Coxarthrosis is a degenerative dystrophic disease in joints. Coxarthrosis implies degeneration of articular cartilages with further modification of articular surfaces of bones, formation of marginal osteophytes, deformities and also motion disorder.
There is primary coxarthrosis and secondary coxarthrosis. The first type is an actual disease whose causes are unknown and it is diagnosed in one out of four cases. The second type is a complication of other diseases of the pelvis (slight dislocation of the whirlbone, cervical hip fracture, etc.). Secondary coxarthrosis unevenly affects the right and left joints and it can also be unilateral.
Symptoms of coxarthrosis
Coxarthrosis is common in people over 40. Its major symptoms are pain in the hip and groin, shortening of the affected leg, limping and atrophy of hip muscles. Pain spreading along the lateral and front surfaces of the hip goes down to the mid part of the hip or to the knee (but the pain below the knee is very rare).
There are 3 stages of coxarthrosis:
- The first stage implies slight pain in the region of the hip joint. It appears after physical overloads, long standing, weightlifting, but disappears after a rest. After long-time walking (more than 2 kilometers) there appears limping.
- The second stage is more intense. Pain radiates to the groin, hip and knee. Upon every move muscles around the coxal articulation reflexively get tense and pain appears – upon body twisting, getting up from a chair and bed, starting to move. Tenseness remains even at night. At this stage of the disease patients have to lean on a walking stick.
- At the third stage pain gets constant and more excruciating. Pain in the coxal joint gets more intense when one tries to move. Dystrophy of gluteal and hip muscles is obvious to the naked eye. The major symptom at this stage is patients’ inability to stand on their feet. They can walk only with the help of crutches to small distances of no more than a few meters. Pain appears in the loins and sacrum and mobility of the spine is seriously affected.
- Prolonged overloads on the joint. It is more common for sportsmen and people who have to walk a lot due to their occupation. Obese people also suffer from coxarthrosis as the load on their knees and coxal articulations on jumping or running is 2-3 times higher. Moreover, obese people have a metabolic disorder which contributes to coxarthrosis in coxal and knee joints.
- Joint injuries. Various injuries lead to coxarthrosis even in young people. Chronic injuries (micro traumas) lead to “accumulation” of injuries in articulations which in the course of time causes atrophy of the cartilage or destruction of the ventral bone along with further deformation and coxarthrosis.
- Although coxarthrosis is not an inherited disease, genetics takes its toll as the structure of the cartilage tissue, metabolism and skeleton weakness are usually inherited.
- Arthritis (joint inflammation) modifies the properties of cartilage tissues and they get damaged. Moreover, arthritis often leads to blood circulation disorder and unfavorable deformations in the articular synovial membrane. Thus, arthritis, even when treated, causes coxarthrosis and osteoarthrosis in 50% of cases.
- Other factors contributing to coxarthrosis are osteoporosis, diabetes, hormonal changes and metabolic disorder.
First of all, it is necessary to identify complaints of the patient, examine the joint and check its range of motion. But instrumental methods are crucial here. First of all, it is necessary to make an X-ray image of the joint.
- narrowing of articular interspaces;
- ossification of joint cartilage;
- bone accretions on the edges of articular cartilage;
- osteoporosis – exhaustion of bone tissues;
- subchondral sclerosis – thickened bone tissue under the cartilage;
- ‘articular mice’ – saturated with lime torn-off pieces of fibers near the synovial membrane.
Nowadays arthroscopy and ultrasonic examination are widely used.
How to Treat Coxarthrosis
As a rule treatment starts with conservative methods. Non-steroidal anti-inflammatory drugs, painkillers, physiotherapy (paraffin baths, mud therapy, ultrahigh frequency treatment, radon baths, sulfur baths, electrophoresis), remedial gymnastics are prescribed. It is recommended to cut down on physical activity and use auxiliary means of movement, orthopedic footwear, retentive bandage, various patches and bandages. At an early stage after therapy patients note improvement and pain relief. But if a patient has a progressive type of the disease with obvious symptoms of coxarthrosis, surgery is the only effective method of treatment. Usually it is hip osteotomy with further fixation of bone fragments.
At the third stage only arthroplasty of the coxal joint, total replacement of the joint, can help. After arthroplasty the foot functions are restored and pain goes away. The general condition is significantly improved and after surgery patients can go back to normal life. For example, in the USA more than 120 thousand metallic coxal joints are implanted each year and that helps people go on living healthily.
In two to four weeks after surgery patients can walk with the help of crutches and after 2 months they can impose a little load on the extremity. When they start walking without crutches, remedial gymnastics is prescribed in order to strengthen the muscles around the implant. Usual load on the operated extremity is allowed only in 6 months after surgery.