Dysplastic coxarthrosis is a degenerative process, a disease of a dystrophic nature. Sometimes it causes a congenital defect - the hip joint does not develop, as it should be for a normal body. This phenomenon is commonly called "dysplasia."
What and what about?
Dysplastic coxarthrosis of the hip joint is characterized by the fact that in the bones the articular extremities are deformed under the influence of incorrect development, the shape becomes irregular, the acetabulum is of abnormal depth. At the hip bone, the proximal section changes. Studies show an abnormal cervical-diaphyseal angle.
More often the disease is fixed in women. The risk group is the age from 30 to 40 years, although, according to some doctors, it is up to 55. If disco-joint surfaces of the joints are fixed, the likelihood of developing pathology increases almost twice.
How often?
Statistics show that dysplastic coxarthrosis of the hip joint is a fairly common disease. Among others, classified as degenerative, dystrophic pathologies affecting this joint, coxarthrosis, according to some researchers, occurs in every fourth case. But other scientists claim that it is diagnosed in 77% of patients. The most famous studies devoted to this issue were carried out in 2006 by Finland under the leadership of Antti Eskelinen, as well as in 1996 by S.V. Sergeev, in 2001 by V.I. Ugnivenko.
European researchers estimate the prevalence of the disease among the adult population of Europe at 7-25%. Scientific events dedicated to this were held in 1965 and 1996. If we study the statistics on pathological disorders of the musculoskeletal system, it becomes clear that dysplasia is about 16.5% of cases known to science. Against the background of such a high percentage, the question of how to treat dysplastic coxarthrosis of the hip joint becomes especially urgent. Up to 60% of all patients lose their ability to work over time, and 11.5% become disabled.
Dysplastic coxarthrosis: what happens?
The classification of the subspecies of the disease is based on the signs:
- anatomical relationships change in the joint (how pronounced is the process?);
- articular cartilage changes (how active is arthrosis?).
In modern medicine, the most commonly used classification is called Crowe. This is a system in which they evaluate how much the femur shifts in the head area. There are 4 subtypes of the disease.
Dysplastic coxarthrosis of the 1st degree is expressed by a proximal displacement of no more than half the height, which relative to the pelvis will be within 10%. The second stage involves indicators of bias of 50-75%, 10-15%, respectively. Dysplastic coxarthrosis of the 3rd degree is a shift of 75-100%, 15-20%. Finally, the fourth stage - when the displacement occurred more than the size of the head of the bone, which relative to the pelvis shows a violation of the position by 20 percent or more.
Hartofilakidis Classification System
This theory suggests evaluating how much the femur in the region of the head changes its position cranially. They also study the state of the acetabulum, suggest the true position and reveal the position of the head relative to it. This classification of dysplastic coxarthrosis distinguishes three degrees of development of pathology.
In the first type of disease, dysplasia of the cavity is expressed in that the entrance to the cavity is larger than the normal size, that is, there is a subluxation. Dysplastic coxarthrosis of the 2nd degree in this terminology is diagnosed with low dislocation, subluxation, high displacement of the head. Diagnosis allows you to determine the neoarthrosis associated with the true cavity. The figure formed by the organs in this image is similar to the number "8". False cavity, bone head interact. Finally, the third type of pathology is a complete dislocation. The false, true cavities of the acetabulum are demarcated and not connected. The femur is associated only with the false cavity.
If the Crowe technique is applicable when it is necessary to determine the effectiveness of surgical intervention, Hartofilakidis is widespread due to its ease of use. It must be remembered that Crowe does not allow for the most accurate consideration of how much the depressions change due to dysplasia. Hence the problems of endoprosthetics of dysplastic coxarthrosis are born: the lack of information to draw up a clear plan creates difficulties in the implementation of surgical measures.
However, Hartofilakidis also has some imperfections. Such a methodology makes it impossible to track the position of the proximal section. Namely, these changes strongly affect the operation. In order to choose the treatment logic, various classifications must be applied: both those that reflect dysplasia and those evaluating osteoarthritis.
Arthrosis: how does this happen?
So, where does bilateral dysplastic coxarthrosis come from? How do other subtypes of the disease develop? What does the joint undergo?
The first thing that is subject to negative changes is joint fluid. It thickens, turns into a viscous one. The reasons for this may be very different, but the result is the same - the cartilage does not receive proper lubrication, which is why it dries up. The surface of the cartilage is covered with small cracks, roughness. The fabric becomes thinner over time, which is provoked by strong friction during any movements. The joints are separated by a smaller and smaller distance. From under the cartilage, the surface of the bone becomes visible, which leads to increasing pressure, and in the future - to deformation. Therefore, dysplastic coxarthrosis is also known as deforming.
What's next?
Unfortunately, degenerative processes are not limited to changes in the joint fluid. Over time, the blood supply to the tissues is disrupted, the metabolism becomes slower than normal, since the blood is not saturated with useful components, including oxygen, through the vessels with the desired activity.
Over time, bilateral dysplastic coxarthrosis causes muscle atrophy of the affected limb. But changes occur for a long time, gradually, so the patient often does not notice the progression of the disease. In some cases, a chronic disease worsens, which is accompanied by severe joint pain. The period is usually called "reactive inflammation." A severe pain syndrome forces a person to visit a doctor, and only then they are diagnosed with dysplastic coxarthrosis for the first time.
Causes of the disease
Dysplastic coxarthrosis can appear due to a variety of factors:
- Circulatory problems leading to insufficient nutrition of tissues and accumulation of metabolic products not oxidized to the necessary degree, which activates enzymes that destructively affect cartilage.
- Mechanical, provoking the load on the joint beyond measure. This affects athletes, people who are overweight. The second is characterized by metabolic problems, lack of blood flow, which additionally negatively affects the joints.
- Biochemical reactions, metabolic problems, hormonal.
- Injuries, fractures, dislocations, often provoking the disease at a young age.
- Pathology of the spine.
- Infectious, inflammatory processes affecting the joints.
- Aseptic necrosis.
- Congenital Disorders
- Passive lifestyle.
- Age-related changes.
A strong influence is exerted by heredity, a genetic predisposition to various arthrosis. Coxarthrosis cannot be inherited, but it is the inheritance mechanisms that determine the specificity of cartilage tissue and metabolism. If the closest relatives suffer from arthrosis, the probability of getting sick in a person increases dramatically.
How to suspect?
Medicine distinguishes the following symptoms of the disease:
- stiffness, movements are given "tight";
- pain syndrome;
- atrophy of the femoral muscles;
- shortening a sick limb;
- mild lameness.
Most often, patients go to the doctor when the leg, joints begin to hurt. This symptom is the most characteristic and noticeable. You need to understand that the manifestations of the pathology depend on the level to which it has developed.
The stage of the disease directly determines the duration of pain attacks, their intensity and the area in which sensations are localized. Treatment of dysplastic coxarthrosis of the hip joint shows good results only when it was started at an early stage of the development of the disorder. But this happens infrequently, as the joint pain is not strong, and people delay the trip to the doctor.
Without contacting a specialist on time, patients lose time - the joint is destroyed more and more every day. Over time, mobility is lost, pain intensifies, even the first steps are difficult, you can only move without pain. The person is lame, atrophy of the femoral muscles occurs. Of course, all these signs stimulate a trip to the clinic, but it is already too late.
Pain and atrophy
In pathology, atrophy of the femoral muscles provokes an additional pain syndrome - it is localized where the tendons are attached. The knees hurt the most, but the syndrome is less pronounced in the groin and hip. This leads to an incorrect diagnosis. A common mistake is the determination of arthrosis of the knee joint , which leads to an incorrect choice of therapy.
Arthrosis is not the only cause of pain in the femoral, inguinal region. Perhaps this is an echo of pain associated with inflammatory processes in the tendon, so damage to the spine can also manifest itself.
Dysplastic coxarthrosis: treatment. Where do we start?
Several different methodologies for approaching patients with this pathology were invented. Any option has its positive and weak points. But there is one general rule: self-medication is unacceptable. Even if you are convinced that you know exactly what you are sick with, how it can be cured, therapy is allowed only under the supervision of a doctor with a specialized education. Otherwise, there is a chance not only not to slow down the degenerative processes, but only to aggravate them. It should also be understood that the stage of the disease greatly affects approaches to its treatment.
If the first or second stage is diagnosed, conservative therapy can be practiced. In this case, the treatment of dysplastic coxarthrosis is carried out using ointments, tablets and injectable drugs. When diagnosing the third stage, there is only one way - surgical intervention. Endoprosthetics of the joint, performed with this diagnosis, involves the replacement of the joint with an artificial product. The procedure is quite complicated, expensive, but effective. The implant is implanted in the bones of the pelvis and hips. The prosthesis is identical to the biological joint.
The first, second stage: what are we treating?
If it was possible to detect the disease before the development of the third degree, the positive results of conservative therapy can be achieved. Widely used non-steroidal drugs against inflammation, the most effective in the reactive period. The main advantage of these drugs is the relief of pain, due to the strong influence on inflammatory processes. Medications quickly relieve inflammation and eliminate swelling.
However, everything has flaws. So, the regular use of anti-inflammatory drugs reduces the body's ability to recover by natural mechanisms. In addition, most of the drugs known to science have a wide range of side effects, affecting the body as a whole and on individual organs and organ systems. The choice of medication should be entrusted to the doctor. Categorical It is not recommended to use several drugs at the same time. If the prescribed medicine does not help stop the pain, you can take a larger dose or consult a doctor for a prescription for another medication.
What else will help?
Quite well proven drugs that can expand blood vessels. At the same time, smooth muscles relax, the lumen of the vessels becomes larger. If coxarthrosis is diagnosed, such therapy shows good results quickly enough.
On the one hand, with the correct use of medicines of this group under the supervision of a doctor, the result is good, you won’t have to wait long. Also attracted by a small list of contraindications. The joint is restored over time, as better blood flow is provided, that is, the tissues receive nutrition in the right amount. Vasodilator drugs have been shown to be extremely effective against night pain.
But there are also weaknesses. Not all patients tolerate this group of drugs, and with individual intolerance to at least one component, therapy becomes inapplicable. Before starting, you need to consult a doctor, take tests. Starting a course of treatment, initially take no more than a tablet per day - this dose is maintained for the first three days, controlling the body's indicators. If everything is normal, you can go to the concentration recommended by the doctor and manufacturer.
Muscle relaxants and chondroprotectors
Muscle relaxants are medications that help relax muscles. If coxarthrosis is diagnosed, such drugs are used very carefully, but they achieve the elimination of spasms, stop the pain syndrome. The use of drugs helps to improve blood flow to the affected area. But a depressing effect on the nervous system is possible, which makes the head spin, consciousness slows down and a sensation similar to the effect of alcohol appears.
Chondroprotectors are aimed at restoring cartilage. They are considered one of the most useful for arthrosis, as they improve the structure of cartilage tissue and direct useful, nutritious components to the cells. If such drugs are used regularly, the development of the disease stops. True, there is no noticeable quick positive effect when using chondroprotectors: this is felt only in the future. Even after the cessation of the course of treatment, trends in cartilage improvement continue. True, it is impossible to practice taking these medications during pregnancy, inflammatory processes in the joints. Individual intolerance to the components is also possible.
Hormone therapy
Finally, one cannot fail to mention the hormonal steroid medications that have received quite widespread in recent years. They are injected directly into the joint. The result often manifests itself almost immediately after the start of treatment, it is most pronounced if the inflammation affects the femoral tendons. But the effect passes quite quickly, and the course of therapy is accompanied by side effects.
Doctors recommend no more than three injections in one joint. Between two injections should be maintained for two weeks or more.