Musculoskeletal disorders are affecting more and more people every year and their development at a young age is increasingly being observed. This is being facilitated not only by lifestyle changes, but also by an increase in injuries, which are largely interrelated. One of the most common pathologies of the musculoskeletal system is osteoarthritis of the hip joint, which is characterized by the appearance of progressive pain and reduced mobility. Ultimately, the disease can lead to complete immobility of the joint and disability. In order to avoid the occurrence of such undesirable consequences, it is important to start treating osteoarthritis as early as possible. And if in the early stages of development it can be stopped by conservative methods, then with serious changes it is possible to restore the functions of the hip joint and get rid of unbearable pain only with the help of high-tech surgery.
What is osteoarthritis of the hip joint
Osteoarthritis of the hip joint is a chronic degenerative-dystrophic disease that leads to gradual destruction of the hip joint. At the same time, all its components are gradually involved in the pathological process, but hyaline cartilage is especially affected, which leads to narrowing of the joint space and deformation of its other components. More often, pathological changes only occur in one hip joint, but both can be affected at the same time.
The hip joints are the largest in the human body because they carry the most stress during the day. They are each formed by the femoral head and the hip socket, a bowl-shaped depression in the pelvis. Both surfaces are covered with smooth, moderately elastic hyaline cartilage. It ensures that the femoral head moves easily and unhindered in a natural depression, thus enabling movements in different planes.
The movement of the hip joint is provided by a muscle group connected to it by fascia. It is also surrounded by ligaments whose role is to limit its mobility within physiological limits and ensure the stability of its position.
The entire joint is surrounded by a joint capsule covered with a synovial membrane. Its main task is the synthesis of synovial fluid, which lubricates the adjacent parts of the hip joint and at the same time serves as a nutrient carrier for it. From the synovial fluid, the hyaline cartilage covering the head of the femur and the surface of the acetabulum constantly receives components for the formation of new cells, i. H. the regeneration. This is extremely important for this cartilage structure, which wears down with every movement of the hip, but is usually rebuilt immediately. However, with injuries or under the influence of other factors, this does not happen, which leads to the development of arthrosis of the hip joint, i. e. H. Thinning and destruction of his hyaline cartilage.
As a result, in the ideally smooth cartilage, deformed areas are formed, which increase as the pathology progresses. Grinding down exposes the surfaces of the bones that make up the joint. When they come into contact, there is a characteristic crunch and severe pain. This provokes the formation of osteophytes, and at the final stage of development, the femoral head completely fuses with the acetabulum, making any movement in the hip joint impossible.
At the same time, arthrosis of the hip joint can provoke the development of various inflammatory processes in the joint, including:
- Bursitis - inflammation of the synovial bag;
- tendovaginitis - an inflammatory process in the sheath of the tendon sheath of the muscles;
- Tunnel Syndrome - Compression of nerves causing pain radiating along the pinched nerve.
The reasons
One of the most common causes of the development of osteoarthritis of the hip joint is mechanical damage, not only direct injuries, but also micro-damages caused by the destructive effect of excessive loads. One of the most common causes of the development of the disease is a femoral neck fracture.
It leaves the femur at an angle of 120° and connects it to the head. The presence of osteoporosis greatly increases the likelihood of a hip fracture, but this type of injury can also be the result of a traffic accident, a fall from a height, an impact, etc.
A femoral neck fracture can be accompanied by aseptic necrosis of the femoral head, which becomes the trigger for the development of degenerative-dystrophic changes in the joint. The presence of dysplasia or subluxation of the hip joint, tears of its ligaments, transcondylar fractures or fractures of the acetabulum also create favorable conditions for damage to its structures. In such situations, post-traumatic arthrosis of the hip joint is diagnosed.
Post-traumatic hip osteoarthritis is common in professional light and weight lifters, skydivers, loaders, and skaters.
The development of osteoarthritis of the hip joint after injury is due to a violation of the congruence (comparability) of the articular surfaces, a decrease in the quality of blood supply to the joint components, and prolonged immobilization. As a result of prolonged immobility, there is not only a deterioration in blood circulation in the fixed area, but also a shortening of the muscles, a decrease in their tone. The likelihood of post-traumatic arthrosis increases significantly if an inappropriate situation or untimely treatment is carried out, which leads to the preservation of defects of varying severity. The risks of their development also increase if the joint is loaded too early and exercise therapy is insufficient, even if it is too intensive, started late or, conversely, early.
Sometimes the disease occurs after surgical procedures on the hip joint due to scarring and additional tissue trauma. However, in some cases, surgery is the only way to eliminate the consequences of the injury.
Excessive loads can also provoke changes in the hip joint as it leads to microtrauma. Regular tissue damage activates the process of dividing chondrocytes (cartilage cells). This is accompanied by an increase in the intensity of the production of cytokines, which are normally produced in small quantities. Cytokines are inflammatory mediators, in particular the cytokine IL-1 leads to the synthesis of specific enzymes that destroy the hyaline cartilage of the hip joint.
In addition, high loads can cause microfractures of the subchondral plate. This leads to its gradual compaction and the formation of bone growths on the surface, called osteophytes. They can have sharp edges and cause more damage to the joint and surrounding tissue.
The subchondral plate is the outermost part of the bone that is in direct contact with the hyaline cartilage.
In some cases, it is not possible to determine exactly what provoked the development of degenerative-dystrophic changes in the hyaline cartilage of the femoral head and acetabulum. In such situations, idiopathic or primary arthrosis of the hip joint is diagnosed.
Today it has been established that the tendency to develop can be inherited, i. e. H. The presence of this pathology in close relatives significantly increases the likelihood of developing arthrosis of the hip joint. It probably has a polygenic inheritance, i. H. its development depends on the presence of many genes. Each of them individually creates mild conditions for the development of the disease, but in combination it becomes a matter of time, especially when leading a sedentary lifestyle and obesity or, conversely, hard physical work.
There is a theory that osteoarthritis of the hip joints is the result of a congenital or acquired mutation of the type II procollagen gene.
There is also secondary arthrosis of the hip joint, which develops against the background of the presence of concomitant diseases and age-related changes.
symptoms
The disease is characterized by the appearance of pain, reduced mobility and crunching in the hip joint, the severity of which directly depends on the degree of neglect of pathological changes. In the final stages of development, shortening of the affected leg and complete immobility of the hip joint can be observed, which is due to the complete fusion of the bone structures that make it up.
Initially, the disease can proceed without pronounced signs and cause mild, short-term pain. As a rule, they appear after physical exertion, especially when walking, carrying heavy loads, squatting, bending over. But as the degenerative-dystrophic changes in the joint progress, the pain intensifies. Over time, they not only become more intense, but also last longer, and the time between the start of physical activity and their onset also decreases. At the same time, rest, even a long one, cannot bring relief. Subsequently, pain can torment a person even with prolonged immobility of the hip joint, for example, after a night's rest.
When the intra-articular structures injure adjacent nerves, pain can radiate to the groin, buttocks, thigh, and knee. However, they tend to intensify with hypothermia. At the last stage of the development of the disease, the pain becomes unbearable. This leads to an unconscious desire to feel sorry for the leg and put less stress on it, leading to lameness.
Another symptom of osteoarthritis of the hip joint is a reduction in range of motion. Most often, the ability to rotate the leg inwards and outwards and to raise the leg bent at the knee to the chest is limited. Over time, the so-called morning stiffness occurs, which disappears after the patient "diverges". Subsequently, a compensating pelvic curvature is possible, which leads to a change in gait. In the future, patients completely lose the ability to perform certain movements with the affected leg.
If arthrosis of both hip joints develops at the same time, the development of the so-called duck gait with the pelvis retracted and the body deflected forward is observed.
All this can be accompanied by the formation of edema in the hip joint. But if you are overweight, they can go unnoticed.
During movements, especially stretching movements, there is often a crunching in the affected joint. It is a consequence of the exposure of the bony surfaces of the femoral head and acetabulum and their rubbing against each other. In this case, there is a sharp increase in pain.
Arthrosis of the hip joint can also cause painful cramps in the thigh muscles. In extremely advanced degenerative-dystrophic diseases, when the joint space almost completely disappears and the head of the femur begins to flatten, shortening of the affected limb by 1 cm or more is observed.
In general, there are 3 degrees of arthrosis of the hip joint:
- Grade 1 - the joint space of the hip joint is narrowed, and the edges of the bone structures are slightly pointed, which indicates the beginning of osteophyte formation. Clinically, there is a mildly pronounced pain syndrome and some movement restrictions.
- Grade 2 - The joint space is narrowed by more than 50% but less than 60%. Significant osteophytes are observed, as well as signs of cysts in the epiphyses of the bones. Patients note significant limitations in movement in the hip joint, the presence of a crunch during movements, pain and atrophy of the thigh muscles of varying severity can be traced.
- Grade 3 - the joint space is reduced by more than 60% or is completely absent, and osteophytes occupy a large surface area and are large, subchondral cysts are observed. The hip joint is stiff and the pain can become unbearable.
diagnosis
The appearance of pain and other symptoms characteristic of arthrosis of the hip joints is the reason for contacting an orthopedist. The doctor will already be able to point this out based on the data obtained during the interview and examination, especially if he has suffered hip or pelvic injuries in the past.
The presence of arthrosis of the hip joint is indicated by pain, the intensity of which increases over several years. Much less often there is a rapid development of degenerative-dystrophic changes, when several months pass from the appearance of the first signs to a strong permanent pain syndrome. This is characterized by increased pain when standing or doing physical work. Arthrosis is also characterized by morning stiffness lasting up to half an hour, which also occurs after prolonged immobility. Gradually, there is an increase in mobility restrictions and deformations of the hip joint, which the orthopedic surgeon may notice during the examination in later stages of development.
Nevertheless, all patients are necessarily assigned instrumental research methods, with the help of which it is possible to confirm the presence of hip arthrosis and establish its degree, as well as distinguish it from some other diseases with similar symptoms. The diagnosis is usually made with:
- Radiography - allows you to identify the main signs of arthrosis, in particular, the narrowing of the joint space and the presence of osteophytes. However, recently CT has become a more informative research method, which allows to more accurately assess the condition of the hip joint.
- MRI is a very informative method for diagnosing various changes in the condition of soft tissue structures, including cartilaginous tissue, which makes it possible to detect the slightest signs of hyaline cartilage degeneration.
Also, patients may be prescribed laboratory tests, including KLA, OAM, a biochemical blood test, etc. You need to identify concomitant diseases that have created conditions for the development of secondary osteoarthritis of the hip joint.
Treatment of osteoarthritis of the hip joint without surgery
Treatment of degenerative-dystrophic changes in the hip joint by methods of conservative therapy is only possible with arthrosis of the 1st and 2nd degree. The prescribed measures can improve the patient's condition, stop or at least slow down the progression of the disease and thus maintain the ability to work. However, they cannot lead to a complete regression of changes that have already occurred in the joint.
Today, as part of the conservative treatment of osteoarthritis of the hip joint, the following are prescribed:
- drug therapy;
- exercise therapy;
- Physical therapy.
Also, patients are advised to make certain lifestyle adjustments. So, in the presence of excess weight, it is worth taking measures to reduce it, that is, increasing the level of physical activity and reconsidering the type of nutrition. If the patient is actively involved in sports and overloads the joint, causing microtrauma, it is recommended to reduce the intensity of training.
Medical therapy
Drug therapy of arthrosis of the hip joint is always complex and includes drugs from different groups aimed at reducing the severity of the symptoms of the disease and improving the course of metabolic and other processes in the joint. That:
- NSAIDs - drugs with anti-inflammatory and analgesic effects, produced both in oral form and in the form of local agents, which allows you to choose the most effective and convenient option of use.
- Corticosteroids - drugs that have strong anti-inflammatory properties and are used in most cases in the form of a solution for injection, since when choosing systemic therapy they cause the development of undesirable side effects;
- Chondroprotectors - drugs synthesized on the basis of natural components of cartilage tissue, used by the body to restore it (prescribed for long courses);
- muscle relaxants - drugs for muscle spasms that cause pain of varying degrees of severity;
- B vitamins - help improve nerve conduction, which is necessary for the development of carpal tunnel syndrome;
- Preparations that improve microcirculation - help to increase the intensity of blood flow in the affected area, which leads to an increase in metabolic rate and helps to restore damaged cartilage.
If concomitant diseases are detected, consultation with specialists and appropriate treatment is indicated.
With very strong, debilitating pain syndrome, which cannot be eliminated with the help of prescribed NSAIDs, intra-articular or periarticular blocks can be performed. A local anesthetic combined with a corticosteroid is injected directly into the joint cavity, which quickly leads to an improvement in well-being. Interventions of this type may only be carried out in a medical facility by a qualified specialist, otherwise there is a high risk of complications.
exercise therapy
Physiotherapeutic exercises play one of the leading roles in the non-surgical treatment of osteoarthritis of the hip, both idiopathic and post-traumatic forms. However, the exercises must be selected individually, taking into account the type of previous injury, the patient's physical development status and existing concomitant diseases.
Exercise therapy should be carried out daily in comfortable conditions without haste. All movements should be performed smoothly and without jerks, so as not to injure the already deformed hip joint. This makes possible:
- reduce the intensity of the pain syndrome;
- increase mobility of joints;
- reduce the risk of muscle atrophy;
- increase the intensity of blood circulation and metabolic processes.
physical therapy
To increase the effectiveness of the prescribed measures, it is often recommended to subject patients with osteoarthritis of the hip joint to a number of physiotherapeutic procedures. Traditionally, those that have anti-inflammatory, anti-edematous and analgesic effects are selected. That:
- ultrasound therapy;
- electrophoresis;
- magnetotherapy;
- laser therapy;
- shock wave therapy, etc.
In some cases, a plasmolifting is indicated, i. e. the introduction of cleaned and platelet-saturated patient's own blood plasma. For this purpose, venous blood is taken and then centrifuged. As a result, it is divided into erythrocyte mass and plasma, which is used to treat degenerative-dystrophic changes in the hip joint.
Operation for osteoarthritis of the hip joint
When diagnosing osteoarthritis of the hip joint degree 3, surgical intervention is indicated for patients. It can also be carried out in the 2nd stage of the development of the disease even if conservative therapy is ineffective and pain and restricted movement persist.
In general, the indications for hip surgery are:
- a significant decrease in the size of the joint space;
- the presence of persistent, severe pain;
- significant mobility restrictions.
The most effective and safest operation for arthrosis of the hip joint is endoprosthetics. Today, regardless of the reasons for its development, it is recognized as the gold standard for the treatment of this pathology. The essence of this type of surgical intervention is to replace part or all of the components of the hip joint with artificially made endoprostheses. The prostheses themselves are made of biocompatible materials and are durable.
Their installation allows you to fully restore the normal mobility of the pathologically changed hip joint, eliminate pain and allow the patient to lead a full life. The type of endoprosthetics is selected for each patient individually according to the degree of destruction of various joint components.
The most effective is total or total hip arthroplasty. The entire joint is replaced by an artificial endoprosthesis, i. e. the hip socket, the femoral head and its neck. Such prostheses can serve continuously for 15-30 years and ensure the restoration of the full functional volume of the joint.
They are installed without cement or with the help of special cement. The first method is more suitable for young patients, as the prosthesis is fixed in the pelvis by growing into the spongy layer of the patient's own bone. For older people, the method of inserting an endoprosthesis with cement, which holds the artificial material firmly to the bone surfaces even with osteoporosis, is more suitable.
If the normal hyaline cartilage lining the surface of the acetabulum is preserved, patients may be offered a partial arthroplasty. Its essence is to replace only the head and neck of the femur with an endoprosthesis. Today there are two types of structures of this type: monopolar and bipolar.
The former are less reliable, after their installation later there is a need for total arthroplasty. This is because the replaced artificial femoral head rubs directly against the cartilage of the acetabulum during movement, leading to faster wear.
Bipolar endoprostheses do not have such a disadvantage, since the artificial femoral head is already enclosed in a special capsule adjacent to the acetabulum. Therefore, the cartilage surrounding it is not deformed as the capsule serves as a kind of buffer and artificial replacement for the natural hyaline cartilage of the femoral head.
However, regardless of the type of endoprosthesis performed, postoperative rehabilitation is indicated in all patients. It consists in the appointment of drug therapy, exercise therapy and therapeutic massage. Recovery time depends on individual characteristics. However, it is important to remember that the effectiveness of the operation directly depends on the quality of compliance with the doctor's recommendations during the rehabilitation period.
Osteoarthritis of the hip joint is therefore a common disease of the musculoskeletal system, which can also occur without direct prerequisites for its development. This pathology can cause not only severe pain, but also disability, so it is important to diagnose at the first signs and take measures to stop its progression. Nevertheless, the current level of development of medicine makes it possible to cope with advanced cases of arthrosis of the hip joint and restore full freedom of movement in it, as well as permanently eliminate severe pain.