Osteoarthritis of the hip joint: treatment,symptoms, degrees

Update: December 2018

Osteoarthritis of the hip joint is progressive.
degenerative degenerative disease. Most often it
develops in old age, in case of provoking
factors – infectious, non-inflammatory diseases of the joint,
injuries, genetic location, curvature of the spine.

Coxarthrosis is another name for hip joint arthrosis,
treatment of which is very difficult, long, at first conservative,
then surgical. The main symptom of the disease is pain.
sensations, restriction of movement, occurs in late stages
shortening of the diseased limb, atrophy of the femoral muscles.

However, recently the term arthrosis has been abolished and now
The disease is called osteoarthritis of the joints. Previously, arthrosis was considered
not an inflammatory process, but now it is also recognized in osteoarthritis
inflammation. As with the whole theory of aging – interleukins
are excreted by different cartilage structures and trigger inflammation,
the result of which is his degeneration, that is, the cracking and
decay. And so now there is no arthrosis, there is only osteoarthritis.

Causes of hip joint arthrosis

The disease itself is not inherited, but such
features that provoke its development, such as weakness of cartilage tissues,
various metabolic disorders, genetic features
skeletal structures – can be transferred from parents to children. therefore
risk of arthrosis of the joints in the presence of this disease in
next of kin, rises.

However, the main causes of hip osteoarthritis
the joint are considered related diseases:

  • Perthes disease – impaired blood supply and nutrition of the head
    бедренной кости и в целом  сустава, развивается в детстве,
    more often in boys
  • Congenital dislocation of the hip, hip dysplasia
  • Injuries – hip fracture, sprains, pelvic fractures
  • Necrosis of the femoral head
  • Inflammatory, infectious processes – rheumatoid arthritis,
    purulent arthritis (read the causes of pain in the hip joint).

As the disease develops slowly, it can be as
unilateral and bilateral.  Factors that
contribute to the onset of arthrosis:

  • The presence of concomitant diseases of the spine – scoliosis,
    kyphosis, osteochondrosis, etc., flat-footedness, arthrosis of the knee joint
    (see symptoms of osteoarthritis of the knee joint).
  • Hormonal changes in the body, violations
    blood circulation
  • Excessive load on the joints – sport, heavy physical
    work overweight
  • Sedentary lifestyle in the complex with obesity
  • Age – in old and old age the risk of arthrosis
    increases significantly

The main diagnostic methods are MRI and CT,
radiography. MRI data provide a more accurate picture of the condition
soft tissue, and CT bone tissue pathology is also taken into account
clinical signs and symptoms of hip arthrosis.
It is very important to establish not only the presence of pathology, but also the degree
arthrosis, and its causes.

For example, if the changes in the pictures relate to the proximal
hip, this is a consequence of Perthes disease, if it increases
cervical-diaphyseal angle and noticeable flattening of the acetabulum –
this is hip dysplasia. You can also find out about injuries.
from radiographic images.

Symptoms 1 2 3 degrees of hip joint arthrosis

The main symptoms of osteoarthritis of the hip joints are considered
following:

  • The most important and constant is severe, constant pain in
    groin, in the thigh, in the knee joint, sometimes radiating pain in
    leg, groin area
  • Stiffness, limited mobility of the joint
  • Restriction of abduction of the affected leg to the side
  • In severe cases, lameness, gait disturbance, shortening of the leg,
    atrophy of the femoral muscles

1 degree of hip arthrosis:

At this stage of the disease, a person experiences pain only when
after exercise, from long running or walking, while
basically the joint itself hurts, very rarely does the pain give into the thigh or
knee. Also at the same time, the person’s gait is normal, no limping
observed, thigh muscles are not atrophied. When diagnosing
The images are observed bone growths, which are located
around the inner and outer edges of the acetabulum, others
pathological disorders in the neck and the femoral head is not
are observed.

2 degree of arthrosis:

In case of arthrosis of grade 2 hip, symptoms
становятся значительными и  боли уже приобретают более
constant and intense, and at rest, and at
movement, give and in the groin, and in the thigh, with the load the patient is already
limping. There is also a limitation of hip abduction,
thigh movements are reduced. In the pictures, the narrowing of the gap becomes
half of the norm, bone growths are found and on
on the outside and on the inside edge, the head of the bone of the hip begins
increase, deform and shift upwards, its edges
become jagged.

3 degree of hip arthrosis:

At this stage of the disease the pains are painful. constant
nature, and day and night, the patient becomes difficult
move independently so a cane is used or
crutches, the amount of movement of the joint is very limited, will atrophy
leg muscles, thighs and buttocks. Shortening of the leg and the person occurs
forced to tilt the body when walking in the direction of the sick leg. From
the displacement of the center of gravity increases the load on the damaged
joint. X-rays show multiple
bone growths, expands the head of the thigh and significantly
the joint gap narrows.

How to treat osteoarthritis of the hip joint?

To avoid surgery, it is very important
timely establish the correct diagnosis, differentiate arthrosis
from other diseases of the musculoskeletal system – reactive
arthritis, spit bursitis, etc. With 1 and 2 degrees of arthrosis
treatment should be made in a complex, conservative,
медикаментозными средствами,  с помощью мануальной терапии,
therapeutic massage, therapeutic gymnastics, but only under control
qualified orthopedist.

  • Week One – simple paracetomol.
  • If there is no effect, then NSAIDs (better diclofenac or ketorol in
    a small dose) under the cover of proton pump blockers (but not
    omeprazole because it enhances bone destruction during prolonged
    admission).
  • Plus at any stage chondroprotectors.

The combination of all therapeutic measures should decide immediately
several tasks:

Reduce pain

For this today there is a huge selection of different NSAIDs –
nonsteroidal anti-inflammatory drugs, which, though removed
pain, but do not affect the development of the disease, they do not
can stop the process of cartilage destruction. They possess
a number of serious side effects, which are also long-term
and due to the fact that these agents affect the synthesis
proteoglycans, contributing to the dehydration of cartilage tissue that
only aggravates the condition. Of course, pain is unacceptable, but
and use painkillers should be with caution, under
supervised by a doctor, only during periods of acute illness.

The NSAIDs include: Celebrex, Arcoxia, Texmen, Nise, Nimulid,
Нимика, Налгезин, Мовалис,  Мелоксикам Артрозан,
Кетанов,  Кеторолак, Кетарол,  Артрозилен, Кетонал,
Bystrumskaps, Fleksen, Burana, Ibuprofen, Faspik, Nurofen,
Voltaren, Diclofenac, Ortofen, Diklak. (see full list,
side effects and contraindications of all NSAIDs in our article shots
from back pain).

Such local remedies for the treatment of deforming arthrosis, as
warming ointments are not expressed drugs
therapeutic effect, but they reduce pain by acting like
distracting means and partially relieve muscle spasm, to such
means include – Gevkamen, Espol, Menovazin, Nikofleks-cream.

Provide better nutrition for cartilage tissue and intensify
circulation

Хондропротекторы, такие как глюкозамин и хондроитинсульфат
are important drugs that can improve
condition of cartilage, but only in the early stages of the disease.
A complete description of these drugs in pills, injections, creams, with
average prices and treatment courses in the article osteoarthritis of the knee
the joint. Чтобы улучшить circulation, сократить спазм мелких
vasodilators are commonly recommended vascular drugs – Stugeron
(100 rubles), Zinnarizin (20 rubles), Agapurin (150-200 rubles), Trental
(160 -1000 rubles), Vazonid Retard (300 rubles), Pentoxifylline (60 rubles),
Xantinol nicotinate (170-200 rubles).

Only according to strict indications can muscle relaxants be prescribed –
muscle relaxants such as tizanidine –
Sirdalud, Tizalud, Tizanil, as well as Tolperisone – Mydocalm. Their
use can have a positive effect and
negative, muscle relaxation on the one hand reduces pain,
улучшает circulation, но с другой спазм и напряжение мышц — есть
defensive reaction of the body and removing it can only accelerate
разрушение тканей the joint.

Intra-articular injections

Injections with hormonal preparations are carried out only with synovitis.
то есть накоплении жидкости в полости the joint. Once, and not more often
3 times a year (Kenolog, Metipred, Hydrocartisone). Hormonal
remedies relieve pain and inflammation, but have pronounced
immunosuppressive effect, and their use is not always justified.
It is more expedient to make injections into the thigh with chondroprotectors
– Goal T, Hondrolon, Alflutop 5-15 procedures 2-3 times a year.
Intra-articular hyaluronic acid injections are also shown.
Ostenil, Fermatron, Synvisc, Hiastat, is an artificial lubricant for
joints.

Physiotherapy

The opinion of doctors on the effectiveness of these procedures is divided into
supporters and opponents, some consider them to be justified,
others are meaningless. Possible laser therapy, magnetic laser
therapy and makes sense in case of hip joint arthrosis, the rest
procedures many doctors do not find necessary for the treatment of this
diseases because the hip joint is a joint
deep occurrence and many such procedures are simply not able to
reach the goal and are a waste time, effort and maybe
funds for the patient.

Professional massage, hip joint traction
(hardware traction), manual therapy, therapeutic physical training

All of these therapeutic interventions are very useful in complex.
treatment of the disease, they help strengthen the muscles surrounding
joint, increase its mobility and with proper combination with
drug treatment may increase the distance
from the head to the hollow and reduce the pressure on the femoral head
bones. This is especially true of physical therapy, without it.
competent selection and regular performance without exacerbations
It is impossible to achieve a real improvement in the patient’s condition.

If a patient is overweight, then, of course, a diet can
help reduce the strain on the affected joint, but
She has no independent therapeutic action. Also
Doctors recommend using canes or crutches depending on
степени нарушения функции the joint.

In case of arthrosis of grade 3, doctors always insist on operative
intervening because a destroyed joint can be restored
only by replacing it with an endoprosthesis. According to testimony
apply a bipolar prosthesis that replaces both the head and
hollow, or monopolar, which changes only the head of the thigh without
acetabulum.

Such operations today are made quite
often, only after a thorough examination, in a planned manner
under general anesthesia. They provide full restoration of functions.
thighs with competent and careful performance of all postoperative
мероприятий —  противомикробной антибиотикотерапией и
rehabilitation period of about six months. Such prostheses for
hip joint serve up to 20 years, after which
their replacement is required.

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