Deforming arthrosis of the hip joint, otherwise referred to as coxarthrosis or osteoarthrosis, is a chronic inflammatory pathology associated with the destruction of cartilage tissue, a decrease in the joint gap and impaired mobility of the lower limb. A joint is a mechanism that has contacting surfaces. When lubrication ends, friction occurs, bone surfaces wear out, pain occurs. Signs of deforming arthrosis of the hip joint are often found in elderly people, and the female half, due to the anatomical structure of the joint, is more prone to this ailment than the male.
What is osteoarthritis of the hip joint?
Coxarthrosis is an ailment associated with the destruction of hyaline cartilage and deformation of the structure of the heads of bones. The mechanism of the development of the disease is as follows:
- The structure of the joint fluid changes and its amount decreases.
- Cartilage ceases to receive proper nutrition and becomes inelastic. Cracks appear on its surface. It is gradually being destroyed.
- The joint clearance decreases. When the bones move, they rub against each other, causing pain.
- Osteophyte growths are formed on the surfaces of the bones, limiting the mobility of the joints.
At the same time, there is inflammation of the synovial membrane. There is a disease - deforming arthrosis of the hip joint, according to ICD-10, the code of which is M16. The disease leads to disability, disability and a significant deterioration in the quality of life.
Causes of coxarthrosis
The main causes of the development of the disease are:
- hip injuries;
- congenital defects in the development of bones of the hip joint;
- hereditary predisposition;
- overweight;
- increased or insufficient physical activity;
- flat feet;
- metabolic disorders;
- age-related changes;
- benign and malignant bone tumors;
- Pertis disease, rheumatoid arthritis, ankylosing spondylitis.
Distinguish, depending on the cause of the disease, deforming arthrosis:
- Primary - changes in the articular cartilage pass for no apparent reason. This is due to natural changes in the joint. Heavy loads lead to its rapid wear.
- Secondary - develops as a result of an injury or illness. Inflammation can be autoimmune or infectious.
Signs of coxarthrosis
The initial stage of coxarthrosis passes with minor painful sensations that cause a minimum of discomfort to the individual. With the development of the disease, several main symptoms of deforming arthrosis of the hip joint are distinguished, which depend on the stage of the disease:
- Severe pain in the hip area. They accompany this disease constantly, intensifying with its progression.
- Violation of the function of movement of the limb. Restrictions of movements increase gradually, with the development of the disease.
- Weakening of muscles and complete atrophy of muscle tissue located in the thigh.
- Crunch in the joint during movement, indicating the depletion of cartilage between the bones of the joint.
- Changes in gait, lameness due to bone deformation.
- Reduction in the length of a sore leg due to bone deformation.
The main symptom of the disease is pain, the intensity of which is directly dependent on the stage of the pathology.
Degrees of disease
In medical practice, for the convenience of diagnosis, three stages of deforming arthrosis of the hip joint are distinguished:
- The first one begins with minor painful sensations in the knee and inguinal region that occur after physical exertion and pass after rest. Gait disturbances are not observed, joint maneuverability is normal. Starting treatment during this period, the destruction of the joint can be stopped and all its functions can be completely preserved. But most patients do not seek medical help, considering the symptoms insignificant.
- The second is manifested by aching pain at rest. After the load, the painful sensations persist for a long time, to remove them you have to use painkillers. After a prolonged state of rest, difficulties arise at the beginning of movement. The muscle tone in the sore leg during movement increases, lameness appears. Medicines stabilize the condition, but complete cure of deforming arthrosis of the hip joint of the 2nd degree does not occur.
- Third, the symptoms of the disease are permanent. Pain often occurs at night when the leg is at rest. The muscles of the lower leg and thighs atrophy, the limb is shortened. The patient uses a cane or crutches to move around. X-ray images indicate bone growths and a sharp narrowing of the joint space. Pharmacotherapy does not give a positive effect; surgical intervention is required to replace the joint with a prosthesis.
In some cases, the fourth, most severe degree is distinguished, when the joint is completely destroyed and loses its function. The patient has severe pain that cannot be stopped and potent drugs, urgent surgery is needed.
The disease is completely cured only in the first stage, so if you even have minor pain in the hip joint, you need to seek medical help.
Coxarthrosis in young children
The possibility of a child developing deforming arthrosis of the left hip joint at an early age increases when there are congenital disorders of the skeletal system, for example, dysplasia. Improper development leads to dislocation of the femoral head. Anomalous articulation of the joint leads to an increase in overload, has a detrimental effect on its component parts. It should be noted that the child’s muscles are not sufficiently developed to compensate for structural defects. The occurrence of failures in metabolic processes is also a risk of developing joint diseases in childhood. This contributes to the improper formation of bone and cartilage, a change in the composition and amount of synovial fluid. Obesity, which is not uncommon in childhood, has a great negative effect on fragile joints.
Coxarthrosis in pregnant women
Pregnancy with deforming arthrosis of the hip joint of the 2nd degree is aggravated by the fact that there is no possibility to carry out therapy with certain drugs, so as not to harm the baby's health. Often at the beginning of pregnancy an exacerbation of the disease occurs, but after the first trimester the symptoms disappear, and after delivery they worsen again. In the treatment of coxarthrosis during the gestation period, babies sometimes reduce the dosage of drugs. And drugs belonging to the group of non-steroidal and having anti-inflammatory effects are prohibited. The exception is corticosteroid injections into the joint. They do not adversely affect the embryo. Throughout pregnancy, a woman is under the supervision of specialists: an orthopedist, rheumatologist, therapist and gynecologist. At this time, it is possible to use physiotherapeutic procedures that do not harm the fetus, but reduce pain, inflammation and swelling. In the presence of stage 2 deforming arthrosis of the hip joint and a serious intention to become pregnant, it is necessary:
- Reduce excess weight, excess it will significantly increase the load on the joints.
- Strictly adhere to a diet containing all the nutrients necessary for the body, eliminating negative foods.
- In the early stages of pregnancy, exercise therapy, a set of exercises is developed by a doctor.
- The entire period of pregnancy can be engaged in swimming.
- Take daily walks in the fresh air.
Be sure to follow all the doctor's recommendations.
Treatment of osteoarthrosis of the hip joint
After diagnosis, the treatment of deforming arthrosis of the hip joint at stages 2 and 3 of the disease is carried out according to the established scheme. Necessary:
- Eliminate pain and discomfort in the area of the damaged joint.
- Improve the nutrition of articular cartilage, and establish the recovery process.
- Promote the production of joint fluid.
- Increase microcirculation and improve joint tissue nutrition.
- Remove excess joint load.
- Strengthen periarticular muscle tissue.
- Stabilize deformation and achieve greater joint mobility.
Achieving positive results is possible only with an integrated approach to the problem, starting all types of treatment and completely changing the lifestyle. Deforming arthrosis of the hip joint at stage 3 is treated only by surgery. The damaged joint is changed to an endoprosthesis, implanting one part of it into the pelvic, and the other into the femur. A time-consuming and complex operation requires a long recovery period, after which the patient becomes efficient and does not experience pain. At stages 1 and 2 of the disease, all methods of conservative treatment are used. Moreover, in the first stage, the disease is completely cured, and in the second, lifelong supportive therapy is needed.
Drug therapy
With coxarthrosis, the following groups of medications are used:
- NSAIDs - are used to eliminate pain and inhibit the inflammatory process.
- Chondroprotectors - nourish cartilage, accelerating recovery. Especially necessary in the treatment of deforming arthrosis of the hip joint of the 2nd degree. Long-term therapy is carried out, consisting of several courses. The same medicines are successfully used to treat the disease in the first stage.
- Muscle relaxants are used to improve blood supply to joint tissues and relieve muscle spasm.
- Steroids are substances that accelerate protein synthesis in tissue cells, and increase muscle growth. They eliminate pain and relieve exacerbation.
- Vasodilating - accelerate the delivery of nutrients for tissue repair.
- Local values - ointments and creams reduce pain, restore blood circulation.
To help pharmacotherapy, you can use folk remedies.
Physiotherapeutic procedures
In addition to drug therapy, for the treatment of deforming arthrosis of the hip joint of the 2nd degree, experienced orthopedists recommend physiotherapy that can limit the use of drugs and avoid endoprosthetics. To do this, use:
- Miostimulation. It restores the work of weakened muscles due to insufficient joint mobility.
- Shock wave therapy. It acts on the joints with sound waves, providing blood flow to them. This improves metabolic processes and tissue regeneration.
- Ozone Therapy The ozone-oxygen mixture has a beneficial effect on the growth of cartilage and relieves pain.
- Phonophoresis. Ultrasound promotes better penetration of therapeutic ointment and cream to the affected joint.
All these measures are also successfully used for the treatment of a disease of the first degree, if the patient, at the first symptoms, seek medical help.
Kinesitherapy for joints
For the complex treatment of deforming arthrosis of the hip joint of the 2nd degree, the following procedures are widely used and give good results:
- Massage. Together with manual therapy, it stimulates the work of muscles, ligaments and joints. As a result, pain decreases, mobility increases, and cartilage tissue growth is stimulated.
- Exercise therapy. The regular execution of specially selected exercises helps to strengthen the muscles and ligaments near the damaged joint, which eliminates the discomfort during everyday movements.
- Joint traction. Using a special traction apparatus or the influence of a chiropractor, the internal space in the joint is adjusted, thereby restoring its functionality and facilitating the patient's condition.
- Mechanotherapy. Work on simulators removes muscles from stagnation, blood flow increases, and the supply of cartilage tissue improves. Often prescribed to elderly patients.
Kinesitherapy is used to treat any degree of deforming arthrosis of the hip joint.
Diet for coxarthrosis
Diet with deforming arthrosis is an integral part of multifaceted treatment measures and is aimed at alleviating the patient's condition. With the disease, low-calorie, balanced and rich in vitamins and minerals nutrition is used. The main meal should be in the morning and afternoon. A diet is required regularly. Its main goal is to stimulate the normal functioning of the joints. This requires a balanced diet that contains a sufficient amount of fats, proteins, vitamins and minerals. Regardless of the degree of deforming arthrosis of the hip joint for the diet, it is recommended:
- Meat of low-fat varieties - boiled or steamed rabbit meat, turkey, chicken.
- Dairy and sour-milk nonfat products.
- Fish containing omega-3 fatty acids - cod, trout, salmon.
- Porridge from oat, corn, buckwheat.
- Saturated bone broth from fish and lean meat.
- Fresh or frozen vegetables and fruits.
- Natural freshly squeezed juices - pineapple, pomegranate, orange.
- Linseed oil.
- Nuts - walnuts, hazelnuts, almonds, flax seeds.
- The eggs.
Dishes containing a large amount of protein are consumed in the morning, salads are seasoned with vegetable oil. The drinking regimen should also be balanced; lack of water leads to the destruction of bones and the formation of calcareous deposits on the joints.
Physiotherapy
In the treatment of deforming arthrosis of the hip joint, gymnastics occupies one of the important places. It is able to maintain joint mobility and prevent its fusion. The purpose of the exercises is to develop a sore joint. This excludes exercises with serious physical exertion, sharp and deep squats, with a large range of motion. Water treatments are very helpful. Swimming in a pool, sea or river does not give a strong load on the joints, but at the same time smoothly develops them.
If for some reason swimming is impossible, then classes are carried out in a bath with warm water. The procedure helps relieve muscle tension and soothe pain. Especially at the 1st and 2nd degrees of deforming arthrosis of the hip joint, lying in warm water and performing slow and smooth movements with legs, the patient strengthens muscles, relieves pain and improves joint nutrition. In addition to water procedures, there are complexes of exercises performed lying on the stomach, back and standing on legs, which in each specific case will help the doctor to choose. It is very important that during exercise therapy no sharp pain in the joints appears.
Surgical treatment
All surgical interventions are performed by the surgeon in a hospital. In this case, the patient is hospitalized, with the exception of the procedure for taking a puncture of the joint fluid. After operations, a long recovery period of several months is required.
In the treatment of deforming arthrosis of the hip joint of the 2nd degree, the following surgical interventions are sometimes performed:
- Puncture is a minimally invasive operation. It is performed when a large amount of fluid accumulates in the joint cavity. The result of the procedure is pain relief, improved mobility. Puncture can be performed more than once, especially before using steroid drugs.
- Arthroscopic surgery - used to wash the articular surface from damaged tissue. In addition, during the manipulation, the joint cavity is flushed with a special solution that relieves inflammation. For the procedure, several punctures are used without opening the articular cavity.
With deforming arthrosis of the hip joint of the 3rd degree, when conservative therapy does not give a significant effect, apply:
- Periarticular osteotomy - it consists in an artificial fracture of the femur and its subsequent fusion at a different angle. The operation is performed to reduce the load on the joint and gives temporary relief to the patient from pain up to five years. In some situations, when it is impossible to perform endoprosthetics, such an operation is a way out of the situation.
- Endoprosthetics - a complete replacement of a joint with a prosthesis. , . 20 , . , .
Conclusion
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