Coxarthrosis (Deforming arthrosis of the hip joint, Deforming osteoarthritis of the hip joint)

Coxarthrosis of the hip joint, grade 3, is an extreme manifestation of the degenerative-dystrophic process, which prevents a person from working and leading to disability.

Signs of osteoarthritis deformans (DOA) are observed in patients after 40 years. Depending on the rate of destruction of cartilage, from the moment of the first symptoms until its final destruction can take from 5 to 15 years.

The disease often occurs on the background of the anatomical and functional inferiority of the hip joint (congenital or acquired).

Causes of coxarthrosis

The main risk factors for osteoarthritis are:

  • prolonged overload of the articulation in people with a large body mass, athletes (gymnasts, wrestlers, jumpers in the water),
  • effects of hip joint injury
  • recurrent arthritis of different etiology,
  • Perthes disease: congenital insufficiency of blood supply and nutrition of articular tissues,
  • congenital dislocation of the hip,
  • hip dysplasia,
  • femoral head necrosis
  • diabetes, metabolic syndrome, dyshormonal processes,
  • passive lifestyle,
  • involutive changes that accompany the process of aging.

The disease can develop in one joint (right-sided or left-sided coxarthrosis), in severe cases, the process is bilateral.

Mechanism of development of the disease

At the first two stages of DOA, there is a gradual degradation of cartilage (it becomes thinner, microcracks appear on the surface), sclerotic processes in the subchondral bone layer, formation of osteophytes. Without treatment, damage to the joint continues to progress.

At the last stage of coxarthrosis, the cartilage is thinned so much that the cracks in it reach the subchondral layer, and in some places the cartilage tissue may be completely absent. The synovial cavity is filled with its fragments, which interferes with the full movement.

In order to increase the contact area of ​​the articular surfaces and thereby reduce the load on the edges of the bone, even more osteophytes are formed. Overloading the subchondral region leads to the formation of cysts and disruption of the blood supply to the bone. Friction of the exposed areas of the bone against each other contributes to increased pain.

Constant muscle spasm adjacent to the joint creates strong pressure on the articular surfaces. Fibrous ankylosis (splices) are formed, which completely immobilize a limb without surgical treatment.

General information

Coxarthrosis (osteoarthritis or deforming arthrosis of the hip joint) is a degenerative-dystrophic disease. Usually develops at the age of 40 years and older. It may be the result of various injuries and diseases of the joint. Sometimes there is no apparent reason. For coxarthrosis characterized by a gradual progressive course. In the early stages, conservative treatment methods are applied. In the later stages, the function of the joint can be restored only by surgery.

In orthopedics and traumatology, coxarthrosis is one of the most common arthrosis. The high frequency of its development is due to a significant load on the hip joint and the wide prevalence of congenital pathology - joint dysplasia. Women suffer from coxarthrosis a little more often than men.

Symptoms of coxarthrosis of the hip joint 3 degrees

This stage of deforming osteoarthritis is characterized by the fact that all manifestations of the disease reach their maximum.

The main symptoms of coxarthrosis 3 degrees:

Constant (including at night), amplified at the slightest movement of the limb. The patient is even uncomfortable with palpation of the surrounding tissues.

Clearly audible even from a distance

Independently, the patient can only move with assistive devices for short distances. The most difficult internal rotation, abduction and bending

Visually noticeable, palpation palpable multiple bone growths. Extremity greatly shortened, occupies the forced position (shown and turned inward)

The muscles of the buttocks and thighs are weakened, atrophied. In a one-sided process, the difference in the volume of the limbs is visually noticeable. The patient has aggravated spinal curvature in the lumbar region (lordosis). At this stage of coxarthrosis progression, the gait becomes antalgic — when you try to load the affected limb, the pelvis is lowered.

Complications are often observed in the third stage of the DOA hip joint:

  • secondary bursitis, synovitis,
  • pathological dislocations,
  • secondary femoral neck fracture
  • aseptic necrosis of the femoral head,
  • acetabular protrusion.

Causes of coxarthrosis

There are primary (arising for unknown reasons) and secondary (developed as a result of other diseases) arthrosis of the hip joint.

Secondary coxarthrosis can be caused by the following diseases:

Coxarthrosis can be both unilateral and bilateral. In primary coxarthrosis, a concomitant lesion of the spine (osteochondrosis) and knee joint (gonarthrosis) is often observed.

Diagnosis of coxarthrosis

It is not difficult to suspect the presence of hip joint DOA with such a bright clinical picture.

After interviewing the patient and examining him, the doctor will prescribe additional studies:

  • X-ray of two hip joints
  • Ultrasound with cartilage thickness measurement,
  • arthroscopy
  • MRI or CT scan.

Radiological changes in coxarthrosis 3 degrees:

  • significant narrowing or complete absence of the joint space,
  • multiple osteophytes (fungus-shaped femoral head),
  • subchondral sclerosis, cysts,
  • bone tissue with areas of osteoporosis,
  • change the configuration of the femoral head,
  • deepening the acetabulum,
  • aseptic necrosis of the femoral head,
  • subluxations

Treatment of coxarthrosis of the hip joint 3 degrees

It is impossible to cure a joint with osteoarthritis, it cannot be restored. Basic therapy with chondroprotectors and intraarticular glucocorticosteroid injections are ineffective.

Therapy of advanced stage DOA is aimed at relieving pain, training in the use of auxiliary tools and preparation for surgery (muscle strengthening, physiotherapy, apparatus traction, treatment of concomitant pathology, weight correction).

To reduce the intensity of pain are appointed:

  • nonsteroidal anti-inflammatory drugs (NSAIDs): preferably from the group of selective COX-2 blockers,
  • non-narcotic painkillers: Paracetamol,
  • Narcotic analgesics: Tramadol, is used for severe pains that are resistant to other drugs.

Surgery

The only effective method for the treatment of grade 3 coxarthrosis, which gives a chance for the restoration of mobility, is the operation of hip arthroplasty.

  • unipolar (endoprosthesis replace a certain part of the joint),
  • total (to be replaced head and joint head).

This type of intervention refers to planned procedures (the patient on the eve is undergoing all the necessary studies). A few days before the operation, he goes to the hospital where prevention of infectious complications and blood clots is carried out.

The choice of the type of prosthesis depends on the age and condition of the patient’s bone tissue. Young people with no signs of osteoporosis are implanted with a prosthesis with a cementless type of fixation.

In elderly patients with a weakened bone apparatus and the need to use a walker in the postoperative period, an artificial limb with a cement type of fixation is installed.

The operation of hip joint arthroplasty takes place under general anesthesia and lasts from 1.5 to 3 hours. The duration depends on the type of endoprosthesis, the scale of the damage, and the patient's state of health.

Possible postoperative complications:

  • inflammation or infection at the site of the incision,
  • thrombosis,
  • graft rejection reaction,
  • dislocation of the endoprosthesis,
  • exacerbation of chronic pathology.

The patient's stay in the hospital in the absence of complications does not exceed 8–10 days. During this period, healing of the postoperative wound occurs and the patient trains himself to serve himself in everyday life.

Rehabilitation after arthroplasty

In articles devoted to modern studies of the dependence of quality of life indicators on the amount of rehabilitation, doctors insist on the use of a wide range of rehabilitation measures immediately after endoprosthesis replacement.

Rehabilitation of the patient starts on the second day after the intervention under the supervision of a methodologist of physiotherapy exercises. Doctors in the earliest possible time provide the patient with physical activity (they are taught to get out of bed correctly, to move around the bed with assistive devices).

After discharge home, there is a period of adaptation to a foreign body (4–6 weeks). This period is necessary for the final scarring of the joint capsule and the resorption of postoperative hematoma.

General recommendations

At home, the patient should follow these guidelines:

  1. Walk on crutches without stepping on the operated limb.
  2. Perform at least three of the proposed list of exercises aimed at strengthening the thigh muscles (in particular, the quadriceps).
  3. Wear compression stockings for the prevention of thromboembolism for one month.
  4. Adhere to the diet, which prevents weight gain.
  5. Systematically take prescribed medication.

Exercises

Exercises should be performed 6–8 times a day, starting from 10–20 repetitions and gradually increasing them to 50–70. Regular and systematic exercises exercise guarantee a quick resumption of work capacity.

  • bending the leg at the knee to 80% lying on the bed and straightening to a straight position, without lifting the heel from the bed,
  • extension in the knee joint to an even position due to the raising of the foot (there should be a roller of 25–40 cm under the knee),
  • knee extension while sitting on the edge of the bed (imitation of hitting the ball).

Massage procedure for hip joint DOA provides:

  • decreased muscle tension,
  • an increase in the contractility of weakened muscles,
  • improvement of blood circulation, nutrition and regeneration in the joint,
  • weakening of neurological manifestations.

At home, the patient can massage the area of ​​the joint and surrounding muscles independently (avoiding the incision area) or resort to the help of a professional. It is best to start with procedures lasting 10–15 minutes 2–3 times a day. Massage should be stopped immediately in case of discomfort.

The question of whether it is possible to do without crutches and the full load of the operated limb is decided upon a second consultation with an orthopedic surgeon in 8–10 weeks.

In patients with coxarthrosis (especially in the presence of congenital dysplasia), complete disability can occur in a few years. Without surgery, the articular surfaces will gradually grow together and the limb will completely lose mobility.

Total endoprosthetics in the modern world remains the only inevitable and most effective treatment for grade 3 coxarthrosis, allowing the patient to regain the ability to move and work independently.

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Education: Rostov State Medical University, specialty "General Medicine".

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Coxarthrosis of the hip joint of the first degree

Grade 1 is the mildest form of the disease, which may not bother the patient for a very long time, but if you do not navigate and cure the disease in time, it will develop into more severe forms.

In the first stage of the disease, periodic pains in the area of ​​the affected hip joint are noted after prolonged and intense physical exertion. With bilateral lesions of the joints, pain manifests itself in both joints, with unilateral damage - in one. This stage is not characterized by the appearance of lameness and severe muscle rigidity. Pain syndrome passes immediately after the end of physical activity and is not of a permanent nature. On the radiological image, a slight narrowing of the gap located between the joints can be seen.

Coxarthrosis of the hip joint of the second degree

Grade 2 is characterized by more significant damage to the joint - the destruction of cartilage tissue. With this degree, all the symptoms intensify.

The pain syndrome in the second stage of the lesion is often enhanced by the irradiation of pain in the groin and thigh region. The pain occurs not only after physical exertion, but also in a state of rest.In the absence of restorative measures, the normal mechanism of movement is disturbed - the patient begins to limp, his gait gradually changes. The strength of the muscles responsible for the extension and abduction of the hip decreases. Over time, morning stiffness syndrome occurs.

Coxarthrosis of the hip joint of the third degree

Grade 3 is one of the most severe forms of pathology, which is characterized by almost complete destruction of articular cartilage. On radiographs, there is a filiform narrowing of the joint space. The joint is severely deformed.

Pain in this condition is permanent, it can only be temporarily removed with the help of drugs. It is difficult for a patient to move without a cane or other assistive devices, since the joint is constrained, its movements are restricted. In the area of ​​the joint, development of edema is noted, tissues atrophy.

Diagnosis of diseases of the osteo-articular system

At the first stage, the diagnosis of coxarthrosis includes a survey, collecting anamnesis of life and disease, patient complaints, examination of the joint and carrying out functional tests.

In the clinical analysis of blood in coxarthrosis, there is a slight increase in ESR (erythrocyte sedimentation rate) - up to 30 mm / h and higher.

In the biochemical analysis of blood, the level of inflammation markers was significantly increased: c-reactive protein, globulins, immunoglobulins and seromucoid. This analysis provides significant assistance in the differential diagnosis of joint damage: arthritis or arthrosis?

The basis of all diagnostic activities are instrumental methods.

The main method for detecting lesions of the joints is x-ray, which marks:

the presence of osteophytes - bone growths at the edges of the articular cartilage,

narrowing the gap between the joints

areas of ossification of the articular cartilage,

compaction of bone tissue under the cartilage.

The minus in the X-ray examination is that only the bones are visible, the soft tissues of the joint (cartilage, the articular capsule) are not visible in the images.

No less informative diagnostic method is magnetic resonance or computed tomography, which allows to recognize the disease at the earliest stages of its development.

Drug treatment for hip joint destructive changes

Drug therapy mainly consists of symptomatic treatment. The main actions that are required from drugs are the elimination of pain, removal of swelling and inflammation, improvement of blood circulation, cartilage nutrition and muscle relaxation.

Nonsteroidal anti-inflammatory drugs:

These drugs are shown in the reactive stage of the inflammatory process. Perfectly relieve swelling, inflammation, eliminate pain due to the strongest anti-inflammatory effect. The disadvantage of using this group of drugs is rapid addiction, cartilage tissue ceases to regenerate independently, and a number of side effects negatively affect the internal organs.

To date, a newer drug has been developed with a smaller list of side effects - moval. Thanks to his refinement, addiction does not develop so quickly.

Experts do not recommend taking several anti-inflammatory drugs at the same time, if the used drug does not bring the necessary effect, it is necessary to either increase the dosage or change it.

The purpose of these drugs is to relax the smooth muscles of the blood vessels and expand their lumen to ensure good blood circulation. When used correctly, the drugs in this group have a minimum number of contraindications and complications. Vasodilator drugs have a very important effect - they relieve spasm, including night "vascular" pain, which bring the maximum discomfort to patients.

Before using these drugs should consult a doctor, as one of the most frequent side effects is an allergic reaction to the components. Efficiency depends on this factor.

Preparations of this group with coxarthrosis should be taken with extreme caution. They are used to eliminate painful muscle spasm and improve blood circulation. The risk of using muscle relaxants is that they affect the nervous system, manifested in the form of frequent dizziness, nausea, inhibition of consciousness or a state of intoxication.

This category of drugs is the most useful and effective, its actions are aimed at restoring the structure of cartilage. Regular use of chondroprotectors can stop the development of coxarthrosis in the early stages. Contraindications to use are pregnancy, allergies and inflammation of the joints.

Hormonal drugs (injection):

This kind of therapy has a positive effect in the absence of inflammatory processes affecting the femoral tendons. Injections are not recommended to do more than once every two weeks and not more than three injections in one joint.

Drugs of local action (ointment, lotions, compresses)

Such therapy is not fundamental in the treatment of coxarthrosis, since the likelihood that all necessary substances penetrate through the skin, the fatty layer and muscles is very small, therefore, the rubbing process itself has a positive effect, increasing blood circulation in the affected area.

The main causes of

The main root cause affecting the development of coxarthrosis is a violation of the body's metabolic functions. Because of this, the deposition of salts and the formation of osteophytes are observed in the articular structures, which gradually destroy the internal tissues and provoke the characteristic symptoms. The factors that influence the occurrence of the disease are many, but the most common are:

  • Blood supply failure. As a result of injuries, bruises or other pathologies in the field of TBS, the normal blood supply is disrupted. Because of this, toxic elements quickly contribute to the production of substances that destroy cartilage structures in the tissues.
  • Heredity. The pathology itself is not genetically transmitted, but sometimes the child has an altered structure of the cartilage structure. Under the influence of negative factors in older age, the disease can manifest itself if you do not monitor your health.
  • Hormonal, systemic, metabolic and endocrine disorders. In this case, secondary coxarthrosis is diagnosed, which developed as a complication in the severe course of these pathologies.
  • Infectious inflammations that trigger necrosis of the femoral head.

Other reasons

Pathology progresses under the influence of such factors:

If you move a little, the muscles gradually weaken, leading to problems with the joints.

  • Frequent injuries that occur in the hip area. Due to the chronic violation of the integrity of the articular elements, cartilage and articular membranes are gradually destroyed and thinned.
  • Increased load. Excessive body weight or excessive exercise provoke inflammatory processes localized in the hip joints.
  • Passive and sedentary lifestyle. In this case, there is atrophy of the muscles and dysfunction of one or both joints.
  • Improper nutrition. Abuse of food containing large amounts of fats, carbohydrates, dyes and carcinogens, adversely affects the state of TBS, resulting in coxarthrosis.
  • Diseases of congenital nature - dysplasia, dislocation of the right or left joint at birth.

The extent and characteristic symptoms

Signs of coxarthrosis worsen as the pathology progresses. The initial stages are difficult to identify and diagnose because the painful symptoms are unexpressed and after a while they stop bothering. But the greater the degree, the more acute the manifestations and cure the problem in the neglected state is much harder. If a person has suspicious symptoms, it is necessary to undergo a full examination and establish an accurate diagnosis.

The initial degree is most easily treated, because the joints are subject to minimal changes. The first symptoms are not expressed, pain and discomfort appear only after prolonged physical exertion. With the defeat of both joints, pain is disturbed on both sides, and right-sided or left-sided coxarthrosis may also develop. If you do not proceed to therapy for grade 1, the disease will gradually progress.

Symptoms of the disease become more acute. Because of the destructive processes in cartilage, the joint is more sore, the deformity spreads to new areas. There is discomfort in the hips, pain in the groin, pain in the person to walk, and legs and joints ache even after a small load. If such signs bother you for a long time, but the person does not take any measures, the outcome can be dangerous, even to the point of complete immobility of the joint.

At this stage, a person is worried about severe pain after exertion and in a calm state. Due to the destruction of the articular structures and the maximum narrowing of the joint space, the gait changes. Limping in coxarthrosis grade 3 becomes permanent, in the morning the diseased joint is constrained and completely restricted in movement. Attached inflammatory complication, swelling, the temperature of the skin at the site of injury increased.

4th degree

Due to the progression of degenerative-dystrophic disorders, the patient’s joint completely loses its functionality. The bones of the joints grow together, with the result that the patient is no longer able to move. Due to the atrophy of the articular elements 4 tbsp. characterized by shortening of the lower limbs on the left or right. Concerned about severe pain, from which it is impossible to get rid of with the help of the usual painkillers, the prognosis for recovery is negative.

Consequences of the disease

Arthrosis of TBS is a dangerous pathology in which the structures of the articulation without the provision of medical care are gradually destroyed. Such dangerous complications develop:

  • femoral tissue necrosis
  • acetabular protrusion,
  • arthrosis of the knee and elbow joints,
  • arthritis,
  • bursitis,
  • ankylosis,
  • kyphosis,
  • cyst,
  • spinal deformity.

Treatment methods

Treatment of coxarthrosis should be complex, which means the doctor should prescribe the scheme of treatment, taking into account the individual characteristics of the patient. Often prescribed drugs presented in the table:

Physiotherapy and proper nutrition

Physiotherapy procedures are aimed at normalizing blood circulation and feeding the affected areas. Effective proven such therapeutic measures:

Hirudotherapy helps in the treatment of the disease.

  • magnetic therapy
  • laser therapy
  • ultrasound,
  • electrophoresis
  • therapeutic bath with mud wraps,
  • therapy with leech worms.

For therapeutic purposes and for prevention it is important to follow the diet. The diet should include:

  • animal protein
  • veal and red fish,
  • milk and dairy products,
  • vegetables fruits,
  • vegetable fats,
  • porridge,
  • jelly and broths on the bones.

Prevention and prognosis

So that a person with such a diagnosis can live a full life, it is important to be treated under the supervision of a doctor, do exercises, eat right, monitor weight, and not ignore uncharacteristic symptoms. If coxarthrosis was diagnosed in the initial stage, the prognosis for successful recovery is positive. At later stages, in order to recover, you will have to make a lot of effort.

What is coxarthrosis of the hip joint

The whole group of arthrosis is a disease characterized by degenerative-deformational changes in the tissues. Coxarthrosis among them is distinguished by the frequency of diagnosis, especially in women, and the hip lesion occurs more often than others because of increased stress even in a person who is not involved in a great sport. The rate of coxarthrosis progressed slowly, so at an early stage, the doctors' forecasts are positive. The mechanism of disease development is as follows:

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

The main sign of dystrophic changes is pain: which can be localized in the groin, hip area, and even the knee area. The nature of the pain depends on the stage of the disease - at the initial stage, it appears only when the patient is exercising. Later, the pain becomes constant, torments 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 (to limp),
  • reduction of the amplitude of movement in the hip area,
  • shortening of the limb with the affected joint.

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

  • long loads on the joint
  • spinal pathologies,
  • problems with blood circulation and hormones,
  • advanced age
  • sedentary work.

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

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

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

  1. 1st degree - narrowing of the joint space, the head and neck of the femur bone in the normal state, but there is an enlargement at the acetabulum.
  2. 2nd degree - X-rays will show an uneven significant narrowing of the gap, there is a deformity of the femoral head, which is shifted upwards and enlarged. Bone growths at both edges of the acetabulum.
  3. 3rd degree - characterized by a significant narrowing of the slit and the expansion of the femoral head. From the symptoms of this stage, constant pain, muscle atrophy (due to impaired blood circulation of the joint), shortening of the limb stand out.

Risk factors

Among the factors that increase the likelihood of developing coxarthrosis include:

  • Permanent increased load on the joint. Most often observed in athletes and people with overweight.
  • Circulatory disorders, hormonal changes, metabolic disorders.
  • Spinal pathology (kyphosis, scoliosis) or stop (flatfoot).
  • Elderly and old age.
  • Sedentary lifestyle.

By itself, coxarthrosis is not inherited.However, certain features (metabolic disorders, structural features of the skeleton and weakness of the cartilage tissue) can be inherited by the child from the parents. Therefore, in the presence of blood relatives suffering from coxarthrosis, the probability of occurrence of the disease increases slightly.

Pathology

The hip joint is formed by two bones: the iliac and femoral. The head of the femur articulates with the acetabulum of the Ilium, forming a kind of "hinge". During movements, the acetabulum remains stationary, while the head of the femur moves in different directions, providing flexion, extension, abduction, adduction and rotational movements of the thigh.

During the movements, the articular surfaces of the bones freely slide relative to each other, thanks to the smooth, elastic and durable hyaline cartilage covering the acetabulum cavity and the femoral head. In addition, hyaline cartilage has a cushioning function and is involved in the redistribution of the load during movement and walking.

In the joint cavity there is a small amount of articular fluid, which plays the role of a lubricant and provides nourishment for hyaline cartilage. The joint is surrounded by a dense and durable capsule. Above the capsule are large femoral and gluteal muscles that provide movement in the joint and, along with hyaline cartilage, are also shock absorbers that protect the joint from injury during unsuccessful movements.

When coxarthrosis articular fluid becomes more dense and viscous. The surface of hyaline cartilage dries out, loses smoothness, becomes covered with cracks. Because of the roughness that has arisen, cartilages during movements are constantly injured about each other, 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 is worsening. In the late stages of coxarthrosis, marked atrophy of the muscles of the diseased limb is observed.

Differential diagnostics

First of all, coxarthrosis should be differentiated from gonarthrosis (osteoarthritis of the knee joint) and osteochondrosis of the spine. Muscular atrophy that occurs in stages 2 and 3 of coxarthrosis can cause pain in the area of ​​the knee joint, which is often more pronounced than pain in the area of ​​damage. Therefore, if the patient complains of pain in the knee, a clinical (examination, palpation, determination of range of motion) study of the hip joint should be performed, and if a coxarthrosis is suspected, refer the patient to an X-ray.

Pain in the radicular syndrome (compression of the nerve roots) in osteochondrosis and some other diseases of the spine can imitate pain in coxarthrosis. In contrast to coxarthrosis, when the roots are squeezed, pain arises suddenly, after an unsuccessful movement, a sharp turn, weight lifting, etc., is localized in the area of ​​the buttock and spreads along the back of the thigh. A positive symptom of tension is revealed - severe pain when the patient tries to lift a straightened limb while lying on his back. At the same time, the patient freely moves the leg to the side, whereas in patients with coxarthrosis, the lead is limited. It should be borne in mind that osteochondrosis and coxarthrosis can be observed simultaneously, therefore, in all cases a thorough examination of the patient is necessary.

In addition, coxarthrosis is differentiated from trochanteritis (trochanteric bursitis) - aseptic inflammation in the area of ​​attachment of the gluteal muscles. Unlike coxarthrosis, the disease develops quickly, within 1-2 weeks, usually after an injury or significant physical exertion. The intensity of pain is higher than with coxarthrosis. Restrictions of movements and shortening of the limb are not observed.

In some cases, with an atypical course of ankylosing spondylitis or reactive arthritis, symptoms resembling coxarthrosis may be observed. Unlike coxarthrosis, at these diseases the peak of pain occurs at night. Pain syndrome is very intense, may decrease when walking. Characterized by morning stiffness, which occurs immediately after waking up and gradually disappears within a few hours.

Surgery for coxarthrosis of the hip joint

Surgical intervention is carried out at the last stage of the development of the disease, when the functional capabilities of the joint are completely impaired.

Endoprosthetics - joint replacement. This is the most difficult of all operations related to the hip joints, its success accounts for almost 70% of all performed interventions. When choosing a prosthesis, the patient's age, sex, weight and anatomical features of the organism are taken into account, the amount of time that the implant will serve depends on it. Often this is the only way to return the patient's ability to walk.

Externally, a conventional endoprosthesis is identical with a conventional joint, it is designed for the same functions and is able to withstand the same loads as the natural joint.

By type of prosthetics, such joints are distinguished:

unipolar (only the head of the hip joint is prosthetic),

bipolar (replaces all the anatomical elements of the joint).

Arthrodesis - the bones of the joint are fastened with the help of special screws and plates to restore functionality. The disadvantage of this technique is that the joint, as before, is constrained in movement. This surgical intervention is prescribed only in cases where other types of treatment do not give any result.

Arthroplasty is the modeling of a damaged surface - cartilage.

Osteotomy is a specific bone dissection to eliminate the deformity. Unlike arthrodesis, this surgery restores not only the support function, but also the motor function.

Gymnastics with coxarthrosis of the hip joint

Therapeutic gymnastics for this disease is one of the most effective therapeutic methods of treatment, yielding a positive result. At the initial stages, exercises aimed at strengthening the muscles surrounding the joint can prevent the further development of coxarthrosis.

It is very important that medical gymnastics was carried out under the supervision of a highly qualified specialist, as there are a number of exercises that can both benefit and harm the patient.

Exercises for the treatment of coxarthrosis of the hip joint have a certain mechanism. Training the gluteus and periphery muscles helps to improve blood circulation, fixation and nutrition of the cartilage. Stretching exercises make it possible to level the shortened limbs due to the specific stretching of the articular capsule.

Statistical exercises, rational dynamic loading and stretching are excellent for treatment. Complex of the most rational exercises:

in the supine position, it is necessary to raise and tighten the gluteal muscles as much as possible,

not getting up, in the same position - bend the leg at the knee and gradually expose it,

staying in a prone position, straighten the legs and try to raise them, as you can at the same time, while not lifting the upper end of the body,

sitting on a chair, squeeze the ball for fitness between your legs and try to squeeze it with maximum force,

in a sitting position, straightening the legs trying to clasp your toes.

All exercises must be performed regularly and correctly. To relieve tension, you can take a relaxing bath with oils.

Contraindications for therapeutic gymnastics:

rehabilitation period after surgery,

acute inflammatory processes affecting internal organs,

heart and pulmonary insufficiency,

severe pain,

exacerbation of joint diseases,

Watch a visual video:

Before you start doing the exercises at home, you should consult with your doctor and get all the necessary advice on how to perform these or other exercises.

Physiotherapy

Physiotherapy for coxarthrosis is not the main method of treatment, but rather an auxiliary one. A positive result, physiotherapy can bring only in the early stages of the disease, prescribe them to relieve spasm and improve blood circulation.

Most commonly used:

mud therapy - spa treatment,

thermal procedures - electrophoresis,

Massage for pathology of the hip joint:

Massage is prescribed for any of the 4 stages of the disease, regardless of the treatment: conservative or operative. It is absolutely safe, relieves tension, swelling, spasm and strengthens muscles. It is recommended to spend it as often as possible. In addition, any massage procedures improve blood circulation, which contributes to the restoration of cartilage tissue.

In the first stage of the disease, massage is prescribed only after the use of drugs that restore cartilage, vasodilator and anti-inflammatory. Before the start of the course of massage, the patient is recommended to minimize the load on the affected joint, walk less, lie more.

The massage is performed manually in the area of ​​the hip joint, lower back and hips. It is recommended to combine it with medical gymnastics and water procedures, ideal for visiting the pool 3 - 4 times a week.

In specially equipped sanatoriums massage is performed with a stream of water (hydrokinesitherapy). You can also stretch the joint with a manual massage.

In the third - fourth stages, coxarthrosis is treated with the help of surgical intervention. Therefore, massage treatments are prescribed after removing the stitches. During this period, massage is simply necessary, it contributes to the improvement of blood circulation, relieves muscle tension and provides a speedy recovery.

Diet

A balanced diet, the right approach to the distribution of food intake is the most important factors affecting the restoration of the patient's health. Nutrition for coxarthrosis of the joints should be fractional, up to 5-6 times a day, while the portions should be small but nutritious.

Thanks to the correct setting of the meal schedule, the following results can be achieved:

cartilage repair,

new tissue formation.

A diet for coxarthrosis should exclude such foods:

fatty meat broths,

products containing a large amount of fat in its composition (mayonnaise, chocolate, red fish, sour cream and high-fat cottage cheese, cream),

meat and fish semi-finished products,

a large amount of salt (more than 1 tablespoon per day),

foods with a high content of preservatives (chips, canned food, sausages, caviar, sauces, some types of cheeses, nuts).

Healthy foods for coxarthrosis

Sour-milk products are quite useful for the restoration of joints, since the human body easily absorbs the milk protein necessary for tissue regeneration. In addition, dairy products, namely cottage cheese (low in fat) and cheese, are rich in calcium fortifying the bone system.

Some of the necessary protein can be obtained from certain types of meat and fish products, a very important aspect is that these products must be low-fat. In the daily diet, in addition to animal protein, it is imperative to include vegetable, which is contained in lentils and buckwheat.

An element such as collagen is needed to restore bone and cartilage. It is contained in aspic fish or aspic.

As for desserts, fruit jelly, rich in vitamin complexes and gelatin, is an ideal option for restoring normal joint function. It also has a positive effect on the restoration of joints and cartilage foods rich in phosphorus and phospholipids.

A separate role in proper nutrition in the treatment of coxarthrosis of the joints is played by carbohydrates, which provide the body with the necessary amount of energy. Energy potential is the basis of all processes of human activity. Preference is better to give complex carbohydrates - polysaccharides and monosaccharides. As a consequence, the usual sugar is better to replace natural honey.

No less useful and necessary for the restoration of cereals are also rich in complex carbohydrates and essential elements that feed the brain.

Are fats good for you?

When considering all the advantages and disadvantages of fat intake, it is best to use vegetable fats for nutrition in coxarthrosis.

Meals should be organized in such a way as to affect such factors:

weight loss,

normalization of metabolic processes.

Diet with destructive changes in the hip joint is one of the important steps towards speedy recovery.

Prevention of coxarthrosis

The main and most important method of prevention of coxarthrosis of the hip and other joints is early diagnosis, as well as such measures as:

skiing, with sticks,

self-massage using ointments,

regular intake of chondroprotectors.

Physical activity in the treatment of coxarthrosis should be directed to such properties:

restoration of joint functionality,

strengthening the muscular system

improving the blood supply to the joint and the area around it,

increased lumbar stability

prevention of severe complications.

Prevention and self-treatment are two big differences, so before you start any kind of measures aimed at restoring joints, you should consult with experts.

Education: Diploma in "General Medicine" received in 2009 at the Medical Academy. I.M. Sechenov. In 2012, completed a postgraduate course in the specialty "Traumatology and Orthopedics" in the City Clinical Hospital. Botkin at the Department of Traumatology, Orthopedics and Disaster Surgery.

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Coxarthrosis - a deforming arthrosis of the hip joint, is a very common disease. The development of this disease is influenced by many facts, in particular the abnormal development of the pelvic, spinal and lower extremity bones: a decrease in the acetabulum, congenital dislocations and subluxations, scoliosis of the spine.

If you are faced with coxarthrosis of the hip joint, you can recommend one good folk method that will help you cope with the disease. You need to make a bath with an extract of Jerusalem artichoke, pine branches with the addition of 1 kg of sea salt, 1 dessert spoon of turpentine gum and 2 tablespoons of honey. Need to take 10-12 baths.

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How to cure coxarthrosis of the hip joint without surgery

If congenital abnormalities of the connective or cartilage tissue or the spine contribute to dystrophic arthrosis, treatment will be directed only at preventing exacerbation and relieving the main symptoms. In other cases, the doctor acts on the cause of the disease, for which the patient is prescribed:

  • drug therapy (topical, injectable, oral),
  • physiotherapy on the sore joint,
  • physical therapy (preserves mobility of the hip area),
  • massage,
  • diet

Injections for coxarthrosis of the hip joint

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

  • Artradol - on chondroitin sulfate, stops inflammation, adapts the joint to the load, does not allow cartilage to collapse.
  • Diclofenac is an anti-inflammatory agent that eliminates swelling and pain, but they can be treated for no longer than 2 weeks.

Correction of nutrition to treat coxarthrosis does not help - it is only needed to reduce the load on the joint, if the patient suffers from excess weight. It is recommended to completely abandon simple carbohydrates, consume more water, and in the diet it is necessary to include the dairy group of products, fish, buckwheat, beans and dishes based on gelatin (collagen) - aspic, jelly.

Physiotherapy

Heavy loads for a patient with coxarthrosis are prohibited in order to prevent the progression of the disease, but it is impossible to refuse activity - it contributes to the preservation of joint mobility. A set of exercises for physical therapy should be compiled by a doctor and exclude axial load. Such options are possible:

  • Lying on your back, slowly “pedaling” with your legs raised for 15 seconds. Take a break, repeat the exercise.
  • Lying on your stomach and putting your hands on your hips, raise your straight legs alternately.
  • Lie on the side, lower arm under the head. Slowly lift the upper leg and lower it.

Massotherapy

Manual techniques are shown not only in the hip area, but also in the entire spine (extension procedure), especially at the 2nd stage of the disease. Massage enhances blood circulation, strengthens muscles, and reduces the load on their articulation zones. Home massage is a circular rubbing and stroking the affected hip area for 10 minutes (directions can be studied from the photo), but it is important to remember:

  • You can not allow abrasions and bruises - do not push hard.
  • You should feel how the sore joint and the adjacent tissues relax, not spasm more.

Arthroplasty

At the early stage of the destruction of cartilage or bone (often when coxarthrosis occurred on the background of an injury), doctors prescribe the restoration of missing surfaces. Arthroplasty is performed under general anesthesia: the surgeon moves the tissues apart or cuts the muscles to access the affected area, fixes a prosthesis onto the bone cement and, if necessary, back stitches the muscles or other tissues that were dissected.

Endoprosthetics

Replacement of the hip joint with an artificial (metal / ceramic) is performed only with complete destruction of its own according to the scheme similar to arthroplasty. Before surgery, they are examined, during the procedure general anesthesia is done. The prosthesis, which is put to the patient, can replace only the head of the femur or her, but with the acetabulum. During rehabilitation, antibiotics are prescribed, the patient is kept in the hospital for 10-12 days, and then the sutures are removed and sent home.

Consequences of the disease

The main danger of coxarthrosis is disability, which develops if the disease is not treated even at the last stage, or if the therapy is not correct. Irreversible progressive changes will lead to the need to move rarely, with little and only a cane. If you ignore the initial form of coxarthrosis, a person will receive less serious complications:

  • violations of posture,
  • osteochondrosis,
  • leg shortening.

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