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Osteoarthritis of the hip joint

rehabilitation after treatment of osteoarthritis of the hip

Osteoarthritis of the hip joint (ATS) is a slow destructive disease. Under the influence of a number of reasons, during the development of the disease, irreversible changes in the structure and properties of hyaline cartilage occur, which leads to increased pressure on the articular surfaces and their deformation or fusion. Since mechanical overload is considered one of the main causes of the development of the disease, 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 joint makes it possible to reduce and spread the lower limbs, raise the legs and pull them towards the body, and perform walking movements. From birth and throughout life, a person carries a high load on the hip joint.

On the side of the pelvic bone, the "acetabular" cavity participates in the joint, on the side of the femur, its epiphysis. The acetabulum has a collagen lip along the edges, which acts as a sort of seal that holds the femoral epiphysis firmly in its recess. The recess in the center of the acetabulum is lined with a collagen membrane and is the attachment site for the ligament of the femur.

The composition of the TS capsule includes the ligaments:

  • femoroiliac - the strongest ligament that can withstand a load of more than 200 kg and prevents excessive arching of the hips;
  • femoro-pubic - is responsible for abduction and reduction of the thigh, thereby limiting its circular movements;
  • femoral ischial - protects the vehicle from concussions, reduces the load when walking and running;
  • circular (loop) - prevents dislocations and holds the head of the femur in the cavity of the pelvic cavity and forms the basis of the articular bag.

Many muscle groups and tendons allow the vehicle to move around three axes:

  1. Longitudinal (vertical).
  2. Transversal (horizontal, frontal).
  3. Sagittal (antero-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 functions of shock absorption and protection against damage to the surfaces of the joint. ATS is a developing disease in which the structure of collagen cartilage fibers changes, which then leads to their fragmentation and destruction. Fragments of cartilaginous fibers, if they get into the joint cavity, can provoke an inflammatory process. Bare surfaces experience changes in bone tissue caused by friction and increased pressure. The cartilaginous tissue remaining along the edges of the epiphyses grows compensatoryly with subsequent ossification, causing ankylosis (immobility of the bone junction). At later stages, in the absence of adequate treatment, the patient completely loses mobility and becomes disabled. Destructive processes are provoked by various reasons.

There are the following types of arthrosis of the hip joint:

  1. Primary. Its etiology is not fully understood. Idiopathic (primary) osteoarthritis develops in a previously healthy joint. Most often it develops in older people.
  2. 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 disease

Among the causes contributing to the onset of the disease and its progression, the following are distinguished:

  1. Hereditary genetic predisposition to the development of the disease.
  2. Bone joint injuries (dislocations, fractures, sprains and tendons).
  3. Unbearable systematic power and physical activity.
  4. Overweight.
  5. Functional disorders of the endocrine system (diabetes, psoriasis).
  6. Congenital pathologies of the structure and development of the musculoskeletal skeleton.
  7. Professional characteristics of the work activity.
  8. Bad local circulation.
  9. Previous diseases caused by pathogenic flora.
  10. Legg-Calvé-Perthes disease.
  11. Metabolic disorders (gout).
  12. Physical inactivity.
  13. Immune diseases.

These reasons are not always able to cause ATS. Most often, the activation of pathological processes can be provoked by:

obesity as a cause of hip arthritis
  • increased stress and physical activity;
  • constant overwork;
  • hypothermia of the vehicle or the body as a whole;
  • sudden lifting of heavy objects;
  • Hormonal imbalance;
  • radiation exposure.

Disease symptoms

Symptomatic manifestations of ATS are similar to manifestations of arthrosis of other joints.

The main characteristic symptoms of this disease are considered:

  1. Stiffness in the morning or after a long period of immobility.
  2. Decreased range of motion, change in gait.
  3. Pain, first caused by mechanical or physical stress, then constant.
  4. The manifestation of creaks, creaks and pops during sudden movements.
  5. Pronounced lameness on the affected limb.
  6. The occurrence of contractures (restriction of passive movements).
  7. Narrowing or closing of the joint space (x-ray sign).

The severity of signs of arthrosis of the hip joint depends on the degree of development of the disease and the reactive abilities of the patient's body.

arthritis pain in the hip

Coxarthrosis stages

According to the clinical manifestations, 4 stages of arthrosis of the hip joint are distinguished:

  1. Arthrosis of the 1st degree of the hip joint does not have pronounced pain and other manifestations. The stage is difficult to diagnose, the disease can be detected with the help of a biochemical study of hyaline cartilage tissue and the determination of an insufficient amount of glycosaminoglycans. The patient feels pain in the joint and rarely pain at the beginning of physical activity.
  2. Arthrosis of the second degree of the hip joint is characterized by changes in the density and elasticity of the cartilage fibers. Cracks and breaks appear. Damping functions are reduced. The pain intensifies, radiates to the inguinal region, the movements of dilution and reduction of the affected limb are limited.
  3. In the third degree, stratification of cartilaginous fibers occurs with greater intensity. Articular surfaces experience excessive pressure, foci of ischemia develop. Cartilage tissue grows along the edge of the epiphyses. The feeling of pain in the area of the damaged bone junction does not depend on the state of activity and rest. With each movement, the joint "squeaks" and "creaks". The range of motion is reduced in all axes.
  4. The fourth degree is characterized by the exposure of the surfaces of the joint components with the formation of ulcers and depressions. The articular head of the femur is poorly fixed in the acetabulum, which leads to a violation of the comparison and separation of the articular surfaces. During this period, the patient experiences excruciating pain caused by the narrowing, sometimes closing of the articular lumen and compression of the bundles of nerve fibers and blood vessels. Movement is limited, sometimes completely.

Classification of pathological changes caused by ATS is necessary to understand the mechanism and features of disease development. Determining the severity of the disease helps to determine the correct tactics of treatment and disability (in case of serious illness).

Possible consequences

Progression of ATS leads not only to deformation of the femoral head and pelvic cavity, but also to the development of pathological processes in the functioning of the articular apparatus as a whole.

Pathologies resulting from complications of osteoarthritis of the hip:

  • 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 the joint of the bones) partial or complete;
  • contractures (limitation of mobility and impossibility of flexion-extension of the limb).

The development of complications from ATS always leads to deterioration of the patient's general condition, quality of life and loss of unassisted movement.

Diagnostic methods

Diagnosis of arthrosis of the hip joint at the initial stage is difficult. Symptomatic manifestations become noticeable only when the epiphyses of bones and nerve fibers are involved in the pathological process.

X-ray image of hip joint with arthrosis

During a medical examination in the progression phase, we note:

  • visual change in joint contour;
  • pain on palpation;
  • sometimes pastosity of periarticular tissues;
  • shortening of the diseased limb.

The main role in the diagnosis of ATS is assigned to X-ray examination. As auxiliary diagnostic methods used:

  1. Ultrasound, magnetic resonance imaging.
  2. CT.
  3. Joint lubrication puncture (synovial fluid).
  4. Diagnosis using an arthroscope (microprobe).
  5. Clinical and biochemical laboratory tests of urine, blood.

Prompt diagnosis improves the prognosis of treatment and the future life of the patient.

How do I apply for disability?

It is impossible to completely cure this disease. To confirm the right to social benefits and assign a group of disabled people after passing the examination by narrow specialists, you should contact your doctor.

consultation with a doctor for hip arthritis

The indication for assigning disability in osteoarthritis of the hip joint is:

  • oligoarthrosis (damage of no more than 2 joints) TS 2 degrees;
  • combined 2nd degree osteoarthritis of the TS and 3rd degree osteoarthritis of the knee joint;
  • a decrease in the length of the diseased limb by more than 6 cm;
  • automatic reactive flow telephone exchange, documented.

To determine the disability group, you will help:

  • carefully collected anamnesis;
  • the conclusion of the Medical Advisory Committee (MCC);
  • results of diagnostic studies;
  • pass the medico-social expertise commission (MSEC).

If the expert committee's decision is negative, an appeal can be made to higher authorities.

Prevention

Preventive measures are an easy way to avoid the development of this disease. Preventive measures include:

  1. Adherence to an active lifestyle.
  2. Control of body weight indicators.
  3. Optimization of nutrition and mode of work and rest.
  4. Reduced mechanical and physical load.
  5. Treatment of diseases of viral and infectious etiology.
  6. Prevention and prevention of injuries at home and at work.
  7. Regular preventive examination.

Conclusion

The answer to the frequently asked question: "Is it possible to cure arthrosis of the hip joint? " Experts give a negative answer. The destroyed cartilage tissue cannot be fully restored, just as it is impossible to completely correct the deformation and destruction of the bones included in the joint. Do not ignore even minor manifestations of arthrosis of the hip, this reduces the chances of preventing the further development of the disease.