Every year, diseases of the musculoskeletal system concern more and more people and their development at a young age is noticed more and more. This is facilitated not only by a change in lifestyle, but also by an increase in the level of injuries, which is largely interrelated. One of the most common pathologies of the musculoskeletal system is osteoarthritis of the thigh, which is characterized by the appearance of progressive pain and limited mobility. Ultimately, the disease can lead to complete joint immobility and disability. To avoid the appearance of such unwanted consequences, it is important to start treating osteoarthritis as soon as possible. And if in the early stages of development can be stopped by conservative methods, then in case of severe changes, it is possible to restore the functions of the hip joint and eliminate the unbearable pain only with the help of a high-tech surgery.
What is hip arthrosis
Osteoarthritis of the thigh joint is a chronic degenerative-dystrophic disease in which gradual destruction of the hip joint occurs. At the same time, all its components are gradually involved in the pathological process, but the hyaline cartilage is particularly affected, which leads to a narrowing of the joint space and deformation of its other components. Most often, pathological changes occur only in one hip joint, although both can be affected simultaneously.
The hip joints are the largest in the human body, as they carry the greatest load during the day. Each is formed by the femoral head and the acetabulum, which is a bowl-shaped depression in the pelvis. Both surfaces are covered with smooth, moderately elastic hyaline cartilage. It is the one that ensures the softness and unobstructed sliding of the femoral head in a natural depression and thus makes it possible to make movements in different planes.
The movement of the thigh joint is provided by a group of muscles connected to it by the fascia. He is also surrounded by ligaments, whose tasks are to restrict his mobility within physiological limits and to ensure the stability of his position.
The entire joint is surrounded by an articular capsule covered with a synovial membrane. Its main task is the synthesis of synovial fluid, which lubricates the adhesive parts of the hip joint and at the same time acts as a carrier of nutrients for it. It is from the synovial fluid that the hyaline cartilage that covers the femoral head and the surface of the acetabulum constantly receives components for the formation of new cells, d. m. th. , regeneration. This is extremely important for this cartilaginous formation, as with every movement of the thigh it is consumed, but normally restored immediately. But when injured or under the influence of other factors, this does not happen, which leads to the development of osteoarthritis of the thigh joint, ie thinning and destruction of its hyaline cartilage.
As a result, deformed areas form in the ideally smooth cartilage, which increase with the progression of the pathology. As it erodes, the bone surfaces that form the joint are exposed. When they come in contact, there is a characteristic crack and severe pain. This provokes the formation of osteophytes and, in the later stages of development, the femoral head fuses completely with the acetabulum, making any movement in the hip joint impossible.
At the same time, osteoarthritis of the hip joint can provoke the development of various inflammatory processes within the joint, including:
- bursitis - inflammation of the synovial sac;
- tendovaginitis - an inflammatory process in the lining of the muscle tendons;
- tunnel syndrome - compression of nerves, causing radiation pain along the choked nerve.
reason
One of the common causes of the development of osteoarthritis of the thigh joint is mechanical damage, not only direct damage, but also micro-damage caused by the destructive effect of excessive loads on it. One of the most common causes of developing the disease is a fracture of the femoral neck.
He leaves the femur at a 120 ° angle and connects it to the head. The presence of osteoporosis significantly increases the possibility of a thigh fracture, but this type of injury can also be a consequence of a traffic accident, falling from a height, stroke, etc.
A femoral neck fracture may be associated with aseptic necrosis of the femoral head, which will trigger the development of degenerative-dystrophic changes in the joints. The presence of dysplasia or subluxation of the thigh joint, rupture of its ligaments, transcondylar fractures or fractures of the acetabulum also creates favorable conditions for damage to its structures. In such situations, post-traumatic osteoarthritis of the hip is diagnosed.
Often, post-traumatic osteoarthritis of the hips occurs in professional weightlifters, parachutists, loaders, and skaters.
The development of osteoarthritis of the thigh joint after injury is due to violation of the congruence (comparability) of articular surfaces, reduced quality of blood supply to the ankle components and prolonged immobilization. As a result of prolonged immobility, there is not only a deterioration of blood circulation in the fixed area, but also shortening of the muscles, reduction of their tone. The possibility of post-traumatic osteoarthritis increases significantly when an inappropriate situation or premature treatment is performed, which leads to the preservation of defects of varying severity. Also, the risks of developing it increase with too early loading of the wrist and inappropriate exercise therapy, including too intense, started late or vice versa early.
Sometimes the disease appears after surgical interventions on the hip joint due to the formation of wounds and additional tissue trauma. Although in some cases, surgery is the only way to eliminate the consequences of injury.
Excessive loads can also provoke changes in the hip joint, as they lead to microtrauma. Regular tissue damage activates the process of chondrocyte division (cartilage tissue cells). This is accompanied by an increase in the intensity of cytokine production, which is usually produced in small quantities. Cytokines are mediators of inflammation, in particular, cytokine IL-1 leads to the synthesis of specific enzymes that destroy the hyaline cartilage of the hip joint.
In addition, high loads can provoke subchondral plate microfractures. This leads to its gradual compaction and the formation of bone growths on the surface, called osteophytes. They can have sharp edges and cause more damage to the joints as well as damage to the surrounding tissues.
The subchondral plate is the extreme part of the bone that is in direct contact with the hyaline cartilage.
In some cases, it is not possible to determine exactly what provoked the development of degenerative-dystrophic changes in the hyaline cartilage of the femoral head and acetabulum. In such situations, idiopathic or primary arthrosis of the hip joint is diagnosed.
Today it has been proven that the tendency for its development can be inherited, so the presence of this pathology in close relatives significantly increases the chances of developing osteoarthritis of the hip joint. Apparently, it has a polygenic inheritance, i. e. its development depends on the presence of many genes. Each of them individually creates easy preconditions for the development of the disease, but when combined, it becomes a matter of time, especially when leading a sedentary lifestyle and obesity, or vice versa, hard physical work.
There is a theory that osteoarthritis of the hip joints is the result of a congenital or acquired mutation of the type II procollagen gene.
There is also secondary arthrosis of the hip joint, which develops against the background of the presence of concomitant diseases and age-related changes.
Symptoms
The disease is characterized by the appearance of pain, limited mobility and seizures in the hip joint, the severity of which depends directly on the degree of neglect of pathological changes. In the later stages of development, shortening of the affected leg and complete immobility of the thigh joint can be observed, which is due to the complete fusion of the bony structures that form it.
Initially, the disease may continue without marked signs and cause mild, short-term pain. As a rule, they appear after physical exertion, in particular walking, carrying heavy loads, gathering, bending. But as degenerative-dystrophic changes in the joints progress, the pain intensifies. Over time, they not only become more intense, but also last longer, and the interval between the onset of physical activity and their appearance decreases. At the same time, rest, even if long, may not bring relief. Subsequently, the pain can afflict a person even with prolonged immobility of the hip joint, for example, after a night’s sleep.
If intra-articular structures affect nearby nerves, the pain may radiate to the groin, buttocks, thighs, and knee. However, they tend to intensify with hypothermia. In the final stage of disease development, the pain becomes unbearable. This causes an unconscious desire to feel pity for the foot and put less stress on it, which leads to lameness.
Another symptom of osteoarthritis of the thigh joint is a decrease in range of motion. Most often, there is a limit to the ability to turn the leg in and out, to raise the leg bent at the knee to the chest. Over time, the so-called morning stiffness appears, which disappears after the patient "diverges". Subsequently, a compensatory curvature of the pelvis is possible, which leads to a change in gait. In the future, patients completely lose the ability to make certain movements with the affected leg.
If osteoarthritis of both hip joints develops at the same time, the development of so-called duck walking with the pelvis pulled and the body deviated forward is observed.
All this can be accompanied by the formation of edema in the hip joint. But in the presence of excess weight, they can go unnoticed.
Often, during movements, especially extensor ones, a crack occurs in the affected joint. It is a consequence of exposing the bony surfaces of the femoral head and acetabulum and rubbing them against each other. In this case, there is a sharp increase in pain.
Also, with osteoarthritis of the hip joint, painful spasms of the femoral muscles may occur. With extremely advanced degenerative-dystrophic diseases, when the joint space almost completely disappears, and the femoral head begins to flatten, shortening of the affected limb by 1 cm or more is observed.
In general, there are 3 degrees of hip arthrosis:
- Stage 1 - the joint space of the hip joint is narrowed, and the edges of the bone structures are slightly pronounced, which indicates the beginning of osteophyte formation. Clinically there is a slightly pronounced pain syndrome and some limitations in movement.
- Class 2 - common space is narrowed by more than 50%, but less than 60%. Significant osteophytes are observed, as well as signs of cysts on the bone epiphyses. Patients notice significant limitations of movements in the thigh joint, the presence of a crack during movements, pain and atrophy of the thigh muscles of varying severity can be traced.
- Grade 3 - joint space is reduced by more than 60% or completely absent, and osteophytes occupy a large area and are large, subchondral cysts are observed. The thigh joint is stiff, the pain can become unbearable.
Diagnosing
The appearance of pain and other symptoms characteristic of osteoarthritis of the hip joints is the reason to contact an orthopedist. The doctor will be able to suspect his presence, especially if he has suffered hip or pelvic injuries in the past, already based on data obtained during the interview and examination.
The presence of osteoarthritis of the hip joint is indicated by pain, the intensity of which increases over several years. Rarely, there is a rapid development of degenerative-dystrophic changes, when several months pass from the appearance of the first signs to a strong permanent pain syndrome. This is characterized by increased pain while standing or while performing physical work. Also, for osteoarthritis is typical the presence of morning stiffness, which lasts up to half an hour, which appears even after prolonged immobility. Gradually an increase in mobility restrictions and deformity of the thigh joint is noticed, which in the later stages of development, the orthopedist may notice during the examination.
However, all patients are necessarily assigned instrumental research methods, with the help of which it will be possible to confirm the presence of hip osteoarthritis and determine its degree, as well as to differentiate it from some other diseases associated with symptoms. Similar. As a rule, diagnosis is performed using:
- Radiography - allows you to detect the main signs of osteoarthritis, in particular narrowing of the joint space and the presence of osteophytes. But recently, CT has become a more informative research method, which makes it possible to assess the condition of the hip joint with greater accuracy.
- MRI is a very informative method for diagnosing various changes in the condition of soft tissue structures, including cartilage tissue, which makes it possible to detect the smallest signs of hyaline cartilage degeneration.
Patients may also be prescribed laboratory tests, including KLA, OAM, biochemical blood tests, etc. They are asked to ascertain concomitant diseases that have created preconditions for the development of secondary osteoarthritis of the thigh.
Treatment of osteoarthritis of the thigh without surgery
Treatment of degenerative-dystrophic changes in the hip joint through methods of conservative therapy is possible only with grade 1 and 2 osteoarthritis. The prescribed measures can improve the patient's condition, stop or at least slow down the progression of the pathology and in thisway to maintain work capacity. But they are not able to lead to a complete regression of the changes that have already occurred in the joints.
Today, as part of conservative treatment of hip arthrosis, the following are described:
- drug therapy;
- exercise therapy;
- physiotherapy.
Also, patients are advised to make certain adjustments in their lifestyle. So in the presence of excess weight, it is worth taking measures to reduce it, namely to increase the level of physical activity and review the nature of nutrition. If the patient is actively involved in sports and the joint is overloaded, which causes microtrauma to it, it is recommended to reduce the intensity of exercise.
Medical therapy
Medication therapy for osteoarthritis of the hip joint is always complex and includes medications from different groups that aim to reduce the severity of the symptoms of the disease and improve the flow of metabolic and other processes in the joints. Ajo:
- NSAIDs - drugs with anti-inflammatory and analgesic effects, produced in both oral forms and in the form of local agents, which allows you to choose the most effective and convenient option for use;
- corticosteroids - drugs that have powerful anti-inflammatory properties and are used in most cases in the form of an injection solution, as when choosing systemic therapy they cause the development of unwanted side effects;
- chondroprotectors - medicines synthesized on the basis of natural cartilage tissue components used by the body to restore it (prescribed for long courses);
- muscle relaxants - medicines indicated for muscle spasms, which cause pain of varying severity;
- B vitamins - help improve nerve conduction, which is required for the development of carpal tunnel syndrome;
- preparations that improve microcirculation - help increase the intensity of blood circulation in the affected area, which leads to an increase in the rate of metabolic processes and helps to restore damaged cartilage.
If concomitant diseases are detected, consultation of associated specialists and appropriate treatment is indicated.
With very severe, debilitating pain syndrome that cannot be eliminated with the help of prescribed NSAIDs, intra-articular or periarticular blockades may be performed. They involve injecting a local anesthetic in combination with a corticosteroid directly into the ankle cavity, which quickly leads to an improvement in well-being. But procedures of this type can only be performed in a medical institution by a qualified specialist, otherwise there is a high risk of complications.
exercise therapy
Physiotherapy exercises play one of the main roles in the non-surgical treatment of ankle osteoarthritis, both in idiopathic and post-traumatic forms. But a set of exercises should be chosen on an individual basis, taking into account the nature of the previous injury, the patient's level of physical development, and existing concomitant diseases.
Exercise therapy should be done daily in comfortable conditions without haste. All movements should be performed smoothly, without cracking, so as not to damage the already deformed hip joint. This will allow:
- reduce the intensity of the pain syndrome;
- increase joint mobility;
- reduce the risk of muscle atrophy;
- increase the intensity of blood circulation and metabolic processes.
Physiotherapy
To increase the effectiveness of the prescribed measures, it is often recommended that patients with osteoarthritis of the hip undergo a course of physiotherapy procedures. Traditionally, those that have anti-inflammatory, anti-edematous and analgesic effects are selected. Ajo:
- ultrasound therapy;
- electrophoresis;
- magnetotherapy;
- laser therapy;
- shock wave therapy etc.
In some cases, plasmolifting is indicated, d. m. th. , the introduction of the patient's own blood plasma purified and saturated with platelets. To get it, venous blood is taken, which is then subjected to centrifugation. As a result, it is divided into erythrocyte mass and plasma, which is used to treat degenerative-dystrophic changes in the hip joint.
Surgery for osteoarthritis of the hip
When diagnosing grade 3 hip joint osteoarthritis, surgical intervention is indicated for patients. It can also be performed with the ineffectiveness of conservative therapy and persistent pain and limitations of mobility already in the second stage of disease development.
In general, the indications for thigh surgery are:
- a significant decrease in the size of the common space;
- the presence of persistent and severe pain;
- significant mobility restrictions.
The most effective and safe surgery for osteoarthritis of the hip joint is arthroplasty. Today it is known as the gold standard for the treatment of this pathology, regardless of the reasons for its development. The essence of this type of surgical intervention is the replacement of part of the components of the thigh joint or its entirety with artificially created endoprostheses. The prostheses themselves are made of biocompatible materials and are durable.
Installing them allows you to fully restore the normal mobility of the pathologically altered hip joint, eliminate pain and give the patient the opportunity to live a full life. For each patient, the type of arthroplasty is chosen individually based on the degree of destruction of the various components of the joint.
Total or total hip arthroplasty is most effective. It involves replacing the entire joint with an artificial endoprosthesis, d. m. th. , the acetabulum, the femoral head and its neck. Such prostheses are able to serve uninterruptedly for 15-30 years and ensure the restoration of full volume of joint function.
They are laid without cement or with the help of special cement. The first method is more suitable for young patients, as it involves fixing the prosthesis to the pelvis by growing into the spongy layer of its bone in it. For the elderly the method of installing an endoprosthesis using cement is more appropriate, which firmly holds the artificial material on the bone surfaces even in the presence of osteoporosis.
If the normal hyaline cartilage lining the surface of the acetabulum is preserved, patients may be offered partial arthroplasty. Its essence is to replace only the head and neck of the femur with an endoprosthesis. Today there are 2 types of structures of this type: monopolar and bipolar.
The former are less reliable; after their installation, then the need for total arthroplasty arises. This is due to the fact that the replaced artificial femoral head, when making movements, rubs directly against the acetabulum cartilage, which provokes its faster consumption.
Bipolar endoprostheses do not have such a disadvantage, as in them the artificial femoral head is already enclosed in a special capsule, which is attached to the acetabulum. Therefore, the cartilage that covers it is not deformed, as the capsule serves as a kind of buffer and artificial substitute for the natural hyaline cartilage of the femoral head.
However, regardless of the type of endoprosthesis performed, postoperative rehabilitation is indicated for all patients. It consists of the appointment of drug therapy, exercise therapy and therapeutic massage. Recovery time depends on individual characteristics. But it is important to remember that the effectiveness of the operation depends directly on the quality of compliance with the doctor's recommendations during the rehabilitation period.
Thus, osteoarthritis of the hip joint is a common disease of the musculoskeletal system, which can occur even in the absence of direct preconditions for its development. This pathology can lead not only to severe pain, but also to disability, so it is important to diagnose and take measures to stop its progression even at the first signs. However, the current level of development of medicine makes it possible to cope with advanced cases of osteoarthritis of the thigh joint and restore the full range of motion in it, as well as the permanent removal of severe pain.