"What to do? "- men and women ask themselves when they have pain in the hip joints. One of the most common causes of this symptom is osteoarthritis. In the article we tell you why the hip joints hurt in men or women when walking and at rest, where the pain goes, what other pathologies it occurs in and how to treat it.
Osteoarthrosis of the hip joint (coxarthrosis)- degenerative-dystrophic disease. It often appears in people after age 40, often as a result of injury, but usually begins without an obvious cause.
The disease is characterized by a slow and gradually progressive course. In the initial stages, conservative treatment methods (medications, physiotherapy) are often used. However, in later stages, to restore normal function of the joint, in certain cases it is necessary to undergo surgery to replace the joint.
Many people suffer from coxarthrosis: this fact is due to the fact that the load on the hip joint is usually great. In women, this condition occurs more frequently.
Factors that may increase the risk of developing this disease include frequent and prolonged heavy loads on the hip joint. Coxarthrosis often occurs in seemingly opposite categories of people: people who play sports professionally and people who are obese. Other risk factors include diseases that affect blood circulation, metabolism and hormonal balance, and pathologies of the musculoskeletal system (eg, foot, spine). Coxarthrosis is also more common in old age.
The mechanism of development of osteoarthritis of the hip joint.
Anatomically, the hip joint includes two bones:
- the ilium, which has the acetabulum;
- femoral, which has a head. Doctors call the femur bone the femur for short.
The two parts of these bones are connected to each other to form a joint. When a person moves his leg, the articular surfaces of the two mentioned parts rub against each other.
To prevent damage in the process, they are covered with elastic cartilage and joint fluid is secreted there, which acts as a lubricant. This happens in a healthy person. The hip joint essentially functions as a hinge.
When a person has coxarthrosis, the joint fluid becomes thicker and the cartilage becomes less elastic and cracks appear. As a result, the surfaces of the ilium and femur are less protected during friction and are more easily worn and damaged. As a result, over time they begin to change shape.
Symptoms of osteoarthritis of the hip joint.
Among the main signs of this condition is pain. They are located in the area of the joint itself, as well as in the groin, in the upper part of the thigh.
The following symptoms are also typical:
- limited movement;
- When a person tries to move his leg to the right (if we are talking about coxarthrosis on the right side) or to the left (when the joint on the left is affected), he does not succeed at all;
- the gait becomes different from what it usually is in a healthy person, the patient limps;
- decreased leg muscle mass;
- the affected leg is shortened.
Early stage of osteoarthritis of the hip joint.
At an early stage of the development of the disease, pain appears sometimes, periodically, mainly after physical exertion. For example, after a person has run or taken a long walk. The sensations are concentrated where the hip joint itself is, sometimes in the upper leg or even the knee. When a person rests, the pain usually goes away. Walking is still normal at this stage. The person can move the leg freely, the muscles are fine.
A radiological examination reveals that the joint space is reduced, but not yet by that much. Where the edges of the acetabulum are, bone spurs can be identified. At this stage, the head and neck of the femur do not change.
Progression
In the next stage, the person suffers more pain that occurs both during physical activity and at rest. They are strong, they reach up to the thigh, to the groin. After trying to run, a person may limp, as after walking. Moving your leg laterally becomes more difficult and your range of motion is limited.
A radiological examination shows that the joint space is strongly narrowed. Images reveal displacement and distortion of the femoral head. Bone growths are visible in the acetabulum area.
Late stage of osteoarthritis of the hip joint.
Here the person already suffers from intense and constant pain. They can occur not only during the day at rest, but also at night. The patient finds it difficult to walk, so he buys a cane. Moving the leg becomes even more difficult than before. At this stage, atrophy of the leg and gluteal muscles often occurs, causing the affected leg to become shorter. To make it easier to walk, a person leans to one side, which further increases the load on the large joint.
An X-ray examination at this stage can see that the joint space is greatly narrowed, the head of the femur is enlarged, and there are many bone growths.
Diagnosis of osteoarthritis of the hip joint.
It is carried out through a comprehensive examination, which includes:
- questioning of the patient by the doctor;
- examination by a doctor;
- auxiliary studies, the main one, of course, is x-rays.
On x-rays, the cause of osteoarthritis can sometimes be detected; For example, signs of previous injuries, dysplasia, and other conditions may be seen.
Tomography (CT and MRI) also helps in diagnosis. With the first you can study the changes in the bones and with the second you can study what happens with the soft tissues.
What can osteoarthritis of the hip joint be confused with?
We wrote above that pain with coxarthrosis can occur not only in the hip joint, but also in the knee and the entire upper leg.
This means that if such symptoms occur, the doctor must first rule out the following pathologies:
- osteochondrosis (since it also causes pain in the upper leg);
- osteoarthritis of the knee joint (manifested as pain in the knee).
The pain syndrome caused by osteochondrosis differs from that caused by osteoarthritis of the hip joint. With osteochondrosis, pain appears acutely and is most often provoked by something: for example, a person turned sharply or lifted something heavy. In this case, the pain usually extends from the buttocks to the back of the leg.
With osteochondrosis, even if the pain is severe, a person can move the leg to the left or right. But with coxarthrosis, not always.
In osteoarthritis of the knee joint, pathological changes are detected on the x-ray of the knee joint.
It should be remembered that a person can have several diseases at the same time. For example, osteoarthritis of the knee and hip joints. Or osteochondrosis and osteoarthritis of several joints.
It is important to distinguish osteoarthritis of the hip joint from trochanteritis. The latter is an inflammatory disease of a part of the femur, called in Latin Trochanter major (trochanter major), the greater trochanter. Trochanteritis occurs quickly, compared to osteoarthritis, the pain is stronger and the person can move the leg freely.
In some cases, with pain that raises the suspicion of osteoarthritis of the hip joint, another condition occurs (for example, ankylosing spondylitis, known as ankylosing spondylitis, etc. ). With them, as a rule, pain appears at night, disappears during the day and can even decrease with physical activity.
Treatment of coxarthrosis
If you have joint pain you should go to an orthopedic traumatologist.
Treatment includes conservative therapy (medications, physical therapy) and surgery.
Conservative therapy
Conservative treatment is prescribed in the early stages.
This includes:
- common pain relievers that a person drinks in tablets or in injections (shots), ointments;
- hormones injected into the joint;
- agents that restore the cartilage structure (they are also taken orally and injected into the joint);
- other medications prescribed by a doctor, depending on the patient's condition. These include medications that relax muscles, dilate blood vessels, etc.
All medications must be taken strictly as prescribed by the doctor. This is especially true of conventional pain relievers: with prolonged use, they can have a negative effect on the stomach and cause serious complications, including bleeding. Therefore, the duration of the courses should be determined solely by a doctor.
Physiotherapy is also used in the treatment of osteoarthritis of the hip joint.
Many people benefit from laser and ultrasound treatment (this is called laser therapy and ultrasound therapy, respectively).
Magnetic therapy, inductothermy, phototherapy and several other methods are used.
The therapy uses physical therapy (physiotherapy) and massage.
It is worth saying a few words about the diet. It does not directly treat hip osteoarthritis. However, when a person weighs less, the load on the joint is reduced, making the disease easier.
Surgical treatment of osteoarthritis of the hip joint.
When the disease has already reached an advanced stage, the really "working" method is surgery, when the diseased joint is replaced with an artificial one. It's called an endoprosthesis.
Different parts of the joint can change. For example, only the head of the femur. This is a unipolar prosthesis. When both the femoral head and the acetabulum are replaced, such a prosthesis is called bipolar.
Stent replacement is performed under general anesthesia. First the person is thoroughly examined. After surgery, antibiotics and blood thinners are prescribed. The sutures are removed on the tenth to twelfth day, and then the person is transferred under the supervision of a doctor to a clinic or medical center, where care is provided on an outpatient basis.
After the operation, the person is prescribed a series of rehabilitation measures.
In ninety-five percent of cases, after surgery, a person can walk, work, and some even play sports. An artificial joint "works" for fifteen to twenty years, and then a new operation may be necessary.
Shock wave therapy is one of the effective methods for the treatment of chronic diseases of the musculoskeletal system, which is based on the influence of acoustic waves. The procedure provides quick results and after shock wave treatment a long-term therapeutic effect can be obtained. effect.