Arthritis of the hip joint (ATS) is an indolent destructive disease. Under the influence of many reasons, during the progression of the disease, irreversible changes occur in the structure and properties of the hyaline cartilage, which leads to increased pressure on the articular surfaces and their deformation or fusion. Since mechanical overload is considered one of the main causes of the development of the disease, the joint of the hip joint is often affected by arthropathy.
Features of the anatomical structure of the hip joint
The hip joint (TC) is the junction of the pelvis and femur. This joint makes it possible to lower and spread the lower limbs, lift the legs and pull them to the body, and make walking movements. From birth and throughout life, a person carries a high load on the hip joint.
On the side of the pelvic bone, the "acetabular" cavity participates in the joint, on the side of the femur, its epiphysis. The acetabulum has a collagen rim along the edges, which acts as a sort of gasket that holds the femoral epiphysis tightly in its socket. The recess in the center of the acetabulum is covered with a collagen membrane and is the point of attachment of the femoral ligament.
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 in the back.
- femoral-pubic - is responsible for abduction and reduction of the thigh, thus limiting its circular movements.
- femoral ischial - protects the vehicle from concussion, 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 forms the basis of the synovial sac.
Many muscle groups and tendons allow the vehicle to move around three axes:
- Longitudinal (vertical).
- Transverse (horizontal, frontal).
- Sagittal (anterior-posterior).
Arthropathy can appear both in a healthy joint and become a continuation of existing diseases of the musculoskeletal system.
What is this disease?
The hyaline cartilage performs functions of shock absorption and protection 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 then leads to their fragmentation and destruction. Fragments of cartilage fibers, if they enter the joint cavity, can cause an inflammatory process. Bare surfaces undergo changes in bone tissue caused by friction and increased pressure. The cartilaginous tissue that remains along the edges of the epiphyses grows compensatory with subsequent ossification, causing ankylosis (immobility of the bony junction). In the later stages, in the absence of proper treatment, the patient completely loses mobility and becomes disabled. Destructive processes are caused by various reasons.
There are the following types of joints of the hip joint:
- Primary. Its etiology is not fully understood. Idiopathic (primary) arthropathy develops in a previously healthy joint. Most often, it develops in older people.
- Secondary. It is caused 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 causes that contribute to the appearance of the disease and its development, the following are found:
- Hereditary genetic predisposition to the development of the disease.
- Bone joint injuries (dislocations, fractures, sprains and tendons).
- Unbearable systematic strength 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 work activity.
- Poor local traffic.
- Previous illnesses caused by pathogenic flora.
- Legg-Calve-Perthes disease.
- Metabolic disorders (gout).
- Physical inactivity.
- Immunological diseases.
These reasons are not always able to cause ATS. Most often, the activation of pathological processes can be caused by:
- increased stress and physical activity.
- constant overwork;
- hypothermia of the vehicle or body as a whole;
- sudden lifting of heavy objects.
- hormonal imbalance;
- radiation exposure.
Symptoms of the disease
Symptomatic manifestations of ATS are similar to arthritic manifestations 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, then constant.
- The occurrence of creaking, cracking and clicking during sudden movements.
- Severe lameness in the affected limb.
- The appearance of contractions (restriction of passive movements).
- Narrowing or closing of the joint space (x-ray).
The severity of the signs of arthropathy 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 articulation of the hip joint can be distinguished:
- Arthropathy of the 1st degree of the hip joint does not have severe pain and other manifestations. The stage is difficult to diagnose, the disease can be detected using a biochemical study of hyaline cartilage tissue and determination of an insufficient amount of glycosaminoglycans. The patient feels pain in the joint and rarely pain at the beginning of physical activity.
- Arthropathy of the second degree of the hip joint is characterized by changes in the density and elasticity of cartilage fibers. Cracks and breaks appear. The damping functions decrease. The pain intensifies, radiates to the groin, the movements of thinning and reducing the affected limb are limited.
- In the third degree, the layering of the cartilage fibers is more intense. The articular surfaces show excessive pressure, foci of ischemia develop. Cartilage tissue develops along the edge of the epiphyses. The sensation of pain in the area of the damaged bone ligament does not depend on the state of activity and rest. With any movement the joint "creaks" and "cracks". The range of motion is reduced in 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 attached to 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 synovial 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 essential to understand the mechanism and characteristics of disease development. Determining the severity of the disease helps to determine the correct regular 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 arthropathy:
- arthritis (inflammation of the synovial membrane of the joint).
- aseptic necrosis of the femoral head.
- joint destruction (osteonecrosis);
- inflammation of the synovial sac with a change in the amount of synovial fluid.
- ankylosis (immobility of the bone joint) partial or complete.
- contractures (restriction of mobility and inability to bend-extend 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
Diagnosing arthropathy of the hip joint in the initial stage is difficult. Symptomatic manifestations are felt only when the epiphyses of bones and nerve fibers are involved in the pathological process.
During a medical examination at the stage of development, the following are noted:
- visual change in the outline of the joint.
- palpation pain;
- sometimes saltiness of the periarticular tissues.
- shortening of the diseased limb.
The main role in the diagnosis of ATS is assigned to radiography. As auxiliary diagnostic methods used:
- Ultrasound, MRI.
- The CT scan.
- Puncture of synovial lubrication (joint fluid).
- Diagnosis using an arthroscope (microprobe).
- Clinical and biochemical laboratory tests of urine, blood.
Early diagnosis improves the prognosis of the treatment and the further life of the patient.
How to apply for disability?
It is impossible to completely cure this disease. To confirm the right to social benefits and assign a disability group after passing the examination by close specialists, you must contact your doctor.
The indication for the assignment of disability in case of arthrosis of the hip joint is:
- oligoarthritis (damage of no more than 2 joints) TS 2 degrees.
- combined 2nd degree TS arthropathy and 3rd degree arthropathy of the knee joint.
- reduction of the length of the diseased limb by more than 6 cm.
- Automated reactive flow call center, documented.
Determining the disability group will help:
- carefully collected history.
- the conclusion of the medical advisory committee (MCC);
- results of diagnostic studies;
- passing through the medical and social expert committee (MSEC).
If the decision of the expert committee is negative, an appeal can be made to higher authorities.
Prevention
Preventive measures are an easy way to prevent the development of this disease. Prevention measures include:
- Compliance with an active lifestyle.
- Body weight index control.
- Optimizing nutrition and the way you 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 check-up.
conclusion
The answer to the frequent question: "Is it possible to cure arthropathy of the hip joint? "» The experts give a negative answer. Damaged 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 small manifestations of hip arthropathy, this reduces the chances of preventing further development of the disease.