Arthrosis of the hip joint (ATS) is a sluggish destructive disease. Under the influence of a number of reasons, in the course of the development of the disease, irreversible changes in the structure and properties of hyaline cartilage occur, which leads to increased pressure on the articular 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 makes it possible to reduce and spread the lower limbs, raise the legs and pull them to the body, and make walking movements. From birth and throughout life, a person bears a high load on the hip joint.
From the side of the pelvic bone, the "acetabular" cavity takes part in the articulation, from the side of the femur, its epiphysis. The acetabulum has a collagen lip along the edges, which acts as a kind of gasket that tightly holds the epiphysis of the femur in its recess. The recess in the center of the acetabulum is covered with a collagen membrane and is the site of attachment of the ligament of the femur.
The composition of the TS capsule includes ligaments:
- femoral-iliac - the strongest ligament that can withstand a load exceeding 200 kg and prevents excessive hip arching back;
- femoral-pubic - is responsible for the abduction and reduction of the thigh, thereby limiting its circular movements;
- femoral ischial - protects the vehicle from concussions, 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 the basis of the articular bag.
Numerous muscle groups and tendons allow the vehicle to move around three axes:
- Longitudinal (vertical).
- Transverse (horizontal, frontal).
- Sagittal (anterior-posterior).
Joint arthrosis can occur 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 surfaces of the joint. 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 articular cavity, can cause an inflammatory process. Bare surfaces undergo changes in bone tissue caused by friction and increased pressure. The cartilaginous tissue remaining along the edges of the epiphyses grows compensatory with subsequent ossification, causing ankylosis (immobility of the bone junction). 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. Most often, it develops in older people.
- Secondary. It is provoked by previous diseases of the articular 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 once.
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.
- Injuries of the bone joint (dislocations, fractures, sprains and tendons).
- Unbearable 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 features 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 are not always able to cause ATS. Most often, the activation of pathological processes can be provoked by:
- increased stress and physical activity;
- constant overwork;
- 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 considered to be:
- 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, subsequently constant.
- The manifestation of creaking, crunching and clicking during sudden movements.
- Pronounced lameness on the affected limb.
- The occurrence of contractures (restriction of passive movements).
- Narrowing or closure 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 does not have pronounced pain and other manifestations. The stage is difficult to diagnose, the disease can be detected using a biochemical study of hyaline cartilage tissue and the determination of an insufficient amount of glycosaminoglycans. The patient feels an ache in the joint 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. Depreciation functions are reduced. The pain intensifies, radiates to the inguinal region, the movements of dilution and reduction of the affected limb are limited.
- At the third degree, the stratification of cartilage fibers occurs with greater intensity. Articular surfaces experience excessive pressure, foci of ischemia develop. Cartilage tissue grows along the edge of the epiphyses. The sensation of pain in the area of the damaged bone junction does not depend on the state of activity and rest. With any movement, the joint "creaks" and "crunches". The range of motion is reduced on all axes.
- The fourth degree is characterized by exposure of the surfaces of the articular 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 of the articular lumen and compression of bundles of nerve fibers and blood vessels. Movement is limited, sometimes completely.
The classification of pathological changes caused by ATS is necessary to understand the mechanism and features of the development of the disease. Determining the severity of the disease helps with determining 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 femoral head and pelvic cavity, but also to the development of pathological processes in the functioning of the articular 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;
- joint destruction (osteonecrosis);
- inflammation of the joint bag with a change in the amount of synovial fluid;
- ankylosis (immobility of the articulation of bones) partial or complete;
- contractures (limitation of mobility and impossibility of flexion-extension of the limb).
The development of complications of ATS always leads to a deterioration in the general condition of the patient, the quality of his life and the loss of movement without assistance.
Diagnostic methods
Diagnosis of arthrosis of the hip joint at the initial stage is difficult. Symptomatic manifestations become noticeable only when the epiphyses of bones and nerve fibers are involved in the pathological process.
During a medical examination in the progression stage, the following are noted:
- visual change in the articular contour;
- palpation soreness;
- sometimes pastosity of periarticular tissues;
- shortening of the diseased limb.
The main role in the diagnosis of ATS is assigned to X-ray examination. As auxiliary diagnostic methods used:
- Ultrasound, magnetic resonance imaging.
- CT scan.
- Puncture of articular 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 cure this disease completely. To confirm the right to social benefits and assign a disability group after passing the examination by narrow specialists, you must contact your doctor.
The indication for the assignment of disability in case of arthrosis of the hip joint is:
- oligoarthrosis (lesion of no more than 2 joints) TS 2 degrees;
- combined arthrosis of the 2nd degree of the TS and arthrosis of the 3rd degree of the knee joint;
- a decrease in the length of the diseased limb by more than 6 cm;
- reactive flowing automatic telephone exchange, documented.
In determining the disability group will help:
- carefully collected anamnesis;
- the conclusion of the medical advisory commission (MCC);
- results of diagnostic studies;
- passing the medical and social expert commission (MSEC).
If the decision of the expert commission 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 indicators of body weight.
- Optimization of nutrition and mode of work and rest.
- 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 examination.
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 included in the joint. Do not ignore even minor manifestations of hip arthrosis, this reduces the chances of preventing further development of the disease.