Osteoarthritis of the hip joint (ATS) is a slowly destructive disease. Under the influence of a number of reasons, during the development of the disease, there are irreversible changes in the structure and properties of hyaline cartilage, which leads to increased pressure on the joint surfaces and their deformation or fusion. Given that mechanical overload is considered one of the main causes of 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 enables the reduction and expansion of the lower limbs, lifting the legs and pulling them to the body, and walking movements. From birth and throughout life, a person carries a large load on the hip joint.
On the side of the pelvic bone, the "acetabular" cavity participates in the articulation, on the side of the femur, its epiphysis. The acetabulum has a collagen lip along the edges, which acts as a kind of seal that firmly holds the femoral epiphysis in its recess. The recess in the center of the acetabulum is covered with a collagen membrane andis the place of attachment of the femoral ligament.
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 backwards;
- femoral-pubic - is responsible for the abduction and reduction of the thigh, which limits its circular movements;
- femoral ischial - protects the vehicle from concussions, reduces the load when walking and running;
- circular (loop) - prevents dislocations and keeps the head of the femur in the cavity of the pelvic cavity and is 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).
Arthrosis of the joint can occur both in a healthy joint and become a continuation of existing diseases of the musculoskeletal system.
What is this disease?
Hyaline cartilage has the function of shock absorption and protection against damage to the joint surfaces. ATS is a disease in the development of which the structure of collagen cartilage fibers changes, which then leads to their fragmentation and destruction. Fragments of cartilage fibers, if they enter the joint cavity, can cause an inflammatory process. Exposed surfaces undergo changes in bone tissue caused by friction and increased pressure. The remaining cartilaginous tissue along the edges of the epiphyses grows compensatory with subsequent ossification, causing ankylosis (immobility of the bony joint). In the later stages, in the absence of adequate therapy, the patient completely loses mobility 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 elucidated. Idiopathic (primary) arthrosis develops in a previously healthy joint. It most often develops in older people.
- Secondary. It is provoked by previous diseases of the joint apparatus, congenital anomalies of development, changes in the functioning of organs and systems of human vital activity.
The disease develops in one joint or affects both at once.
Causes of disease
The following are identified among the causes that contribute to the onset of the disease and its progression:
- Hereditary genetic predisposition to the development of the disease.
- Bone joint injuries (dislocations, fractures, sprains and tendons).
- Unbearable systematic strength and physical activity.
- Excessive weight.
- Functional disorders of the endocrine system (diabetes, psoriasis).
- Congenital pathologies of the structure and development of the musculoskeletal skeleton.
- Professional characteristics of work activity.
- Poor local circulation.
- Previous diseases caused by pathogenic flora.
- Legg-Calve-Perthes disease.
- Metabolic disorders (gout).
- Physical inactivity.
- Immunological diseases.
These reasons are not always able to cause ATS. Most often, the activation of pathological processes can be caused by:
- increased stress and physical activity;
- constant overload;
- hypothermia of the vehicle or the body as a whole;
- sudden lifting of heavy objects;
- hormonal imbalance;
- radiation exposure.
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 a long period of immobility.
- Decreased range of motion, change in gait.
- Pain, first caused by mechanical or physical stress, then constant.
- Manifestation of creaking, screeching and clicking during sudden movements.
- Pronounced lameness on the affected limb.
- Occurrence of contractures (restriction of passive movements).
- 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.
Stages of coxarthrosis
Depending on the clinical manifestations, 4 stages of arthrosis of the hip joint can be distinguished:
- Arthrosis of the 1st degree of the hip joint has no pronounced pain and other manifestations. The stage is difficult to diagnose, the disease can be detected by biochemical study of hyaline cartilage tissue and determination of insufficient amount of glycosaminoglycans. The patient feels joint pain and rarely pain at the beginning of physical activity.
- Arthrosis of the second degree of the hip joint is characterized by changes in the density and elasticity of cartilage fibers. Cracks and breaks appear. Amortization functions are reduced. The pain intensifies, radiates to the inguinal region, the movements of dilution and reduction of the affected extremity are limited.
- At the third stage, there is a delamination of cartilage fibers with greater intensity. Joint surfaces experience excessive pressure, foci of ischemia develop. Cartilage tissue grows along the edge of the epiphysis. The feeling of pain in the area of the damaged bone connection does not depend on the state of activity and rest. With every movement, the wrist "squeaks" and "squeaks". The range of motion is reduced on all axes.
- The fourth stage 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 comparison and separation of the articular surfaces. During this period, the patient feels excruciating pain caused by the narrowing, sometimes closing of the joint lumen and compression of bundles of nerve fibers and blood vessels. Movement is limited, sometimes complete.
Classification of pathological changes caused by ATS is necessary for understanding the mechanism and characteristics of disease development. Determining the severity of the disease helps to determine the correct treatment tactics and disability (in case of severe disease).
Possible consequences
The progression of ATS leads not only to the deformation of the femoral head and pelvic cavity, but also to the development of pathological processes in the functioning of the joint apparatus as a whole.
Pathologies resulting from complications of hip arthrosis:
- synovitis (inflammation of the joint synovial membrane);
- aseptic necrosis of the femoral head;
- destruction of joints (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 extremities).
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
Diagnosis of arthrosis of the hip joint in the initial stage is difficult. Symptomatic manifestations become visible only when the epiphyses of bones and nerve fibers are involved in the pathological process.
During the medical examination in the progression phase, the following is noted:
- visual change of joint contour;
- pain on palpation;
- sometimes pastiness of periarticular tissue;
- shortening of the affected limb.
The main role in the diagnosis of ATS is X-ray examination. The following are used as auxiliary diagnostic methods:
- Ultrasound, magnetic resonance.
- CT scanner.
- Puncture of joint lubrication (synovial fluid).
- Diagnosis using an arthroscope (microprobe).
- Clinical and biochemical laboratory tests of urine, blood.
Timely diagnosis improves the prognosis of treatment and further life of the patient.
How to apply for disability?
It is impossible to completely cure this disease. To confirm your right to social benefits and assign a disability group after passing an examination by narrow specialists, you must contact your doctor.
The indication for awarding disability in the case of arthrosis of the hip joint is:
- oligoarthrosis (lesion of no more than 2 joints) TS 2 degree;
- combined arthrosis of the 2nd degree TS and arthrosis of the 3rd degree of the knee joint;
- reduction of the length of the diseased limb by more than 6 cm;
- reactive flow automatic telephone exchange, documented.
Determining the disability group will help:
- carefully collected anamnesis;
- conclusion of the medical advisory commission (MCK);
- results of diagnostic studies;
- passing the medical-social expert commission (MSEC).
If the expert commission's decision is negative, an appeal can be filed with higher authorities.
Prevention
Preventive measures are an easy way to avoid the development of this disease. Prevention measures include:
- Adherence to an active lifestyle.
- Control of body weight indicators.
- Optimizing nutrition and way of working and resting.
- 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 examinations.
Conclusion
The answer to the frequently asked question: "Is it possible to cure arthrosis of the hip joint? " Experts give a negative answer. Destroyed cartilage tissue cannot be completely restored, just as it is impossible to completely correct the deformation and destruction of the bones involved in the joint. Do not ignore even minor manifestations of hip arthrosis, this reduces the chances of preventing the further development of the disease.