The coxarthrosis (deforming arthrosis, osteoarthrosis of a coxofemoral joint) – the disease of degenerate and dystrophic character affecting mainly people of middle and advanced age. The coxarthrosis develops gradually, within several years. Is followed by pains and restriction of movements in a joint. At late stages the atrophy of muscles of a hip and shortening of an extremity is observed. The coxarthrosis can be provoked by various factors among which – injuries, congenital pathology, pathological curvatures of a spine column (, scoliosis), inflammatory and not inflammatory diseases of a joint. Hereditary predisposition is noted. Sometimes the coxarthrosis arises without the visible reasons. Happens both unilateral, and bilateral. The current progressing. At early stages of a coxarthrosis treatment conservative. At destruction of a joint, especially – at patients of young and middle age operation (endoprosthesis replacement) is shown.
The coxarthrosis (osteoarthrosis or the deforming arthrosis of a coxofemoral joint) is a degenerate and dystrophic disease. Usually develops at the age of 40 years and is more senior. Can be a consequence of various injuries and diseases of a joint. Sometimes arises without the visible reasons. Perhaps both unilateral, and bilateral defeat. The gradual progressing current is characteristic of a coxarthrosis. At early stages of a coxarthrosis conservative methods of treatment are applied. At late stages it is possible to restore function of a joint only in the operational way.
In orthopedics and traumatology the coxarthrosis is one of the most widespread arthroses. High frequency of its development is caused by considerable load of a coxofemoral joint and prevalence of congenital pathology – a joint dysplasia. Women have a coxarthrosis a little more often than men.
The coxofemoral joint is formed by two bones: podvzdoshny and femoral. The head of a hip is jointed with a vertluzhny hollow of a podvzdoshny bone, forming peculiar "hinge". At the movements the vertluzhny hollow remains motionless, and the head of a femur moves in various directions, providing bending, extension, assignment, reduction and rotary motions of a hip.
During movements the articulate surfaces of bones freely slide from each other, thanks to the smooth, elastic and strong hyaline cartilage covering a cavity of a vertluzhny hollow and a head of a hip. Besides, the hyaline cartilage performs shock-absorbing function and participates in redistribution of loading at the movements and walking.
In a cavity of a joint there is a small amount of articulate liquid which plays a role of lubricant and provides food of a hyaline cartilage. The joint is surrounded with the dense and strong capsule. Over the capsule are large femoral and gluteuses which provide the movements in a joint and, along with a hyaline cartilage, are also the shock-absorbers protecting a joint from injuries at the unsuccessful movements.
At a coxarthrosis articulate liquid becomes more dense and viscous. The surface of a hyaline cartilage dries, loses smoothness, becomes covered by cracks. Because of the arisen roughness cartilages at the movements constantly are injured the friend about the friend that causes their thinning and aggravates pathological changes in a joint.
In process of progressing of a coxarthrosis of a bone begin to be deformed, "adapting" to the increased pressure. The metabolism in a joint worsens. At late stages of a coxarthrosis the expressed atrophy of muscles of a sore extremity is observed.
Allocate primary coxarthrosis (which arose for the unknown reasons) and the secondary coxarthrosis (which developed owing to other diseases).
The secondary coxarthrosis can turn out to be consequence of the following diseases:
- Displazy of a coxofemoral joint.
- Congenital dislocation of a hip.
- Pertes's diseases.
- Aseptic necrosis of a head of a hip.
- Infectious defeats and inflammatory processes (for example, arthritis of a coxofemoral joint).
- The postponed injuries (traumatic dislocations, fractures of a neck of a hip, basin changes).
It is possible to carry to number of the factors increasing probability of development of a coxarthrosis:
- The constant raised load of a joint. It is most often observed at athletes and at people with excess body weight.
- Blood circulation violations, hormonal changes, metabolism violations.
- Backbone pathology (, scoliosis) or stop (flat-footedness).
- Advanced and senile age.
- Inactive way of life.
The coxarthrosis in itself is not descended. However, certain features (metabolic disorders, features of a structure of a skeleton and weakness of cartilaginous tissue) can be inherited by the child from parents. Therefore in the presence of the blood relatives having a coxarthrosis, the probability of developing of a disease increases a little.
The main symptoms of a coxarthrosis pains in a joint are among, inguinal area, a hip and a knee joint. Also at a coxarthrosis constraint of movements and rigidity of a joint, gait violation, lameness, an atrophy of muscles of a hip and shortening of an extremity on the party of defeat is observed. A characteristic symptom of a coxarthrosis is assignment restriction (for example, the patient experiences difficulties in attempt to walk all on a chair). Existence of these or those signs and their expressiveness depends on a coxarthrosis stage. The first and most constant symptom is pain.
At a coxarthrosis of 1 degree patients show complaints to periodic pain which arises after physical activity (run or long walking). Pain is localized in a joint, is more rare – in a hip or a knee. After rest usually disappears. Gait at a coxarthrosis of 1 degree is not broken, the movements are kept in full, there is no atrophy of muscles.
On the roentgenogram of the patient having a coxarthrosis of 1 degree unsharply expressed changes are defined: moderate uneven narrowing of an articulate crack, and also bone growths around an outer or inner edge of a vertluzhny hollow in the absence of changes from a head and a neck of a femur.
At a coxarthrosis 2 degrees of pain become more intensive, quite often appear at rest, irradiate in a hip and area of a groin. After considerable physical activity of the patient a coxarthrosis begins to limp. The volume of movements in a joint decreases: assignment and internal rotation of a hip is limited.
In x-ray pictures at a coxarthrosis 2 degrees are defined considerable uneven narrowing of an articulate crack (more than half from normal height). The head of a femur is a little displaced up, is deformed and increases in a size, and its contours become uneven. Bone growths at this degree of a coxarthrosis appear not only on internal, but also on an outer edge of a vertluzhny hollow and go out of the cartilaginous bay.
At a coxarthrosis 3 degrees of pain become constants, disturb patients not only in the afternoon, but also at night. Walking is complicated, at movements of the patient is forced to use a coxarthrosis a cane. The volume of movements in a joint is sharply limited, muscles of a buttock, a hip and a shin are atrophied. Weakness of the taking-away muscles of a hip becomes a basin reason for rejection in the frontal plane and shortenings of an extremity on the sick party. To compensate the arisen shortening, the patient having a coxarthrosis when walking inclines a trunk in the sick party. Because of it the center of gravity is displaced, loads of a sore joint sharply increase.
On roentgenograms at a coxarthrosis 3 degrees come to light sharp narrowing of an articulate crack, the expressed expansion of a head of a hip and multiple bone growths.
The diagnosis of a coxarthrosis is exposed on the basis of clinical signs and these additional researches, the X-ray analysis is basic of which. In many cases x-ray pictures give the chance to establish not only degree of a coxarthrosis, but also the reason of its emergence. So, for example, increase cervical a corner, the skoshennost and flattening of a vertluzhny hollow testify to a dysplasia, and changes of a form of a proximal part of a femur say that the coxarthrosis is a consequence of a disease of Pertes or a youthful epifizioliz. On roentgenograms of patients with a coxarthrosis the changes testifying to the postponed injuries can also come to light.
As other methods of tool diagnosis of a coxarthrosis KT and MPT can be used. The computer tomography allows to study in detail pathological changes from bone structures, and the magnetic and resonant tomography gives an opportunity to estimate violations from soft fabrics.
First of all the coxarthrosis should be differentiated from a gonartroz (osteoarthrosis of a knee joint) and backbone osteochondrosis. The atrophy of muscles arising at 2 and 3 stages of a coxarthrosis can become the reason of pains in a knee joint which are quite often expressed more brightly, than pains in the field of defeat. Therefore at complaints of the patient to pains in a knee it is necessary to make clinical (survey, a palpation, scoping of movements) a research of a coxofemoral joint, and at suspicion of a coxarthrosis to direct the patient to a X-ray analysis.
Pains at a radicular syndrome (squeezing of nervous backs) at osteochondrosis and some other diseases of a backbone can imitate a pain syndrome at a coxarthrosis. Unlike a coxarthrosis when squeezing backs pain arises suddenly, after the unsuccessful movement, sharp turn, a raising of weights etc., is localized in a buttock and extends on the back surface of a hip. The positive symptom of a tension – the expressed morbidity comes to light in attempt of the patient to raise the straightened extremity, lying on a back. At the same time the patient freely takes a leg aside whereas at patients with a coxarthrosis assignment is limited. It is necessary to consider that osteochondrosis and a coxarthrosis can be observed at the same time therefore in all cases careful inspection of the patient is necessary.
Besides, the coxarthrosis is differentiated with trokhanterity (a vertelny bursit) – an aseptic inflammation in the field of an attachment of gluteuses. Unlike a coxarthrosis the disease develops quickly, within 1-2 weeks, usually – after a trauma or considerable physical activity. Intensity of pains is higher, than at a coxarthrosis. Restriction of movements and shortening of an extremity is not observed.
In some cases at an atypical course of disease of Bekhterev or jet arthritis the symptoms reminding a coxarthrosis can be observed. Unlike a coxarthrosis, at these diseases the peak of pains falls on night time. The pain syndrome very intensive, can decrease when walking. Morning constraint which arises right after awakening is characteristic and gradually disappears within several hours.
treatment should be carried out only under the supervision of a doctor. Self-treatment is unacceptable!!!
Orthopedists are engaged in treatment of a coxarthrosis. The choice of methods of treatment depends on symptoms and a stage of a disease. At 1 and 2 stages of a coxarthrosis conservative therapy is carried out. In the period of an exacerbation of a coxarthrosis nonsteroid resolvents (piroxicam, indometacin, diclofenac, an ibuprofen etc.) are applied. It is necessary to consider that medicines of this group are not recommended to be accepted for a long time as they can exert negative impact on internals and suppress ability of a hyaline cartilage to restoration.
Means from group of hondroprotektor are applied to restoration of the injured cartilage at a coxarthrosis (a hondroitina sulfate, extract of cartilages of calfs, etc.). For improvement of blood circulation and elimination of a spasm of small vessels vasodilating medicines are appointed (cinnarizine, acid nicotinic, , a ksantinola ). According to indications miorelaksant are used (medicines for relaxation of muscles).
At a persistent pain syndrome to the patients having a coxarthrosis intra articulate injections with use of hormonal medicines can be appointed (a hydrocortisone, a triamtsinolon, a metipred). Treatment by steroids needs to be carried out with care. Besides, at a coxarthrosis local means are applied – the warming ointments which do not render the expressed therapeutic effect, however, in some cases remove a spasm of muscles and reduce pains due to the "distracting" action. Also at a coxarthrosis appoint physiotherapeutic procedures (phototherapy, ultrasonic therapy, laser therapy, UVCh, an induktotermiya, magnetotherapy), massage, manual therapy and remedial gymnastics.
The diet at a coxarthrosis of independent medical effect has no and is applied only as means to weight reduction. Reduction of body weight allows to lower load of coxofemoral joints and, as a result, to facilitate the course of a coxarthrosis. To reduce load of a joint the doctor, depending on coxarthrosis degree, can recommend to the patient to go with a cane or with crutches.
At late stages (at a coxarthrosis 3 degrees) the only effective way of treatment is operation – replacement of the destroyed joint with an endoprosthesis. Depending on the nature of defeat the artificial limb can be applied or unipolar (replacing only a hip head) or bipolar (replacing both a hip head, and a vertluzhny hollow).
Coxarthrosis operation of endoprosthesis replacement is performed in a planned order, after full inspection, under the general anesthesia. In the postoperative period antibiotic treatment is carried out. Seams are removed for 10-12 day then the patient is written out on out-patient treatment. After endoprosthesis replacement rehabilitation events are surely held.
In 95% of cases surgical intervention on replacement of a joint at a coxarthrosis provides a complete recovery of function of an extremity. Patients can work, actively move and even to play sports. Middle service life of an artificial limb at observance of all recommendations makes 15-20 years. After that repeated operation is necessary for replacement of a worn-out endoprosthesis.