Pre-hip joint of 2nd degree treatment

Why does deforming osteoarthritis occur in the hip?

Deforming osteoarthritis is included in the group of diseases of the musculoskeletal system. From this pathology around the world, millions of people suffer. Very often in medical practice, there is a deforming osteoarthritis of the hip joint. This is the largest of all the joints of the human body. The head of the hip bone and the acetabulum of the pelvic bones take part in the formation of the joint in question. He performs an important function in the body: participates in the movement of the lower limbs. The hip joint has a heavy load. If it exceeds normal values, the joint may be damaged.

It is of great importance that arthrosis is progressing steadily, and in the absence of timely and adequate treatment, the joint may become deformed. Osteoarthritis of the hip joint is one of the causes of disability of the able-bodied population throughout the world. It is important that conservative therapy is effective only in the first and second stages of the disease. Let's consider in more detail, what is the classification, etiology, clinic and treatment of this pathology. Not all know what osteoarthrosis is. This disease has many names: arthrosis, deforming osteoarthritis, coxarthrosis.

This is a degenerative-dystrophic disease that affects the cartilaginous tissue of the joint. Osteoarthritis is not only the hip joint. Often suffer knee, elbow and other joints. In the event that simultaneously several joints are destroyed, then there is a polyosteoarthrosis. Deforming osteoarthritis is a group of diseases that have the same clinical manifestations, a single mechanism of development and outcome for the health of a sick person.

The peculiarity of this pathology is that not only the cartilaginous tissue, but also the bone, as well as the synovial membrane, muscles, ligaments are involved in the pathological process. Why is it deforming? The thing is that in the process of cartilage damage and the development of the inflammatory process in the cavity of the hip joint, its deformation is often observed. An interesting fact is that osteoarthritis of the hip joint is most often observed in elderly people. The incidence of this disease increases with age. The age of a person over 65 years is a serious risk factor for getting sick.

Stages of the disease

Deforming osteoarthritis( DOA) can for a long time pass unnoticed for a person. A similar phenomenon is characteristic of the first stage of the disease. There are 3 stages of arthrosis of the hip joint. Symptoms in the first stage may not be evident. At the same time, there are no morphological changes in the structure of the hip joint. Deforming osteoarthrosis of the first stage differs in that the composition of the synovial fluid can change. The latter performs an important function - it nourishes the cartilage. As the inflammation progresses and the pathology progresses, the cartilage can not withstand the usual load. All this provokes a painful syndrome.

At an early stage of the formation of arthrosis of the hip joint muscle strength can be weakened. Polyostoarthritis, like arthrosis of the second stage, is accompanied by the formation of osteophytes. They are bone growths that form along the edge of the articular area. In the second stage, muscles suffer more. X-ray examination during this period allows to reveal the first signs of destruction of cartilaginous tissue and meniscus. In addition, there are constant pains. The second stage of arthrosis of the hip joint is almost always transferred to the third stage. In the latter case, joint deformation takes place, the formation of contractures. In the event that the treatment was not performed, the deforming osteoarthritis can result in ankylosis( complete immobility of the joint).

Classification and pathogenesis of the disease

The classification is such that the primary and secondary osteoarthrosis of the hip is distinguished. Most often the defeat of the hip joint, the joints of the hands and other parts of the body is observed against the background of another pathology. In this situation, it is a secondary form of the disease. Primary lesion of the hip joint or hands is observed when it is impossible to establish an etiological factor. The attending physician and the patient himself should know not only the symptoms( signs) of arthrosis, but the mechanism of its development. The pathogenesis of the disease consists in the gradual destruction of the cartilaginous tissue.

The cartilage contains various substances, including glucosamines. When the synthesis of glucosamine is broken, the cartilage loses its resistance to external influences. In the first stage of arthrosis, it begins to thicken, but as the pathological process develops, the cartilaginous tissue quickly becomes thinner. The cartilage loses its elasticity and elasticity. It becomes friable and soft. The state of cartilage is strongly influenced by synovial fluid. With arthrosis of the hands or the hip joint, the composition of this biological fluid changes, the synthesis of hyaluronic acid is disrupted, which leads to a disruption in the supply of cartilaginous tissue. With arthrosis of the joints of the hands and other parts of the body, anabolic processes are disrupted. At the same time, destruction predominates over the formation of new cells. This is the mechanism of development of degenerative-dystrophic processes.

Etiological factors

Polyostoarthrosis, like simple arthrosis, can occur for several reasons. The most common reasons include the following:

  • congenital defects of the hip joint;
  • inflammatory diseases;
  • traumatic injuries;
  • some infectious diseases( syphilis, tuberculosis, brucellosis, gonorrhea);
  • blood diseases( hemophilia);
  • metabolic disorders in the body;
  • endocrine pathology.

Deforming arthrosis is not always an independent disease. Often this is a complication of another somatic pathology. In a number of cases, hip and hand joint damage is a consequence of autoimmune pathology. Important factors are provoking factors. They include overweight, elderly age, inadequate nutrition( lack of mineral components in the diet, in particular calcium and phosphorus), hypothermia, the action of toxic substances and some others.

Clinical manifestations of

The classification of arthrosis does not play a role in relation to clinical manifestations of pathology. Symptoms in the affected joints of the hands or feet will depend on the stage of the pathological process. At the first stage of osteoarthritis of TBS discomfort appears in the affected area, often there is a crunch when moving. There may be pain syndrome. The pain is not permanent. It appears when the lower limbs move and passes at rest. At palpation the doctor does not reveal soreness. In a situation where reactive arthritis of the arms develops, tenderness may be present. In the first stage, the motor function may be impaired. Osteoarthrosis of the hip joint complicates the internal rotation of the hip, which can lead to muscle atrophy.

With the second degree of hip or hand joint damage, the pain appears at the very beginning of the movement. It can spread to other parts of the body( inguinal region, knee).When palpation, sharp soreness is revealed. The sick person is troubled by weakness, he is not able to move for a long time. Often during this period of illness, patients use a walking stick for movement. At the third stage of arthrosis of the hip joint or joints of the hands, the pains are permanent. They do not disappear even at rest and during a night's sleep. Polyostoarthrosis is most difficult, since pain in this situation occurs immediately in different parts of the body. Symptoms in the third stage include crunching, restriction of motion, tenderness in palpation and joint deformity, which is clearly seen in the course of X-ray examination.

Diagnostic and medical measures

To correctly treat deforming osteoarthritis, it is necessary to put the correct diagnosis. Diagnosis is based on data of anamnesis and external examination, the results of laboratory and instrumental studies. The most valuable is X-ray diagnostics. At the first stage of arthrosis, changes on the x-ray are insignificant, there may be a slight narrowing of the joint space. At the second there are signs of destruction of the cartilaginous tissue and the formation of osteophytes. At the third, severe deformation and thinning or complete absence of cartilage are observed.

Whatever the classification of arthrosis, treatment is always the same. Conservative therapy involves the use of medications, physiotherapy, nutrition optimization, therapeutic gymnastics. Equally important is the normalization of motor activity, because with a pronounced pain syndrome, the person moves less, which provokes hypodynamia. Drug treatment involves the use of chondroprtotectors, painkillers( NSAIDs), drugs that dilate blood vessels.

Anticoagulants and antiplatelet agents are often used. They are used to improve microcirculation. As for the diet, the diet should contain foods rich in calcium and phosphorus( milk and dairy products, fish).Conservative treatment is effective in the first and second stages of the disease. In the third stage, the most effective method of treatment is endoprosthetics. Thus, osteoarthrosis of the hip joint is a serious pathology that requires early detection and treatment.

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Hip Osteoarthrosis( coxarthrosis)

Hip joint osteoarthrosis( coxarthrosis) is a chronic progressive disease in which pathological changes in the joint lead to the destruction of cartilage and the gradual limitation of mobility in it. This is a long-running process that often begins and progresses unnoticeably for a person. And it is diagnosed already at the late stages, when it is already impossible to stop pathology by conservative methods and it is necessary to resort to risky surgical methods of treatment.

What happens in the joint?

The hip joint consists of two bones - the hip and pelvic bone. The surfaces of these bones in a place where they are in contact with each other are lined with an elastic cartilaginous layer. The main function of the articular cartilage is to amortize the movements and ensure a smooth glide of the bones.

Its cartilage does not have cartilage. Its nutrition is carried out by the penetration of the necessary substances from the synovial fluid that is in the joint cavity. With age, the amount of fluid decreases, as microcirculation processes through the capillaries deteriorate, respectively, the cartilaginous layer lacks the nutrients necessary for the functioning. This leads to degenerative changes in the structure of the cartilage, it cracks and gradually becomes thinner.


Thinning of cartilage and growth of osteophytes is the cause of pain in arthrosis

The above described changes contribute to the development of primary or age-related osteoarthrosis of the hip joint. But there is also a secondary disease that can affect even young people if their bodies are affected for a long time by the causes of the disease and provoking factors or there are background diseases.

Provoking factors of development of coxarthrosis:

  • diseases, which are accompanied by a violation of the capillary circulation( systemic connective tissue diseases, vasculitis, diabetes mellitus);
  • permanent micro cartilage cartilage and increased stress on the joint( excess weight and obesity, exercise);
  • pathology of endocrine organs;
  • congenital or acquired deformities of the musculoskeletal system, which increases the load on the hip joint( flat feet, shortening of one leg, curvature of the spine, etc.);
  • patients who in the past suffered a trauma or surgery on the joints and bones of the legs.

Obesity, sedentary lifestyle and malnutrition are often accompanied by coxarthrosis

In later stages of osteoarthritis of the hip joints, the cartilage completely disappears, revealing the articular surfaces of the bones, which, when rubbed, rub against each other, thus causing unbearable pain to the patient.

In order to somehow stabilize the hypermobility of the affected joint, the body reacts with a kind of protective reaction - the formation of osteophytes and their growth around the articulation.

Alas, these bone growths further aggravate the condition of the patient. Growing up, they eventually completely fill the joint cavity with the formation of ankylosis( complete fusion and immobilization).As a result, a person loses the function of the largest joint in the body, this leads to disability. In this case, one can treat a person only surgically. Only replacing the affected area with an endoprosthesis can help the patient regain the joy of movement.

How to recognize pathology?

It is very important that the osteoarthritis of the hip joints is suspected in time. Only in this case, conservative treatment and therapeutic gymnastics will help stop the pathological progress and restore the affected cartilage tissue.

Symptoms of the disease depend on the stage of the pathological process. During coxarthrosis, 3 degrees are released, which gradually replace each other, each successive degree shorter than the previous one, which ultimately leads to a rapid deterioration in the late stages of the disease.

Degrees of coxarthrosis

Coxarthrosis of 1 degree

Very often it does not show any symptoms, patients can feel some discomfort or aching slight pain in the joint after prolonged physical exertion, after rest all signs disappear. This leads to the fact that most people take the first signs of illness for normal fatigue, and do not seek medical help.


Hip pain is the earliest and most reliable sign of

disease. Kasarthritis of 2nd degree

At this stage, the disease is diagnosed in most patients. Pain acquires a pronounced character, worries a person not only after overstrain, but also at rest, to get rid of it, people start drinking uncontrolledly different pain medications. At this stage osteophytes grow in the joint, which leads to a restriction of mobility in the joint, to the appearance of a specific click during movements. Patients are disturbed by gait, deformities of legs, lameness develop. Treatment at this stage consists of conservative methods, and gymnastics is also prescribed. But these methods only temporarily suspend the disease, it is gradually necessary to prepare for the future operation.

Coxarthrosis of 3rd degree

Characterized by complete disappearance of cartilage and development of ankylosis of the joint. A person can not move independently, the leg in the hip joint is deformed. Pain is constant and strong, painkillers stop helping. In such cases, the only treatment is an operation to replace the hip joint.

What additional methods will help to establish the diagnosis?

If you are suspected of having coxarthrosis by clinical signs, be sure to seek medical help. The doctor will examine you and establish the correct diagnosis, which will help to develop an individual therapeutic program for each patient.

Necessary studies for suspected coxarthrosis:

  • radiography of the hip joints in 2 projections;
  • joint ultrasound;
  • magnetic resonance imaging of affected areas;
  • arthroscopy;
  • full set of laboratory tests.

Only after a detailed study of all pathological changes and their extent, the doctor will begin to treat you using an individual and complex approach to therapy.

Principles of treatment

Also you can read:
Treatment of arthrosis of the hip joint folk remedies

Treatment of osteoarthritis has several purposes:

  • elimination of risk factors for disease progression;
  • effective anesthesia and improvement of the quality of life of a person;
  • improved articular function as much as possible;
  • restoration of cartilaginous tissue;
  • slowing the progression of pathological changes;
  • prevention of complications;
  • with ineffectiveness of conservative techniques - operation.

Conservative treatment of

The first step is to revise your lifestyle. It is necessary to modify it so as to eliminate the influence of all negative factors.

If you are overweight, then the diet is the first thing you need to do on your way to recovery. Low-calorie, enriched with vitamins and micronutrients nutrition, should always and everywhere accompany you. After getting rid of extra pounds, the load on the joint will decrease, and the pain can pass by itself.

Physiotherapy and gymnastics should be selected by the physical therapist for each patient individually and take into account the degree of pathological disorders in the joint and the general state of human health.

Pharmacotherapy includes the use of such drugs:

  • analgesics;
  • is a non-steroidal anti-inflammatory;
  • glucocorticoid hormones;
  • chondroprotectors;
  • means that improve microcirculation.

It should be remembered that most of the medications do not affect the progression of the disease, but only temporarily eliminate its symptoms. Therefore, neglect other methods of treatment, except for pills and injections, should not be.

Physiotherapy for arthrosis may even be an alternative to drug treatment. The most commonly used laser therapy, reflexology, thermal procedures.

We should not forget about the sanatorium treatment. Suitable mud resorts, water treatment.

Surgical treatment of

In the second stage of arthrosis, organ-preserving arthroscopic operations can be used that correct osteotomy( eliminate osteophytes from the joint cavity, which leads to an improvement in its function).

In the third stage, the only method of treatment that can restore the lost function of the limb is hip replacement.


Only endoprosthetics can help in 3 stages of coxarthrosis.

Joint replacement is a very difficult, traumatic and expensive operation. Therefore, it is better to start treatment at an early stage of coxarthrosis and, probably, you will not need an operation at all.

MoyaSpina.ru

Hip joint: 1st, 2nd and 3rd degree( treatment)

Applied methods of treatment

In the treatment of DOA of the hip joint of the 1st degree, it may not be necessary to use medication correction methods. For example, weight loss, lifestyle changes, treatment of a common disease, special training, etc. With the right approach to treatment, the disease will not go to the next degree and will help keep motor activity for many years to come.

Treatment of DOA of the hip joint of 2nd degree already necessarily requires medical treatment. In inflammatory processes in the joint will be prescribed non-steroidal or corticosteroid anti-inflammatory drugs. With very severe inflammation, steroid preparations can be injected directly into the joint.

For the prompt regeneration of cartilaginous and bony tissues the doctor will recommend chondroprotectors. A good result is the reception of glycosamines simultaneously with chondroprotective drugs. To reduce intense pain, the doctor will prescribe analgesics.

Spasmolytics and drugs that dilate the vessels will be prescribed according to the indications and in accordance with the concomitant diseases.

The affected joint can not be repaired. These measures can only stop the progression of the disease, in order to keep the joy of movement for years to come.

Physiotherapy and massage

Physiotherapy and manual therapy also help to reduce pain and help to move more fully.

It is also possible to apply a method such as pulling a joint. But it can be used only in a hospital and only by qualified specialists. This may require 10 to 16 procedures. They can be carried out on a bed, on a special table or in a pool.

At the time of treatment, the diseased joint needs to be unloaded as much as possible. It is better at this time to adhere to bed or half-bed regime, and also use a cane or crutches while walking.

Physiotherapy is the key to long-term remission of

After treatment it is important to perform special exercises to maintain the muscle tone surrounding the joint in a tone. They can be lethargic and even atrophied because of the inferior movement of the joint.

The course of exercise therapy should be selected individually. Its implementation is necessary both for the period of treatment and during the rehabilitation period. The more regular the training, the better the amplitude of the movement of the joint. If there is a sharp pain after class or during exercise, it is better to stop the activity.

In this case, either the joint was overloaded, or the exercise was not performed correctly. Here it is important to find the golden mean: to give the joint load as much as possible so that the amplitude of its movements will expand over time, instead of being on one vengeance, while overloading the joint can not be done - this can lead to trauma.

If the disease has already reached the third stage, then the doctor can advise endoprosthetics. This is a surgical operation to replace the patient's joint with a titanium implant. They are very durable and can serve for 20-30 years. It is possible to replace both the entire joint and its parts. This may be the only way for those who have used for years.

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Species and classification

  • Primary osteoarthritis. Appears against the background of the unchanged hip joint;
  • Secondary osteoarthritis. It develops against the background of changes in the joint caused by another pathology( congenital subluxation of the head of the thigh, Perthes' disease, fracture of the neck of the hip, trauma to the head of the hip and other lesions).

Degrees of severity of deforming osteoarthritis are determined by changes detected on radiographs. There are several classifications( NS Kosinskaya, Kelgren and Lawrence, A. Larsen).

N.S.Kosinskaya identifies 3 stages of arthrosis:

  1. 1 stage. Narrowing of the joint gap, chondrosis( cartilage is affected, there are no bone changes).
  2. 2nd stage. More pronounced narrowing of the joint cracks, bone changes( marginal proliferation, subchondral osteosclerosis).
  3. 3rd stage. Pronounced cartilage destruction, bone tissue is sclerotized, joint surfaces are deformed and flattened, marginal bone growths.

Causes and Symptoms

The hip joint has a powerful cartilaginous layer( up to 4 mm in thickness).In addition, it is abundantly blooded. He can withstand a heavy load - the weight of our body, running, jumping, walking. All blows in it are extinguished. Many factors lead to the development of the pathological process:

  • Hyperkinesia and hypodynamia after some time lead to hypoxia of the joint tissues. Against this background, any physical stress can cause osteoarthritis;
  • Overweight overloads joints. Excess weight is one of the main factors that accelerate the progression of coxarthrosis.
  • Physical overload, prolonged microtraumatism cause changes in articular tissues and synovium. Incomplete synovial fluid leads to a disruption in the supply of cartilage, which is carried out diffusely. Overloads and prolonged traumatism are experienced by athletes;
  • Violation of lipid, purine, pigmented metabolism leads to the sclerosis of the vessels and the deposition of uric acid crystals in the cartilage tissue.

Initially, the pain often occurs in the groin or knee area, and not in the lesion, which is associated with the anatomical deep position of the hip joint. The illusion of knee joint disease is created. Osteochondrosis is manifested by pain when walking on the steps of

Early sign of DOA, which makes it necessary to consult a doctor - a decrease in the volume of the thigh. This is because a person unconsciously spares a sick leg. The muscles work less than on the healthy side and as a result the volume of the thigh decreases. You can find it yourself, looking at yourself in the mirror. It is also possible to detect a decrease in the tension of the buttock on the affected side.

Progressive disease causes permanent pain in the thigh

Progressive osteoarthritis causes constant pain when walking, then they are noted at rest. Hypotrophy of the gluteal and femoral muscles is increasing. Gait is sparing, lameness due to limb shortening.

Initially, the disease is limited to retraction in the hip joint, later any movement in it is restricted. A positive symptom of Thomas( lordosis of the lumbar region in the flexural contracture of the hip joint) is positive. The diagnosis of the disease becomes evident with severe symptoms, but it is important to pay attention to the early signs of the disease. This will establish the correct diagnosis as early as possible.

Clinical forms of deforming osteoarthritis( on localization of hip joint lesion):

  1. Defeat of the upper pole. It develops often against the background of anomalies in the development of the hip joint. With this localization, early withdrawal and external rotation are limited, subluxations occur later.
  2. Defeat the lower pole. It arises against the background of dysplasia of the hip joint with a decrease in the neck-diaphysial angle. With this localization, pain is not expressed, internal rotation is limited.
  3. Defeat the central part. It develops against the background of an anomaly of the acetabulum. It is characterized by a favorable current. Predisposes to protrusion of the ileum cavity.

Diagnosis and treatment

The diagnosis is made, taking into account clinical and laboratory data. The results of the x-ray study confirm the diagnosis and reveal the degree of joint damage. It is necessary to make a differential diagnosis with gout, cocitis, rheumatoid arthritis. If necessary, the diagnosis can be clarified with the help of a tomography.

Treatment of osteoarthritis should begin immediately after diagnosis. Deforming osteoarthritis of 1-2 degrees does not require surgical treatment. It is necessary to conduct conservative treatment, as well as slow the progression of the pathological process( reduce body weight and physical activity).

Medical treatment of osteoarthritis of 1-2 degrees is aimed at reducing and arresting inflammation in the joint, suppressing synovitis. To this end, use non-steroidal anti-inflammatory drugs( movalis, voltaren, kenalog, diclofenac).NSAIDs reduce or completely relieve pain.

Non-steroidal anti-inflammatory drugs are used to treat osteoarthritis, for example, such as Movalis

. The destruction of articular cartilage is accompanied by loss of glycosaminoglycans. Therefore, to interrupt the destruction of cartilage and improve its nutrition, use arteparone( chondroprotector 1 generation, this group includes Rumalon).Combined chondroprotectors of the latest generation( Teraflex, Arthron Complex, Formula-C) are now widely used for arthrosis.

Therapeutic gymnastics and physiotherapy treatment. The most effective electrophoresis of drugs, pulse currents, magnetotherapy, ultrasound, paraffin applications.

Balneological procedures. Sanatorium treatment in the North Caucasus, the Southern Coast of the Crimea, the Urals, and Central Asia are shown. Patients are beneficially affected by the climate with low relative humidity, lack of frequent weather changes.

In coxarthrosis of the third degree, progressive destruction of articular surfaces, surgical treatment is performed: joint replacement. After the operation, the patient's ability to work is restored.

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Hip Osteoarthrosis: Causes, Symptoms. How to treat osteoarthritis of the hip joint: : SYL.ru

The sight of an elderly person, slowly walking along the street with the help of a cane, became quite familiar for us. But we do not even guess what pain and suffering these people have to endure. The blame for everything is osteoarthritis of the hip joint - a serious ailment that affects up to 15% of humanity. What is the disease, what are the causes and methods of treatment, we will consider in this article.

Osteoarthritis - what is it?

The hip joint is the largest joint in the human body, which accounts for the bulk of the load. It performs the function of joining the femur with the pelvis. Externally, the joint resembles a hinge: a ball-shaped head located in a round( acetabulum) cavity. The mobility of the bones is ensured by the cartilage surface, which facilitates the sliding damping and the preservation of bones from destruction.

With age, connective tissue loses its ability to retain moisture, thinens and cracks, and exposed bony surfaces begin to rub together. Trying to restore balance, the body increases the production of bone tissue, leading to the formation of build-up( osteophytes).They lead to considerable deformation of bones and further impede movement.

When a person develops osteoarthritis of the hip joint, an imbalance arises between the destruction of the cartilage and its formation in the body. The basis of the changes is a decrease in the production of proteoglycans( complex protein compounds) by the body, leading to premature aging and degeneration of the connective tissue.

Most of all pathology are affected by people of the older age group - after forty years. But, since there are many reasons for the disease, all age categories suffer from it. And in women, the disease occurs much more often than in men. This is explained by intensive leaching of calcium from the bones, followed by its concentration in the cartilaginous tissue during the postmenopause.

Causes of the disease

The disease is often called "coxarthrosis", or "deforming osteoarthrosis of the hip joint", and is classified as degenerative-dystrophic diseases. A typical cause of an ailment is considered to be an increased strain on the joint. Disease most often people are overweight, violation of posture, as well as after a long standing work or long-term employment in some sports( jumping, weightlifting).

Promote the onset of a disease such as osteoarthritis of the hip joint, and other circumstances:

  • hormonal failures;
  • is a genetic predisposition to connective tissue diseases;
  • age threshold;
  • the presence of certain diseases( psoriasis, arthritis).

How coxarthrosis manifests

  • Osteoarthrosis of the hip joint of the 1st degree .External signs of the disease in the initial stage are practically absent. For many years, the disease does not cause much trouble, recalling only the morning and early stiffness of the joints and discomfort.
  • Hip Osteoarthritis of 2nd degree .In the absence of adequate treatment, the disease progresses and brings more and more discomfort and suffering to a person. In the future, during walking or physical exertion, the intensity of pain in the upper part of the thigh, giving up in the knee, groin or buttock, is more and more noticeable. After a night's sleep, negative symptoms disappear.
  • Hip joint osteoarthritis of 3rd degree .Gradually progressive disease leads to increased pain and the appearance of an inflammatory process in the articulation area. Rest no longer brings relief, and cartilage damage is already entering a stage of irreversible process. The constant abrasion of bones leads to difficulty or impossibility of bending the leg in the thigh. To ease the pain, many people try to avoid any physical exertion, which affects the muscles. They quickly weaken, and limping occurs.

What causes

The most common deforming osteoarthritis of the hip arises on one joint. Soon the disease passes to other areas of the body, which took the most burden to alleviate the condition of the diseased joint( knees, foot, spine).Simultaneous defeat of the two hip joints is not very common.

When the restoration of cartilaginous tissue becomes impossible, physicians have to resort to extreme - endoprosthetics. A complex operation helps to avoid disability and can greatly facilitate a person's life.

Hip osteoarthritis significantly increases the risk of serious complications. Many older people, mostly of lean physique, are actively developing osteoporosis - loss of bone strength. In conjunction with coxarthrosis, it can lead to a fracture of the neck of the hip. Dangerous trauma can be cured with difficulty and often leads to complete immobility of the person.

Diagnosis of the disease

The first signs of osteoarthrosis of the hip joint, manifested in the systematic stiffness of the joints, should immediately alert the person. And if the pain continues to worry for several months, then an urgent visit to a rheumatologist or orthopedist is required. Only a specialist will be able to determine precisely whether a patient has osteoarthritis of the hip joint.

Too often and too much is necessary to explain the essence of the disease to patients. The books are written a lot and quite incomprehensible. Yes, it is a degenerative-dystrophic joint disease. It is believed that his nature is still not clear. In most cases, it lies on the surface. It is very difficult to say how simplistic that is written here! And very subjective. ..

Sport, of course, a useful thing. But not for all structures of the body. For the heart, blood vessels, respiratory organs - yes. For the joints - no. All athletes, sooner or later begin to suffer from "joint diseases", namely - DOA.Exceptions, perhaps, two - swimming and chess. Yagudin already rides on the hip joint prosthesis( seen on TV). ..

After the load joints hurt? Sick at night after long hikes? You went on a business trip, where you were on your feet for a couple of days, although you did not get out from behind the wheel before? Have you worked at the dacha, are your legs hurt? And maybe it's it?. .

Deforming osteoarthritis( DOA) - It would make sense. ..

Introduction

In the domestic nomenclature, this disease is called arthrosis, in English - arthritis. Our name emphasizes the absence of an infectious component. The most commonly affected knee( gonarthrosis - 13-29%) and hip( coxarthrosis - incidence of 10-12%( this is from all Europeans!)) Joints, which ultimately leads to the need for endoprosthetics( replacement) of the corresponding joint. Diseases are susceptible to all joints.

Where does it come from?

The main cause of the disease, its onset, is damage to the articular cartilage. It can be traumatic or idiopathic, i.e. The cartilage is erased due to an excessive load on it. The body tries to create conditions for the healing of cartilage, its restoration. For this he needs, first, the joint to immobilize, and secondly, to relieve the load. A traditional, proven mechanism is used - pain. The sites of attachment of the main ligaments and muscles surrounding the corresponding joint begin to ache. The person begins to limp, complain about pain and inability to perform the usual loads. If he "warms up", diverges, pain dulls or passes, a person increases the load( athlete, for example), the process of destruction of cartilage continues, after the pain returns. And so it can continue for a long time. Perhaps, as long as "warming up" does not help. Or there is a night pain. Or there is fluid in the joint, which interferes with the movements. It's about different ages: from young, but reluctant beginners to grow old athletes from 30 and older, to people from 45-50 and older. Load dependence is direct. The more you load the joint, the faster will develop arthrosis. This also applies to overweight. The harder you become, the harder it is for your joints to wear you.

Traumatic cartilage damage. One thing is the consequences of intra-articular fractures, then arthrosis is quite logical, cartilage needs time to heal. Another is knee joint meniscus damage. The earlier the damaged part of the meniscus will be removed( or sewn into place in the early periods - not about us, except for the centers), the less chance for the development of arthrosis. One with another is interconnected. If there is an age-old damage to the meniscus, the "dangling" part of it permanently injures the articular cartilage, which leads to chondromalacia, which is the thinning, erasing of the cartilage, which is the primary substrate of arthrosis.

Stages of

Three pieces. Determined radiographically.

1st stage, initial. In places where the ligaments are attached, tapers appear. In the knee joint - intercondylar elevation( cruciate ligaments) and in the region of the epicondyle of the femur and tibia( lateral ligaments).The joint gap( the one that is the articular cartilage, which is not visible in the picture) is not narrowed, the same. In principle, the clinic is completely reversible, at this stage, the patient, with all other equal, can be detained for many years. Sharpening nowhere will not go away. This is the ossification of the attachment sites of the ligaments. It hurts only during the period of exacerbation after the next excessive load on the joint.

2nd stage. Articular narrowing narrowed. Those.the cartilage is worn out. In response, the so-called closure plate, the bone site, which covers the articular cartilage, is compacted, sclerosed. An irreversible condition with frequent exacerbations and a decrease in the volume of movements. The patient needs to be smoothly prepared for the future replacement of the joint, telling the variants how and where it is done, so that he is ready to get rid of these pains, because they are unbearable.

  1. Unloading the limb. The reason for conventional arthrosis is in an inadequate, excessive load on the joint. It is necessary to remove the cause. Lame - the body's way to unload the leg for the time of exacerbation. For athletes it is enough to simply remove unnecessary load, i.e.to stop training for a while.
  2. Wearing the knee. Or an elastic bandage. The essence is the same, but the knee is more convenient. The task is to help your ligaments, relieve them of the burden, which will ease the pain. At an exacerbation - to wear it is necessary always when the load is( at night - to no avail).The knee is good for prevention. If there is a disease, if a long-distance transition is expected( hike, travel to another city, a friendly football match, etc.), wear a knee pads. Perhaps you will avoid exacerbation.

    What is prescribed by a doctor. Consultations with a doctor are mandatory!

  3. Non-steroidal anti-inflammatory drugs( NSAIDs). Any good that help. All of them have a number of side effects, the main of which is the adverse effect on the stomach. This must be remembered! Diclofenac( orthophene, voltaren) and nimesulide( nimes, nimesil, nimica, etc.) are commonly used. Not bad derivatives of ibuprofen. The most powerful analgesic effect is indomethacin, but it is the most gastrointestinal. Most! Very good are coxibs( celecoxib), oxicams( meloxicam( movalis) and lornoxicam( ksefokam)), but roads are not always available.
  4. External means( ointments, gels).
    • Anti-inflammatory. Gels with ketoprofen( fastum-gel) and nimesulide( nimes, nimulide) are most often used.
    • Heating. The main action is the improvement of the blood supply to the affected area. Any warming, "sports".From the final to the "star", "Sophia" and "Dikul."It will not be worse.
    • Chondroxide and its ilk. MYTH! !!It is not harmful, but chondroitin through the skin, cellulose, all the vascular nets and capsule of the joint to the very joint does not reach, even if you crack. Far. .. But it helps some due to the belief in him and other medical procedures.
  5. Physiotherapy treatment.
    • The most powerful and the last( when nothing is already helping) is X-ray therapy .With all its side effects. X-ray therapy, in general, is the most powerful anti-inflammatory drug. But, there are very few installations left. For us, for example, it is the only one for the entire republic.
    • Magnetotherapy.
    • Laser therapy.
    • Everyone else. Like the previous two, the action is aimed at improving blood circulation in the zones of interest, as well as reducing inflammation.
  6. Massage. Improves blood circulation, microcirculation. Plus passive movements. Passive - when someone moves your foot.
  7. Therapeutic physical training( LFK). The main task is to maintain or expand the volume of movements in the joint due to movements without stress on the joints. Swimming is good, squatting with a barbell is disgusting.

    Separately, individually

  8. Chondroprotectors. The main medicament components of cartilage are three: chondroitin, glycosamine and hyaluronic acid.

    Two of them are accepted in capsules: chondroitin sulfate( structum), glycosamine sulfate( don) or together( teraflex, chondro, etc.), which is more convenient. It is very important that if you are planning to take chondroprotectors, then prepare for a long, no less than three-month course, otherwise the sense will not be accurate. Preparations are a building material for cartilage, so it is important not to continue washing it with loads during the reception, otherwise it is useless to spend money on medicines.

    Hyaluronic acid is a fluid for intraarticular administration, very expensive and effective. It is also called a synovial fluid prosthesis. At the moment, very few of its medicines are registered in Russia: synvisc, ostenil( I may not know others, but it seems that this is all there is).There is also naltrex. They say and write that it is effective. Earlier there was Rumalon and Arteparon in injections. They, it seems, are not present, patients are very upset about this, because they know that they helped them, and "newfangled" do not help. Because they do not believe.

  9. Hormonal intraarticular blockades. At me, personally, to them very ambiguous attitude. Yes, they are, in general, extremely effective. The analgesic effect is obvious, for which their patients are very fond. But the patients do not change their way of life, continue to behave actively, than exacerbate the disease, turning off the natural body pain sensor.

    All blockades must be carried out in strictly sterile dressing conditions! !!Complications of blockades( infectious and inflammatory), fortunately, are not very frequent, but are so "destructive" for everyone and everything that sterility needs to be observed scrupulously. No blockades at home! !!Otherwise, the responsibility lies with the physician entirely. One complication, and you have a stain on the rest. .. By preparations:

  • Hydrocortisone. The first drug that was used for this purpose. Effective only for small joints( fingers, wrist, wrist).
  • Kenalog( triamcinolone). It is used often. Especially those who have seen kinds of doctor. Patients come to them for this. And it or him for intraarticular introduction TO USE it is impossible. Why? It has a very powerful analgesic effect. But it is made on a fat-soluble basis, it is a suspension. Triamcinolone acted, and the base remained in the joint, causing microcrystallization, which increases the injury of the cartilage. In addition, when administered parartistically, i.e."in painful points," causes atrophy of ligaments and tendons that come across on the way. It is indicated only for the introduction of bursa( bags).Why do patients go? Because it anaesthetizes like nothing else! And the disease progresses more than without it.
  • Betamethasone( diprospan, flousterol). At the moment, the most popular and most effective drug available. Side effects are, most important of them - the general action of the hormone with all the consequences. It is very dangerous in terms of infectious complications.
  • Objective-T. Homeopathy. MYTH!!!
  • Alflutop. Romanian extract from algae. He is very fond of and very much hoped for. MYTH!!!I have never seen that somehow help.
  • Intraarticular administration of oxygen. In the presence of oxygen piping, this option is often used. The main idea is the oxygenation of tissues and the "rupture" of adhesions that occur in the joint against the background of concomitant chronic synovitis.
  • 3 stage, the last. Articular cleft very narrow or almost invisible, coarse bone growths around the joint. Sharp restriction of movements, almost constant pain syndrome. The only way out - the final solution of the issue - endoprosthetics( there are exceptions that correct osteotomy, for example).All the rest is extremely( !) Ineffective.

    Treatment of

    The most important thing. The most difficult thing is to explain to the patient that with this disease "saving drowning people is the work of the drowning themselves".Very little depends on doctors! In addition, there is an incredible number of myths and dietary supplements, homeopathy and poultices. And also many, still only announced methods of treatment, which will reach us to the second coming.

    Conservative treatment

    What depends on the patient

    Operative treatment of

    The only common method is endoprosthetics of joints. This is the final solution to the problem of arthrosis. No joint - no, and his arthrosis. But there are other difficulties. Not all prostheses are good, although the difference is "not ours" is not fundamental. They are very( !!!) expensive( several thousand dollars).That the hip, that knee. Therefore, one should strive for state treatment. There are federal programs provided by the budget. Basically, the question is organizational, for each region is individual. The operation is complicated. Complications( of a different nature) are often. Complications greatly change the life of patients( imagine life without joint at all, - when suppuration the prosthesis should be removed).But the operation needs to be prepared, since there are no other effective options for stage 3 arthrosis.

    For arthrosis of smaller joints( ankle, for example), an effective operation is arthrodesis, i.e.complete joint closure. By the 3 stages of the movement there is almost no, and the pain is significant, so the patient loses nothing but pain.

    There are other operations. Corrective osteotomy, for example. Effective, mainly in the hands of the creators. I do not personally have any, or against, opinions.

    Prospects for

    Stem cell treatment and cloning. If you put stem cells on the cartilage, they say, you should get cartilage. Check. .. Not with us. It is said that if the patient is cloned, then among the new organs there will be joints, which can be transplanted from the clone to the patient. Interesting. ..

    Exceptions to

    There are a number of diseases with which it is possible to confuse DOA.Among them, dysplastic coxarthrosis, aseptic necrosis of the femoral head( ANBB) or, in other words, Perthes disease, various bursitis, which may be independent or part of the symptoms of arthrosis.

    Who does this?

    In general, orthopedists and rheumatologists. As it is located territorially, it is not always determined. Patients are treated both by district therapists and surgeons of the polyclinic. In the norm - "the orthopedist in the place of residence."There are a number of organizational moments. Many people like to be treated permanently, although there is no direct evidence for this, since conservative treatment is also possible on an outpatient basis. But, going to the clinic for physiotherapy and blockade is far, which exacerbates the aggravation( you need to walk around with aching legs).There is a conflict of interest between the health system and the patient. Everyone comes out of the situation in different ways, there are no norms. When there is a need for prosthetics, a number of organizational questions arise: obtaining disability, i.e.referral to the MCEC, quotas for high-tech assistance in the Ministry of Health, the direction of the chief traumatologist, etc. Therefore, it is better to immediately turn to the "orthopedist at the place of residence" and get on a dispensary record.

    By the way, simplified, osteochondrosis - this is also arthrosis, only the joints there are peculiar. And the essence is like. ..

    I hope someone will help. .. Regards.

    UPD 14.06.09 16.35: Have
    serov
    Deforming osteoarthritis( DOA)

    Symptoms should be described in detail with an update of their periodicity and duration. To determine the pain threshold, the doctor makes various manipulations with the hip joint: rotation, flexion and straightening of the leg. To assess the external shape of the patient's articulation, the doctor may ask the patient to walk or stand on one leg.

    To decide how to treat osteoarthritis of the hip joint, after external examination the doctor prescribes additional studies:

    • radiography;
    • ultrasound;
    • clinical blood test.

    Both hip joints are examined for the purpose of determining actual changes in the joint space, the presence of spines or other pathologies. Based on the findings, the doctor can determine the degree of the disease with confidence.

    Measures to prevent further development of coxarthrosis

    Treatment of osteoarthritis of the hip is prescribed taking into account the urgent recommendations of the doctor:

    • get rid of excess weight;
    • to balance nutrition;
    • activate physical exercises.

    The diet will provide cartilage tissue with all the necessary elements to maintain it at a quality level. In addition, proper nutrition will allow you to lose weight. Slows the development of the disease increase in the consumption of such products:

    syl.ru

    serov.livejournal.com

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