Hip coxarthrosis, Symptoms and Treatment

Coxarthrosis - a disease in which developing degenerative dystrophic changes that lead to the violation of trophic and joint function. This occurs due to disruption of the structure of cartilage (namely - its destruction) and bone deformities surfaces which participate in the formation of the joint surface.

In medicine, this pathology is also called osteoarthrosis of the hip joint. The disease most often affects middle-aged and older, with men more likely to develop the disease than the fair sex.

The most common pathological process is observed on the one hand (or in the right or in the left hip joint). But there are cases where there is a double-sided defeat. Moreover, such a breach does not occur quickly: the disease is diagnosed first in one joint, and eventually goes to the other side.

What it is?

hip coxarthrosis - a degenerative disease of the musculoskeletal system, which is characterized by slow but progressive course, accompanied by the destruction of intra-articular cartilage and secondary changes of the hip structures joints.

As a consequence of these changes is broken joint mobility, and eventually, if you do not take any treatment measures, it disappears altogether. Developing joint ankylosis, which can cause disability and inability to move independently.

Reasons koksartroza

Coxarthrosis can be primary or secondary. The primary form of the disease develops under the influence of certain reasons that can only be seen as suggestions. Secondary form of coxarthrosis is caused by the presence of other diseases that act as ground for its Development (respectively coxarthrosis regarded as one of the symptoms of the disease against which it developed).

A secondary form of coxarthrosis often develops on the background of the following diseases:

1. Injuries in this area.
2. Inflammation, infectious lesions.
3. Congenital dislocation of the hip shape. This pathology is the result of running the current form of hip dysplasia, its characteristic feature is its underdevelopment and lack of proper articulation between bones. In this case, the femoral head is outside the position of the region (which, as we have already discussed, the acetabulum), due to which there is a dislocation. Furthermore, in this embodiment, the dislocation occurs due to a predisposition to such pathologies.
4. Hip dysplasia. In this case we are talking about the pathology of hip joints, through which, in turn, violation shall be one of the main functions, predefined for limbs, ie support function. Advantageously, the location of the femoral neck is incorrect in relation to the acetabulum.
5. Perthes disease. In this case also, cause of the pathology is in violation in the femoral head blood supply, while power failure of articular cartilage in it, due to which, as a rule, necrosis develops.
6. Aseptic necrosis. In this case, the pathology directly relates to the femoral head. The disease generally has an extremely difficult character displays for the joint, which can be seen even on the basis of the process in this area, it is in necrosis of bone. It occurs necrosis of the femoral head bone tissue due to irregularities in its circulation.

The following variants are considered as factors in the development of coxarthrosis.

1. Overload at elevated body weight. In particular the variant under which this overload is associated with the weight of the patient. This is explained by the fact that in two or even three times the load on the hip and knee joints more than the human body weight. Accordingly, each step determines the load on the joints of the feet in the range of 300-500 kg. At the young age of cartilage is still able to to withstand the constant pressure exerted within such figures, but with the elasticity of cartilage is lost, and the joints over time, respectively, wear. It remains to add to this picture of disorders associated with blood circulation and metabolism, which in almost all cases are present in patients with excess weight - and it becomes clear what is the cause of frequent injury of the knee and hip in this a group of persons.
2. joint overload. This may also be attributed prolonged excessive load exerted on the joint, which may imply the need for overcoming long distances on foot along part of professional activities and the activities of professional athletes. Given the fact that the load in any form is a heavy, offset its not always able to even the good development of the lower limb muscles.
3. Heredity. The role of this factor in the development of the disease before us is subject to continuous diskutirovaniyu. In general, it is obvious when considering the disease is the fact that he coxarthrosis is not inherited. That less, the issue of communication with the parents of all it is also relevant, because the features of the skeleton (in particular the weakness) features of the structure of cartilage, as well as features of the metabolic processes in the body - is not to deny the role of heredity accounts. Thus, substantially increases the risk of coxarthrosis in those patients, parents or close relatives who have a history of arthritic disease. Increased the risk in people who from birth have a particular anomaly of underdevelopment of the joint. It should be noted that the risk of possible development koksartroza to achieve the elderly is large enough even in those patients who have similar anomalies were identified in a timely manner and are subject to appropriate therapy.
4. Traumatization. In general terms, we noted that injuries are among the reasons, now consider this point in more detail. Injuries, especially when it comes to the chronic version of their occurrence, cause the development of coxarthrosis even in young adults. In chronic injury of the joint is "accumulation" of damage, resulting in cartilage later atrophy, in addition, can be destroyed and the underlying bone, which, in turn, provoke its subsequent strain.
5. Hormonal changes, osteoporosis, diabetes, loss of sensitivity of the lower extremities against nerve diseases. These factors for some time been considered as the root causes contributing to the development of arthritic diseases. That less, based on recent discoveries, celebrated in physiology and biochemistry, examination of key issues relating to the formation of arthrosis has undergone certain adjustments. Thus, it became known that on the background of long-term negative experiences, as well as through long periods of stress there are certain changes in the adrenal glands. They in particular are beginning to stand out in an excess of corticosteroid hormones that, in turn, by raising them in the blood, causes lowering produced hyaluronic acid, which is one of the most important constituents in the lubricant for the joints, that is, in the joint liquid. Against this background, there is the launch of the previously discussed mechanism of development of coxarthrosis in which "dry up" articular cartilage thinning, and "crack". Aggravation of the process is caused by the fact that the corticosteroid hormones produced as a result of stress conditions of patients, leads to decrease the degree of capillary permeability, whereby the determined relevance and deterioration of blood supply for joints subjected to shock.
6. Inflammation of the joints. In this case, the factor provoking coxarthrosis development can be attributed to the list above, and we have discussed above diseases, because it implies nothing other than under joint inflammation as arthritis. Against the background of inflammation, secondary arthrosis (secondary coxarthrosis) developed for him actual,. Due to inflammation of the joints due to the presence of infection in the subject cavity change characteristics glenoid fluid, which in turn leads to changes in the properties of the cartilage and the development of its inferiority. Arthritis, in addition, in almost all cases involving violations of blood flow in conjunction with changes in the magnitude of adverse articular synovial membrane. For this reason, even when the cured arthritis almost half of the cases there is a "start-up mechanism", against which the impact of developing osteoarthritis.

It should be noted that the combination of chronic forms of stress in patients with the above factors, there is still a significant loss of cartilage structure. Also, a lesion may lie in the fact that it can be double-sided, with this embodiment pathology is also quite common. Primary coxarthrosis often occurs in conjunction with a lesion of the spine and the knee joint.

symptoms koksartroza

Common symptoms at any stage of the disease, but their intensity is different. hip joint coxarthrosis has the following features:

1. Stiffness of movement. At an early stage it is felt only after you wake up, and later the patient feels it constantly. If the disease progresses further, the stiffness can go into complete immobility.
2. Severe pain in the hip. At an early stage, they appear only in the process of walking. Late stage is characterized by severe, aching pain, which is present almost constantly.
3. Muscle atrophy. This feature is the most severe. He appears on the last stage of the disease. The first degree is characterized by a slight weakening of the muscles and ligaments.
4. Unequal leg length. Such a symptom characteristic to have advanced forms of the disease. The reason for this is a change in the symmetry of the pelvis due to its deformation.
5. Strong crunch in the hip, which is heard well by others.
6. Lameness. The reasons for this lie in the symptom of deformation of the joint bones. In this case, the patient inadvertently changes the gait, which is reeling.

It is advisable to pay attention to the early symptoms of the disease. In this case, treatment is more successful.

hip coxarthrosis 1 degree

For this stage of the disease is characterized by pain in the joint and the hip, sometimes in knee occurring after physical exertion and subsides with rest. joint mobility is not limited and no disturbances of gait.

Coxarthrosis 1 degree - this is the initial stage of the disease, starting treatment is still possible to stop the process of destruction and deformation of the joint and maintain its function fully. But, unfortunately, many do not consider it necessary to consult a doctor because of weak pain in the joint, and the disease progresses in the meantime.

hip coxarthrosis grade 2

The second degree is characterized by a more substantial the affected joints - the destruction of cartilage. With this degree of all symptoms worsen.

Pain syndrome lesions in the second stage amplifies often observed irradiation pain groin and thigh. The pain occurs not only after exercise, but also to rest. In the absence of reducing events disrupted the normal mechanism of movement - the patient starts to limp, gradually changing gait. The strength of the muscles responsible for the extension and retraction of the hip is reduced. Over time there is morning stiffness syndrome.

hip coxarthrosis grade 3

This stage is characterized by koksartroza constant pain in the joint. Patients often complain of pain in the whole of the lower limb, which worried them even at night, because of what the dream is broken.

Because of the pronounced restriction of joint movement, atrophy of the muscles of the thigh, leg and buttocks, patients have to use a cane when walking. Due to the weakness of the hip muscles of the pelvis displacement occurs, which leads to a shortening of the affected limb and severe lameness.

hip coxarthrosis grade 4

This is the last stage, the most severe disease. It characterized by a state of complete fusion of the hip bones together. Constant pain, which does not give a normal life, severe swelling of the surrounding tissues. The complete lack of movement in the hip joint.

Diagnostics

Diagnosis is based on anamnesis data (identification of risk factors or causes of disease) and clinical data additional survey methods.

Clarify the diagnosis and differential diagnosis will help:

1. X-ray of the hip joint;
2. Ultrasound joints;
3. MRI or CT scan.

As a rule, to establish a sufficiently precise diagnosis of clinical and radiographic examinations. Radiographs are specific changes characteristic of each stage of disease: joint space narrowing, the presence of osteophytes, deformation and displacement of the femoral head, subchondral cysts and periarticular osteosclerosis, osteoporotic bone changes.

Depending on the presence of lesions and their severity, extent and set the stage of the disease.

coxarthrosis treatment

Treatment of coxarthrosis hip efficiently and requires less effort the initial stages of the disease, when structural changes are expressed minimally and joint function is not broken. As the disease progresses there is a functional and organic rearrangement intraarticular components deform articular bone surface, osteophytes appear and joint contracture occurs, which greatly complicates the process and degrades the treatment forecast.

The main directions in the treatment of coxarthrosis are therapeutic and surgical measures.

Therapeutic measures used in hip osteoarthritis include:

• massage;
• medication;
• gymnastics and exercises;
• biological methods;
• physiotherapy;
• mechanical methods;
• traditional methods.

The objectives of the non-surgical treatment of coxarthrosis are:

• Improving nutrition of articular cartilage and accelerate its recovery.
• Elimination of pain.
• Reducing the load on the damaged joint bones.
• Activation of blood circulation in the affected joint.
• Increasing the mobility of the joint.

medication

1) For the relief of pain are prescribed medicines from the group of NSAID - Ketorol, Ketonal or Diclofenac (tablets or in solution for intramuscular injection). These drugs can reduce the inflammation and swelling associated with it. Do not take them for a long time as one of their side effects - is to reduce the ability of cartilage tissue to regenerate. In particular, Diclofenac advisable to take short courses (less than 5 days). In the event that shows prolonged therapy aimed at the removal of inflammation, it is recommended to give preference to the drug Movalis.

High intensity of pain, as well as the concomitant inflammation of muscle tissue and tendons become the basis for administration to a patient hormonal drugs - Kenalog or hydrocortisone as solutions for intraarticular injection. Effect after the administration of these drugs into the joint cavity is maintained for a long time. The effectiveness of preparations for external topical administration (gels and ointments) rather doubtful because through the skin and underlying soft tissues directly to the joint penetrates a very small amount of the active substances. Good help rubbing ointments warming, since these procedures contribute to the improvement of the local blood flow and relief of muscle spasms.

2) Chondroprotectors slow cartilage degeneration and promote its recovery. With their help, in some cases it is possible to stop the progression of the disease. The most effective drugs in this category are Teraflex and Artroglikan.

3) Cropped muscle spasm, and as a consequence reduce pain and improve blood flow, help funds belonging to the clinical and pharmacological group of muscle relaxants.

4) In order to accelerate the regeneration of damaged joint cartilage is necessary to improve the microcirculation in the affected area. For this purpose, prescribers having vasodilating properties - such as Cinnarizine or Trental.

Physical therapy in coxarthrosis

Physiotherapy activities are assigned in order to improve blood circulation and trophism (feeding) of the affected joint, as well as to speed up the metabolic and regenerative processes in it.

Physiotherapy coxarthrosis includes:

1. Thermal treatment. It includes mud (silt, psevdovulkanicheskie, peat, mud), paraffin wax, mineral wax (montan wax). All these substances are able to retain heat for a long time, which ensures long and uniform thermal effect on the application area. Due to this, as well as through skin penetration of biologically active substances and inorganic salts is an improvement of the microcirculation and normalization of metabolic processes in the tissues.
2. Electrical muscle stimulation. The principle of this method consists in exposing the muscle pulse currents with different frequencies. Electrical stimulation is a kind of exercise for the muscles, which strengthens the muscles in the area of ​​the joint and improves blood circulation in the entire lower extremity. However, this method can not be compared with a full gym and can not fully replace it. In addition, there are a number of contraindications to the use of electrical stimulation.
3. Magnetic therapy. Principle magnetotherapy consists in exposing the body tissue by the magnetic field produced by using a special installation. The essence of effect consists in heating the joints and surrounding muscles and ligaments at 1 - 3 ° C, which improves blood circulation in the joint, eliminates puffiness and promotes tissue repair. The procedure itself is safe and painless and takes about 5 to 20 minutes. continuous daily treatment should not exceed 3 - 4 weeks. The best results were observed by the end of therapy.
4. Laser therapy. laser principle consists in exposing the body tissue power light beam (laser) which includes ultraviolet, infrared and red emission spectra. Laser light penetrates through the skin to the muscles and joints, causing certain biochemical reactions in the joint tissues. The treatment course consists of 15 treatments, each lasting from 3 to 10 minutes. If necessary, after months of treatment can be repeated.
5. Ultrasound therapy (UST). Ultrasound - this swing of the sound waves, which range is not perceived by the human ear. Ultrasound can penetrate human tissue to a depth of 4 - 6 cm, giving a therapeutic effect on joint components. The procedure is performed every day or every other day for 1.5 - 2 weeks. If necessary, one month course of treatment can be repeated.

Exercises and gymnastics

In coxarthrosis it is recommended to perform the following exercises:

1. Take a starting position lying on his back, and then turn slowly bend and straighten the leg at the knee and hip, trying to push the knee as close to your chest.
2. Lying on his back legs to plant as much as possible to the side, and then return to starting position.
3. Take a starting position lying on his stomach, and then in turn lift one leg, then the other, then - both together. Legs at the same must be straightened at the knee joint.
4. Take a starting position lying on the healthy side (the affected joint must be on top). You need to slowly lift the leg straight up, then also lower it slowly.
5. The next exercise is done standing against a wall, table or other support. Adhering to the hands need to get back on his good leg, and "sick" to relax as much as possible, and then to carry out its pendulum-like (forward and backward, left and right) and a circular motion.

It is important to remember that the purpose of these exercises is not to increase the load on the joint, and its development. You should not perform the full range of exercises from the first day, as it can cause severe pain and aggravate the disease. Root recommended with 1 - 2 exercises repeated for 3 - 5 times. In normal tolerance can gradually increase the load by performing new exercises and increasing the number of repetitions.

Mechanical treatments

This group includes a complex of therapeutic measures which can be used as a supplement to the basic treatment. This eliminates some of the symptoms of the disease, improve blood supply to the affected joint and accelerate the healing process.

For the treatment of coxarthrosis is used:

1. Acupuncture. acupuncture principle consists in the introduction to the special terms of fine sterile needles. This neurohormonal causes certain changes in the body, contributing to the normalization of metabolic processes in tissues. The positive effect of acupuncture observed in the treatment of coxarthrosis, due eliminating muscle spasticity, improvement of microcirculation and supply vessels, and decrease pain. The treatment course consists of 10 - 12 sessions, during each of which is used by the needle 10 or more. After installing the needle patient must remain motionless for 10 - 15 minutes, after which the needles are removed and the patient can go home. In the year that can be performed from 2 to 4 courses of acupuncture, a break between them should be at least 3 months.
2. joint traction. Hardware traction is designed to take the weight off the affected joint, thereby creating the conditions for the suspension of the destructive processes in it and for the restoration of cartilage tissue. Before the procedure, the patient is fixed on the table by means of belts, after which the traction unit is in the limbs along the axis of the body for 15 - 20 minutes. As a result, the joint capsule is stretched and provided rest cartilage tissue at the time of the procedure. The course of treatment consists of 8 - 12 procedures, which are carried out every day or in combination with other physiotherapy treatments. Positive effects after treatment may be made at 1 and 2 degrees of disease. At the initial stage of therapy, the pain can be amplified (in this case it is necessary to weaken the thrust force).
3. Hirudotherapy. It involves the use of leeches for medicinal purposes, grown in special conditions. The method consists on the application of leeches to the patient's skin in the hip. Leech bites through the skin to a depth of 2 mm and injects into the wound different enzymes, one of which is hirudin (dilutes the blood and prevents it from clotting). It improves the microcirculation in the affected area and improves the nutrition of the affected joint. One session is used from 5 to 8 leeches. Duration of treatment may range from 30 to 60 minutes, during which 1 leech can suck up to 5 mL blood. The effect can be seen after a few treatments, but the best results are achieved within a few days after the full completion of the course (6 - 8 procedures from 2 to 5 days interval).

Traditional methods of treatment of hip osteoarthritis

At 1 - 2 degrees coxarthrosis folk remedies can significantly alleviate the disease, eliminate the pain and promote early recovery of damaged tissues. At 3 degrees may use a traditional medicine to relieve symptoms of the disease before the operation.

For the treatment of coxarthrosis is used:

1. Bryonia Alba. For the preparation of healing tools you need to take 200 grams of grass, chop it and pour in 2 times the amount of pork fat. This mixture should boil for 2-3 minutes on low heat, cool and used as an ointment. It can be rubbed into the problem areas every day before the visible relief.
2. To quickly forget about a disease like hip coxarthrosis, it is recommended to use an effective treatment of celandine. For the preparation you need to take only two ingredients - olive oil (1 liter) and celandine (8 tablespoons of finely ground herbs). These components are mixed in any suitable container and infused in a warm location for about 2 weeks. Finished oil rub the problem areas, and then wrap up warm scarf or a scarf.
3. To facilitate the state of a person who suffers from this disease, you can use alcohol tincture of the leaves of lilac. It is necessary to take 100 g dry feed per 500 ml of vodka. The medicine will be ready in about 11 days. It is recommended to drink before a meal in the amount of 50 drops at a time.
4. Cabbage. You need to tear off the sheet from the cabbage head and smear it with honey. Such natural poultice is applied to the joints of patients - preferably overnight. To list does not slipped, it is recommended to fix it with a plastic bag and a warm scarf. The next morning a poultice is replaced by a new one. Cabbage is not only relieves pain but also reduces inflammation. The recommended course of treatment lasts a month.

It is best to use these therapies under medical supervision in order to avoid negative consequences.

operative intervention

If hip coxarthrosis much running, traditional treatments may be useless. In this case, treat the disease have by surgery. Naturally, the transaction should be all the evidence that determines the doctor.

The following types of surgery:

1. Endoprosthesis. Such treatment provides a full or partial replacement of the hip joint. This operation is the most difficult, especially if the lesion bilateral. The success of the procedure is 70%. The prosthesis is obliged to choose a doctor, taking into account the anatomical features of articulation and features of the disease. In coxarthrosis such treatment may be the only opportunity to return mobility. The prosthesis may be unipolar or bipolar. In the first case only the replacement of the hip joint head in the second - all the anatomical elements. Do not forget about the qualitative recovery after surgery.
2. Arthroplasty. This procedure is quite complicated. It is a surgical simulation cartilage destruction. Such an operation is very difficult, because you need to take into account the natural anatomical features of the joint.
3. Osteoma. In this case, it produced bone joint dissection, in which its deformation is eliminated. The operation allows you to restore motor and support function.
4. Arthrodesis. For fastening the hip bone using special tools: plates, screws. This restores the functionality of the joints, but some stiffness remains.

Any surgery involves a long period of rehabilitation. Should carry out its experienced staff.

prevention

Any specific prevention koksartroza does not exist. Primary prevention is early detection and timely treatment of trauma and dislocation of the hip, hip dysplasia, as well as regular monitoring of people with disorders of the hip joint.

Secondary prevention - it is timely diagnosis of coxarthrosis in the first stage and its periodical conservative treatment at least 1-2 times a year. Please observe orthopedic joint unloading mode, choose sedentary profession, control body weight and engage in physical therapy.