Every year, diseases of the musculoskeletal system worry more and more people, and their development at a young age is increasingly observed. This is facilitated not only by a change in lifestyle, but also by an increase in the level of injuries, which is largely interconnected. One of the most common pathologies of the musculoskeletal system is osteoarthritis of the hip joint, characterized by the onset of progressive pain and reduced mobility. Ultimately, the disease can lead to complete immobility of the joint and disability. In order to avoid such undesirable consequences, it is important to start the treatment of arthrosis as soon as possible. And if in the early stages of development it can be stopped by conservative methods, then in case of severe changes it is possible to restore the functions of the hip joint and eliminate unbearable pain only with the help of a high-tech operation.
What is osteoarthritis of the hip joint
Osteoarthritis of the hip joint is a chronic degenerative-dystrophic disease in which gradual destruction of the hip joint occurs. At the same time, all its components are gradually involved in the pathological process, but hyaline cartilage is particularly affected, which leads to a narrowing of the joint space and deformation of its other components. More often than not, pathological changes occur in only one hip joint, although both can also be affected at the same time.
The hip joints are the largest in the human body, as they bear the greatest load during the day. Each of them is formed by the femoral head and the acetabulum, which is a bowl-shaped depression in the pelvis. Both surfaces are covered with smooth, moderately elastic hyaline cartilage. It is he who ensures the smoothness and unhindered sliding of the femoral head in a natural depression and therefore allows movements in various planes.
The movement of the hip joint is provided by a group of muscles connected to it by bands. It is also surrounded by ligaments, whose task 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 contiguous parts of the hip joint and at the same time serves as a nutrient carrier for it. It is from the synovial fluid that the hyaline cartilage that covers the head of the femur and the surface of the acetabulum constantly receives components for the formation of new cells, that is, regeneration. This is extremely important for this cartilage formation, as with each movement of the hip it wears out, but is normally restored immediately. But when injured or under the influence of other factors, this does not happen, which leads to the development of arthrosis of the hip joint, i. e. thinning and destruction of its hyaline cartilage.
As a result, the deformed areas form into an ideally smooth cartilage, which increases as the pathology progresses. When abraded, the surfaces of the bones that form the joint are exposed. When they come into contact, there is a characteristic crunch and severe pain. This results in the formation of osteophytes and, in the final stages of development, the head of the femur fuses completely with the acetabulum, making any movement in the hip joint impossible.
At the same time, osteoarthritis of the hip joint can provoke the development of various inflammatory processes within the joint, including:
- bursitis - inflammation of the synovial bursa;
- tendovaginitis - an inflammatory process in the sheath of the tendon sheath of muscles;
- tunnel syndrome - compression of the nerves, causing radiating pain along the strangled nerve.
The reasons
One of the common causes of the development of osteoarthritis of the hip joint is mechanical damage, not only direct injuries, but also microdamages caused by the destructive effect of excessive loads on it. One of the most common causes of the development of the disease is a fracture of the femoral neck.
It starts from 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 car accident, falling from a height, impact, etc.
A femoral neck fracture can be accompanied by aseptic necrosis of the femoral head, which will become a trigger for the development of degenerative-dystrophic changes in the joint. The presence of dysplasia or subluxation of the hip joint, ruptures of its ligaments, transcondylar fractures or fractures of the acetabulum also creates favorable conditions for damage to its structures. In such situations, post-traumatic osteoarthritis of the hip joint is diagnosed.
Often, post-traumatic hip osteoarthritis occurs in professional weightlifters and light lifters, skydivers, loaders, and skaters.
The development of arthrosis 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 of blood circulation in the fixed area, but also a shortening of the muscles, a decrease in their tone. The likelihood of post-traumatic osteoarthritis increases significantly when an inappropriate situation or premature treatment is performed, which leads to the preservation of defects of varying severity. In addition, the risks of its development increase with excessively early loading of the joint and inadequate, even too intense physical therapy, started late or vice versa.
Sometimes the disease occurs after surgery on the hip joint due to the formation of additional tissue scars and trauma. Although in some cases, surgery is the only way to eliminate the consequences of the injury.
Excessive loads can also cause changes in the hip joint, as they lead to microtrauma. Regular tissue damage activates the process of dividing chondrocytes (cartilage tissue cells). This is accompanied by an increase in the intensity of the production of cytokines, which are normally produced in small quantities. Cytokines are mediators of inflammation, 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, as well as injury to surrounding tissues.
The subchondral plate is the extreme part of the bone in direct contact with the hyaline cartilage.
In some cases, it is not possible to determine exactly what caused the development of degenerative-dystrophic changes in the hyaline cartilage of the femoral head and acetabulum. In such situations, idiopathic or primary osteoarthritis of the hip joint is diagnosed.
Today it has been established that the tendency to develop it can be inherited, eg. the presence of this pathology in close relatives significantly increases the chances of developing osteoarthritis of the hip joint. Presumably, it has a polygenic inheritance, that is, its development depends on the presence of many genes. Each of them individually creates mild prerequisites for the development of the disease, but when combined, it becomes a matter of time, especially when leading a sedentary lifestyle and obesity, or vice versa, 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 a 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 onset 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, due to the complete fusion of the bone structures that form it.
Initially, the disease can proceed without pronounced signs and cause short-term mild pain. As a rule, they appear after physical exertion, in particular, 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 interval between the start of physical activity and their appearance is also reduced. At the same time, even long rest may not bring relief. Later, the pain can plague a person even with prolonged immobility of the hip joint, for example, after a night's sleep.
If intra-articular structures violate nearby nerves, pain can radiate to the groin, buttocks, thigh, and knee. However, they tend to escalate with hypothermia. In the last stage of the development of the disease, the pain becomes unbearable. This causes an unconscious desire to feel compassion for the leg and put less stress on it, which leads to lameness.
Another symptom of hip joint osteoarthritis is a decrease in range of motion. Most often, there is a limitation in the ability to turn the leg in and out, to lift the bent leg at the knee to the chest. Over time, so-called morning stiffness occurs, which disappears after the patient "diverges". Subsequently, a compensatory curvature of the pelvis 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 osteoarthritis of both hip joints develops simultaneously, the development of the so-called duck gait is observed with the pelvis retracted and the body turned forward.
All this can be accompanied by the formation of edema in the hip joint. But in the presence of excess weight, they can go unnoticed.
Often, during movements, especially those of the extensors, a creak occurs in the affected joint. It is a consequence of the exposure of the bony surfaces of the femoral head and the acetabulum and their mutual friction. In this case, there is a sharp increase in pain.
Also, with osteoarthritis of the hip joint, painful spasms of the femoral muscles can occur. With extremely advanced degenerative-dystrophic diseases, when the joint space almost completely disappears and the head of the femur begins to flatten, a shortening of the affected limb by 1 cm or more is observed.
In general, there are 3 degrees of osteoarthritis 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 onset of osteophyte formation. Clinically, there is a slightly pronounced pain syndrome and some movement restrictions.
- Grade 2: The joint space is reduced by more than 50%, but less than 60%. Significant osteophytes and signs of cysts are observed in the epiphyses of the bones. Patients note significant limitations of movements 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 and are large in size, subchondral cysts are observed. The hip joint is stiff, the pain can become unbearable.
Diagnostics
The appearance of pain and other characteristic symptoms of arthrosis of the hip joints is the reason for contacting an orthopedist. The doctor may suspect its presence, especially if he has suffered injuries to the hip or pelvis in the past, already on the basis of the data obtained during the interview and examination.
The presence of osteoarthritis of the hip joint is indicated by pain, the intensity of which increases over the course of 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 powerful permanent pain syndrome. This is characterized by increased pain when standing or when performing physical work. Also, for osteoarthritis, the presence of morning stiffness is typical, lasting up to half an hour, and occurs even after prolonged immobility. Gradually, there is an increase in mobility restrictions and deformation of the hip joint, which in the later stages of development, the orthopedist may notice during the examination.
However, all patients are necessarily assigned instrumental research methods, with the help of which it will be possible to confirm the presence of osteoarthritis of the hip and establish its degree, as well as differentiate it from some other diseases accompanied by similar symptoms. As a rule, diagnostics is carried out using:
- Radiography: allows to detect the main signs of osteoarthritis, in particular the narrowing of the joint space and the presence of osteophytes. But recently, CT has become a more informative research method, which allows you to assess the condition of the hip joint with greater accuracy.
- MRI is a highly informative method of diagnosing various changes in the state of soft tissue structures, including cartilage tissue, which allows you to detect the slightest signs of hyaline cartilage degeneration.
Additionally, patients may be prescribed laboratory tests, including KLA, OAM, a biochemical blood test, etc. They are required to establish concomitant diseases that created the prerequisites for the development of secondary osteoarthritis of the hip joint.
Treatment of osteoarthritis of the hip joint without surgery
Treatment of degenerative-dystrophic changes of the hip joint through the methods of conservative therapy is possible only with 1st and 2nd degree osteoarthritis. Prescribed measures can improve the patient's condition, stop or at least slow down the progression of the pathology and thus maintain working capacity. But they are unable to bring about a complete regression of the changes that have already taken place in the joint.
Today, as part of the conservative treatment of osteoarthritis of the hip joint, the following are prescribed:
- pharmacological therapy;
- physical therapy;
- Physiotherapy.
Additionally, patients are advised to make some lifestyle changes. So, in the presence of excess weight, it is worth taking measures to reduce it, that is, to increase the level of physical activity and reconsider the nature of nutrition. If the patient is actively involved in sports and overloads the joint, causing microtrauma in it, it is recommended to reduce the intensity of training.
Medical therapy
Drug therapy for osteoarthritis 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 flow of metabolic and other processes in the joint. It:
- NSAIDs - drugs with anti-inflammatory and analgesic effects, produced both in oral form and in the form of local agents, which allow you to choose the most effective and convenient option for use;
- corticosteroids - drugs that have powerful anti-inflammatory properties and are used in most cases in the form of an injectable solution, since when choosing systemic therapy they cause the development of unwanted 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 indicated for muscle spasm, which causes pain of varying severity;
- Vitamins of group B: they 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 circulation in the affected area, which leads to an increase in the speed of metabolic processes and helps to restore damaged cartilage.
If concomitant diseases are detected, consultation with related specialists and appropriate treatment is indicated.
With a very strong and debilitating pain syndrome that cannot be eliminated with the help of prescribed NSAIDs, intra-articular or periarticular blockages can be performed. They involve the injection of a local anesthetic in combination with a corticosteroid directly into the joint cavity, which quickly leads to an improvement in well-being. But procedures of this type can only be performed in a medical institution by a qualified specialist, otherwise there is a high risk of complications.
physical therapy
Physiotherapy exercises play a major role in the non-surgical treatment of osteoarthritis of the hip joint, both in idiopathic and post-traumatic form. But a set of exercises must be selected on an individual basis, taking into account the nature of the previous injury, the level of physical development of the patient and existing concomitant diseases.
Physical therapy should be performed daily in comfortable conditions without rushing. All movements should be performed smoothly, without jerking, so as not to damage the already deformed hip joint. This will allow:
- reduce the intensity of the pain syndrome;
- increase joint mobility;
- reduce the risk of muscle atrophy;
- increase the intensity of blood circulation and metabolic processes.
Physiotherapy
To increase the effectiveness of the prescribed measures, it is often recommended that patients with osteoarthritis of the hip joint undergo a course of physiotherapy procedures. Traditionally, those that have anti-inflammatory, anti-edematous and analgesic effects are chosen. It:
- ultrasound therapy;
- electrophoresis;
- magnetotherapy;
- laser therapy;
- shock wave therapy, etc.
In some cases, plasmolifting is indicated, that is, the introduction of the patient's blood plasma purified and saturated with platelets. To obtain it, venous blood is taken, which is then subjected to centrifugation. As a result, it is divided into erythrocyte and plasma mass, which is used to treat degenerative-dystrophic changes in the hip joint.
Hip joint osteoarthritis surgery
When diagnosing 3rd degree hip joint osteoarthritis, surgery is indicated for patients. It can also be performed with the ineffectiveness of conservative therapy and persistent pain and mobility restrictions already in the 2nd stage of disease development.
In general, the indications for hip surgery are:
- a significant decrease in the size of the joint space;
- the presence of persistent and intense pain;
- significant mobility restrictions.
The most effective and safest operation for hip joint osteoarthritis is arthroplasty. Today it is recognized as the gold standard for the treatment of this pathology, regardless of the reasons for its development. The essence of this type of surgery is to replace part of the components of the hip joint or its entirety with artificially created endoprostheses. The prostheses themselves are made from biocompatible materials and are durable.
Their installation allows you to completely restore the normal mobility of the pathologically impaired hip joint, eliminate pain and provide the patient with the opportunity to lead a full life. For each patient, the type of arthroplasty is selected individually based on the degree of destruction of the various components of the joint.
The most effective is total or total hip arthroplasty. It involves replacing the entire joint with an artificial endoprosthesis, namely the acetabulum, the head of the femur and its neck. Such prostheses are able to work continuously for 15-30 years and ensure the restoration of the entire volume of the functioning of the joint.
They are installed without concrete or with the help of special concrete. The first method is more suitable for young patients, as it involves fixing the prosthesis in the pelvis by growing the spongy layer of one's bone inside it. For older people, the method of installing an endoprosthesis using cement is more suitable, which holds the artificial material firmly to the bone surfaces even in the presence of osteoporosis.
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 2 types of structures of this type: monopolar and bipolar.
The former are less reliable, after their installation there is a need for a total arthroplasty. This is due to the fact that the replaced artificial femoral head rubs directly against the acetabulum cartilage during movements, causing it to wear out more quickly.
Bipolar endoprostheses do not have such a disadvantage, since in them the artificial femoral head is already enclosed in a special capsule, which is adjacent to the acetabulum. Therefore, the cartilage that covers it is not deformed, since the capsule acts as a buffer and artificial substitute for the natural hyaline cartilage of the femoral head.
However, regardless of the type of endoprosthesis performed, postoperative rehabilitation is indicated for all patients. It consists in the appointment of drug therapy, physical therapy and therapeutic massage. Recovery time depends on individual characteristics. But 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.
Therefore, osteoarthritis of the hip joint is a common disease of the musculoskeletal system, which can occur even in the absence of direct prerequisites for its development. This pathology can lead not only to severe pain, but also to disability, so it is important to diagnose and take measures to stop its progression even at the first signs. However, the current level of development of medicine allows you to cope with advanced cases of osteoarthritis of the hip joint and restore the full range of motion in it, as well as permanently get rid of severe pain.