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, irreversible changes occur 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 femur. This articulation allows the lower limbs to be lowered and spread, the legs to be raised and pulled to the body, and walking movements to be made. 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 is involved in the articulation, on the side of the femur, its epiphysis. The acetabulum has a collagenous lip at the edges that acts as a kind of seal that firmly holds the epiphysis of the femur in its socket. The depression in the center of the acetabulum is covered with a collagen membrane and is the place of attachment of the ligament of the femur.
The composition of the TS capsule includes links:
- femoral-iliac - the strongest ligament that can withstand a load of more than 200 kg and prevents excessive bending of the hip back;
- femoral-pubic - responsible for the abduction and reduction of the thigh, thus limiting its circular movements;
- femoral ischial - protects the car from shocks, reduces the load when walking and running;
- circular (loop) - prevents dislocations and holds the head of the femur in the cavity of the pelvic cavity and is at the base of the joint bag.
Multiple muscle groups and tendons allow the car to move around three axes:
- Longitudinal (vertical).
- Transverse (horizontal, frontal).
- Sagittal (anterior-posterior).
Joint arthrosis can appear both in a healthy joint and become a continuation of existing diseases of the musculoskeletal system.
What is this disease?
Hyaline cartilage performs shock-absorbing and protective functions against damage to the joint surfaces. ATS is a disease in the process of development of which the structure of collagen cartilage fibers changes, which subsequently 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. Cartilaginous tissue remaining on the edges of the epiphyses grows compensatory with subsequent ossification, causing ankylosis (immobility of the bone joint). In the later stages, in the absence of adequate therapy, the patient completely loses mobility and becomes disabled. Destructive processes are provoked by various reasons.
There are the following types of arthrosis of the hip joint:
- Primary. Its etiology is not fully understood. Idiopathic (primary) arthrosis develops in a previously healthy joint. It most often develops in the elderly.
- Second. It is provoked by previous diseases of the joint apparatus, congenital anomalies of development, changes in the work of organs and systems of human vital activity.
The disease develops in one joint or affects both at the same time.
Causes of the disease
Among the reasons contributing to the appearance of the disease and its progression, the following are identified:
- Hereditary genetic predisposition to the development of the disease.
- Bone joint injuries (dislocations, fractures, sprains and tendons).
- Intolerable systematic power and physical activity.
- Overweight.
- Functional disorders of the endocrine system (diabetes, psoriasis).
- Congenital pathologies of the structure and development of the musculoskeletal skeleton.
- Professional characteristics of labor activity.
- Poor local circulation.
- Previous diseases caused by pathogenic flora.
- Legg-Calve-Perthes disease.
- Metabolic disorders (gout).
- Physical inactivity.
- Immune diseases.
These reasons may not always cause ATS. Most often, the activation of pathological processes can be provoked 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
The symptomatic manifestations of ATS are similar to the manifestations of arthrosis of other joints.
The main characteristic symptoms of this disease are considered to be:
- Stiffness in the morning or after a long period of immobility.
- Decreased range of motion, change in gait.
- Pain initially caused by mechanical or physical stress, subsequently constant.
- The appearance of creaking, crunching and clicking during sudden movements.
- Pronounced lameness of the affected limb.
- The appearance of contractures (restriction of passive movements).
- Narrowing or closing of the joint space (X-ray sign).
The severity of the 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 examination of hyaline cartilage tissue and determination of an insufficient amount of glycosaminoglycans. The patient feels pain in the joints and rarely pain at the beginning of physical activity.
- Arthrosis of the hip joint of the second degree is characterized by changes in the density and elasticity of cartilage fibers. Cracks and breaks appear. Depreciation functions are reduced. The pain intensifies, radiates to the inguinal region, the movements of discharge and reduction of the affected limb are limited.
- In the third degree, the stratification of cartilage fibers is manifested with greater intensity. Joint surfaces experience excessive pressure, foci of ischemia develop. Cartilaginous tissue grows along the edge of the epiphyses. The sensation of pain in the area of the damaged bone connection does not depend on the state of activity and rest. With every movement, the joint "squeaks" and "crunches". The range of motion is reduced on all axes.
- The fourth degree is characterized by 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 the comparison and separation of the articular surfaces. During this period, the patient experiences excruciating pain caused by narrowing, sometimes closing the joint lumen and compression of bundles of nerve fibers and blood vessels. Movement is limited, sometimes completely.
The classification of the pathological changes caused by ATS is necessary to understand the mechanism and characteristics of the development of the disease. Determining the severity of the disease helps to determine the correct tactics of treatment and disability (in case of severe disease).
Possible consequences
The progression of ATS leads not only to deformation of the head of the femur and the 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 synovial membrane of the joint);
- 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 inability to flexion-extension of the limb).
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
The diagnosis of arthrosis of the hip joint in the initial stage is difficult. Symptomatic manifestations become noticeable only when the epiphyses of the bones and nerve fibers are involved in the pathological process.
During a medical examination in the stage of progression, the following is noted:
- visual change in the joint contour;
- soreness on palpation;
- sometimes pastiness of periarticular tissues;
- shortening of the affected limb.
The main role in the diagnosis of ATS is assigned to X-ray examination. As auxiliary diagnostic methods are used:
- Ultrasound, nuclear magnetic resonance.
- CT.
- Puncture of joint lubricant (synovial fluid).
- Diagnosis using an arthroscope (microprobe).
- Clinical and biochemical laboratory tests of urine, blood.
Timely diagnosis improves the prognosis for treatment and the further life of the patient.
How do I apply for disability?
It is impossible to completely cure this disease. To confirm the right to social benefits and determine a group of disabilities after passing an examination by narrow specialists, you should contact your doctor.
The indication for determining disability in the case of arthrosis of the hip joint is:
- oligoarthrosis (damage of no more than 2 joints) TS 2 degree;
- combined arthrosis of the 2nd degree of 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 ATS documented.
When determining the group of disabilities will help:
- carefully collected anamnesis;
- the conclusion of the medical advisory commission (MKK);
- results of diagnostic tests;
- passage of the medico-social expert commission (MSEC).
If the expert commission's decision is negative, it can be appealed to 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 work and rest regime.
- Reduced mechanical and physical stress.
- Treatment of diseases with viral and infectious etiology.
- Prevention and prevention of injuries at home and at work.
- Regular preventive examination.
Conclusion
The answer to the frequently asked question: "Is it possible to cure arthrosis of the hip joint? "" Experts give a negative answer. The 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 arthrosis of the hip joint, this reduces the chances of preventingthe further development of the disease.