Treatment of coxarthrosis of the hip joint in Moscow

With severe osteoarthritis, severe pain, limited physical activity, stiffness of movement and habitual crunching may be observed. These manifestations are typical when the disease is advanced. Among the principles of combating the disease, there are several types of surgical interventions, and treatment of grade 3 hip coxarthrosis without surgery is not an easy, time-consuming task, requiring high professionalism of the doctor and patience of the patient.

Symptoms of arthrosis are varied and differ depending on the severity and degree/stage. The main symptoms of this disease.

Severity

There are three degrees of severity of hip arthrosis:

First degree of coxarthrosis. This degree of severity is characterized by moderate pain and lack of stiffness when performing movements. When performing an X-ray examination, a narrowing of the joint space can be noticed, and isolated bone growths and osteophytes are also possible. It is possible to detect coxarthrosis of the first degree only by undergoing an X-ray examination.

Second degree coxarthrosis. In the second degree of severity, aching pain is observed. It is worth noting that in this case a person experiences pain even when the leg is at rest. When trying to turn the foot of a straightened leg to the left and right, the pain intensifies. A person with grade 2 coxarthrosis limps, and sometimes you can hear a crunching sound in the joint. X-rays show deformation of the femoral head, as well as numerous osteophytes and a significant narrowing of the joint space (by about 1/3).

Third degree coxarthrosis. This is the most severe stage of the disease, in which a person is constantly bothered by severe pain. With degree 3 coxarthrosis, muscle atrophy develops (buttocks and thighs) - the patient experiences a “skew” of the entire body towards the affected side. An X-ray examination reveals a deep deformation of the joint and a narrowing of the joint space up to complete union of the bone surfaces.

conclusions

Coxarthrosis is a serious disease that destroys the hip joint and leads to disability. Due to the widespread prevalence and low effectiveness of conservative therapy, the disease has become not only a medical, but also a social problem. The percentage of disability due to coxarthrosis is one of the consistently high rates in orthopedics.

In recent years, endoprosthetics have become increasingly used in the treatment of the disease. However, the high cost of the operation and long rehabilitation after it do not contribute to its widespread implementation.

One of the new effective techniques, as part of the complex treatment of coxarthrosis, is shock wave therapy. Due to the positive effect on tissue, shock waves lead to a decrease in the intensity of pain, partial restoration of joint function (depending on the stage of the disease) and improvement of its mobility. Moreover, the effect of treatment is often more lasting than that of traditional therapy.

The technique is economically accessible, does not require preparation and rehabilitation, and there is no need for anesthesia. After it is performed there are no side effects or complications. The procedure can be performed in an outpatient setting.

Causes

Among the most common provoking factors, the following are especially worth highlighting:

Mechanical injuries of the femoral region, pelvic bones, articular joints;
Diseases of a systemic nature, including ankylosing spondylitis, psoriasis and others;
Inflammatory processes occurring in the tendons;
Arthrosis, arthritis, osteomyelitis and other similar diseases;
Blood diseases, including those of an oncological nature;
Tuberculosis of the joints, spine or bones;
Increased loads on the lower limbs.

This problem is especially observed in older people, athletes and those who experience problems with excess weight.

Symptoms of coxarthrosis

The primary sign of coxarthrosis is pain after any physical activity. Unpleasant sensations can occur in the groin area, hip or knee.

Often, at the very beginning of the disease, pain is concentrated in the knee joint. A person comes to the doctor with just such a complaint. If the specialist is not experienced enough, he may send the patient for an x-ray of the knee and, if any minor changes are detected, make an erroneous diagnosis - first-degree gonarthrosis. Thus, the person will not be prescribed correct and timely treatment, and coxarthrosis will develop. It is important to seek advice from specialized clinics with experienced doctors.

Untimely treatment of coxarthrosis of the hip joint will lead to the development of the following symptoms:

muscle weakness;
change in gait;
clicks and crunching sounds while moving;
limping.
severe pain in the joints;
muscle spasms;
tingling in the limbs when standing up or moving;
swelling (in some cases);
rapid fatigue of the legs when walking;
pain when distributing the load from one leg to the other;
stiff legs after sleep

Over time, coxarthrosis leads to muscular atrophy of the thigh and visual shortening of the affected limb. In the later stages, osteoarthritis of the hip joint develops into ankylosis - complete fusion of the femur with the pelvis, causing the leg to be fixed in one position and serve only as a support.

Medicines

NSAIDs are used to relieve pain: piroxicam, diclofenac, indomethacin and others.
For very severe pain, hydrocortisone injections are indicated.
Chondroprotectors include aflutop, rumalon, glucosamine, dona, and chondroitin sulfate.

The use of ointments with snake venom is recommended: viprosal, vipratox - they have a local anesthetic effect, dilate blood vessels, and improve tissue nutrition. Ointments based on bee venom have the same effect: apizartron, virapin.

Treatment

The fight against coxarthrosis requires the use of different methods: from medications and physical therapy to courses of joint traction and surgery, which is usually prescribed in unsuccessful attempts to reverse the development of the disease. Conservative treatment. Non-surgical treatment is time-consuming and expensive, but it can improve a patient's quality of life—eliminating the need for surgery. The first thing an orthopedist prescribes to a patient with coxarthrosis is medications that relieve pain and inflammation (non-steroidal and steroidal anti-inflammatory drugs, muscle relaxants). To activate blood supply to the area of arthrosis and restore cartilage tissue, vasodilators and chondroprotectors are prescribed. In addition, the patient can be offered a modern method of stimulating regenerative processes - plasma lifting, that is, injections of the patient’s blood components into the site of the disease. These measures are most effective for osteoarthritis of the hip joint of 1st and 2nd severity.

Diet

Due to limited mobility and inflammation, muscle protein breakdown increases, which reduces immunity. Therefore, the diet should contain sufficient amounts of protein products.

Research also shows that destructive processes in the joint occur with elevated cholesterol levels - therefore it is necessary to reduce the consumption of foods with a lot of fat (fatty fish, nuts, butter).

Low-fat fish, meat, dairy products, vegetables, herbs, and grains are very useful for coxarthrosis. To restore cartilage, you need to consume aspic, jellied meat, jellies, and jelly. Sources of carbohydrates are cereals, honey, dried fruits.

Do not eat:

products with preservatives and dyes;
pickled vegetables;
smoked meats;
fast food;
carbonated and strong alcoholic drinks, beer.

It is also important how the dish is prepared: it is better to consume fruits and vegetables raw, juices – freshly squeezed, foods should not be fried – it is healthier to boil, bake or steam them.

Conservative treatment of coxarthrosis

Non-surgical methods

In addition to drug therapy, ointments, and injections, treatment of coxarthrosis requires the use of physiotherapy and kinesiotherapy, as well as diet correction. A care strategy developed by an experienced orthopedist allows people with grades 1 and 2 arthrosis of the hip joint to avoid endoprosthetics and limit the need for medications.

Physiotherapy (ultrasound, heat, cold stop inflammatory processes, relieve pain, relax muscles, enhance the effect of medications, normalize blood circulation, which helps restore cartilage)
Kinesitherapy
Diet therapy
Therapeutic exercise (improves joint mobility, strengthens muscles, relieves tension)
Massage (warming effect allows muscles to relax and relieve spasms)
Drug therapy (allows to relieve pain and eliminate muscle spasms)

Surgical treatment of coxarthrosis

Surgical treatment is prescribed when conservative methods are ineffective or the disease develops. Surgical intervention is also used for grade 3 coxarthrosis of the hip joint, and the worn-out joint is replaced with an artificial one (hip arthroplasty). Methods such as osteotomies and arthrodesis are now used extremely rarely, because outdated.

Surgery includes procedures performed by a surgeon in an operating room. All of them, except for puncture of the hip joint, require hospitalization and a many-month recovery period. In case of coxarthrosis of the 3rd degree, when conservative treatment does not bring relief, only prosthetics helps relieve the patient from discomfort and pain, restoring the joy of movement.

Puncture (minimally invasive intervention) involves pumping out excess fluid from the joint cavity, which relieves pain and improves leg mobility. May be performed repeatedly, especially when steroid drugs are prescribed.
Arthroscopic debridement involves cleaning the inner surface of the joint from fragments of altered cartilage tissue, washing its cavity with a medicinal solution to relieve inflammation. This operation is performed through several punctures, without opening the joint cavity.
Periarticular osteotomy is an artificial fracture of the femur followed by its fusion at a different angle, which reduces the load on the joint. Such an intervention cannot be called a panacea - after 2-5 years the pain returns, but in some conditions, when endoprosthetics is impossible, periarticular osteotomy of the hip joint is the best solution to the problem of coxarthrosis.
Endoprosthesis replacement means a complete replacement of a joint with a prosthesis that can last up to 20 years. Despite the complexity of the intervention, it is well tolerated by patients of different ages who are ready for active rehabilitation after surgery. Surgeons note that an important condition for success is preliminary treatment of obesity and the use of kinesitherapy methods to restore the strength of the muscles surrounding the joint.

Rehabilitation after surgical treatment of coxarthrosis

The patient’s time for complete recovery after surgery is up to 3 months; the ability to move and walk appears in a week at best. Additional support (crutches) is required to be able to move. There are much more effective methods of treatment that do not require hospitalization and a period of rehabilitation.

Rehabilitation after endoprosthetics

In articles devoted to modern studies of the dependence of quality of life indicators on the volume of rehabilitation, doctors insist on the use of a wide range of restorative measures immediately after endoprosthetics.

After endoprosthetics, it is important to use auxiliary devices during the rehabilitation period

Rehabilitation of the patient starts on the second day after the intervention under the supervision of a physical therapy methodologist. Doctors provide the patient with physical activity as early as possible (teach him how to get out of bed correctly, move around the bed with assistive devices).

After discharge home, a period of adaptation to the foreign body begins (4–6 weeks). This period is necessary for final scarring of the joint capsule and resorption of the postoperative hematoma.

General recommendations

At home, the patient should follow the following recommendations:

Walk on crutches without stepping on the operated limb.
Perform at least three from the proposed list of exercises aimed at strengthening the thigh muscles (in particular the quadriceps).
Wear compression stockings to prevent thromboembolism for one month.
Stick to a diet that prevents weight gain.
Systematically take prescribed medication.

Exercises

Exercises should be performed 6–8 times a day, starting with 10–20 repetitions and gradually increasing them to 50–70. Regular and systematic exercise therapy classes guarantee a quick return to work capacity.

Exercises must be performed under the guidance of an instructor

Types of exercises:

bending the leg at the knee up to 80% while lying on the bed and straightening it to a straight position, without lifting the heel from the bed;
extension at the knee joint to a level position by raising the foot (there should be a roller 25–40 cm high under the knee);
knee extension while sitting on the edge of the bed (imitation of hitting a ball).

Massage

The massage procedure for DOA of the hip joint provides:

decreased tone of tense muscles;
increased contractility of weakened muscles;
improvement of blood circulation, nutrition and regeneration in the joint;
weakening of neurological manifestations.

At home, the patient can massage the area of the joint and adjacent muscles independently (avoiding the incision area) or seek the help of a professional. It is optimal to start with procedures lasting 10–15 minutes 2–3 times a day. The massage should be stopped immediately if discomfort occurs.

The question of the possibility of doing without crutches and full weight-bearing of the operated limb is decided at a follow-up consultation with an orthopedic surgeon after 8–10 weeks.

Treatment of coxarthrosis using MBST therapy

Treatment of coxarthrosis of the hip joint can be carried out using unique and unparalleled magnetic resonance therapy. The technique is based on the restoration of cartilage tissue by applying a magnetic field to the damaged area, followed by a reaction from hydrogen atoms. As a result of the impact, the regenerative capabilities of the body are enhanced, degenerative processes that destroy bones and joints are reduced and then completely stopped, and the damaged structure of ligaments, bones, tendons and cartilage is healed more quickly.

MBST therapy, used in the ArthroMedCenter clinic, is a technology that consistently demonstrates amazing effectiveness in the treatment of diseases of the musculoskeletal system. The effectiveness of the technique is in no way inferior to traditional surgical intervention, while in a number of factors it is simply superior to it. MBST has nothing to do with surgical methods in particular and non-invasive treatment methods in general.

By influencing cartilage tissue, MBST therapy helps restore its energy potential, as a result of which regenerative processes are activated, restoring cartilage tissue to its original state. After just 3 months, they are restored by about 30%, which is quite enough for the normal functioning of the joint. But the process does not stop there, continuing for another 9 months, until the damaged area is completely regenerated.

The course of treatment is prescribed by the attending physician - it is individual and depends on the complexity of the disease, its degree and the physiological characteristics of the patient’s body. The standard program includes 5 – 7 procedures.

Mechanism of disease development

In the first two stages of DOA, gradual degradation of cartilage occurs (it becomes thinner, microcracks appear on the surface), sclerotic processes in the subchondral layer of bone, and the formation of osteophytes. Without treatment, joint damage continues to progress.

As the disease progresses, cartilage tissue thins and osteophytes grow

At the last stage of coxarthrosis, the cartilage becomes so thin that cracks in it reach the subcartilaginous layer, and in some places the cartilage tissue may be completely absent. The synovial cavity is filled with its fragments, which interferes with full movement.

In order to increase the area of contact between the articular surfaces and thereby reduce the load, an even greater number of osteophytes are formed along the edges of the bone. Overload of the subchondral area leads to the formation of cysts and disruption of the blood supply to the bone. The friction of exposed bones against each other increases pain.

Constant spasm of the muscles adjacent to the joint creates strong pressure on the articular surfaces. Fibrous ankyloses (fusions) are formed, which, without surgical treatment, completely immobilize the limb.

Prevention of coxarthrosis

Prevention of osteoarthritis of the hip joint is important for people over 40 years of age, athletes and relatives of people with already diagnosed coxarthrosis or a fracture of the femoral neck. Doctors recommend that the risk group watch their figure, protect themselves from injuries (for example, wear shoes with non-slip soles in winter) and exercise regularly. At the first symptoms of arthrosis of the hip joint, contact an orthopedist. Treatment of the disease must be carried out by a specialist doctor who is experienced and attentive to any changes in the patient’s well-being.

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Prices

Services list	Price
Appointment (examination, consultation) with a traumatologist-orthopedist, kinesiotherapist, primary	1 600
Ultrasound diagnostics of 1 joint	1 300
Individual lesson with a kinesiotherapist instructor	2 700
Acupuncture	2 700
Khivamat - therapy	2 200
Shock wave therapy, 1 procedure	2 000
Manual therapy 1 department (15 min.)	2 700
Osteopathic correction	7 500
Massage of the lumbosacral spine + one lower limb (leg) (30 min.)	3 000
Kinesio taping	1100

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