Coxarthrosis of the hip joint: causes and mechanism of development, symptoms, treatment

Coxarthrosis of the hip joint is a severe localization of DOA (deforming osteoarthritis). This disease belongs to a group of pathologies that are based on degenerative-dystrophic damage to all components of the joint and surrounding tissues, which is accompanied by discomfort and decreased mobility of the lower limb.

Coxarthrosis develops gradually and leads to decreased mobility of the lower limb

Osteoarthritis involving the hip joint accounts for more than 40% of all pathology locations. This is explained by the fact that the joint belongs to the support group, i.e., it provides the ability to stand and move while experiencing a constant load.

The phenomena of arthrosis of the hip joint more often develop in women, due to the special structure of the pelvic bones and excessive stress that occurs during pregnancy and childbirth. In men, the course of the disease is more subtle due to the powerful musculo-ligamentous apparatus.

What is coxarthrosis of the hip joint?

The entire group of arthrosis is a disease characterized by degenerative and deformational changes in tissues. Among them, coxarthrosis is distinguished by the frequency of diagnosis, especially in women, and damage to the hip area occurs more often than others due to the increased load, even in a person not involved in major sports. The rate of progression of coxarthrosis is slow, so at an early stage, doctors’ prognoses are positive. The mechanism of disease development is as follows:

1. The joint fluid thickens and its viscosity increases. The cartilage surface dries and cracks form on it.
2. Friction of articular cartilage leads to their thinning, and pathological processes in the tissues begin.
3. The process of bone deformation starts, and the mobility of the hip area is impaired. Local metabolism suffers, the muscles of the affected leg atrophy.

Symptoms

The symptoms and localization of pain in coxarthrosis are quite characteristic, and the cause can be correctly diagnosed by an experienced doctor.

The intensity of their manifestation depends on the degree of damage to the joint.

Signs of coxarthrosis:

• Pain localized in the hip joint. The first symptoms appear only after walking or exertion; in the final stages, the sensations turn into aching, constant sensations that are difficult to endure.
• Stiffness. With early pathology, stiffness of movement is felt only in the morning. As the disease progresses, normal walking becomes difficult and may develop into complete immobility.
• Shortening the sore leg. In advanced stages, pelvic asymmetry may appear due to bone deformation.
• Lameness. Deformation of the bones leads to forced movements when walking, which is why the patient’s gait changes.
• Crunch. Appears due to growths and can be heard by others.
• Amyotrophy. Inflammation, swelling and limited mobility lead to atrophy of muscle tissue and ligaments.

If coxarthrosis is confirmed, treatment should be started immediately. Bilateral damage can lead to disability.

Which doctor treats this disease? In the early stages, you can contact a regular therapist, who will then refer you to a more specialized specialist - an orthopedist or surgeon.

Symptoms

The main sign of dystrophic changes is pain: which can be localized in the groin area, hip area and even the knee area. Moreover, the nature of the pain depends on the stage of the disease - at the initial stage it appears only when the patient gives himself physical activity. Later, the pain becomes constant, tormenting even at rest, the area of ​​pain expands. Osteoarthritis of the hip joints is mainly characterized by the following symptoms:

• stiffness of movements;
• gait disturbances (up to lameness);
• decreased range of motion in the hip area;
• shortening of a limb with an affected joint.

Degree of damage

Based on the nature of joint damage, there are 4 degrees of coxarthrosis:

If a person knows what coxarthrosis is, he can notice the signs of the disease in time and begin treatment that will help stop the deforming process.

Treatment must be carried out necessarily and can begin at any stage.

Causes

Modern medicine divides all osteoarthritis into 2 categories: primary is characterized by the absence of obvious causes for the onset of the disease, excluding risk factors and some congenital factors. Thus, an indirect prerequisite may be a violation of metabolic processes or weakness of cartilage tissue, but predominantly primary coxarthrosis develops against the background of:

• prolonged loads on the joint;
• spine pathologies;
• problems with blood circulation and hormonal levels;
• old age;
• sedentary work.

Secondary coxarthrosis is a disease that is supported by a whole “bouquet” of diseases associated with the musculoskeletal system, cartilage and bone tissue, or occurs as a post-traumatic complication. Unilateral damage to the hip area occurs mainly against the background of osteochondrosis, and bilateral damage occurs due to diseases of the knee joint. Main causes of the disease:

• aseptic necrosis affecting the head of the femur;
• dysplasia;
• Perthes disease;
• congenital hip dislocation;
• inflammatory process (often complicated by infection) in the hip area.

Mechanism of development of coxarthrosis

In a healthy person, the joint at the junction of the two bone ends is completely covered with a layer of cartilage (strong, smooth and elastic tissue), which provides shock absorption when walking and evenly distributes loads within the joint.

In order to produce synovial fluid in sufficient quantities, cartilage must be well supplied with blood from the underlying bone and contain a large amount of fluid, collagens and proteoglycans.

Strongly developed muscles of the buttocks, thighs and back help to properly distribute pressure and act as backup shock absorbers when walking and running.

Fundamental to the occurrence of DOA are excessive loads on the joint with normal anatomy and constant trauma to the areas of the hip joint due to inconsistency of the articular surfaces (improper structure of the acetabulum).

Pathogenesis of DOA

First, the metabolism in cartilage tissue is disrupted with a predominance of decay processes, and the rate of collagen formation decreases. The production of inflammatory factors into the synovial cavity increases, which further impede the restoration of cartilage and further contribute to the formation of microthrombi in the subchondral layer of bone.

With osteoarthritis, cartilage tissue loses elasticity and bone growths appear

Excessive load on the joint leads to its gradual thinning. The tissue loses its elasticity, the cartilaginous surface becomes rough and becomes covered with microcracks. Over time, the area of ​​bone under the cartilage becomes exposed, its tissue becomes denser, cysts and marginal growths (osteophytes) are formed, which further disrupt the statics of the joint.

The lack of shock absorption gradually weakens the ligamentous apparatus, thereby making the joint even more unstable and susceptible to dislocation. A reflex spasm of surrounding muscles occurs in response to prolonged pain. Subsequently, contracture, shortening of the limb, and lameness may occur.

Degrees

Official medicine reports that deforming arthrosis of the hip joint has 3 stages of development, for which the only common symptom is pain, which gradually increases in intensity. The remaining signs change as coxarthrosis progresses, so it is easy to determine from them how advanced the disease is. The classification is simple:

1. 1st degree - narrowing of the joint space, the head and neck of the femoral bone are in normal condition, but there are growths near the acetabulum.
2. 2nd degree - an x-ray will show an uneven significant narrowing of the gap, there is a deformation of the femoral head, which is displaced upward and enlarged. Bone growths on both edges of the acetabulum.
3. 3rd degree - characterized by significant narrowing of the gap and expansion of the femoral head. The symptoms of this stage include constant pain, muscle atrophy (due to impaired blood circulation in the joint), and shortening of the limb.

Coxarthrosis: symptoms

Depending on the characteristics of the pathological process, coxarthrosis, like other diseases, is characterized by compliance with specific degrees, there are three in total. In addition, as part of the consideration of the degrees corresponding to the course of the pathological process, we will also highlight the symptoms of coxarthrosis that are relevant for these degrees.

Coxarthrosis of the 1st degree is characterized by the appearance of periodic pain in patients, their occurrence is noted after certain forms of physical activity (running, walking, etc.). Mostly, the localization of pain is concentrated within the hip joint, but it is possible that the pain may begin with pain in the knee joint or hip. As a rule, rest helps the pain disappear. There are no restrictions in movements at this stage, there are no disturbances in gait, and there are also no changes in muscle strength. An X-ray image can reveal the presence of bone growths that are insignificant on a scale, but these growths do not extend beyond the boundaries of the articular labrum. The location of the bone growths is noted in the environment of the outer or inner edge of the articular surface in the area of ​​the acetabulum. The femur in the area of ​​the head and neck undergoes virtually no changes. There is an uneven narrowing of the joint space.

Coxarthrosis of the 2nd degree is accompanied by increased pain, which in this case manifests itself in an even more pronounced form than before. In addition to the fact that pain appears in the joint, there is also an attachment of pain sensations radiating to the thigh and groin area; moreover, all pain sensations during this period of the disease are characterized by their presence even if the patient is at rest. When walking for a long time, lameness is noted, the normal functionality of the affected joint is impaired. Significant limitations are also observed in internal rotation, as well as in hip abduction. The muscles that provide abduction and flexion/extension lose their characteristic functionality. When viewing a radiograph at this stage of the course of coxarthrosis, one can notice pronounced growths, and they are located along both the inner and outer edges of the acetabulum, extending beyond the boundaries of the cartilaginous lip. Deformation of the head of the femur occurs, as well as its increase in volume with the appearance of an uneven contour. In those areas of the acetabulum and head where the greatest load occurs, cysts can form. The neck of the femur is also subject to changes, which gradually thickens and widens. An uneven narrowing occurs in the gap of the hip joint - it loses about 1/3-1/4 of its original height. Changes associated with the actual upward displacement of the head of the hip joint are also diagnosed.

Coxarthrosis of the 3rd degree is characterized by the persistence of pain, and the pain is noted not only during the daytime, but also at night. There are pronounced difficulties in walking, and the need for support arises, which in this process is a cane. There is a sharp limitation in the range of movements produced by the joint; in addition, atrophy of the muscles of the lower leg, thigh and buttocks occurs. Due to the weakness of the femoral abductor muscles, the pelvis deviates within the frontal plane while shortening the limb on the affected side. To compensate for the actual shortening, the patient has to tilt his torso towards the affected side when walking. A shift in the center of gravity leads to a sharp increase in the load, which, one way or another, falls on the affected joint. When examining the radiograph of this stage of the pathological process, a sharp form of narrowing of the joint space (its almost complete disappearance) is noted with a significant expansion of the femoral head and the presence of multiple bone growths. Accordingly, all these processes minimize the mobility of the affected joint due to the practical pressing of the femoral head into the acetabulum. Due to the fact that at this stage there is almost no cartilage tissue left, it can be argued that the joint is practically irreparable. And even if restoration of the affected cartilage tissue were possible in some way, due to the too advanced process of deformation, which is already relevant for the head of the femur, adequate functionality of the joint is impossible in any case.

Thus, achieving stage 3 coxarthrosis requires either surgical intervention or a long-term and rather difficult to implement combination form of therapy. Meanwhile, therapy of any type is considered as a more than controversial option, and therefore treatment mainly comes down to surgical intervention.

Considering the features of the development of coxarthrosis, it is also necessary to dwell on two important points. They relate to what we have already touched upon in passing when considering the causes of coxarthrosis, in particular this is the state of the blood vessels surrounding the affected joint, due to which its condition is directly determined within the pathological process. In almost all cases of the disease, blood circulation is severely limited in this area. Moreover, the progression of coxarthrosis in combination with a forced limitation of mobility without an appropriate degree of “pumping” becomes the cause of increased actual stagnation within the blood vessels surrounding the joint, which, as can be understood, causes the deterioration of its condition. Thus, a kind of vicious circle is formed, which is quite difficult to break.

In addition, an important point is that the rate of development of the disease we are considering is also determined by the state of the patient’s muscular system as a whole. For example, in men, with a sufficient degree of development of muscles and ligaments, the course of the disease occurs in a milder form, which is explained by the “removal” of part of the muscle load from the hip joint, which has undergone a pathological process relevant for coxarthrosis. Accordingly, the stronger and stronger the muscles surrounding the affected joint, the slower the process of its destruction will proceed. This factor plays an important role in determining treatment, which should also be focused on strengthening muscles through a special set of physical exercises.

Diagnostics

The main method of checking the condition of the hip area if coxarthrosis is suspected is radiography: the information content of the image is close to absolute - you can even find out exactly the cause of the disease. As an addition to x-rays, the doctor may prescribe:

• MRI (checking for soft tissue problems);
• CT scan (for a detailed examination of bone structures).

Non-surgical treatment

Stage 2 coxarthrosis of the hip joint is treated without surgery. Doctors always prescribe conservative therapy in the hope of restoring joint trophism and leg mobility. This is due to the fact that joint replacement surgery is complex and expensive, and it also requires a very long rehabilitation period. Thus, anyone who does not know how to treat grade 2 coxarthrosis of the hip joint needs to prepare for long-term drug therapy. Additionally, physiotherapy, exercise therapy and other auxiliary methods are used aimed at restoring nutrition to the joint structures.

Drugs

Injection of one ampoule relieves pain well

First, in case of arthrosis of the hip joint of the 2nd degree, the symptoms are relieved. Pain and stiffness must be eliminated to improve the patient's quality of life. Additionally, anti-inflammatory drugs may be prescribed if pathological processes develop in the joint. In other words, how to treat grade 2 arthrosis of the hip joint will depend on the characteristics of the pathology and the severity of symptoms. The following groups of drugs are most often used:

1. Non-steroidal anti-inflammatory drugs in tablets - relieve pain, inflammation, quickly relieve symptoms. The most powerful remedies for joint pain are Diclofenac, Ketoprofen, Nimesulide. For severe pain, intramuscular and intra-articular injections of painkillers can be used, but only as prescribed by a doctor.
2. Vasodilators are drugs that improve oxygen transport and blood circulation. Improve metabolic processes in the joint, stimulate blood supply to cartilage tissue. Drugs such as nicotinamide (nicotinic acid), Cinnarizine, Trental and other drugs with similar properties may be prescribed.
3. Intra-articular injections of hormonal drugs are used as prescribed by a doctor. A specialist gives the injection into the joint. Such drugs quickly eliminate pain, block inflammatory mediators, reduce swelling in the joint capsule and stimulate metabolic processes. The drugs Hydrocortisone, Metipred and other drugs of this group are used.
4. Chondroprotectors are used to restore cartilage tissue. Popular drugs in tablets (Chondroitin, Glucosamine) have recently been found to be ineffective, so drugs are most often prescribed in the form of an injection solution. Chondroprotectors are selected by a doctor on an individual basis. Such products improve the nutrition of cartilage tissue and stimulate its restoration. However, recent studies have proven that this process occurs very slowly, and drug stimulation does not produce a pronounced therapeutic effect, therefore, the advisability of using chondroprotectors should be consulted with your doctor.

The first thing to do with stage 2 coxarthrosis is to reduce the load on the joint. Left-sided coxarthrosis of the 2nd degree, as well as right-sided coxarthrosis of the 2nd degree, requires the use of a cane during treatment.

Note! Drugs for the treatment of coxarthrosis of the 2nd degree of the hip joint must be taken for a long time.

Signs of grade 2 coxarthrosis of the hip joint can be relieved with the help of topical medications. Such medications that can be used to treat coxarthrosis or arthrosis of the hip joint of the 2nd degree are various ointments and gels with non-steroidal anti-inflammatory drugs in the composition - Diclofenac, Fastum, Deep Relief and analogues. These medications can be used as needed, for example after exercise.

Exercise therapy

In acute forms of the disease, therapeutic exercises cannot be done.

Having understood what stage 2 coxarthrosis of the hip joint is, you should not expect that the disease can be overcome only with medications. An integrated approach is needed here. Physical therapy, or exercise therapy, helps:

• restore joint mobility;
• reduce swelling;
• increase exercise tolerance;
• improve joint nutrition;
• reduce the feeling of heaviness and crunching when moving.

The set of exercises includes stretching and simple exercises for the joint, for example, moving the leg bent at the knee back and to the side. Despite the simplicity of performing all the exercises, it is necessary to visit the exercise therapy room at the clinic and exercise under the guidance of a rehabilitation doctor, who will create an individual program and teach you how to do exercises correctly.

Physiotherapy

Is it possible to cure grade 2 coxarthrosis of the hip joint without surgery? It depends on how much the patient is willing to do for his own health. The main problem for most is that they do not complete treatment.

Physiotherapy is one of the effective ways to treat grade 2 arthrosis of the hip joint without surgery. This method improves tissue nutrition, thereby preventing further progression of joint deformity.

For grade 2 coxarthrosis, the attending physician may prescribe:

• medicinal electrophoresis with vasodilators (nicotinic acid);
• magnetic therapy;
• mud applications;
• heating with paraffin;
• phonophoresis.

The most effective method for grade 2 coxarthrosis of the left or right limb is electrophoresis with a vasodilator. Typically, such procedures are prescribed in courses of 10-15 daily sessions.

Manual therapy and joint traction

Massage should only be performed by an experienced specialist, otherwise the problem will only get worse

Treatment of grade 2 arthrosis of the hip joint with manual therapy is one of the methods that allows you to normalize leg movement without surgery. Massage must be done in a course. During the procedure, the chiropractor develops the joint and stretches the limb to return the joint to its natural position. The procedure is quite unpleasant, but very effective, especially for lameness and chronic pain.

A massage course should be taken twice a year. Usually 10 sessions are prescribed every day or every other day.

Joint traction can also be carried out in a physical therapy room and rehabilitation after injury; for this purpose, special loops are used, into which the patient threads his legs, and then does simple exercises.

Diet

Bilateral coxarthrosis of the 2nd degree is diagnosed quite rarely, and is most often a consequence of excess body weight. In this case, a diet is prescribed, since the patient needs to lose weight to reduce the load on the joint.

There is no therapeutic diet specifically for coxarthrosis; joint diseases cannot be treated with food.

To lose weight, your doctor will recommend reducing your caloric intake and eating a balanced diet.

Folk remedies

Another useless treatment method is the fight against grade 2 coxarthrosis of the hip joint with folk remedies, ignoring the medications prescribed by the doctor. At home they use:

• tincture of lilac flowers;
• white cabbage leaves;
• ointment with propolis;
• garlic tincture;
• chicken paw broth.

Remember: none of the popular folk remedies are effective for grade 2-3 coxarthrosis of the hip joint, but are just a waste of time.

If symptoms of coxarthrosis appear, it is necessary to urgently begin drug and physiotherapeutic treatment before the disease of grade 2 develops into damage to the hip joint of grade 3.

How to cure coxarthrosis of the hip joint without surgery

If dystrophic arthrosis is caused by congenital pathologies of connective or cartilaginous tissue, or the spine, treatment will be aimed only at preventing exacerbation and relieving the main symptoms. In other cases, the doctor influences the cause of the disease, for which the patient is prescribed:

• drug therapy (local, injection, orally);
• physiotherapy for a sore joint;
• physical therapy (maintains mobility of the hip area);
• massage;
• diet.

Drug treatment

All tablets and local medications (ointments, injections) are prescribed to the patient according to the cause of coxarthrosis and the stage of its development. NSAIDs help relieve pain, but they will not cure – they will only relieve symptoms. To improve blood supply to the joint and eliminate spasm, muscle relaxants and vasodilators are used, and chondroprotectors are used to restore cartilage. Effective drugs for coxarthrosis are:

• Indomethacin - exclusively in case of exacerbation of coxarthrosis of the hip area, to relieve inflammation and pain.
• Chondroitin sulfate is safe, allowed during pregnancy, and protects against further cartilage destruction.

Blockade

When coxarthrosis becomes acute, the patient needs not only to be treated, but also to make him feel better by relieving the attack of pain in the joint. For this purpose, doctors inject novocaine, followed by a glucocorticoid drug that has strong anti-inflammatory properties. The blockade can last for several weeks, but the injection agent is selected exclusively by the doctor.

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Injections for coxarthrosis of the hip joint

Injections for this disease can be intramuscular, intravenous and into the joint cavity. The latter - with drugs that replace joint fluid, based on hyaluronic acid, which protect and restore cartilage tissue. Intramuscular injections can be with chondroprotectors and anti-inflammatory drugs:

• Artradol - based on chondroitin sulfate, stops inflammation, adapts the joint to the load, and prevents cartilage from deteriorating.
• Diclofenac is an anti-inflammatory drug that eliminates swelling and pain, but it can be treated for no longer than 2 weeks.

Diet

Nutritional correction will not help treat coxarthrosis - it is only needed to reduce the load on the joint if the patient is overweight. It is recommended to completely give up simple carbohydrates, drink more water, and be sure to include dairy products, fish, buckwheat, beans and gelatin (collagen)-based dishes in your diet - jellied meat, jelly.

Physiotherapy

Heavy loads are prohibited for a patient with coxarthrosis in order to prevent the progression of the disease, but activity cannot be abandoned - it helps maintain joint mobility. A set of physical therapy exercises should be drawn up by a doctor and exclude axial load. The following options are possible:

• Lying on your back, slowly pedal with your legs raised for 15 seconds. Take a break and repeat the exercise.
• Lying on your stomach and placing your hands on your hips, raise your straight legs one at a time.
• Lie on your side, lower arm under your head. Slowly raise your upper leg and lower it.

Massotherapy

Manual techniques are indicated not only for the hip area, but also for the entire spine (traction procedure), especially at the 2nd stage of the disease. Massage helps to increase blood circulation, strengthen muscles, and reduce the load on their joint areas. Home massage is a circular rubbing and stroking of the affected hip area for 10 minutes (directions can be studied from the photo), but it is important to remember:

• Do not allow abrasions and bruises - do not press too hard.
• You should feel the painful joint and surrounding tissues relax, rather than spasm more.

Physiotherapeutic procedures

Improving blood circulation and relieving vascular spasms are the main goals of all procedures (from electrophoresis to UHF), but without drug treatment they will be almost useless, especially at the 2nd stage of the disease and beyond. Often, treatment of coxarthrosis of the hip joint involves:

• Magnetotherapy is the effect on a joint of a magnetic field (constant/pulsed), which dilates blood vessels.
• Shock wave therapy is the effect of waves on bone outgrowths to improve joint mobility.
• Laser exposure – to a depth of 15 cm to enhance metabolic and regenerative processes in the cartilage of the hip area.

What is stage 2 coxarthrosis?

Already at the first stage of the disease, changes in the joint are visible on x-rays

In simple terms, coxarthrosis is the gradual destruction of a joint through thinning of the cartilage and narrowing of the joint space. As a result, the joint loses mobility; in place of the collapsing structures, osteophytes are formed - bone growths or fragments that fall into the joint capsule and disrupt movement in the joint. Over time, an inflammatory process may develop, and secondary coxarthrosis itself arises from advanced inflammation in the joint.

There are three degrees of the disease. The easiest - the first degree - is characterized by discomfort only after exercise and the absence of pathological changes in the joint noticeable on an x-ray. This form is most amenable to conservative therapy and offers a chance for complete recovery.

For grade 2 coxarthrosis of the hip joint, symptoms and treatment depend on how long a person lives with this form of the disease. X-rays show the first changes (narrowing of the joint space), thinning of the cartilage, so treatment for grade 2 coxarthrosis should be started immediately. Conservative therapy is successful in most cases, or at least can stop the progression of the disease, preventing the development of the most dangerous form. Grade 3 leads to severe degeneration of joint tissue, as a result of which it loses mobility. The limb shortens, the head of the joint thickens, and the cartilage becomes thinner. Articular fluid stagnates in the joint, movement of the limb is difficult or completely impossible, and the person is forced to move with a cane. There is only one way out - endoprosthetics surgery.

Causes of the disease

The obvious cause of stage 2 coxarthrosis is the lack of timely treatment of stage 1 disease. There is nothing surprising here, since at the beginning of the pathological process the symptoms are mild, and 95% of patients do not consult a doctor, believing that the pain will go away after rest. In general, this is what happens, because at the initial stage the joint hurts only when under load.

All women after menopause are at risk of developing the disease. Men with coxarthrosis are less likely to experience it.

The main cause of the disease is wear and tear of the joint. Each person has his own prerequisites for the development of this condition. Among them:

• joint injuries;
• inflammation in the joint;
• problems with the spine;
• excess weight;
• heavy load on the joint;
• physical inactivity;
• connective tissue pathologies;
• congenital diseases of the hip joint;
• femoral neck fracture;
• arthritis of the hip joint.

The disease can also occur as a result of advanced infectious diseases of the pelvic organs, when the infection spreads to the hip joint, or as a result of metabolic disorders, due to which the nutrition of the joint tissues deteriorates.

Symptoms of grade 2 coxarthrosis

After walking a short distance, a person already begins to feel pain in the thigh

To understand whether grade 2 coxarthrosis of the hip joint can be treated with medications, you should know how it manifests itself.

The following symptoms are characteristic of coxarthrosis of the second degree:

• intense pain in the joint that occurs after exercise (long walking, climbing stairs, running);
• aching pain at rest;
• shooting pains that occur for no reason, radiating to the groin and thigh muscles;
• lameness after heavy exertion;
• decreased range of motion in the joint.

A simple test for coxarthrosis - you need to sit on a chair with a back so that your legs are on either side of the seat. With coxarthrosis of the second degree, this is difficult to do, since the amplitude of hip abduction to the side is reduced due to degenerative-dystrophic processes.

How dangerous is the disease?

The main danger with grade 2 coxarthrosis is the progression of the pathology. The destruction of joint structures occurs slowly but inevitably. If nothing is done, the pathology will develop into a third-degree disease that cannot be cured with medication.

Also, in some cases, grade 2 coxarthrosis can lead to shortening of the limb due to an increase in the volume of the joint and severe lameness. An advanced disease leads to disability; mobility in the affected limb can only be restored by replacing the destroyed joint with a prosthesis.

Operation

Before the last stage of coxarthrosis, surgical intervention is not recommended, since any operation cannot exclude a lot of complications and negative outcomes. It is prescribed if attacks of pain can no longer be stopped and the joint ceases to function normally. According to doctors, in 95% of cases a person returns to the usual rhythm of life and does not even lose the opportunity to play sports, and the remaining 5% is due to arthrodesis - bone fixation, as a result of which the limb retains only its supporting function.

Arthroplasty

At the early stage of destruction of cartilage or bone (often when coxarthrosis occurs as a result of trauma), doctors prescribe restoration of the missing surfaces. Arthroplasty is performed under general anesthesia: the surgeon spreads the tissues or cuts the muscles to access the affected area, fixes the prosthesis with bone cement and, if necessary, stitches back the muscles or other tissues that were cut.

Endoprosthetics

Replacement of the hip joint with an artificial one (metal/ceramic) is performed only when the own one is completely destroyed, according to a scheme similar to arthroplasty. Before the operation, an examination is carried out, and general anesthesia is administered during the procedure. The prosthesis that is placed on the patient can replace only the head of the femur or it, but with the acetabulum. During rehabilitation, antibiotics are prescribed, the patient is kept in the hospital for 10-12 days, and then the stitches are removed and sent home.

Prognosis, complications

If treatment is started in a timely manner, the functionality of the joint can be maintained. It is best if the disease is detected in the initial stages, when conservative methods can be used.

The pathology is very dangerous and, if left untreated, can lead to complications such as:

• deformation of articular bones, which become less strong and more susceptible to damage during physical activity;
• tissue death of the head of the femur, which limits mobility in the hip joint;
• kyphosis or scoliosis are diseases of the spinal column that develop because deformation of the hip joint increases the load on it;
• arthrosis of the knee joints, caused by improper load on the remaining articular structures of the lower extremities;
• arthritis – inflammation in the joint cavity;
• bursitis: with coxarthrosis, calcium salts accumulate in the area of ​​attachment of the tendons to the femur, which irritates the membranes of the joint and provokes their inflammation;
• ankylosis is a complete fusion of the articular surfaces, due to which the movement of the joint is completely limited.

If a person with coxarthrosis loses the ability to move independently without special devices and cannot care for himself, he is assigned a disability group.

Prevention

If a person is at risk of developing coxarthrosis (both due to the presence of congenital prerequisites and due to the influence of external factors), his main task is to protect the cartilage tissue and the joint itself as much as possible. It is important to monitor your diet (the diet mentioned above for coxarthrosis of the hip joints), and also:

• practice daily long walking or play sports (swimming, gymnastics);
• avoid overloading the joint;
• avoid hypothermia.

General characteristics of the pathology

Coxarthrosis is a persistent violation of the integrity of the articular surfaces, which occurs rather slowly, but at the same time affects cartilage tissue and deforms bone structures. The disease belongs to the group of dystrophic disorders.

The progression of the pathology is primarily due to a deterioration in the quality of the joint fluid, which becomes too viscous. As a result of such changes, the upper part of the cartilage dries out completely from time to time and therefore loses its smoothness. As a result, the cartilage becomes covered with cracks, becomes thinner, and provokes destruction of the joint.

The pathology develops slowly, so this disease can rarely be detected in the early stages of the disease, when the prognosis is most favorable.

Coxarthrosis is a common pathology of the hip joint. This is due to the fact that this anatomical structure regularly experiences increased loads.

The main causes of the disease

Coxarthrosis can also be caused by:

• Various infections of influenza, streptococcus and staphylococcus. The disease develops quite quickly with fever in the area of ​​the affected joint.
• Inflammation of the tendons or so-called tendonitis may also occur. Most often it affects athletes or people who put a lot of mechanical stress on their joints.
• Due to arthritis that was not treated in time.

For various connective tissue diseases, including rheumatism, which affect both the heart valves and joints. It occurs as a consequence of a sore throat due to a streptococcal infection.

Development of the degenerative process

What is coxarthrosis? Pathology is regarded as a complex of symptomatic manifestations accompanying degenerative-dystrophic changes in articular cartilage.

In the largest joint, the pelvic bone and femoral head are united using the acetabulum, covered with cartilaginous lips. The surface of the articulating bones is covered with a durable layer of hyaline cartilage. Thus, nature created a kind of natural hinge to ensure unhindered gliding and perform flexion, extension, and adduction movements.

In normal condition, the smooth functioning of the mechanism is ensured by the joint fluid, which fills the free cavity of the movable joint, endowed with the properties of a lubricant and protective material. Together with the articular elements, the activity of the hip joint is supported by muscles and ligaments. The vessels of the muscle frame pump blood, which supplies the joint with nutrients.

Under the influence of various factors, the joint fluid loses its usual properties. Cartilaginous fibers, deprived of proper support, lose their firmness and elasticity, soften, and become unfibered. Over time, in some areas the cartilage tissue is completely destroyed. The exposed surfaces of the articulating bones come into contact, injuring each other. Constant trauma is compensated by marginal bone growths.

As it progresses, coxarthrosis of the hip joint spreads to nearby ligamentous-muscular tissues, leading to their hypotrophy, decreased muscle tone, and impaired static-dynamic function. Limitation of the functional abilities of the joint depends on the anatomical structure, location of pathological growths, and the level of cartilage degeneration.

Psychosomatic reasons

Some psychologists adhere to the theory that the cause of a particular disease is always a psychological problem of a person. To the question of why arthrosis of the hip joint occurs, psychosomatics also has its answer. It is known that joint diseases can cause impairment and loss of mobility, since every movement is often associated with pain.

Psychologists believe that joints suffer due to the fact that a person is unconfident and indecisive. The cause of the disease may also be fatigue and lack of desire to continue the work started. When the function of the joints is disrupted due to pain, a person’s movements are constrained, as if he is stopping himself and suppressing the need to move on. And if you pretend that the problem does not exist, then it will make itself felt more and more, and over time it can develop into a more serious form of the disease.

As you know, older and elderly people are most susceptible to coxarthrosis. Often, after 40 years, a person is afraid to change anything in his life, preferring to be content with what he has and not reach for something more. At the same time, he believes that at his age it is already difficult to achieve anything, that only young people can take up sports or business from scratch. A person loses faith in his own strength and flexibility of thinking. Against this background, the functioning of the joints is also disrupted, causing arthrosis and other diseases.

A person’s internal problem can also be judged by the location of the lesion. If the problem concerns the hip joint and, in particular, coxarthrosis, then this indicates a person’s indecision and reluctance to complete the work he has started.

But it is necessary not only to eliminate the psychological cause of the disease, but also not to forget about traditional treatment. Any doctor will tell you that a healthy lifestyle, a positive attitude towards everything and the desire to create something new play an important role in recovery.

Coxarthrosis can be caused by various factors, some of which can occur simultaneously. These can be either predispositions or other diseases that result in arthrosis of the hip joint.

How the disease manifests itself: main symptoms

The main factor in the occurrence of coxarthrosis of the knee joint is mechanical damage.
When even a minor injury to the articular cartilage occurs, a large load is placed on the knee. At this point, the membrane that covers the cartilage of the joint begins to break down. As a result, the patient develops coxarthrosis. If measures are not taken in time, the disease develops into a more severe form, which is more difficult to treat.

To correctly understand why coxarthrosis applies only to the hip joint, you need to understand the mechanism of development of this disease. The hip joint consists of two articulating bones - the ilium and the femur. The ilium consists of a depression called the acetabulum.

What begins to happen in the joint with the development of deforming coxarthrosis? The root cause is a change in the properties and composition of the synovial fluid, which thickens (for various reasons) and ceases to properly nourish and lubricate the articular cartilage. Without lubrication, friction begins, which dries out its surface.

The cartilage tissue cracks, becomes covered with cracks and roughness. As a result, the cartilage becomes thinner, which leads to a decrease in the joint space. The load on the articular parts of the bones, after partial or complete destruction of the cartilage tissue, begins to deform them. Hence the name - deforming coxarthrosis.

Changes in arthrosis of the knee joint

Two factors play a role in the development of the pathogenesis of this disease:

• normal load on damaged cartilage (trauma);
• increased load on healthy cartilage, which leads to abrasion.

At high risk are athletes, whom orthopedic doctors jokingly call walking “disabled people.” Even a short period of professional sports almost always leads to the formation of microtraumas in the joint, which can manifest themselves even when physical activity stops. Also at risk are doctors, teachers, hairdressers, salespeople - that is, people who spend most of their working time on their feet.

Women suffer from coxarthrosis more often than men. There are several reasons:

• their body is designed for lower loads;
• Wearing high heels increases stress on the hip and knee joints.

It must be borne in mind that nature has built very great strength into the joints. Their service life is enough for 1.5-2 human lives. And even if pathological changes begin in the joint, they will not immediately make themselves felt with pain and other symptoms. Before a diseased joint manifests itself, some change must occur in the functioning of the body.

There are three degrees of development of coxarthrosis:

• 1st degree. Symptoms: mild, short-lived pain felt in the hip and knee. All motor functions of the legs are performed without restrictions.
• 2nd degree. Symptoms: pain intensifies and is also felt during rest. They begin to feel pain in the groin and knee. A slight lameness appears when walking for a long time. Leg mobility in the hip joint is limited.
• 3rd degree. Symptoms: constant pain, often interrupting sleep. The patient cannot walk without additional support. Leg mobility is severely limited. The leg shortens, the body leans forward. Due to improper weight distribution, the load on the affected joint increases.

Particular mention should be made of the stress during pregnancy, when a woman’s total weight increases by 10 kg on average. It is interesting to note that women in Africa have much less pain in their leg joints. But this seems to be due to the way infants are carried (on the back), which makes the load more even.

The rapid development of the pathological process is facilitated by metabolic disorders, in particular diabetes mellitus. Frequent stress has a negative impact on joint health. During emotional stress, the adrenal glands produce large amounts of corticosteroids that disrupt metabolic processes in the body. The main reasons for the development of degenerative changes in the knee are considered to be:

• Hormonal imbalance.
• Overweight. The knees are constantly overloaded due to the pressure of a person's own weight.
• Intense loads. For this reason, athletes and lovers of long walks suffer.
• Anomalies of skeletal structure. Any deviations from the norm should be identified in childhood to avoid the development of complications.
• Burdened heredity. Children may experience the same metabolic disorders that provoke coxarthrosis as their parents.
• Injuries. Improperly fused cartilage or bone can become inflamed over time.

The main signs of coxarthrosis of the knee joints:

• constant pain that does not depend on the patient’s activity;
• stiffness, especially in the morning;
• limited mobility;
• crunching, feeling of friction while walking;
• increase in local temperature;
• hyperemia of the skin over the affected joint.

The joint crunches and hurts even with minor physical activity.
At the beginning of the development of the disease, the patient has pain in the knee after prolonged exercise. As the pathology develops, the pain syndrome will remain at rest. There is a feeling of aching, the presence of a foreign body in the joint. When severe inflammation develops, discomfort occurs on the inside of the knee. In the morning, almost all patients complain of stiffness. The symptom lasts several minutes or hours, depending on the degree of coxarthrosis.

Due to the inflammatory process and the replacement of cartilage with bone tissue, partial, and over time, complete fusion of the parts of the joint develops. This manifests itself in the form of contracture - a decrease in range of motion, and ankylosis - complete immobilization of the leg. While walking, the patient hears a crunching sound in the joint and notes a feeling of friction. This is due to a decrease in the amount of intra-articular fluid and thinning of the cartilage layer.

Prolonged physical activity causing microtrauma and thinning of the joint.

Local metabolic disorders (gout, hemochromatosis, chondrocalcinosis, achronosis)

Osteoporosis and bone myelia (destruction)

Joint infection

Dysplasia

Hereditary factors associated with the weakness of cartilage to loads.

The main mechanism that triggers the development of coxarthrosis is a decrease in proteoglycans in articular cartilage.

Coxarthrosis is characterized by changes in the joint fluid, which thickens and becomes more viscous. The surface of the cartilage gradually dries out, it becomes brittle, and cracks form on the surface.

During movement, friction is generated, the cartilage tissue becomes thinner, which entails more serious consequences. Pathogenic processes continue, the joint adapts to changes, various deformations appear, metabolism deteriorates, muscles atrophy.

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There are three degrees of the disease:

1. First. The patient experiences slight pain in the knee joint. It has virtually no effect on walking, only slight stiffness is possible. An X-ray may show a slight narrowing of the joint space.
2. Second. Painful sensations now occur not only during movement, but also at rest. While moving, the patient may limp slightly and there is a crunching sound when walking. The x-ray shows a narrowing of the joint gap, the formation of osteophytes, and the ends of the bone are “flattened.”
3. Third. The painful sensations do not stop even during sleep. Swelling appears in the knee area, and a local increase in temperature is possible. The formation of osteophytes causes blockade of the joint, which is accompanied by unbearable pain and “jamming.” The axis of the limb is disrupted and the knee becomes deformed.

Etiological factors

According to etiological forms, primary (genuine) coxarthrosis is distinguished, in which cartilage degeneration occurs due to functional overload. This category also includes idiopathic osteoarthritis, which develops for unknown reasons.

The secondary (reactive) type is formed as an echo of painful conditions:

• blood supply disorders;
• deformation of the bottom (protrusion) of the acetabulum;
• inferiority of the joint due to improper development;
• metabolic failure;
• traumatic injuries;
• inflammatory diseases of the mobile joint.

If the cause of coxarthrosis of the hip joint is an injury, the body does not have time to sufficiently compensate for the degenerative-dystrophic process with an adaptive response. Due to the rapid development of pathological changes, patients show significant impairment of functional abilities in less than 3 years.

Reasons that can accelerate the clinical manifestations of coxarthrosis:

• excessive mechanical and physical overload of the joint;
• sedentary lifestyle;
• changes in hormonal status;
• increased uric acid levels;
• rachiocampsis;
• flat feet;
• prolonged exposure to stress.

An inherited gene that conveys information about what kind of disease this is and predisposes to its development has not been identified. But having a close relative with similar abnormalities increases the risk of developing coxarthrosis.

Stages of the disease

Due to the fact that the disease is degenerative, it goes through different stages of formation. Moreover, the longer a person does not pay attention to the existing problem, the more his condition worsens and his vital signs worsen.

Doctors classify 3 stages of the disease:

• When the disease begins to form, this is the first stage. It does not manifest itself as pronounced pain. Discomfort may only appear after prolonged exertion, for example, when walking several kilometers or when the patient climbs stairs with a heavy load on his hands.
• At the second stage of coxarthrosis, pain affects not only a localized area, directly at the joint itself, but can also spread to the groin area, as well as all sides of the femoral part of the leg. In the vast majority of cases, they occur when the body has experienced a certain level of stress. When a person is at rest, negative sensations disappear.
• During the third stage, the condition becomes so depressing that pain can occur both at rest and at night. Lameness appears. A person begins to use a cane for additional support, as he cannot fully transfer his body weight to the affected leg.

  Sergey Bubnovsky

Naturally, it is necessary to catch the disease in the early stages of development, since stopping the process in this case will be easiest. The choice of suitable treatment methods is carried out directly by the doctor after a complete diagnosis. Only in this case, when the extent of the disease and the affected area is determined, can the doctor prescribe conservative treatment methods. They include:

• Medications. Several groups of medications are used here. Some of them relieve pain symptoms, others are aimed at reducing inflammatory processes, others restore osteochondral structures by saturating them with essential vitamins, micro- and macroelements and biochemical components.
• Physiotherapy procedures of different spectrum of action, which also help relieve the inflammatory process and establish the full functioning of this part of the musculoskeletal system.
• And, of course, therapeutic exercises, which will maintain the human body in good condition throughout the rest of its life. Preventing relapses of the disease and strengthening the bone, muscle and cartilage structure.

Fractures and dislocations

A hip fracture is a fairly common injury in old age, which occurs due to weakening of bone structures. When this situation occurs, the patient experiences severe pain and can no longer make any movements in this joint.

In this case, the patient needs urgent hospitalization and proper treatment. The healing process can be weakened and worsened by the presence of any type of infection, such as bacterial arthritis or an infection affecting the joint. In this case, bone fusion will occur quite slowly. In addition, it is necessary to take into account that a fracture of the femoral neck quite often has consequences for health in the future.

Hip dislocation most often occurs with various types of injuries. Most often these are road accidents, work injuries or falls.

This condition is accompanied by the following symptoms:

• Sharp acute unbearable pain.
• Movement of this leg is quite difficult.
• If at the same time the nerve endings are damaged, then tactile sensations and sensitivity are lost in this limb at the level of the foot itself.
• If a bilateral dislocation occurs, the person may experience a “duck-walk” lameness.

There is also dislocation of the hip joints that occur in a child at birth. In this case, the small patient has insufficient development of the acetabulum. As a result, the head does not stay in the recess and simply falls out of it. Thus, a dislocation of the hip joint in an infant is formed.

How to treat coxarthrosis

Treatment of coxarthrosis of the hip joint is a difficult and lengthy process, including a variety of procedures. After identifying the disease and determining the degree of progression of the disease, the specialist must develop an individual treatment regimen for hip arthrosis. It includes not only taking pharmaceutical drugs, but also therapeutic exercises, as well as physiotherapy.

In addition, many doctors recognize the effectiveness of traditional medicine recipes, but only as a supplement to the main treatment.

Drug therapy for coxarthrosis:

1. The basis of treatment is taking chondroprotective drugs. They delay degeneration processes in damaged cartilage tissue and promote its restoration. They must be taken in long courses of up to six months. The most effective drugs were Teraflex, Glucosamine and Rumalon.
2. Nonsteroidal anti-inflammatory drugs are taken strictly according to the schedule and require medical supervision. Do not exceed the dosage prescribed by your doctor, as this can cause serious complications. In addition, constant use reduces sensitivity to this group of drugs, so therapy may be ineffective. Most often, drugs such as Diclofenac, Indomethacin, and Piroxicam are used to treat coxarthrosis. They help eliminate the inflammatory process in tissues, so they are used at any stage of the disease.
3. Muscle relaxant drugs are also used with caution. They have a relaxing effect on spasming muscles, but can negatively affect the activity of the central nervous system.
4. Vasodilators help normalize blood circulation in the damaged joint. In addition, they help relieve spasms and relax smooth muscles. In the treatment of arthrosis of the hip joint, the drugs Teonicol and Trental are usually used.
5. To quickly relieve pain, injections of hormonal drugs are used. This is a first aid remedy, but only in the absence of tendon inflammation. The drug Kenalog is usually prescribed, but it cannot be used often due to the high risk of side effects.

Local treatment involves the use of compresses with ointments or medicinal herbs. This is an effective remedy for relieving inflammation with minimal risk of complications. However, such therapy will not completely eliminate the disease, but will only reduce the severity of the pain syndrome.

Main set of symptoms

Among the main symptoms that appear in a patient during the development of bursitis are:

• Pain in the lumbar region.
• When a person moves his legs, he experiences discomfort. Moreover, they intensify with increasing amplitude.
• When a person holds the same position for a long time, his discomfort increases.
• When lying on your side, the pain becomes unbearable and burning, it covers most of the thigh and upper leg.
• If an infection is added to the inflammatory process of bursitis, the pain is acute. In addition, a person cannot fully straighten his leg in this case.
• During palpation, the doctor, and the patient himself, in this case can feel a lump that is localized on most of the surface of the thigh.

Classification of the disease depending on the age group of patients

Any changes in the hip joint are classified depending on the age at which the patient is:

• Thus, in middle-aged and elderly people, the disease coxarthrosis is most often caused by injury and deformation of the joints. Pressure of the acetabulum is also observed.
• In childhood and adolescence, the changes are called Perthes disease, synoitis. In this case, most often the pushing factors are varus deformities of the joints, any types of injuries in this area, as well as damage to bone structures by the tuberculosis bacillus.
• In infants under 1 year of age and newborns, dislocations of the hip joints may be observed as a result of epiphysiolysis, congenital varus deformity, as well as acute osteoarthritis of purulent etiology.

Clinical picture

The course of coxarthrosis is characterized by a number of symptoms, the severity of which directly depends on the stage or degree of the disease. Based on their presence and specificity, a disease can be suspected and additional research methods (for example, X-ray or MRI) can be performed to confirm the diagnosis. Characteristic manifestations:

1. Joint pain. This is usually the main complaint with coxarthrosis, with which a person is forced to see a doctor. In the initial period of the disease, pain is not expressed, but as the disease progresses, its intensity increases. Appears during physical activity, and in the later stages of the disease - at rest.
2. Joint stiffness in the morning.
3. Crunching in the joint, accompanying movements in it.
4. Violation of the main function of the joint - motor. It may manifest itself as stiffness, or, conversely, “looseness.” Lameness appears.
5. Disruption of the normal functioning of the lower limb. Hypotrophy of the muscles surrounding the joint occurs, shortening of the affected limb and disability develops.

For a more accurate and correct idea of ​​the disease, the course of the disease is conventionally divided into stages or degrees.

Surgical treatment of coxarthrosis

The thermal stage of the disease means that conservative therapy will be ineffective, because coxarthrosis of the hip joint leads to irreversible processes in the structure of the joint. Only surgical intervention can help the patient, and its type is selected based on the severity and extent of the disease.

There are several types of joint surgery:

1. Osteomy, in which the bones of the joint are cut. This allows you to restore mobility and correct joint deformity;
2. Arthrodesis involves fastening the joint parts together using special plates, screws and staples. The functionality of the joint is restored, but the stiffness of movements remains to some extent;
3. Arthroplasty involves modeling destroyed cartilage. The procedure is quite complex and expensive, but as a result, the normal structure of the articular joint is almost completely restored;
4. Endoprosthetics is one of the most effective methods of treating coxarthrosis in advanced stages. The recovery prognosis is about 70%, but the complexity of this operation should be taken into account. Depending on the progression of the lesion, a complete replacement of the joint (bipolar prosthetics) or its head (unipolar prosthetics) may be required.

After any type of surgical treatment of joint coxarthrosis, long-term rehabilitation will be required. The patient must perform a specially designed set of exercises, take medications, and also adhere to the rules of a balanced diet.

In the first month after surgery, massage is contraindicated. Subsequently, this can also help in developing joint mobility, but only after the permission of the attending physician.

In general, the rehabilitation period takes several months, and its success depends on the patient’s age and compliance with medical prescriptions.

Exercises for coxarthrosis of the knee joint

Therapeutic gymnastics is most effective when the joint is not completely affected. It reduces pain and reduces the inflammatory process in general, slows down the process of joint destruction, and relaxes muscle tissue.

The patient remains mobile much longer. The main thing is to do the exercises regularly, thus preventing the process of stagnation of the joint. Loads should be distributed on both legs and given gradually, avoiding sudden movements.

In the primary stage of the disease, the following exercises are recommended:

• Lying on your stomach, gently lift the limb.
• Sit with your legs together, your heels turned out, and gently squeeze the ball, holding it between your knees. Lying on your back with your legs together, make lifting and lowering movements, leaning on your palms and feet.
• Repeat these exercises 1-2 times for 10 approaches.

If the disease has entered the second stage, the following complex is more appropriate:

• Holding onto a secure support, squat and stand up.
• Rise up on your toes.
• Make circular movements with your leg.

Pain
For the third degree of coxarthrosis, doctors have developed another group of movements:

• Standing straight and leaning securely, swing your leg back and forth.
• Take a stretchable tourniquet and, putting it on your foot, swing the affected limb, avoiding muscle tension.
• Sit with your feet on the floor and spread your bent legs.
• Sitting on the mat, bend over, stretching your hands towards your feet.
• Don't do squats or walk a lot.
• As an additional exercise, self-massage of the thigh after physical exercise is good. It consists of massaging the lateral and front sides of the thigh from the knee towards the groin.

Experimental methods

Recently, an experimental but very promising method of treating coxarthrosis has been increasingly discussed - the introduction of stem cells into the joint cavity.

What are stem cells? These are young cells that have the ability to:

• almost endlessly sharing;
• transform into tissue needed by the body;
• accumulate in a certain damaged area and restore it.

Stem cells capable of restoring joint cartilage are isolated from the patient's own adipose tissue. They are washed, examined and waited until they are mature enough to divide. The preparatory stage can last up to 1 month.

Click on photo to enlarge

Stem cells are injected into the joint cavity under local anesthesia. After the procedure, the patient is not allowed to put any weight on the leg for some time.

Improvement occurs within a few days, but complete healing of coxarthrosis and restoration of cartilage may require a longer period. It directly depends on the degree of destruction of cartilage tissue.

Classification

There are primary and secondary osteoarthritis of the hip joint. The main cause of primary coxarthrosis is age-related changes in the hip joint. It develops in both men and women over the age of forty.

Secondary coxarthrosis is always associated with some cause or disease that has a direct impact on its development.

Based on the localization of the pathological process, unilateral or bilateral coxarthrosis is distinguished.

Symptoms of pathology

The first signs of this disease have much in common with the symptoms of many diseases of the musculoskeletal system. In order to accurately make a diagnosis, and therefore begin therapy, it is necessary to conduct a number of studies. The early stage of the disease is manifested by periodic pain and difficulty walking.

Usually, immediately after waking up, stiffness of movements is felt, which subsequently passes. It is this asymptomatic onset that prevents timely detection of the disease and the initiation of its treatment. At later stages, the symptoms are pronounced and are characterized by the following signals.

Main manifestations of the disease:

• Constant aching pain in the joint, aggravated by sudden movements, prolonged immobility and during a long walk;
• Impaired functionality of the hip joint. The patient cannot repeat some movements, joint mobility decreases, and attempts at physical exercise lead to pain and discomfort;
• Rocking "sea" gait. Appears due to destruction of the joint and shortening of the leg. At first it appears involuntarily, but as the disease develops it becomes more pronounced;
• Weakness of ligaments and muscles leads to the progression of muscle atrophy in the final stage of the disease;
• Limb disproportion. Shortening of the limb occurs gradually, visually this is noticeable at the third or fourth stage of the disease;
• With any movement, a crunching sound is heard in the joint.

The severity of symptoms depends on the progression of the disease, as well as the individual characteristics of the patient.

Typically, the patient may not be aware of the existing problem, especially when it manifests itself at a young age. In the vast majority of cases, coxarthrosis of the hip joint appears in patients already suffering from arthrosis of the limbs or spine,

Characteristic symptoms of 1st degree

Coxarthrosis of the 1st degree is the initial, mildest stage of the disease. Symptoms of the disease at this stage appear only after significant exertion - for example, after a brisk walk of 3-5 km.

The clinical picture of grade 1 coxarthrosis may include:

• Pain in the hip, groin, back or buttocks. The outbreak of pain worsens when the joint affected by arthrosis is loaded. In some patients, pain often spreads down the leg and down the thigh towards the knee. After a short rest the pain goes away.
• Stiffness of movements. In the morning, patients with grade 1 coxarthrosis may experience slight stiffness of movement, which quickly disappears after physical activity.
• Decreased mobility. This symptom in grade 1 coxarthrosis can be detected during a targeted examination. The mobility of the hip joint at this stage of the disease is reduced by only 10–20% - it does not at all limit daily activities and the performance of professional duties.

Symptoms of coxarthrosis: 1 – pain in the hip joint; 2 – stiffness in the morning; 3 – pain may spread down the thigh

Joint traction and the benefits of manual therapy

In the initial stages, to treat coxarthrosis without surgery, sessions of hardware traction, that is, extension of the joint, can be prescribed. The procedure is carried out using a special apparatus, with the help of which they achieve bone separation and reduce the load on the cartilage. The process lasts from 10-15 minutes and involves undergoing treatment courses, on average their number varies from 10 to 12 sessions. In most cases, the patient is prescribed traction therapy no more than 2 times a year.

Reviews from patients confirm the effectiveness of traction procedures, but a significant portion of patients advise paying attention to the benefits of manual therapy. When working with patients, doctors of this specialization use 2 main methods of influence:

• mobilization - gentle traction of the hip joint is performed;
• manipulation - adjustments are made to restore motor activity of the joint.

The method of manual therapy for treating coxarthrosis without surgery has both supporters and opponents. Contacting an unqualified specialist can cause harm to the patient and further aggravate the situation.

Reviews suggest that by contacting a professional, you can get better results than with rehabilitation using a special device and avoid surgery. This is due to the fact that the technique is capable of carrying out pulling movements only along the longitudinal axis, while a professional in the field of manual therapy “feels” the hip joint and is able to develop it in several directions.

Today, reviews from many patients confirm the possibility that coxarthrosis can be treated without surgery if the pathology is detected in the early stages. Therapy and the rehabilitation period involve an integrated approach, including the prescription of drugs and non-drug treatment. A favorable prognosis largely depends on the stage of the disease and the range of techniques used.

Prevention of such diseases

Coxarthrosis is a complex systemic disease that without proper treatment leads to inevitable disability of the patient. However, like any other disease, it is easier to prevent. That is why a lot of information is devoted to the prevention of such diseases, which should also be taken into account by every person.

How to prevent pathology:

• Stick to the basics of a healthy lifestyle. Giving up bad habits will have a beneficial effect not only on the health of the joints, but also for the entire body;
• Provide regular physical activity to all muscle groups. It is optimal to go swimming, do simple exercises three to four times a week and maintain general body tone;
• Get a massage regularly. You can also learn self-massage techniques at home;
• After 35 years of age, for prevention, you can take an annual course of taking chondroprotectors. This will help prevent the destruction of cartilage tissue;
• It is definitely worth solving the problem of excess weight. This will reduce the load on the joints and also help prevent their premature wear;
• Organizing good rest is also of great importance in order to prevent many diseases;
• If problems with the musculoskeletal system have already been identified, it is advisable to carry out spa treatment in specialized sanatoriums.

Coxarthrosis of the hip joint is a serious pathology that leads to the destruction of cartilage and deformation of the joint. In the future, without proper treatment, this can lead to impaired mobility and disability.

The main causes of the disease, symptoms, as well as how to treat coxarthrosis of the hip joint - all the necessary information on the topic is presented in our article.

Pathanatomy

The hip joint is formed by two bones: the ilium and the femur. The head of the femur articulates with the acetabulum of the ilium, forming a kind of “hinge”. During movement, the acetabulum remains motionless, and the head of the femur moves in various directions, allowing flexion, extension, abduction, adduction and rotation of the hip.

During movements, the articular surfaces of the bones slide smoothly against each other, thanks to the smooth, elastic and durable hyaline cartilage covering the cavity of the acetabulum and the head of the femur. In addition, hyaline cartilage performs a shock-absorbing function and is involved in the redistribution of load during movements 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 during unsuccessful movements.

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 resulting roughness, the cartilages are constantly injured against each other during movements, which causes their thinning and aggravates pathological changes in the joint. As coxarthrosis progresses, the bones begin to deform, “adapting” to the increased pressure. Metabolism in the joint area deteriorates. In the later stages of coxarthrosis, pronounced atrophy of the muscles of the diseased limb is observed.

Signs of coxarthrosis

The most interesting thing is that the symptoms of this disease include severe pain in the healthy knee. The reason is clear: they are transmitted through the common tendons and muscles that connect the hip and knee joints. Moreover, these pains are so clearly expressed that in some cases doctors mistakenly begin to treat the knee, and coxarthrosis in the hip joint progresses at this time.

Here are the most common symptoms of coxarthrosis of the hip joint:

• persistent pain in the joint, radiating to the thigh, groin, knee, both when walking and at rest;
• the sore leg moves with difficulty, its stiffness is observed, which leads to lameness;
• Over time, the leg shortens;
• the thigh muscles, due to forced limitation of the load, atrophy.