Coxarthrosis Of The Joints - The Causes And Symptoms Of Coxarthrosis 1, 2 And 3 Degrees. How To Treat?

2024 Author: Josephine Shorter | [email protected]. Last modified: 2024-01-07 17:49

Causes and symptoms of coxarthrosis 1, 2 and 3 degrees

Content:

• What is coxarthrosis of the joints?
• Causes and types of classification
• Degrees and symptoms of development of coxarthrosis
• Localization and forecast
• Diagnosis of coxarthrosis
• How to treat coxarthrosis?

What is coxarthrosis of the joints?

Coxarthrosis - 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 bones of the pelvis, spine and lower extremities: a decrease in the acetabulum, congenital dislocations and subluxations, spinal scoliosis, asymmetry of growth, different lengths of the lower extremities. Secondary coxarthrosis often affects both joints unequally or is unilateral. Primary ones are usually symmetrical.

Coxarthrosis statistics are disappointing. Among all types of osteoarthritis, large joints account for 50%. Of these, the incidence of coxaratrosis is 25%.

After the analysis, the scientists received the following data:

• coxarthrosis of unknown etiology accounts for 40% of the total morbidity;
• secondary coxarthrosis occurs in 20% of cases;
• the remaining 40% are the consequences of injuries, excessive physical and occupational stress.

People of middle working age are more often affected. Recently, coxarthrosis is getting younger.

The mechanism of the disease

In the hip joint, the nameless (pelvic) and thigh bones are articulated. In the pelvic cavity is the acetabulum, in which the head of the femur is placed. The acetabulum itself is covered by the cartilaginous cover. It is slightly thinner below and in front, thicker above and behind. The very head of the femur is also covered with cartilage. The slit space that remains inside the joint is filled with synovial fluid. It is transparent, viscous, resembling egg white. Being a derivative of blood plasma with the addition of hyaluronic acid, the synovial fluid carries out metabolic functions in the joint, it is a representative of the immune defense.

Since the joint is powerful and is subject to a large load, it is equipped with a large number of ligaments that form its capsule. Cartilage is not penetrated by blood vessels and nerve fibers. They are devoid of sensitive nerve fields that could signal excessive stress. Therefore, under their influence, the cartilage tissue is gradually loosened, the physicochemical properties of the extracellular matrix change. The renewed cartilage cells are defective. As a result, cartilage loses its biomechanical properties.

The synovial fluid captures the smallest particles of exfoliated cartilage. Once between the rubbing surfaces, these pieces penetrate into the synovial membrane and joint capsule. The membrane becomes inflamed, more synovial fluid is secreted, but its quality becomes worse. This enhances the destruction of the joint. It swells, becomes covered with bone growths (osteophytes), which create pain when moving.

In addition to physiology, the biomechanics of the joint is grossly disturbed.

Causes and types of classification of coxarthrosis

Distinguish between primary and secondary coxarthrosis:

• in the first case, the disease develops in the joint, the cartilage of which was healthy from birth, and the problems appeared due to excessive stress;
• with the secondary, degeneration of the already altered cartilage occurs.

Secondary forms include:

• dysplastic coxarthrosis (congenital underdevelopment of the joint, which manifests itself very early);
• congenital anomalies (dislocation of the hip);
• Koenig's disease (osteochondrosis dissecans of the hip joint);
• Perthes disease (osteochondropathy of the femoral head);
• aseptic necrosis of the head of the hip bone.

In addition, depending on the localization of the pathological process, it is customary to distinguish the following clinical forms of coxarthrosis:

• defeat of the upper pole of the hip joint. This kind comes from birth defects. You start to get sick early and often experience pain;
• defeat of the lower pole of the hip joint. Pain in the bones is not particularly felt, everything is visible on the x-ray;
• lesion of the central part of the hip joint, central arthrosis. The form of this disease is favorable.

Based on this, it is possible to identify the main causes and classification types of coxarthrosis.

• Involutive - one that is associated with age-related changes. It manifests itself in the region of 50 years.
• Idiopathic - when the cause of the occurrence is not clear. This type is often referred to as primary coxarthrosis.
• Congenital or dysplastic.
• Post-traumatic - when the appearance of coxarthrosis was preceded by trauma. More often it is a fracture of the pelvic bones, the head of the femur. Sometimes even adequate treatment of the injury still leads to coxarthrosis.
• Post-infectious coxarthrosis can occur after trauma, due to a trapped and untreated infection, with rheumatoid arthritis.
• Dyshormonal or metabolic coxarthrosis is manifested in case of metabolic disorders, abuse of certain medications (hormones, corticosteroids).
• The most common cause is impaired blood flow and outflow to the joint. It can be caused by varicose veins.
• Coxarthrosis is more common in people who have diseases of the spine. With scoliosis, lordosis, intervertebral hernias and other pathologies, due to pain syndromes, the biomechanics of movement is disrupted. This increases the load on the hip joint. This is how the body adapts to existing problems.
• Insufficient physical activity can lead to coxarthrosis.
• One of the main reasons is heredity. If there is a weakness of the skeleton in the family, some features of the structure and development of cartilage tissue, metabolic diseases - the risk of developing coxarthrosis is significantly increased.

The common reasons for the development of coxarthrosis are:

• congenital subluxation of the femoral head, which accounts for about 20% of all degenerative arthrosis of the hip joint, and is more common in women;
• fractures of the pelvis and acetabulum;
• hip fractures;
• fractures and necrosis of the femoral head with a change in the cervico-diaphyseal angle;
• benign and malignant bone tumors;
• arthrosis caused by Paget's disease;
• ankylosing spondylitis and rheumatoid arthritis.

Degrees and symptoms of development of coxarthrosis

A symptom of coxarthrosis is pain in the joints, in particular in the legs, which appears for the first time towards the end of your working day. The next day, joint pain persists for the whole day. Later, you simply will not be able to sleep.

Very early on, your thighs and buttocks begin to atrophy. Walking becomes problematic for you. Subsequently, the limbs are shortened, and you simply begin to limp. This is followed by the defeat of the joint itself, which leads to its change, and it ceases to perform its function. In the early stages, the joint is simply limited in its movement, and after that it may even immobilize you altogether.

Initial pain and significant limitation of joint mobility appear at 2 or even 3 degrees of coxarthrosis:

1 degree of coxarthrosis

I degree of the disease is characterized by:

• slight aching pain that is localized in the joint area after significant exertion. In this case, the biomechanics of movement is not disturbed, the pain passes quickly;
• on the X-ray you can see a slight narrowing of the joint space, osteophytes.

2 degree of coxarthrosis

With II degree:

• pain increases, joint mobility is impaired;
• extension is not brought to an angle of 20 ° C, the flexion angle decreases and does not reach the norm of 115 ° C. The amplitude of the adduction is less than 40 and the amplitude of the leads is 45 ° C. The violation and limitation of rotational movements is especially strongly felt;
• pain radiates to the groin, knee, popliteal ligament. Often these pains are associated with diseases of the spine or knee joint. The diagnosis is incorrect;
• aching pains appear at rest, which are caused by developing inflammation;
• biomechanics is impaired, functional abilities decrease;
• characteristic sounds appear in the joint during movement (crepitus);
• dystrophy of the gluteal muscles begins to appear, a slight specific lameness. The limb is visually shortened due to the skew of the pelvis;
• X-ray images show significant growth of osteophytes, the femoral head is deformed, its contour changes. There is a narrowing of the joint space by a third of its normal physiological state. The head of the hip bone begins to move upward.

3 degree of coxarthrosis

• muscles are strongly atrophied;
• pains become permanent and disturb at night;
• the biomechanics of the joint is severely impaired;
• sharp starting pain significantly complicates movement;
• the skew of the pelvis increases, the limb is shortened;
• gait becomes a specific "duck";
• X-ray shows significant deformation of the head of the bone, a large number of osteophytes. The joint gap is either strongly narrowed or absent altogether. The femoral neck thickens.

In the presence of 3 degrees of coxarthrosis, we can talk about the patient's disability. Often such patients cannot move without a cane.

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Localization and forecast

Depending on where the joint is more affected, you can predict the course of the disease:

• If the lesion falls on the central part, this gives the right to hope for a calmer and longer course of the disease. At the same time, the pain is moderate. The joint gap is more narrowed in the central part of the acetabulum. With such localization, the patient can be supported for a long time with conservative therapy, without resorting to surgical interventions.
• When localized in the lower pole, pains are mild. Internal rotation is more disturbed than external rotation. Endplate sclerosis is observed. This type of coxarthrosis also may not proceed very aggressively for many years. The prognosis for conservative treatment and maintenance of the joint is positive.
• Coxarthrosis with a lesion of the upper pole is considered the most difficult. Such localization is more common in cases of congenital joint anomalies. The pain is severe and can begin to manifest itself already in adolescence. In the advanced stage, joint subluxation occurs. External rotation is more disturbed. The upper part of the head of the bone and the acetabulum is killed. The prognosis of the course of the disease is not very encouraging. Such patients have to resort to surgical interventions.

Diagnosis of coxarthrosis

In the diagnosis of coxarthrosis, the qualifications of a doctor are of great importance. If an orthopedist starts treating the spine and forgets to schedule a hip x-ray, time will be wasted. This happens very often.

4 modern methods are recognized as the most truthful and accurate for establishing the diagnosis of coxarthrosis:

1. Radiography. The picture will show the size of the joint space, the presence or absence of osteophytes, the condition of the femoral head.
2. Ultrasonography. It allows you to establish the degree of the disease. View the location, the number of growths, the state of the acetabulum. The presence of changes in the ligamentous apparatus.
3. CT (computed tomography). In essence, it differs little from X-ray, but allows you to get more voluminous and detailed images.
4. MRI (magnetic resonance imaging). It is considered the most complete and true survey method. Allows you to scan the joint in layers, fixing the slightest changes in the structure of bones and cartilage.

Additional laboratory tests will help determine the degree of inflammation in the joint. At the same time, an examination by an orthopedic doctor remains an integral part of the diagnosis. Only by summing up all the data, it is possible to establish a diagnosis with confidence, indicating the degree of development of the disease.

How to treat coxarthrosis?

Treatment can be divided into several areas.

1. Medical treatment includes:

   • correction of disorders inside the joint;
   • relieving pain;
   • improved blood supply;
   • stimulation of metabolic processes,
   • reduction or removal of inflammatory processes;
   • chondroprotective therapy.

2. Physiotherapy. This includes:

   • electrical procedures;
   • paraffin and mud therapy.
3. Massage and manual therapy.
4. Plasmolifting. A new technique based on injections of platelet autoplasma.

5. Unconventional methods:

   • acupuncture;
   • reflexology;
   • apitherapy.
6. Traditional remedial gymnastics.
7. Author's techniques.
8. Operative intervention.

Drug treatment

NSAIDs (non-steroidal anti-inflammatory drugs)

The first step to take is to relieve inflammation and pain. To do this, use non-steroidal anti-inflammatory drugs:

• Acetylsalicylic acid, courantil (a heart drug that simultaneously thins the blood) and paracetamol. They are not strong enough, but for patients at risk of thrombosis, acetylsalicylic acid in low doses, or curantil is necessary.
• Olfen, naklofen, indomethacin - can quickly relieve inflammation and pain, but are not suitable for long-term use, as they have a number of side effects. These are emergency medications, for example, for exacerbation
• Meloxicam (rheumoksikam), nabumeton, etodolac, nimesil - have sufficient strength, have fewer side effects. Of all the above, meloxicam is considered the best option for long-term use, which is best used in the form of suppositories.

Antispasmodics and drugs that improve blood circulation

With coxarthrosis, the thigh muscles, gluteal muscles, are in a state of spasm, since due to the tone, the musculoskeletal system tries to compensate for the stability of the joint. This negatively affects blood circulation.

To solve this problem, muscle relaxants and agents that reduce vascular permeability are used:

1. Muscle relaxants: no-shpa, midocalm, sirdalud, riabal.
2. Means to reduce permeability and improve peripheral circulation: askorutin, upsavit, trental, cavinton.

Coxarthrosis application therapy

It consists in applying ointments, aerosols, gels, compresses, which contain anti-inflammatory drugs, to the affected joint.

Advantage:

• reduces the need for systemically prescribed drugs;
• a convenient, safe and painless method that the patient can use independently.

Most drugs include menthol, salicylates, turpentine, nicotinic acid esters. Long-term use is necessary to obtain a clinical effect.

The most commonly used drugs are:

• finalgel;
• olfen gel;
• ibuprofen gel;
• chondroxide ointment;
• voltaren;
• diclak gel.

FPVS (steroidal anti-inflammatory drugs)

In acute processes, corticosteroids are used locally, intra-articularly. Such injections allow you to stop the pain for a long time.

For such therapy, short-acting drugs are more often used:

• hydrocortisone acetate;
• dexamethasone;
• kenalog;
• diprospan;
• metipred.

It should be noted that with coxarthrosis, frequent therapy will be ineffective, since the cause of inflammation is of a biomechanical nature. In addition, it is not suitable for frequent use, since it does not restore cartilage tissue. This is an ambulance that allows you to prepare the joint for further complex treatment.

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Chondroprotectors

They are the most modern and effective drugs for the treatment of coxarthrosis, since they allow to influence not only the consequences of destruction, but also to prevent their further development.

This group can be conditionally divided into two types of funds.

1. Natural components of cartilage.
2. Hyaluronic acid preparations.

The first type includes glucosamine sulfate and chondroitin sulfate.

Chondroitin preparations:

• Kondronova;
• mucosat;
• structure;
• teraflex;
• chondrollar;
• chondrolone;
• chondrotek;
• arthra chondroitin 750.

Glucosamine preparations:

• glucosamine;
• don;
• Kondronova;
• teraflex;
• unit;
• chondro;
• aminoartrin;
• arthra.

This group of drugs inhibits the process of degeneration and activates the regeneration of cartilage. Has anti-inflammatory, chondroprotective and analgesic effects. Influences phosphorus-calcium metabolism in cartilage tissue. It makes it possible to restore the mechanical, elastic integrity of the cartilage matrix. Serves as a lubricant for articular surfaces.

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Hyaluronic acid preparations:

• synovisk;
• orthoisk;
• synocorm;
• ostenil;
• fermatron;
• hyalual;
• coxartrum.

Hyaluronic acid is a natural factor, a natural component of cartilage and synovial fluid. She takes an active part in the nutrition of cartilage. Used for intra-articular administration. It is called a "prosthesis" or synovial fluid substitute.

Hyaluronic acid preparations lubricate the joint surfaces and eliminate mechanical friction. This saves the joint and stops further degeneration.

Of the entire list, the most effective for coxarthrosis is coxarthrum. This medication is specially designed for the treatment of the hip joint, as it combines a high concentration and molecular weight of hyaluronic acid. In addition, one dose is 3 ml as opposed to 2 ml of other drugs. This allows you to limit yourself to 1 injection.

A group of hyaluronic acid medicines can be injected only after removing the inflammation.

Plasmolifting

One of the newest and most progressive methods of coxarthrosis treatment. It allows you to stimulate the restoration of bone and soft tissue of the joints using autoplasma with a high concentration of platelets. The drug is obtained using a special apparatus and ampoules. There are more than 30 growth factors in platelets. They are effective biostimulants of regenerative processes. It is used in various branches of medicine. It is advisable to use the procedure in stages I - II of coxarthrosis.

Physiotherapy, massage, manual therapy

Physiotherapy is aimed at relieving pain, improving the penetration of drugs to the joint.

The most effective and common ones:

• electrophoresis with novocaine and dimexide;
• radiation therapy;
• ultrasound;
• magnetotherapy.

Massage improves blood circulation, enhances tissue trophism, strengthens the ligamentous apparatus, relieves the tone of spasmodic muscles. Vibration massage is especially useful for coxarthrosis, which better affects the deeply located joint.

Mud therapy (peloid therapy)

It is a very effective treatment for coxarthrosis. Healing mud of different composition (peat, sulphide-silt) enhance tissue regeneration and trophism. Saturate joints with minerals, stimulate cartilage regeneration and relieve inflammation well.

For medicinal purposes, an application technique is used. With coxarthrosis, mud is applied from the lumbar region to the middle of the thigh. For medicinal purposes, it is necessary to undergo mud therapy 2 times a year.

Manual therapy for coxarthrosis includes:

• manipulation (performing sharp movements aimed at returning the range of motion, relieving spasm);
• mobilization (stretching the limb, increasing the distance between the acetabulum and the head of the femur).

One of the most common and effective in coxarthrosis is the method of chiropractor V. Gitt.

Non-traditional techniques (acupuncture, apitherapy) are an effective additional means of combating coxarthrosis.

Exercise therapy for coxarthrosis

The method of selection of exercises for coxarthrosis is to exclude axial loads on the joint. A properly selected complex allows you to reduce pain, relax the adductor muscles, improve blood circulation and trophism. Exercise is best done in the morning and evening.

• Pulling. We lie with our backs on the mat, press the popliteal fossa to the mat, tighten the buttocks, stretch out the socks and linger in this position for a minute.
• From the same position we pull the socks on ourselves and away from ourselves.
• We lie in the same way. We spread our legs slightly to the sides. Alternately from the hip, turn the leg left and right. Then we do it with two legs at the same time.
• Raise one leg above the floor by 10 cm. Pull the sock over ourselves and "freeze".
• Lying on your back, bend your leg as much as possible and pull the knee to your chest.
• Lying down, we bend the left leg and put the foot under the right knee. With the right hand, we pull the knee with the left to the floor.
• Lying down, bend your legs at the knees, spread the hips as wide as possible to the sides. One by one we try to press our knees to the floor.
• Raise your leg 10 cm above the floor. Move as far as possible from the hip, and then cross it over the other leg.
• Lying down, we bend the sore leg at the knee, and, without lifting our feet from the floor, we try to perform rotational movements.
• Lying on your back, raise your legs perpendicular to the floor. We spread and reduce from the hip.
• Lying on your stomach, raise your leg from the hip up to a small height, trying to hold it up to 5s.
• Lying on your stomach, bend and unbend the leg at the knee, heel to the buttock.
• Lying on the left side, remove and bring the right leg. Then, the same on the other side.
• Standing on our knees, we tear off one leg from the floor and sharply throw it back, as if we want to kick someone.
• Standing in the same way, raise the leg up, bend and unbend it.
• Kneeling, we bring our legs together, we turn our feet outward, and we press the heels together. We try to sit down on the heels.

Author's methods

The most effective methods of treating coxarthrosis with exercises include the methods of V. Gitt, S. Bubnovsky and V. Evminov.

Each of them offers interesting exercises for relieving axial loads, stretching the joint. At the same time, the physical effect on the periarticular muscles and ligaments remains. This allows the joint to stretch and strengthen at the same time.

V. Gitta's technique is based on the implementation of low-amplitude movements with a large number of repetitions. This allows the joint to warm up without much effort:

• Lying on your back, placing a roller under your knees, spread your legs slightly to the sides and perform small abductions and adductions with your foot from the hip to the feet, left to left, right to right.
• Lying on your stomach, put your head on its side over your hands. Place a roller under the ankle joints. We perform oscillatory movements with the pelvis to the right and left. You can also put a roller under the hip joints.
• We sit on a chair so that the legs are slightly apart, and the thigh and lower leg are 90 ° C. The feet are flat on the floor. We carry out a small abduction and knee reduction.
• From the same position, we perform alternate blows with the heels on the floor, without lifting our toes.

Simple exercises based on small amplitude movements allow the patient to achieve good results on their own.

The technique of S. M. Bubnovsky offers exercises that are performed through special blocks from various starting positions. Exercises of this technique must be performed in the gym under the supervision of an experienced instructor.

Exercises on the Evminov's dispensary allow you to remove the axial load and stretch the joint during vibrational oscillatory movements in the hang at different angles.

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Operative intervention

If we are talking about the advanced III degree of the disease, we can talk about the ineffectiveness of conservative treatment and the need for endoprosthetics or arthrodesis:

1. Endoprosthetics allows replacing a damaged joint with a prosthesis. The wear resistance of existing prostheses is 15–20 years. Then the structure loosens under the influence of the load and has to be changed. Each subsequent operation will be more difficult, and the rehabilitation period will be longer.

   Modern medicine offers joints from:

   • polymer alloys;
   • metal;
   • ceramics.

   Usually, the friction pair (head of the bone, acetabulum) can include products made of metal and plastic or metal and metal. The second option is more durable and reliable.

2. Arthrodesis, or bonding of bones using plates and screws, is used in cases where even endoprosthetics is impossible. The operation preserves only the support function of the leg. The limb remains motionless.

In addition, there are 2 more types of surgical interventions that are carried out in the early stages of the disease:

1. Osteotomy is a method of dissecting bones to remove deformities and then fasten them. With this type of operative technique, the motor and support function of the limb is preserved.
2. Arthroplasty is a method of reconstructing or modeling the surfaces of destroyed bone and cartilage. It also maintains motor and support function.

It should not be forgotten that any surgical intervention has its own risks:

• the occurrence of inflammatory processes;
• rejection of foreign bodies (including prostheses);
• complications that may occur during surgery (bleeding, poor tolerance to anesthesia, thrombosis);
• an inaccurately fitted prosthesis, which will begin to loosen in a very short time.

Therefore, it is necessary to try to prevent further joint degeneration by conservative methods. The idea of synthesizing and building up artificial cartilage on the head of the bone has long been hatched. Perhaps, in the future, the treatment of coxarthrosis will become a less energy-consuming and expensive process.

Author of the article: Kaplan Alexander Sergeevich | Orthopedist

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