The symptoms and treatment of osteoarthritis of the hip joint, the nature of the illness

Osteoarthritis of the hip joint is a progressive disease that destroys the cartilage and bone of the hip joint (abbreviated to TBS). Another name of the disease – osteoarthritis.

The disease develops after age 40, more common in women. According to statistics, in elderly patients osteoarthritis TBS – 70% of cases occur due to natural aging. Young able-bodied people develop osteoarthritis because of the impact on the joint adverse factors: intense physical exertion, injury, obesity.

The initial stage of the disease is manifested by periodic pain in the region of the hip joint, is not a major concern, so are often not encouraged to go to the doctor. However, without treatment, the pathology continues to progress and can even lead to disability. To avoid disability and preserve traditional ways of life – the treatment of osteoarthritis of the hip is necessary, and it must start at the first sign of the disease.

Later in this article we will explain in detail about the essence of the disease, its causes, symptoms and principles of treatment. This information will help you to suspect arthritis in the early stages and in time to see a doctor. Treat the pathology needs a rheumatologist after a thorough examination of – self leads to the progression of osteoarthritis and the development of complications.

The mechanism of development of coxarthrosis

The hip joint is the largest joint in the human body. He carries a tremendous load during the movement and has a narrow joint space, making it vulnerable to adverse factors.

The hip joint is formed by head of femur and acetabular cavity the pelvic bone, on the outside bag strengthened articular and muscular-ligamentous apparatus.

Inside joint capsule is lined with synovial membrane. It synthesizes synovial fluid, a biological lubricant that nourishes the joint and provides smooth movement in iuncturam. Intra-articular surfaces of the bones are covered with elastic and shiny hyaline cartilage that performs the damping function during walking. The correct anatomical structure and functional activity of all structures of the joint allows for normal physical activity without limitation and pain.

Due to age-related changes in the body or the effect of adverse factors impaired blood flow and metabolism in the joint. Cartilage loses water, becomes less elastic and fragile, its surface cracks – these are the first signs of osteoarthritis

The progression of the disease leads to formation of defects of cartilage, wear and cracking. Particles of cartilage into the joint cavity and cause aseptic or "sterile" inflammation, occurring without the participation of pathogenic microorganisms.

Further, the inflammatory process extends to the bone, causing avascular necrosis (necrosis) areas of the acetabulum and the femoral head. Formed bony growths – osteophytes – which can injure surrounding tissue, exacerbating the inflammatory process and cause intense pain.

In the advanced stage of the disease there are signs periarthritis' when affects the periarticular soft tissues (muscles, ligaments, nerves, vessels).

The final disease – the complete destruction of the joint, which leads to its immobilization to ankylosis of the hip joint.

The causes of the disease

Osteoarthritis of the hip can be primary and secondary.

The primary form of the disease	Secondary
The cause of osteoarthritis is unknown (not set). Primary or idiopathic osteoarthritis often develops in old age after reaching 50-60 years, is characterized by symmetrical lesions of the hip joint and has a unfavorable course.	Secondary osteoarthritis develops on the background of various diseases. The causes of this form of osteoarthritis in many ways similar to adverse factors of degenerative disease in other joints. However, some causes are inherent only in coxarthrosis (i.e. they are not "adverse factors"): for example, dysplastic pathology of the hip joint and Perthes disease (necrosis of the femoral head).

The main causes of osteoarthritis of the hip joint:

• trauma (fractures, dislocations, bruises);
• heavy physical exertion (carrying heavy loads, professional sports);
• microtrauma of the joints for a long time;
• curvature of the spine (scoliosis, pathological kyphosis);
• flat feet;
• hip dysplasia after birth, during menopause;
• infection (bacterial or viral inflammation – arthritis);
• endocrine disorders (gout, diabetes);
• obesity grade 3-4;
• rheumatoid arthritis;
• Perthes disease;
• defects of cartilage with formation of free intra-articular bodies (chondromatosis of the joints).

Secondary osteoarthritis usually develops at a young age, affects one hip, has a slow progressive course and favorable outcome with timely treatment to the doctor.

Characteristic symptoms

The symptoms of osteoarthritis of the hip joint depending on the stage of the disease, the severity and individual characteristics of the organism. Signs of any arthritis have a slow progressive course with gradual increasing pain, limitation of motor activity of the affected limb and impairment of quality of life.

Clinical and radiographic signs of isolated grade 3 pathology.

1 degree of coxarthrosis

Phase changes of the joint for osteoarthritis, for example, lesions of the knee. Click on photo to enlarge.

The initial portion occurs without significant symptoms, and therefore usually perceived by patients is not serious, and they put off a visit to the doctor. The guarantee of recovery is early diagnosis and treatment of 1-th stage of the disease. Otherwise, to completely restore the structure of the joint is extremely difficult, treatment takes a long time and often does not give positive effect.

• Osteoarthritis of 1 degree is manifested by periodic pain in the region of the hip joint that occur after heavy physical exertion. The pain is dull and aching, pass quickly after a short rest.
• Sometimes the only sign of the disease may be discomfort in the groin.
• Range of motion is not restricted.
• On radiographs do not reveal pathological changes or detect a slight narrowing of the joint space.

Effectively treated 1 the degree of the disease is possible by means of conservative methods.

2 degree

• The progression of the disease leads to increased pain; now they emerge with slight exertion. Usually discomfort in the joint appears at the end of the day, for its elimination it is necessary to drink painkillers. With a significant defect structures of the joint pain to bother alone, worse at night.
• The long walk appears limp or "duck" walk – man like swinging from side to side. This is a limitation of range of motion due to the destruction of cartilage and inflammation of the periarticular tissues.
• The patient is difficult to wear shoes or socks, bend the leg at the hip joint, to take her to the side.
• There are "starter" pain: discomfort during the first steps after a long stay in a stationary state. When the discomfort passes, but then returns again after a heavy load on the injured leg.
• The leg is shortened, the muscles of the thighs and buttocks on the side of the pathology was reduced in volume. This is because the patient is spared the leg during movement, the muscles don't contract and gradually shrink (atrophy).
• On the radiograph, the doctors reveal a significant narrowing of the joint space, necrosis of the iliac bone and femoral head, the growth of osteophytes.
• When conducting magnetic resonance or computed tomography detects thinning of the cartilage, its fragmenta in the joint cavity, inflammatory changes in periarticular soft tissues.

For treatment of the disease at this stage prescribe medications that slow the progression of disease and further destruction of the cartilage.

3 degree

Osteoarthritis of the hip joint of 3 degrees – the final stage, which leads to impaired motor activity of the legs and causes of disability.

• Pain syndrome is permanent, not dependent on physical activity. As a consequence, impaired General condition, worsening sleep, there is irritability and depression.
• Lower limb is usually shortened, however, in 10% of cases, the leg can be extended – this is due to destruction of the joint.
• Develops ankylosis of the joint, in which any movement is not possible.
• The patient when walking very lame, he can use the cane.
• On the radiograph and CT scan reveal the lack of the cartilage layer of the bone, destruction of the femoral head and acetabulum, the formation of large osteophytes.

To treat grade 3 osteoarthritis can only be surgically removed.

Treatment tactics

Principles – how to treat osteoarthritis depend on the severity of the disease. At the first degree can be completely conservative methods to restore the structure of cartilage, while the second is to stop the progression of the disease, and the third degree requires radical treatment with surgery.

Methods of conservative treatment of coxarthrosis 1 and 2 degrees

Medicines

Group of drugs	The therapeutic effect
Nonsteroidal anti-inflammatory drugs (NSAIDs). Examples of medications.	Anti-inflammatory effect, eliminates pain syndrome. They are used as symptomatic treatment.
The glucocorticoids.	Have analgesic and anti-inflammatory effect. Doctors prescribe them with the ineffectiveness of NSAIDs.
Chondroprotectors.	Restores the structure of cartilage, normalizes the production of synovial fluid, prevent breakdown of cartilage. Chondroprotectors eliminate the cause of the disease and therefore the symptoms. Their drinking rates at 3-6 months.
Hyaluronic acid ("liquid denture").	These medications are injected into the joint cavity, and they replace the synovial fluid that lubricates joint surfaces and provide painless movement.
The muscle relaxants.	Reduce pathological muscle spasm, normalize blood flow, reduce pain.
Traction of the joint.	Stretches the capsule of the joint, relieves the articular surface of the bone.

Massage, manual therapy

Restores the correct anatomical position of the joint components, improves blood flow and metabolism.

Physiotherapy

Strengthens muscles and ligaments, and normalizes motor activity in iuncturam.

Treatment 3rd degree

The final stage arthritis not amenable to drug therapies that are prescribed as a means of support. In this situation surgery to replace his joint. In the rehabilitation period prescribed massage and complex therapeutic exercises to restore motor activity.

In the General case of osteoarthritis of the hip joint has a favorable prognosis with timely diagnosis and treatment of the disease.