Coxarthrosis of the hip joint, degree 2, how to treat, disability

Coxarthrosis of the hip joint, grade 2, is a serious disease that is accompanied by degenerative changes in cartilage tissue. Without treatment, the disease rapidly progresses, causing dangerous complications in the patient; loss of ability to work and disability cannot be excluded.

Joint anatomy: Without understanding its structure, it is difficult to understand the causes and consequences of the disease.

Deforming coxarthrosis of the hip joint, grade 2, is most often diagnosed in women and men aged forty years and older. It is men who are at high risk (65% of cases where the disease is detected).

A network of blood vessels that surround and nourish bone and cartilage tissue.

Features of the development and nature of the disease:

Initially, grade 2 coxarthrosis of the hip joint begins to progress due to impaired blood supply to the tissues of the joint.
Gradually this leads to a lack of oxygen and poor cell nutrition.
The result is oxygen starvation of tissues, accumulation of harmful metabolic products that worsen the condition of cartilage, provoking its further destruction.
Due to thinning of the cartilage in grade 2 coxarthrosis, the load on bone tissue increases during walking, which leads to bone deformation and the development of osteophytes.

Pay attention to the right side of the image: this is what the disease looks like on an x-ray.

Among all pathologies of the musculoskeletal system, coxarthrosis is detected in 40-48% of patients.

More information about the development of coxarthrosis:

in patients over 65 years of age, advanced coxarthrosis is detected in 85% of cases;
among the many types of arthrosis of the hip joint, the detection of coxarthrosis in the dysplastic form is 65%;
most often the disease causes congenital dislocation of the femoral head (this cause leads to coxarthrosis in more than 20% of cases).

This is what the destroyed cartilage surface looks like.

Coxarthrosis of the hip joint of the 2nd degree is a very insidious disease, since its symptoms can be completely invisible, up to the third or even fourth degree. In such a condition, traditional drug therapy will simply be ineffective for the patient; only surgery is indicated.

Classification

Coxarthrosis of the hip joints, degree 2, can be unilateral or bilateral. Unilateral coxarthrosis of the 2nd degree leads to degenerative damage to the cartilage of only one joint (right or left). Paired lesions are characterized by bilateral coxarthrosis.

Symmetrical damage to two joints at the same time.

According to localization, grade 2 coxarthrosis of the hip joint can be as follows:

damage to the upper zone of the joint is accompanied by pronounced symptoms already in the first stages of the disease;
damage to the lower area of the joint has not clearly expressed signs, noticeable only on X-ray images;
localization of the degenerative process in the central part of the joint (this disease is accompanied by vivid symptoms and responds well to treatment).

Dynamics of disease progression. The higher the degree, the smaller the joint space.

Forms of progression of coxarthrosis of the 2nd degree:

Form of pathology	Peculiarities
Primary coxarthrosis of the hip joint	It can go completely unnoticed even for several years. Pain occurs only during physical activity. Treats well
Secondary	It develops against the background of existing diseases. Progresses quickly, so patients often require urgent surgical intervention

Prognosis and possible complications

Only stage 1 degenerative-dystrophic disease is amenable to successful conservative treatment. In other cases, there can be no talk of complete restoration of the functional activity of the hip joint, excluding cases of installation of an endoprosthesis.

In the absence of treatment, at the final stage of development of pathological processes, the patient develops limited mobility of the flexion type joint, which makes it impossible to move due to a constantly bent limb.

After complete fusion, the patient is unable to independently solve basic everyday issues and is assigned the status of a disabled person.

Causes of the disease

Coxarthrosis of the hip joint, degree 2, develops due to the influence of the following factors:

pronounced loads on the joints (coxarthrosis is very often detected in athletes);
obesity;
congenital changes in the joint;
genetic predisposition to pathology;
endocrine disruptions;
traumatic injury;
poor nutrition, in which the joints do not receive enough nutrients and vitamins.

Exercises

The main therapeutic gymnastics program includes 6 exercises:

Starting position: lying on your back, with your knees bent. We alternately pull the right and left legs towards the stomach as far as possible.
Without changing the starting position, we lean on our legs and raise our pelvis.
IP - the same. Having lowered the right leg, we try to carry out maximum abduction to the side with the left leg. Repeat the exercise with the other leg.
Starting position - lying on your right side, with your left leg straight (right leg bent at the knee). Slowly and smoothly raise your left leg at an angle of 45º. Repeat the exercise on the other side.
Starting position: lying on your stomach. Alternately raise the bent leg at the knee up.
The exercise is repeated with the leg straightened.

A good set of exercises on video from an expert:

When performing a gymnastic complex, 5-6 repetitions with one and the other leg are enough.

In case of pain or in case of acute inflammation in the hip joint, therapeutic exercises are prohibited.

Symptoms of the disease

Symptoms of the second stage of coxarthrosis:

Pain that can be sharp, aching or stabbing. It often bothers a person when walking or even at rest at night.
Lameness due to joint deformation.
A sharp limitation of the motor functions of the hip joint due to narrowing of the joint space, the formation of osteophytes, and cartilage damage.
Atrophy of muscles, which, in the absence of load on the limb, quickly lose tone.
The photographs clearly show the deformation of the head of the joint and the unevenness of its outline.
Due to inflammation, high body temperature, swelling, and weakness are possible.

The main symptom is always the same - pain.

Disability with coxarthrosis in the second degree can occur in the event of complete loss of motor functions of the hip joint. This is a direct indication for surgery.

What is coxarthrosis

Coxarthrosis is a complex pathology of one or both hip joints, in which the destruction of the cartilaginous layers covering the head of the femur and acetabulum occurs, which leads to a decrease in the size of the joint space. As the disease progresses, deformation of bone surfaces and the formation of bone growths on them, called osteophytes, occur.

Coxarthrosis is the second most common disease of the musculoskeletal system. More often, only gonarthrosis is diagnosed, i.e., a degenerative-dystrophic change in the knee joint. However, the likelihood of disability with coxarthrosis is significantly higher.

The hip joints are paired and at the same time the largest joints of the human body, which bear significant loads every day. Each of them is formed by the femur, which has a neck directed at an angle of 120° with a round head. It is located in a cup-shaped depression in the pelvic bone called the acetabulum. This structure allows the head of the femur to move freely in various directions, that is, not only to bend and extend the leg at the hip, but also to adduct and abduct, and rotate it.

The movement of the joint is carried out by a group of femoral and pelvic muscles attached to it by fascia. At the same time, the group of ligaments surrounding it is responsible for its stability, maintaining the correct position and limiting the amplitude of movements within the normal range.

The contacting parts of the bones, namely the head of the femur and the acetabulum, are covered with hyaline cartilage. It is a moderately elastic, perfectly smooth layer that prevents friction of bone structures against each other and ease of movement of the head of the femur inside the acetabulum, as well as shock absorption of the hip joint when walking, running and performing other movements.

The entire hip joint is enclosed in a specific case, which is called the joint capsule. It has a so-called synovial membrane, which produces synovial fluid. This fluid is extremely important for the proper functioning of the joint, since it not only lubricates the hyaline cartilage, but also provides it with a source of nutrients.

Normally, cartilage is constantly worn out and immediately restored due to the continuous process of regeneration, carried out with the help of substances entering it from the synovial fluid. But with injuries or age-related changes, the rate of regeneration processes decreases, which leads to gradual wear and tear of hyaline cartilage and the development of coxarthrosis.

This is explained by changes in the amount of synovial fluid produced and its composition. Under the influence of unfavorable factors, it becomes thicker and produced in less volume. As a result, the synovial fluid is no longer able to provide the hyaline cartilage with all the substances it needs in the required quantity, which leads to its rapid dehydration and thinning. Gradually, the strength and elasticity of the cartilage decreases, areas of separation of the fibers that form it, cracks form in it, and the thickness also decreases. These changes can be noticed when carrying out instrumental diagnostic methods; in particular, the narrowing of the joint space attracts attention.

The narrowing of the joint space leads to increased friction between the bone structures that form the hip joint and increased pressure on the already degrading hyaline cartilage. This provokes even greater damage, which affects the functioning of the joint and the person’s condition, since the deformed areas prevent the femoral head from sliding easily in the acetabulum. As a result, symptoms of coxarthrosis occur.

If left untreated, the pathological changes worsen, and the hyaline cartilage wears out more and more. Subsequently, in some areas it completely disappears, which leads to exposed bones and a sharp increase in the load on the joint. Since when moving inside the acetabulum, the head of the femur rubs directly against the bone, this provokes severe pain and a sharp limitation of mobility. In this case, the pressure of bone structures on each other leads to the formation of bone growths on their surface.

Formed osteophytes may have sharp parts that can injure the muscles and ligaments surrounding the hip joint. This leads to severe pain both directly in the joint area and in the groin, buttocks and thigh. As a result, the patient spares the injured leg, puts less load on it and tries to avoid making unnecessary movements with it. This causes muscle atrophy to develop, which further aggravates mobility impairment and ultimately leads to lameness.

Diagnostics and therapeutic therapy

The following studies will help establish the diagnosis of coxarthrosis:

Ultrasound diagnostics;
CT;
MRI;
radiography;
arthroscopy (examination of intra-articular fluid);
blood tests.

Anamnesis is also collected and the affected joint is examined by a doctor.

Most often, only an x-ray is required to make a correct diagnosis.

Drug therapy is selected for patients individually, depending on the nature of the disease, its causes, and the degree of neglect. The general course of treatment is complex and lengthy. It includes drug therapy, physical therapy, and surgery (as a last resort).

Goals of traditional drug therapy:

effective treatment without surgery;
pain relief;
reduction of inflammation;
normalization of blood circulation;
improvement of tissue nutrition.

Drug treatment involves the mandatory prescription of the following groups of drugs:

Group of drugs	Best representatives	Therapeutic effect of drugs
Chondroprotectors	Glucosamine, Structum	Chondroprotectors are the basis for the treatment of coxarthrosis. They act on cartilage, promoting its restoration, helping to slow down the progression of the disease
NSAIDs	Diclofenac, Movalis	They stop the inflammatory process, relieve pain and swelling. NSAIDs have many side effects, so they can only be treated with a doctor’s permission.
Vasodilators	Trental, Teonicol	Relaxation of blood vessels, improvement of blood circulation in the affected area. Help eliminate spasms. Prescribed for nighttime shooting pains
Hormonal agents	Diprospan	Used as intra-articular injections. Relieves pain, inflammation, restores tissue at the site of the degenerative process

The method of administration and dosage are prescribed individually. The use of these medications is contraindicated during pregnancy, active inflammation, or allergies. Can be used with caution for gastrointestinal diseases, pathologies of the heart, kidneys, and liver.

Joint traction

The procedure is carried out using a special traction apparatus. Less often it is practiced manually. The goal is to reduce the load on the hip joint.

It is advisable to do stretching not only for the joints, but also for the spine.

Traction is a complex procedure that can only be performed by a specialist. It can be repeated several times a year, but only after the permission of the attending physician.

Surgical treatment

Surgery is prescribed when drug therapy no longer has an effect, and the joint is completely deformed.

The most effective operation is endoprosthetics. The essence of the procedure is to remove the affected joint and replace it with an artificial analogue - a prosthesis made of metal alloys or ceramics. The results of endoprosthetics are relief from pain, inflammation, and restoration of mobility. After surgery, the person will again be able to exert normal load on the hip joint. A high-quality endoprosthesis will last about twenty years, which is a good indicator.

Physiotherapy

Treatment with physiotherapy is mandatory when diagnosing coxarthrosis. With its help, you can effectively reduce pain, inflammation, relieve swelling, and enhance the effect of medications.

Sanatorium treatment will not cure the disease, but it can significantly alleviate the condition.

Before carrying out such treatment, it is important to make sure that the patient has no contraindications to physiotherapy (pregnancy and lactation, allergies, respiratory pathologies, vascular diseases, skin diseases).

The best physiotherapy for coxarthrosis:

Procedure name	Action
UHF therapy	Regeneration of damaged tissues
Magnetotherapy	Elimination of inflammation, pain
Laser therapy	Reduced pain
Phototherapy	Normalization of metabolic processes
Acupuncture	Elimination of muscle tension, normalization of metabolism
Hirudotherapy	Improved blood circulation

Therapeutic exercises

A timely course of exercise therapy will help to successfully treat grade 2 coxarthrosis of the hip joint without surgery. Exercise strengthens muscles, improves blood circulation, relieves pain, and normalizes joint nutrition.

Exercise therapy should be carried out during periods of remission of the disease, when the patient does not suffer from acute pain. Active physical activity is contraindicated in case of hypertension, purulent lesions of the joints, pregnancy, and active inflammation.

A set of exercises for hip joints with arthrosis:

Sit down, stretch your legs. Slowly reach your feet with your hands, bending as much as possible so that the hip joint “works.” The same exercise can be performed in a standing position.
Stand straight and perform circular movements with your feet.
Lie on your back, perform swings with straight legs.
Lying on your stomach, raise your legs straight and hold them in this position for a few seconds. The same exercise should be performed while lying on your side.

Active physical exercise (running, squats or jumping) is strictly prohibited for patients with coxarthrosis: exercise will do more harm than good and will cause a new wave of inflammation.

The pool is an excellent place for gymnastics for hip joint disorders.

Exercise therapy can be supplemented with therapeutic massage, swimming, walking or skiing.

Conservative treatment

Conservative treatment is used at stages 1 and 2 of coxarthrosis and is aimed at reducing pain, increasing range of motion in the joint, preserving muscle function and stopping joint destruction.

The main part of conservative treatment is drug therapy. Treatment is aimed at reducing pain, restoring (stopping destruction) of cartilage, and improving blood circulation.

Drug treatment (tablets, injections and ointments)

NSAID drugs. Indicated during periods of exacerbation to relieve pain.
Chondroprotectors (for cartilage restoration).
Muscle relaxants (to relax muscles). Relieves muscle spasms during coxarthrosis and helps improve blood supply to the joint.
Vasodilators that improve blood microcirculation (trental, nikoshpan, cynaresin, teonicol, etc.). Helps improve articular blood supply.
Steroid drugs (diprospan, kenalog, hydrocotisone).

They are used for severe pain and ineffectiveness of NSAIDs.

The above drugs can be used in the form of ointments, lotions and compresses.

Physiotherapeutic methods occupy an important place in the complex treatment of coxarthrosis: magnetic therapy, electrotherapy, UHF therapy, ultrasound therapy, cryotherapy, etc. Physical therapy, unloading the joint using orthopedic devices (crutches, canes), and the use of massage are important.

Coxarthrosis of grade III requires the use of surgical treatment methods. In advanced cases, surgery (arthroplasty, osteotomy, arthrodesis, endoprosthetics) is the only effective treatment method.

Principles of therapeutic nutrition

Treatment of grade 2 coxarthrosis of the hip joint requires mandatory adherence to the principles of dietary nutrition, which will help reduce the inflammatory process, restore cartilage tissue, and saturate the body with useful substances.

Diet principles:

Avoid drinking any alcoholic beverages, fatty or fried foods.
Limit the consumption of salt and sugar, both in pure form and as additives to dishes.
To restore cartilage and bone tissue, include meat, fish, seafood, legumes, and cereals in the menu.
Regularly consume low-fat fermented milk products (kefir, fermented baked milk, cottage cheese).
As a side dish, it is useful to eat porridge (buckwheat, rice, oatmeal). You can add honey, raisins, dried apricots, and dried fruits to them.
Sugar should be replaced with honey.
Vegetables are useful in raw, baked or boiled form. When preparing vegetable salads, season them with olive oil.
Eat nuts regularly.
To enrich the body with vitamin C, drink rosehip decoction.
Sausages, fresh baked goods, chocolate, and hot sauces are strictly prohibited.

This is what your diet should look like.

Those who are overweight are advised to reduce the calorie content of their meals. A nutritionist will help the patient determine the correct diet and choose a menu.

Traditional therapy

Treatment of coxarthrosis of the 2nd degree of the hip joint with the help of traditional therapy can be practiced after the doctor’s permission.

Traditional medicine helps relieve inflammation and reduce pain. Popular recipes:

Grind lemon, garlic, celery. Pour boiling water over the mixture and leave for an hour in a thermos. Take a spoon twice a day.
To restore the joint, you can rub aloe juice mixed with eucalyptus oil into it.
To strengthen bones and restore cartilage, you need to drink rich broth from beef joints.
If there is poor blood circulation, a tincture of iodine, honey, and glycerin should be rubbed into the joint.
Mix elecampane and cinquefoil in equal quantities. Pour alcohol into the mixture. Use for regular massages.

It is no longer possible to completely cure bilateral coxarthrosis of degree 2 due to severe damage to cartilage tissue. But the patient’s condition can be stabilized by significantly slowing down the progression of the pathology.

Help from traditional medicine

The therapeutic response in the early stages is based on drug treatment and good physical therapy. In case of pain, treatment of grade 1 and 2 coxarthrosis begins with the use of analgesic medications. Basically, due to the lack of side effects, Paracetamol®, an antipyretic and anti-inflammatory analgesic, is prescribed at the initial stage of the disease.

In case of exacerbation and in the absence of severe renal and hepatic disorders, the attending physician prescribes analgesics with an anti-inflammatory non-steroidal effect - Ibuprofen®, Celexib®, Diclofenac® or Etoricoxib®.

Such drugs require careful administration to patients with impaired cardiovascular function, chronic diseases of the gastrointestinal system and blood diseases.

Pain treatment is not only medication, but also active physiotherapeutic treatment:

electrotherapy with ultrasound, short waves and ionization;
thermotherapy of the lumbar region, hips and lower extremities;
manual acupressure and massage.

For the entire period of treatment, the patient is recommended to adhere to dietary nutrition standards, active mineralization and saturation of the body with vitamins.

A complex of therapeutic and prophylactic gymnastics is required to stretch the joints and tone the ligamentous-muscular system.

Preventing Disease

Basic preventive measures:

Give up bad habits (smoking, overeating, drinking alcohol).
Protect yourself from severe hypothermia.
Eat nutritiously so that your joints receive enough essential nutrients for normal functioning.
Regularly exercise the hip joint to protect it from the development of degenerative diseases. This could be running, cycling, swimming, therapeutic exercises, or at least daily morning exercises.
Avoid heavy lifting.
Annually undergo a preventive course of treatment with chondroprotectors and take vitamins. Before taking medications, you should consult your doctor.
People over 40 years of age should undergo regular medical examinations and hormone tests in order to identify any disorders in time.
Promptly treat joint diseases that cause coxarthrosis.
Control your weight and avoid obesity, otherwise the risk of developing coxarthrosis increases several times.

Treatment of grade 2 arthrosis of the hip joint should be carried out immediately after the disease is identified, before it causes dangerous complications. At the first signs of pathology, do not self-medicate, but consult a doctor.