Osteoarthritis of the hip joint (AT) is a slowly destructive disease. Under the influence of a number of reasons, during the development of the disease, irreversible changes occur in the structure and properties of hyaline cartilage, which leads to increased pressure on the articular surfaces and their deformation or fusion. Considering that mechanical loading is considered one of the main reasons for the development of the disease, the articulation of the hip joint is often affected by arthrosis.
Features of the anatomical structure of the hip joint
The hip joint (TC) is the junction of the pelvis and the femur. This articulation allows lowering and spreading the lower limbs, lifting and pulling the legs to the body, walking movements. From birth and throughout life, a person carries a high load on the hip joint.
The "acetabular" cavity is involved in articulation on the side of the pelvis, and the epiphysis on the side of the femur. Along the edges of the acetabulum there is a collagen lip, which acts as a kind of gasket that keeps the epiphysis of the femur firmly in its socket. The recess in the center of the acetabulum is lined with a collagen membrane and is where the femoral ligament attaches.
The composition of the TS capsule includes ligaments:
- femoral-iliac - the strongest ligament that can withstand a load of more than 200 kg and prevents excessive bending of the hip;
- femoral-pubic - is responsible for the abduction and reduction of the thigh, thereby limiting its circular movements;
- femoral ischial - protects the vehicle from shocks, reduces the load during walking and running;
- circular (loop) - prevents dislocations and keeps the head of the femur in the cavity of the pelvis and forms the basis of the joint bag.
Numerous muscle groups and tendons allow the vehicle to move around three axes:
- Longitudinal (vertical).
- Transverse (horizontal, frontal).
- Sagittal (anterior-posterior).
Joint arthrosis can occur both in a healthy joint and become a continuation of existing diseases of the musculoskeletal system.
What is this disease?
Hyaline cartilage performs shock-absorbing and protective functions against damage to the surfaces of the joint. ATS is a disease in which the structure of collagen cartilage fibers changes during development, which subsequently leads to their breakdown and destruction. Fragments of cartilage fibers, if they enter the articular cavity, can cause an inflammatory process. Bare surfaces undergo changes in bone tissue due to friction and increased pressure. The remaining cartilage tissue along the edges of the epiphyses grows compensatory with subsequent ossification, causing ankylosis (immobility of the bone joint). In the later stages, in the absence of adequate therapy, the patient completely loses the ability to move and becomes disabled. Destructive processes are caused by various reasons.
There are the following types of arthrosis of the hip joint:
- Primary. Its etiology is not fully understood. Idiopathic (primary) arthrosis develops in a previously healthy joint. It often develops in older people.
- Secondary. It is provoked by previous diseases of the articular apparatus, congenital anomalies of development, changes in the work of organs and systems of human vital activity.
The disease develops in one joint or affects both at the same time.
Causes of the disease
Among the reasons that contribute to the appearance of the disease and its development, the following are identified:
- Hereditary genetic predisposition to the development of the disease.
- Damage to the bone joint (dislocations, fractures, sprains and tendons).
- Unbearable systematic strength and physical activity.
- Excess weight.
- Functional disorders of the endocrine system (diabetes, psoriasis).
- Congenital pathologies of the structure and development of the musculoskeletal system.
- Professional characteristics of work.
- Poor local circulation.
- Previous diseases caused by pathogenic flora.
- Legg-Calve-Perthes disease.
- Metabolic disorders (gout).
- Physical inactivity.
- Immune diseases.
These reasons do not always lead to ATS. It can often lead to the activation of pathological processes:
- increased stress and physical activity;
- constant overwork;
- hypothermia of the car or the body as a whole;
- sudden lifting of heavy objects;
- hormonal imbalance;
- exposure to radiation.
Symptoms of the disease
Symptomatic manifestations of ATS are similar to manifestations of arthrosis of other joints.
The main characteristic symptoms of this disease are:
- Stiffness in the morning or after prolonged inactivity.
- Decreased range of motion, change in gait.
- Pain caused by mechanical or physical stress at first, then constant.
- Manifestation of squeaking, crunching and clicking during sudden movements.
- Marked lameness in the affected limb.
- Formation of contractures (restriction of passive movements).
- Narrowing or closing of the joint space (X-ray sign).
The severity of symptoms of arthrosis of the hip joint depends on the degree of development of the disease and the reactive abilities of the patient's body.
Stages of coxarthrosis
Depending on the clinical manifestations, 4 stages of arthrosis of the hip joint can be distinguished:
- There is no acute pain or other manifestations in the 1st degree arthrosis of the hip joint. It is difficult to diagnose the stage, the disease can be detected by biochemical examination of hyaline cartilage tissue and determination of insufficient amount of glycosaminoglycans. The patient feels pain in the joint and rarely feels pain at the beginning of physical activity.
- Secondary arthrosis of the hip joint is characterized by changes in the density and elasticity of cartilage fibers. Cracks and fractures appear. Depreciation functions are reduced. The pain intensifies, spreads to the inguinal region, the movements of thinning and reducing the affected limb are limited.
- In the third degree, layering of cartilage fibers occurs with greater intensity. Articular surfaces are subjected to excessive pressure, foci of ischemia develop. Cartilage tissue grows on the edge of the epiphyses. The feeling of pain in a damaged bone joint does not depend on the state of activity and rest. With any movement, the joint "creaks" and "crunches". The range of motion on all axes is reduced.
- The fourth degree is characterized by exposure of the surfaces of the articular components with the formation of ulcers and depressions. The articular head of the femur is poorly fixed in the acetabulum, which causes a violation of the comparison and separation of the articular surfaces. During this period, the patient experiences excruciating pain caused by narrowing, sometimes closing the joint lumen and compressing nerve fibers and bundles of blood vessels. Movement is limited, sometimes completely.
The classification of pathological changes caused by ATS is necessary to understand the mechanism and characteristics of the disease. Determining the severity of the disease helps to determine the correct tactics of treatment and disability (in case of severe disease).
Possible outcomes
The progression of ATS leads not only to the deformation of the femoral head and pelvis, but also to the development of pathological processes in the functioning of the articular apparatus as a whole.
Pathologies caused by complications of hip arthrosis:
- synovitis (inflammation of the synovial membrane of the joint);
- aseptic necrosis of the femoral head;
- joint destruction (osteonecrosis);
- inflammation of the joint bag with a change in the amount of synovial fluid;
- ankylosis (immobility of bone articulation) partial or complete;
- contractures (restriction of mobility and impossibility of flexion-extension of the limb).
The development of complications of ATS always leads to deterioration of the patient's general condition, quality of life and loss of unaided movement.
Diagnostic methods
It is difficult to diagnose arthrosis of the hip joint at the initial stage. Symptomatic manifestations are noticeable only when the epiphyses of bones and nerve fibers are involved in the pathological process.
During the medical examination in the advanced stage, the following are noted:
- visual change in the articular contour;
- pain during palpation;
- sometimes pastosia of periarticular tissues;
- shortening of the diseased limb.
The main role in the diagnosis of ATS is given to X-ray examination. Used as auxiliary diagnostic methods:
- Ultrasound, magnetic resonance imaging.
- CT scan.
- Puncture of articular lubrication (synovial fluid).
- Diagnosis using an arthroscope (microprobe).
- Clinical and biochemical laboratory tests of urine, blood.
Timely diagnosis improves the prognosis of treatment and the subsequent life of the patient.
How to apply for disability?
It is impossible to completely cure this disease. You should contact your doctor to confirm the right to receive social benefits and to assign a disability group after being examined by narrow specialists.
Indication for determining disability during arthrosis of the hip joint:
- oligoarthrosis (damage to no more than 2 joints) TS 2 degree;
- 2nd degree combined arthrosis of TS and 3rd degree arthrosis of the knee joint;
- reduction of the length of the diseased limb by more than 6 cm;
- jet flowing ATS, documented.
It will help to determine the disability group:
- carefully collected anamnesis;
- medical advisory commission (MCC) opinion;
- results of diagnostic studies;
- pass the medical and social expert commission (TSEK).
If the decision of the expert commission is negative, it can be appealed to higher authorities.
Prevention
Preventive measures are an easy way to prevent the development of this disease. Prevention measures include:
- Maintaining an active lifestyle.
- Body weight control.
- Optimizing nutrition and work and rest mode.
- Reduced mechanical and physical load.
- Treatment of diseases of viral and infectious etiology.
- Prevention and prevention of injuries at home and at work.
- Regular preventive examination.
The result
The answer to the frequently asked question: "Is it possible to treat arthrosis of the hip joint? " Experts give a negative answer. It is impossible to completely restore the destroyed cartilage tissue, just as it is impossible to completely correct the deformation and destruction of the bones included in the joint. Do not ignore even small manifestations of hip arthrosis, this reduces the chances of preventing further development of the disease.