Hip arthrosis: treatment, symptoms, grades

Osteoarthritis of the hip is a progressive dystrophic-degenerative disease. It most often develops in old age, with the occurrence of provocative factors - infectious, non-inflammatory diseases of the joint, trauma, genetic predisposition, curvature of the spine.

Coxarthrosis is another name for hip arthrosis, which is very complex to treat, long-term, first conservative, and then surgical. The main symptoms of the disease are pain, restriction of movement, shortening of the patient's limb in later stages and atrophy of the thigh muscles.

Recently, however, the term arthrosis has been abolished and the disease is now called osteoarthritis of the joints. In the past, arthrosis was not considered an inflammatory process, but today inflammation is also recognized in arthrosis. Like the whole theory of aging, interleukins are secreted by different structures in the cartilage and cause inflammation, which results in degeneration, i. e. , rupture and decomposition. So now there is no arthrosis, just osteoarthritis.

Causes of hip arthrosis

The disease itself is not inherited, but traits that provoke its development, such as weakness of cartilage tissue, various metabolic disorders, genetic characteristics of skeletal structure, can be passed on from parents to children. Therefore, there is an increased risk of developing arthrosis of the joints in the presence of this disease in the following relatives.

However, the main causes of hip arthrosis are comorbidities:

  • Perthes disease is a violation of the blood supply and nutrition of the thigh head and joint as a whole, developing in childhood, more often in boys;
  • Congenital displacement of the hip, dysplasia of the hip joint;
  • Injuries - hip fractures, displacements, pelvic fractures;
  • Femoral necrosis;
  • Inflammatory, infectious processes - rheumatoid arthritis, purulent arthritis (read the causes of hip pain).

Because the disease progresses slowly, it can be unilateral or bilateral. Factors contributing to osteoarthritis:

  • Accompanying diseases of the spine - scoliosis, kyphosis, osteochondrosis, etc. , flat legs, presence of knee arthrosis (see symptoms of knee arthrosis).
  • Hormonal changes in the body, circulatory disorders.
  • Excessive stress on the joints - sports, hard physical work, being overweight.
  • Sedentary lifestyle and obesity.
  • Age - the risk of developing arthrosis increases significantly in old and old age.

The main diagnostic methods are MRI and CT, radiography. MRI data provide a more accurate picture of the condition of the soft tissues and also take into account CT examination of bone tissue pathology, clinical signs and symptoms of hip arthrosis. It is very important to determine not only the presence of pathology, but also the extent and causes of arthrosis.

For example, if the changes in the images apply to the proximal femur, this is a consequence of Perthes disease, when the cervico-diaphyseal angle increases and the acetabulum noticeably flattens, this is hip dysplasia. You can also learn about X-ray injuries.

Symptoms of 1 2 3 degree hip arthrosis

The main symptoms of hip arthrosis are:

  • The most important and constant is severe, constant pain in the groin, hip, knee joint, sometimes radiant pain in the leg, in the groin area.
  • Stiffness of movement, restriction of joint mobility.
  • Limit the side robbery of the affected foot.
  • In severe cases, lameness, gait disturbance, shortening of the legs, atrophy of the thigh muscles.
Symptoms

1 degree arthrosis of the hip joint:

At this stage of the disease, a person only suffers during and after physical exertion, from prolonged running or walking while the joint itself hurts, very rarely the pain radiates to the hips or knees. Furthermore, human gait is normal, lameness is not observed, thigh muscles are not atrophic. When diagnosed, bone growth is observed in images located around the inner and outer edges of the acetabulum, with no other abnormalities observed in the neck and head of the femur.

Grade 2 arthrosis:

With grade 2 arthrosis of the hip joint, the symptoms will be significant and the pain will become more constant and intense, radiating to the groin and thigh at rest and while moving, already limping with the load of the patient. There is also a limit to hip abduction, the range of motion of the hip decreases. In the photographs, the narrowing of the gap becomes half the norm, the bone growths are found on both the outer and inner edges, the head of the femur grows, deforms and shifts upwards, its edges are uneven.

3-degree arthrosis of the hip joint:

At this stage of the disease, the pain is painful and constant, day and night, making it difficult for the patient to move independently, so a cane or crutch is used, the range of motion of the joint is severely limited, and the leg, thigh and buttocks muscles wither. The foot shortens and the person is forced to tilt the body while walking towards the sore foot. Shifting the center of gravity increases the load on the damaged joint. X-rays show several bony growths, the femoral head dilates, and the joint space narrows significantly.

How to treat hip arthrosis?

In order to avoid surgery, it is very important to make a correct diagnosis in time, to distinguish arthrosis from other diseases of the musculoskeletal system - reactive arthritis, trochanteric bursitis, etc. hand therapy, therapeutic massage, therapeutic gymnastics, but only under the supervision of a qualified orthopedist.

  • First week - simple paracetomol.
  • If there is no effect, non-steroidal anti-inflammatory drugs (preferably low doses of diclofenac or ketorol) are covered by proton pump blockers (but omeprazole is not, as it increases bone loss with prolonged use).
  • Plus chondroprotectors at any stage.

You need to solve several problems at once with a combination of all treatment measures:

Reduce the pain

There is a huge variety of NSAIDs available today for this - non-steroidal anti-inflammatory drugs that, while relieving pain, do not affect the development of the disease but cannot stop the process of cartilage destruction. They have a number of serious side effects, the long-term use of which is also unacceptable, as these agents affect the synthesis of proteoglycans, contributing to the dehydration of cartilage tissue, which only exacerbates the condition. Of course, it is unacceptable to tolerate pain, but painkillers should be used with caution, under medical supervision, only during the period of exacerbation of the disease.

Non-steroidal anti-inflammatory drugs include: celecoxib, etoricoxib, texamen, nimesulide, naproxen sodium, meloxicam, ketorolactromethamine, ketoprofen-lysine, ketoprofen, ibuprofen, diclofenac.

Topical treatments for deforming arthrosis, such as warming ointments, are not very therapeutic, but they reduce pain by acting as a distraction and partially relieving muscle cramps.

Provide better nutrition for cartilage and increase blood circulation

Chondroprotective agents such as glucosamine and chondroitin sulfate are important drugs that can improve cartilage, but only in the early stages of the disease. A full description of these drugs in tablets, injections, creams, average prices, and treatments for the article in knee arthrosis. In order to improve blood circulation and reduce the spasm of small blood vessels, vasodilators are usually recommended - cinnarizine, pentoxifylline, xanthinol nicotinate.

Muscle relaxants such as tizanidine and tolperisone hydrochloride should only be prescribed under strict indications. Their use can have both positive and negative effects, muscle relaxation reduces pain on the one hand, improves blood circulation, and on the other hand muscle cramps and tension - the body has a protective reaction and its removal can only accelerate the destruction of joint tissue.

Intraarticular injections

Hormonal injections are performed only with synovitis, ie the accumulation of fluid in the joint cavity. Once and up to three times a year (methylprednisolone, hydrocortisone acetate). Hormonal agents relieve pain and inflammation, but they have a pronounced immunosuppressive effect and their use is not always warranted. It is better to inject with chondroprotectors in the thigh - chondroitin sulfate, 5-15 procedures 2-3 times a year. Intra-articular injection of hyaluronic acid is also seen - it is an artificial lubricant for the joints.

Physiotherapy

Physicians' opinions on the effectiveness of these procedures are divided between supporters and opponents, some see their implementation as justified, others as meaningless. Perhaps laser therapy, magnetic laser therapy and makes sense for hip arthrosis, many doctors can’t find other procedures to treat the disease because the hip joint is a deep joint, and many of these procedures simply fail to achieve their goal and waste time, effort and possibly money. for the patient.

Professional massage, hip traction (hardware traction), manual therapy, physiotherapy exercisesAll these therapeutic measures are very useful in the complex therapy of the disease, help to strengthen the muscles surrounding the joint, increase its mobility and increase itand may reduce the pressure on the femoral head. This is especially true for physiotherapy practices, without their competent selection and regular implementation outside of exacerbations, it is impossible to achieve real improvement in the patient’s condition.

If the patient is overweight, then of course diet can help reduce the strain on the sore joint, but it has no independent therapeutic effect. Doctors also recommend the use of canes or crutches, depending on the degree of joint dysfunction.

In grade 3 arthrosis, doctors always insist on surgery because the destroyed joint can only be restored by replacing it with an endoprosthesis. The indications are to use a bipolar prosthesis that replaces both the head and the base, or a unipolar prosthesis that changes only the femur without an acetabulum.

Today, such operations are performed quite often, only after a thorough examination, as planned under general anesthesia. Complete restoration of hip function is ensured by competent and careful implementation of all postoperative measures — antimicrobial antibiotic therapy and a rehabilitation period of approximately six months. Such hip replacements can last up to 20 years, after which they need to be replaced.

31.12.2020