Coxarthrosis (deforming arthrosis, osteoarthritis of the hip joint) is a degenerative-dystrophic disease that affects mainly middle-aged and elderly people. Coxarthrosis develops gradually over several years. It is accompanied by pain and limitation of movement in the joint. In the later stages, there is atrophy of the thigh muscles and shortening of the limb. Coxarthrosis can be provoked by various factors, including trauma, congenital pathology, pathological curvature of the spinal column (kyphosis, scoliosis), inflammatory and non-inflammatory diseases of the joint. There is a hereditary predisposition. Sometimes coxarthrosis occurs for no apparent reason. It can be both one-sided and two-sided. The course is progressive.
In orthopedics and traumatology, coxarthrosis is one of the most common arthrosis. The high incidence of its development is due to a significant load on the hip joint and the widespread prevalence of congenital pathology – joint dysplasia. Women suffer from coxarthrosis a little more often than men.
Hip anatomy
The hip joint is formed by two bones: the ilium and the femur. The femoral head articulates with the acetabulum of the ilium, forming a kind of “hinge”. During movement, the acetabulum remains stationary, and the head of the femur moves in various directions, providing flexion, extension, abduction, adduction, and rotational movements of the hip.
During movement, the articular surfaces of the bones slide freely relative to each other, thanks to the smooth, elastic, and strong hyaline cartilage that covers the acetabulum cavity and the femoral head. In addition, hyaline cartilage performs a shock-absorbing function and is involved in the redistribution of the load during movement and walking.
The joint cavity contains a small amount of joint fluid, which acts as a lubricant and provides nutrition to the hyaline cartilage. The joint is surrounded by a dense and durable capsule. Above the capsule are large femoral and gluteal muscles, which provide movement in the joint and, along with hyaline cartilage, are also shock absorbers that protect the joint from injury in case of unsuccessful movements.
The mechanism of development of coxarthrosis
With coxarthrosis, the joint fluid becomes thicker and more viscous. The surface of the hyaline cartilage dries out, loses its smoothness, and becomes covered with cracks. Due to the roughness that has arisen, the cartilages are constantly injured against each other during movement, which causes their thinning and aggravates pathological changes in the joint.
As coxarthrosis progresses, the bones begin to deform, “adapting” to the increased pressure. The metabolism in the joint area is deteriorating. In the later stages of coxarthrosis, there is pronounced atrophy of the muscles of the diseased limb.
The reasons for the development of coxarthrosis
There are primary coxarthrosis (caused by unknown reasons) and secondary coxarthrosis (developed as a result of other diseases).
Secondary coxarthrosis can result from the following diseases:
- Dysplasia of the hip joint.
- Perthes disease.
- Aseptic necrosis of the femoral head.
- Infectious lesions and inflammation (for example, arthritis of the hip joint).
- Postponed injuries (traumatic dislocations, hip fractures, pelvic fractures).
Coxarthrosis can be both unilateral and bilateral. In primary coxarthrosis, concomitant lesions of the spine (osteochondrosis) and knee joint (gonarthrosis) are often observed.
The factors that increase the likelihood of developing coxarthrosis include:
- Constant increased stress on the joint. Most often seen in athletes and overweight people.
- Circulatory disorders, hormonal changes, metabolic disorders.
- Pathology of the spine (kyphosis, scoliosis) or feet (flat feet).
- Elderly and senile age.
- Sedentary lifestyle.
By itself, coxarthrosis is not inherited. However, certain features (metabolic disorders, structural features of the skeleton, and weakness of cartilaginous tissue) can be inherited by the child from the parents. Therefore, in the presence of blood relatives suffering from coxarthrosis, the likelihood of the onset of the disease somewhat increases.
Symptoms and degrees of coxarthrosis
The main symptoms of coxarthrosis include pain in the joint, groin, hip, and knee joint. Also, with coxarthrosis, stiffness of movements and stiffness of the joint, gait disturbances, lameness, atrophy of the thigh muscles, and shortening of the limb on the side of the lesion is observed. A characteristic sign of coxarthrosis is the limitation of abduction (for example, the patient has difficulty when trying to sit “astride” on a chair).
The presence of certain signs and their severity depends on the stage of coxarthrosis. The first and most constant symptom of coxarthrosis is pain.
With coxarthrosis of 1st degree, patients complain of intermittent pain that occurs after physical exertion (running or walking for a long time). The pain is localized in the joint, less often in the hip or knee. Usually disappears after rest. The gait with coxarthrosis of the 1st degree is not disturbed, movements are preserved in full, and there is no muscle atrophy.
On the roentgenogram of a patient suffering from coxarthrosis of the 1st degree, mildly expressed changes are determined: moderate uneven narrowing of the joint space, as well as bony growths around the outer or inner edge of the acetabulum in the absence of changes from the head and neck of the femur.
With coxarthrosis of the 2nd degree, the pain becomes more intense, often appears at rest, radiates to the thigh and groin area. After significant physical exertion, the patient with coxarthrosis begins to limp. The range of motion in the joint is reduced: abduction and internal rotation of the thigh are limited.
On X-ray images with coxarthrosis of the 2nd degree, a significant uneven narrowing of the joint space is determined (more than half of the normal height). The femoral head shifts slightly upward deform and increases in size, and its contours become uneven. Bony growths with this degree of coxarthrosis appear not only on the inner but also on the outer edge of the acetabulum and extend beyond the cartilaginous lip.
With coxarthrosis of the 3rd-degree pain becomes permanent, bothering patients not only during the day but also at night. Walking is difficult, during movement the patient with coxarthrosis is forced to use a cane. The range of motion in the joint is sharply limited, the muscles of the buttocks, thighs, and lower legs are atrophied. Weakness of the abductor muscles of the thigh becomes the cause of the deviation of the pelvis in the frontal plane and shortening of the limb on the sore side. In order to compensate for the resulting shortening, a patient suffering from coxarthrosis, while walking, tilts the body to the affected side. Because of this, the center of gravity shifts, the load on the diseased joint increases dramatically.
On radiographs with coxarthrosis of grade 3, a sharp narrowing of the joint space, pronounced expansion of the femoral head, and multiple bone growths are revealed.
Diagnosis of coxarthrosis
Orthopedic examination
X-ray
Joint ultrasound examination.
Coxarthrosis treatment
Treatment options depend on the symptoms and stage of the disease.
At stages 1 and 2, conservative therapy is carried out: drug therapy.
Oxygen therapy through the joint puncture.
Puncture of the joint with the introduction of chondroprotectors.
Magnetotherapy on a stationary Italian device “Magnetotherapy PMT QS”.
Ultrasound therapy on an ultrasound device “Sonoplus 490” (Holland) providing deeper penetration of drugs.
High-tone therapy: The latest development of German scientists is a unique 2-channel device “Hi-Top 2 touch” (Germany).
Dry hydromassage: on the device “Wellsystem medical plus” (Germany) – the hydraulic effect of water flows without direct contact with the patient’s body.
In the later stages (with degree 3 coxarthrosis), an operation is used – the replacement of a destroyed joint with an endoprosthesis. Endoprosthetics surgery for coxarthrosis is performed after a full examination, under general anesthesia. The stitches are removed on day 14, after which the patient is discharged for outpatient treatment.
The center’s specialists have developed a program for the rehabilitation of patients.
In 95% of cases, joint replacement surgery for coxarthrosis ensures complete restoration of limb function. Patients can work, actively move and even play sports.
