 procedures 2-3 times a year. Intra-articular injections of hyaluronic acid are also indicated - this is an artificial lubricant for the joints.
Physicians' opinion on the effectiveness of these procedures is divided into supporters and opponents, some consider their implementation justified, others meaningless. Perhaps laser therapy, laser magnetic therapy and it makes sense for hip arthrosis, many doctors do not find other procedures needed to treat this disease, as the hip joint is a deep joint and many such procedures simplyare unable to achieve the goal and are a waste of time, beat and possibly funds for the patient.
Professional massage, hip joint traction (hardware traction), manual therapy, physiotherapy exercisesAll these therapeutic measures are very useful in the complex therapy of the disease, they help strengthen the muscles surrounding the joint, increase its mobility and, when properly combined with medication treatment, can help increase the distance from the head to the cavity and reduce the pressure on the femoral head. This is especially true for physiotherapy exercises, without its competent selection and regular implementation outside of exacerbations, it is impossible to achieve a real improvement in the patient's condition.
If the patient is overweight, then, of course, diet can help reduce the load on the injured joint, but it has no independent therapeutic effect. Doctors also recommend the use of canes or crutches, depending on the degree of joint dysfunction.
For grade 3 osteoarthritis, doctors always insist on surgical intervention, as a damaged joint can only be restored by replacing it with an endoprosthesis. According to the indications, a bipolar prosthesis is used, which replaces both the head and the nest, or a unipolar prosthesis, which changes only the femoral head without the acetabulum.
Today such operations are performed quite often, only after a thorough examination, in a planned manner under general anesthesia. They ensure a full restoration of hip function with competent and careful implementation of all postoperative measures - antimicrobial therapy with antibiotics and a rehabilitation period of about six months. Such prostheses for the hip joint last up to 20 years, after which they need to be replaced.