Arthrosis of the hip joint is the most common type of arthrosis. Since the hip joint (HJ) is larger than all others and has a multi-vector axis of rotation, it experiences enormous load throughout a person’s life - when walking, running, jumping, climbing stairs, playing sports and everyday activities.
Often patients have to worry about the symptoms and treatment of arthrosis of the hip joint already at the age of 25-35 years. The disease can rapidly progress under the influence of injury, decompensated physical activity (failure to comply with the technique of performing sports exercises, “standing” work, excess weight), hereditary factors, infectious and chronic diseases.
Effective treatment of hip osteoarthritis, however, can preserve mobility and prevent bone breakdown. In old age, it helps to avoid even more dangerous pathologies - such as necrosis or fracture of the femoral head.
Symptoms of arthrosis of the hip joint
Symptoms and treatment of hip arthrosis depend on the stage of the disease.
- Stage 1.
Patients feel mild pain in the groin area, which occurs after physical activity, prolonged standing or sudden movements in the joint, and then completely disappears at rest. - Stage 2.
The pain syndrome intensifies and bothers the patient even with normal household activities. The pain may radiate to the lower back or inner thigh. Stiffness and crunching appear, and the range of motion in the joint is reduced. The muscular-ligamentous system begins to weaken, which causes increased fatigue. - Stage 3.
The pain is felt constantly, and it is difficult for patients to move without a cane or walker. Movement in the joint is severely limited. Climbing stairs is a serious challenge. There are gait disturbances (lameness, falling on one or both legs). With unilateral coxarthrosis, pelvic distortion and spinal curvature are visible to the naked eye. - Stage 4.
The joint space closes due to the proliferation of osteophytes and any movement in the joint is almost impossible. It loses its functions and becomes severely deformed due to bone destruction.
Possible complications
Coxarthrosis is a dangerous disease that must be treated regardless of its degree. Otherwise, there is a risk of complications and the pathology moving into an advanced stage. Timely treatment of coxarthrosis guarantees a quick recovery and return to a normal lifestyle. Conservative therapy helps prevent the following complications:
- inflammatory and infectious processes in adjacent tissues;
- subluxations of the hip joint;
- pinched sciatic nerve;
- bursitis or inflammation of the bursae;
- tenosynovitis;
- tunnel symptom;
- fractures or necrosis of bones.
Prognosis for arthrosis of the hip joint
With successful lifelong treatment, pain due to arthrosis of the hip joint may be completely absent or rarely bother the patient. The prospects for this therapy depend on the patient’s compliance with the rheumatologist’s rules and his personal self-discipline. Please note that the most accurate prognosis for the disease can only be made by the attending physician.
With timely and regular treatment
If chronic diseases do not contribute to the progression of the disease and treatment of hip arthrosis began at stage 1 or 2, hip replacement can be avoided. Disability and loss of ability to work, if the doctor's recommendations are followed, shifts by 20 years, and sometimes the patient retains an almost unlimited range of motion in the joint until old age. The best prognosis is possible with the so-called. benign arthrosis - when the wear of cartilage depends on external factors (professional activity, sanitary violations). In this case, it is worth excluding them and undergoing a course of restorative therapy to slow down further degeneration of the joint.
Timely surgical treatment of grade 3 osteoarthritis of the hip joint will help avoid joint immobility, consequences for the entire musculoskeletal system and many years of pain. In the absence of contraindications, prosthetics will help you return to your former activity.
When self-medicating
When choosing a treatment method for arthrosis of the hip joint, the doctor takes into account the age, constitution, physical fitness of the patient, his state of health, specific symptoms of the disease and its stage. In this case, the narrowing of the lumen of the joint space, the presence of osteophytes, the rate of progression of arthrosis, the quality of synovial fluid and other indicators are examined.
Self-treatment of osteoarthritis of the hip joint with traditional methods does not take into account these individual indicators and, instead of the desired result, can lead to severe exacerbation, metabolic disorders and worsening the stage of the disease. But the worst thing is the time spent on the illusion that such a serious chronic disease as arthrosis of the hip joint can be cured only with traditional methods. Avoid taking anti-inflammatory drugs without a doctor's prescription - this can cause serious problems with the digestive and endocrine systems!
No treatment
Left untreated, arthrosis of the hip joint progresses on average 2-4 times faster. A deterioration in the quality of life and the onset of disability in this case is possible already at a relatively young age - about 45-50 years. Patients' sleep deteriorates, physical activity decreases, and psycho-emotional disorders are observed. The pain prevents them from getting out of bed in the morning, walking with their grandchildren, or going to work.
Diet
With the help of nutritional correction, the patient can not only reduce body weight, but also reduce inflammatory reactions, salt deposits in tissues and metabolic disorders. It is recommended to follow a balanced menu with sufficient, but not excessive amounts of carbohydrates, proteins and fats, as well as vitamins and minerals. Particular attention should be paid to unsaturated fats (olive and flaxseed oil), omega-3 acids (found in abundance in fish), collagen (jelly, aspic). It is recommended to minimize fast carbohydrates, alcohol, strong coffee, products with artificial flavors, preservatives and flavor enhancers.
Treatment of osteoarthritis of the hip joint
The priority direction of treatment for grade 1 arthrosis of the hip joint is outpatient conservative therapy. It includes drug treatment of arthrosis of the hip joint, physiotherapy, diet therapy, wearing bandages and adjustable orthoses. This approach allows you to relieve pain, maintain muscle function and increase mobility in the joint. Treatment of grade 2 arthrosis of the hip joint is carried out similarly.
If conservative treatment of arthrosis of the hip joint is delayed or ineffective, cartilage degeneration progresses rapidly, and surgery is performed. Occasionally, the doctor may decide on osteotomy or arthrodesis, but in most cases, when treating arthrosis of the hip joint of the 3rd degree, endoprosthetics is prescribed - partial or complete replacement of the diseased joint. A prosthesis made of metal and a ceramic or polymer liner lasts from 15 to 25 years, after which it requires replacement. Total arthroplasty (total joint replacement) is the most effective treatment for hip arthrosis. It allows you to fully restore its functionality with a minimal incision of up to 8 cm in length and the ability to walk with support within a day. Complete rehabilitation lasts 1-3 months.
Physiotherapeutic methods for treating arthrosis of the hip joint
Physiotherapy for arthrosis of the hip joint is carried out in courses, according to the doctor’s indications. Almost all techniques, except magnetic and cryotherapy, are allowed only during the period of remission, in the complete absence of inflammatory symptoms. The following measures are used to treat osteoarthritis of the hip joint:
- ultra-high frequency therapy;
- ultrasound therapy;
- laser therapy;
- magnetic therapy;
- therapeutic exercises (therapeutic gymnastics);
- therapeutic massage and manual therapy;
- ozone therapy;
- cryotherapy;
- acupuncture;
- traction therapy (traction);
- paraffin applications and wraps;
- balneotherapy and mud therapy;
- hydromassage.
Treatment of arthrosis of the hip joint with exercise therapy
Physical therapy for arthrosis of the hip joint is aimed at strengthening muscles and ligaments - they are a natural orthosis that reduces the load on the joint and maintains it in the physiologically correct position. As a result, treating osteoarthritis of the hip joint with exercises helps relieve pain and inflammation, improves mobility, slows down the wear of cartilage and ensures the supply of nutrients to the synovial fluid. The following exercises will help strengthen your legs:
- Starting position - sitting on the floor, focusing on outstretched arms behind you. Legs straight in front of you. We bend and straighten our toes.
- The starting position is the same. Alternately bend and straighten your feet (toes towards you, toes away from you).
- The starting position is the same. Bend your leg at the knee, pulling it towards you along the mat or on weight. It is advisable to touch the floor only with your toe after completing the movement.
- Starting position - lying on your back, legs bent at the knees, feet on the floor. We do the “frog” exercise - we spread our bent knees and hold them for 20 seconds. Then we bring it together again.
- Starting position - lying on your back, one leg straight, the other bent and laid to the side. We lie like this for one minute, then change legs.
- Starting position - lying on your back, legs straight, lying freely. We bring the socks inward, touching them, and then spread them apart. Repeat at a pace 10 times.
- Starting position - lying on your back, one leg (from the side of the affected joint) crossed over the other. We move the foot of the lower leg as in the exercise above.
- Starting position: lying on your back. We pull the knee towards the stomach, holding the back of the thigh with clasped fingers. Perform for 30 seconds on each leg.
- The starting position is the same. We pull our legs bent at the knees towards the stomach and hold them under the knees with interlocking fingers. Perform for at least 30 seconds.
- The starting position is the same. We move the straightened leg to the side above the floor. 20-30 times on each leg.
- Starting position: standing. Place a chair to the side, with its back facing you. Holding the back of a chair and standing on one leg, swing the other back and forth like a pendulum. 20-30 times.
Massage in the treatment of osteoarthritis of the hip joint
Massage is an effective relaxation and restorative technique for the treatment of arthrosis of the hip joint in the early stages. As a treatment for arthrosis of the hip joint of the 1st degree (as well as the 2nd - in the absence of pain and swelling), it can prolong remission, relieve discomfort and pain without drugs, improve tissue trophism and slow down cartilage degeneration. It also eliminates spasms that interfere with sleep and movement, strengthens ligaments, normalizes gait, and allows you to quickly warm up when changing from rest to active activity and vice versa.
For arthrosis of the hip joint, professional therapeutic massage is desirable (at least 10-12 sessions). But gentle self-massage at home also helps improve the condition. It is important to avoid pain and severe discomfort. At the slightest sign of inflammation in the joint, manipulations are temporarily stopped - they can be resumed with the permission of the attending physician, after a course of anti-inflammatory therapy.
Even in cases where the patient suffers from unilateral coxarthrosis, massage is performed on both sides. How to do it correctly?
- To begin, take a comfortable position that will allow you to relieve stress on your hips and lower back. For example, lying on your back, side or stomach.
- Begin to gently massage the area around the affected joint. If you have a helper, ask him to stroke your back for 7-10 minutes from your shoulder blades to your sacrum to improve blood circulation.
- Proceed to slowly stroking the lower back, and then a circular warm-up of the sacrolumbar region with two fingers.
- Massage the spine with your thumbs, as far as the pose allows, gradually moving down to the lower back.
- Press your palms into the sacrogluteal area and begin rubbing and stretching the muscles. This completes the preparation.
- Rub your thighs with your palms and then massage them well in a circle with your thumbs.
- Knead the inner thigh without applying pressure (so as not to squeeze the blood vessels). It’s better to grab the fat fold between your thumb and other fingers and knead it thoroughly.
- Important! Complete the procedure with relaxing strokes and pats.
In thigh massage, transverse, longitudinal, grasping, squeezing movements are used. Rubbing is performed with different parts of the palm or bent fingers towards the groin area.
After surgical treatment of grade 3 osteoarthritis of the hip joint and removal of sutures, massage is used for rehabilitation and restoration of motor functions.
Treatment of arthrosis of the hip joint with diet
The main principle of nutrition in the treatment of arthrosis of the hip joint is its diversity and balance in key indicators (vitamins, minerals, proteins, including essential amino acids). It is important to eat foods high in calcium, sulfur, zinc, magnesium and selenium. Of the vitamins, vitamins A and group B (give an anti-inflammatory effect), C, D, E are of primary importance. Low-protein diets are contraindicated in the treatment of osteoarthritis of the hip joint. Therefore, be sure to include in the menu:
- Dietary meat, poultry, fish.
- Eggs.
- Milk and dairy products.
- Fruits, vegetables and fresh herbs.
- Whole grains and oilseeds (such as flax), as well as nuts.
- Dishes and products with natural chondroprotectors (jelly, jelly, cartilage, pork legs, ears, etc.).
But it’s better to reduce your carbohydrate intake - after all, even slight excess weight creates a colossal load on the sore joint. It’s not for nothing that rehabilitation specialists joke that losing a couple of kilos is the most effective treatment for arthrosis of the hip joint. You also need to exclude salty, spicy, sweet and fried foods, which cause the body to retain water. Minimize your intake:
- fast food and semi-finished products;
- baked goods, sweets and confectionery;
- sausages and marinades.
Don't forget to drink at least 2.5 liters of water per day!
Drug treatment of arthrosis of the hip joint
Treatment of osteoarthritis of the hip joint with drugs is carried out strictly as prescribed by the doctor. In case of exacerbation and severe pain, it is allowed to take conventional analgesics or gentle anti-inflammatory drugs (ibuprofen), but no more than 10 days before contacting a specialist. Otherwise, the picture of the disease will be blurred and it will be difficult for the doctor to select adequate treatment for arthrosis of the hip joint.
There are several medicinal groups of drugs for the treatment of arthrosis of the hip joint. In the complex treatment of arthrosis of the hip joint with drugs, 5 main pharmaceutical groups are used.
Anti-inflammatory drugs in the treatment of osteoarthritis of the hip joint
Swelling, stagnation of blood and other fluids, local fever and pain - these common symptoms of inflammation in arthrosis not only poison the patient’s life, but also aggravate the course of the disease. Over time, they lead to tissue starvation, depletion of synovial fluid, which “feeds” the cartilage and disruption of its viscosity (due to which friction destroys the surface of the articular membrane!), muscular dystrophy and persistent deterioration in mobility.
But the main danger of inflammation is the death of cartilage cells - chondrocytes. When they break down in large quantities, they create an accumulation of enzymes that “eat away” the surface of the articular cartilage.
Therefore, to relieve inflammatory symptoms and restore tissue metabolism, 2 groups of anti-inflammatory drugs are used: non-steroidal (NSAIDs, NSAIDs) and glucocorticosteroids.
NSAIDs are considered gentler, although they can also affect the digestive system. That's why they are appointed first. In the treatment of grade 2 arthrosis of the hip joint - in courses or as needed.
These include: Artradol, Nimesulide, Ibuprofen, Meloxicam, Ketoprofen, Xefocam, Indomethacin, Diclofenac.
If NSAIDs fail, rheumatologists prescribe the “heavy artillery” - corticosteroid drugs. They immediately relieve even severe pain and inflammation, but they cannot be taken for a long time and in large dosages. Like any hormonal drugs, they can affect the weight and condition of internal organs, and if the therapeutic dose is exceeded, they can aggravate the course of arthrosis.
The drugs of choice for the treatment of grade 3 arthrosis of the hip joint are: Hydrocortisone, Diprospan, Prednisolone, Methylprednisolone.
Chondroprotectors for osteoarthritis of the hip joint
Although anti-inflammatory drugs relieve symptoms, they do not solve the problem - they do not restore the destroyed surface of the cartilage and do not enrich the synovial fluid with glycosaminoglycans. Therefore, effective treatment of arthrosis of the hip joint is unthinkable without the drugs chondroitin and glucosamine sulfate, which supply the body with building material for the formation of new cartilage cells.
Since the metabolism in cartilage tissue is very slow, chondroprotectors need to be taken for a long time - 3-6 months annually. But, with lifelong preventive use, they help achieve drug-free remission.
Chondroprotectors include: Artracam, Elbona, Teraflex, Movex, Protekon, Dona, Chondroitin Complex, Alflutop.
Angioprotectors and microcirculation correctors
Inflammation and microtraumas that accompany arthrosis disrupt the blood supply around the affected joint. But it is the capillaries that bring nutrients to the boundaries of the joint capsule.
The following help relieve swelling and improve tissue trophism: Troxevasin, Troxerutin, horse chestnut extract, Detralex, Actovegin, Pentoxifylline.
Muscle relaxants
When the supporting function of a joint is impaired, the body tries to compensate for it using muscles and ligaments that are not designed for such almost continuous load. Due to chronic overstrain, pain and spasms appear in the muscles. These cramps may interfere with sleep or walking.
To eliminate them, in the treatment of osteoarthritis of the hip joint, the following are prescribed: Mydocalm, Baclofen, Sirdalud, Tolperisone.
External and warming agents
Drugs in this group have a vasodilating effect. They help relieve swelling, reduce pain and psychologically distract from joint discomfort.
Usually, for the treatment of arthrosis of the hip joint, products based on animal poisons or burning plant extracts are used: Viprosal, Apizartron, Cobratoxin, Larkspur, Espol, Capsaicin ointment.
Release form of drugs for the treatment of arthrosis of the hip joint
Depending on the clinical manifestations of arthrosis and the patient’s lifestyle, the rheumatologist prescribes drugs for the treatment of osteoarthritis of the hip joint in various forms.
Tablets, capsules, powders
These products for the treatment of hip arthrosis are easy to dose and take with you. All you need to take is a glass of water. Also, the blister or packaging allows you to track how many days the course has already lasted. Such drugs have good bioavailability (90% for tablets and 95% for sachets, such as Artracam). But anti-inflammatory tablets can have a negative effect on the mucous membranes of the stomach and intestines - for gastritis, ulcers, colitis, it is better to prefer injections for the treatment of osteoarthritis of the hip joint.
Injections for intramuscular and intraarticular administration
Anti-inflammatory drugs, muscle relaxants and chondroprotectors are usually administered by injection. This guarantees maximum bioavailability and is gentle on the gastric mucosa, but usually requires the presence of a medical professional. Making intra-articular injections without special qualifications is strictly prohibited!
Diagnosis of coxarthrosis
Timely diagnosis and proper therapy will help stop the progression of the disease, relieve pain, and normalize motor activity. Treatment of coxarthrosis of the hip joint is carried out by orthopedic doctors: orthopedists, traumatologists and rheumatologists.
For correct diagnosis, the following types of examinations are prescribed:
- visual inspection, tactile examination, specification of complaints;
- laboratory tests of blood and urine;
- X-ray;
- CT scan;
- ultrasonography;
- Magnetic resonance imaging.
