Osteoarthritis is a disease inherent only to people. This is the price of a human upright posture. Since earliest humans began walking upright on two feet and made their hands free for work, they also had got this disease. Numerous archaeological excavations proved this many times. It happened because of the redistribution of the body weight to the articular surfaces that were not ready to that.
Coxarthrosis is arthrosis of the hip joint. The Latin word “coxa” means “thigh”, “articulation” is the joint, and “os” indicates a non-infectious nature of the disease. In other words, coxarthrosis is a degenerative disease of cartilage tissue of the hip joint.
When formation of the bony skeleton is finished, cartilage tissue ceases to regenerate. This means that any damage to the cartilage tissue leaves its traces. To old age, such damages are numerous and cartilage can be nearly gone: joint bones start rubbing against each other. This causes typical clinical manifestations of the disease.
Coxarthrosis of the hip is associated with the severe form of osteoarthritis. It is the most often occurring condition among all the diseases of the musculoskeletal system, accounting more than 40% of all cases. This disease, usually, starts developing after 40 both in men and women. However, women are affected by this disease more severely.
Coxarthrosis is a degenerative arthritis of the hip joint that can be successfully treated at the initial stage of development. But, unfortunately, people tend not to seek for the medical help immediately as soon as they feel the first pain in the hip joint, which allows the disease to progress.
At the heart of this pathology, there is the viscosity of the joint fluid, thinning of the cartilage tissue and reduction of the joint gap. All of the above leads to degeneration of the joint cavity as a whole.
Thick articular fluid cannot sufficiently lubricate the articular surfaces, which leads to the joint surface roughness, increased friction and thinning of the cartilage. The joint gap decreases and the bones are deformed. Violation of the blood circulation leads to the slump of nutrients to the joint and muscle atrophy.
Coxarthrosis can be bilateral (at two sides) or one-sided. The latter oftener occurs at the right joint. Left-sided coxarthrosis is less common.
All cases of this difficult disease can definitely be divided into two large groups: the primary and the secondary hip osteoarthritisis.
Primary coxarthrosis is disease that occurs without any cause, of itself. With the primary form of the disorder, the both joints usually affected, that is called bilateral coxarthrosis. Typically, this disease occurs in older people. In the development of this type of coxarthrosis, hereditary factor plays the significant role. So, in women whose mothers suffer from excess weight and coxarthrosis, the probability to get the disease is higher than in the population on the average.
Secondary coxarthrosis happens in an already altered joint as a consequence of any primary disease (for example, inflammation or trauma).This large group includes all possible causes of coxarthrosis and all risk factors. They can also be divided into several large groups.
1st Cause: Hereditary Factors
There are many hereditary diseases that may lead to coxarthrosis. As a rule, these are the conditions involving deterioration of connective tissue (ligaments, bones and joints), or collagenosis diseases, for example, Stickler syndrome.
2nd Cause: Age
Age is one more important risk factor. In younger people (under 30-35 years), this disease is very rare. Later, at 40-45 years it affects about 2-3 % of the population (the U.S. statistics). But then, after 65 years, the number of people with osteoarthrosis of the hip increases dramatically: at the age of 45-65 years, almost one third (30%) can suffer of the condition, and at the age of 65-70 years, the probability of degenerative osteoarthritis increases to 70 -75% or more! In other words, most of elderly have some signs of the degenerative joint disease, and with a high degree of probability, it can be hip arthrosis.
3rd Cause: Dysplasia
Hip dysplasia is a congenital joint disorder of the joint that has its origin in underdevelopment of the articular bones and ligaments, so that such children often develop subluxations and dislocations of the femur head.
Some people may have dysplasia and not even know, until they found it by accident, for example, when having X-Rays.
These patients can develop osteoarthritis caused by dysplasia. Mostly, it occurs in women from 25 to 55 years. This happens due to the reduced physical activity that helps the joint to work normally. In young women, the disease can develop during pregnancy and after childbirth, while in mature and elderly people it caused by decrease in physical activity after retirement.
So, if you know that you have dysplasia of the hip joints, you should, at least once a year, to see an orthopedist and have an examination including X-Rays, and very carefully follow doctor’s instructions: to avoid physical activity, such as weight lifting, but, at the same time, to do useful exercises that strengthens the hip (skiing, swimming, etc.).
4th Cause: Obesity
This is one of the most important risk factors contributing to the development of arthrosis, mainly of the knee, and, also, the hip joint. Indeed, all the extra 5-10-20 kg not needed to the body, literally, lying about like so much dead (and heavy!) weight and overloading the hip joints.
Under the circumstances, cartilage cannot withstand such heavy loads, and is not able to recover even at rest!
5th Cause: Metabolic Disorder
Many diseases and conditions associated with metabolic disorder can greatly affect the blood supply and nutrition of joint cartilage, and, unfortunately, not for the better.
Unlike the other tissues, the cells that produce the cartilaginous matrix – chondrocytes –get nutrients not from blood vessels, but directly from synovial fluid. This is a very subtle biochemical mechanism that can be violated easily, which often happens.
Diseases such as diabetes mellitus, ochronosis, primary and secondary gout, hemochromatosis, Wilson disease, as well as the lack of female sex hormones (estrogens) in menopause, can become the culprits of joint disorders.
Since estrogens regulate metabolism in bones, ligaments, joints and generally in connective tissue, the lack of these hormones can also become a trigger for the development of the disease.
6th Cause: Injuries and Surgeries
Very often injuries of the joint, that sometimes require surgery, contribute to the occurrence of coxarthrosis. As after such events, the joint becomes a bit “defective” (in the medical sense), deterioration of the cartilaginous tissue of the joint can begin due to any, even a weak risk factor, and, then, degenerative osteoarthrosis develops.
That is why, if you had a trauma or surgery in the hip area, you need to be especially careful choosing your lifestyle and avoid unfavorable factors described in this article, as much as you can.
7th Cause: Inflamations (coxitis)
The hip joint, like other parts and organs of our body, can be prone to inflammation. Inflammation of the joint (coxitis) can result from infection. In this case, the disease develops with massive damage of joint cartilage, and recovery can take quite a long time and, as a result, secondary coxarthrosis may begin.
In some cases, inflammation can occur not because of microorganisms – it is called aseptic inflammation. This inflammation often results from autoimmune disorders that can be caused by such diseases as systemic lupus erythematosus (SLE) or rheumatoid arthritis (RA).
8th Cause: Overloads
Sports and physical work associated with high load on the joint, including standing at work without the possibility to sit down and “unload” the hip joints, can also contribute to the development of coxarthrosis.
Why is this happening? It is possible, because the delicate cartilage tissue is not intended to be exhausted by constant load or jumping for 18-20 hours a day. Unceasing movements in the joint together with a high load lead to cartilage wears out very quickly, whilst the rest time seems insufficient for joints to recover.
9th Cause: Environmental factors
Let’s slow down before saying that the “bad ecology” is what always blamed when the true cause of the disease cannot be found. In fact, many external factors can actually facilitate developing of coxarthrosis. These include, for example, poisoning with salts of heavy metals that is not uncommon in some cities.
Furthermore, such “trivial” things like smoking and drinking alcohol can also become the main triggering factor that contributes to the development of the disease. So, sometimes, it makes sense to do tests in order to reveal intoxication with harmful substances and, at the same time, quit smoking. In any case, your body will be thankful for this!
Symptoms of coxarthrosis are pronounced, so diagnosing is not difficult. However, you should remember that the symptoms of coxarthrosis depend on the degree of the disease. The main signs of the disease include:
- Pain in the joint, not passing even while rest, and also nocturnal pains. The pain intensifies even with little physical efforts and can go into the groin, knee joint, shin, and hip.
- Constant tension of the pelvic girdle muscles or hip muscles.
- Stiffness and significant limitation of joint mobility.
- Limping while walking.
- Crackling or snapping joints.
- Over time, the limb with the diseased becomes shorter and its muscles atrophy.
- Deformation of the joint.
The symptoms of bilateral, or symmetric, coxarthrosis are the same, but they are present in the both extremities. A specific feature is that the pathological process extends to the lumbosacral spine. Minor movements and lameness lead to the spine deflection and, over time, protrusion of intervertebral discs and bending of the spinal column occurs.
There are three degrees of coxarthrosis of the hip joint.
Coxarthrosis of the 1st degree is characterized by minimal changes in the joint. But the first signs of disorder appear already in this period. The joint sores after physical activities, such as long walking, or running. A pain is localized in the hip region or, rarely, in the thigh and knee. The condition can be improved while you rest and pain disappears. Movement range is not limited, gait is not affected, and muscles are not atrophied. X-Rays show bone growths that do not extend beyond the joint lip. There is a slight narrowing of the joint gap, whilst the other components of the femur have no changes.
Coxarthrosis of the 2nd degree: Pain intensifies significantly and its duration increases. Pain in the knee and inguinal areas is also possible. Lameness during prolonged walking is developing. There is a limitation of movements: it is impossible to move the hip to the side and turn it inward: the muscles do not work properly anymore. With the help of an X-Ray, it is possible to reveal bone growths that extend beyond the acetabular to its inner and outer boundaries. The head of the femur increases in size, shifts relative to the acetabulum, and its surface becomes rough. Cysts may appear. The joint gap is unequally narrowed all over.
Coxarthrosis of the 3rd degree: Pain is permanent and does not pass at rest and at night. Walking without a cane is hardly possible. Muscles of the thigh, calf and buttocks significantly atrophy. Due to this, the diseased limb becomes shorter. To compensate this, the patient walks on his toe, which leads to a significant increase in the load on the affected joint. X-Rays demonstrate massive growths of bone tissue on the head of the femur and the acetabulum, and a thickening of the cervix. The joint gap is severely narrowed.
Hip joint arthrosis can be diagnosed by a practicing doctor only with the help of X-ray techniques. The examination helps to define the degree of disease development and its etiology.
The first thing to pay attention to is doctor’s qualification: it matters a lot for disease diagnostics. Pretty often, a specialist develops the plan for spine treatment forgetting about hip joint examination and losing precious time.
Today, the following ways of diagnostics are used and considered to be the most informative:
- X-ray examination. It allows visualizing the state of hip head and reveals the symptoms of osteophyma.
- Ultrasound examination. This examination is necessary to define the stage of disease and the localization of degenerative-dystrophic source.
- Computer tomography or magnetic-resonance imaging Most often, MRI is preferred due to the absence of X-ray radiation and detailed view. The apparatus allows performing scanning layer by layer, reveal the stage of disease and find it out at early stages of development.
Patients should understand that coxarthrosis is a progressing disease. Even if it’s revealed at early stages and treated with medicaments, there’s no 100% guarantee that it’ll be eliminated fully. In most cases, the disease can be paused, but practice shows the mechanism of its development restarts within 5-10 years.
At the 1st stage of disease doctors prefer conservative treatment and apply different drugs and products (non-steroid anti-inflammatory medications, neuromuscular relaxants, cartilage protectors and other drugs).
NSAIDs (Non-steroid anti-inflammatory drugs) — are good pain-killers for coxarthrosis that reduce swelling and inflammation of the joint relieving pain.
Miorelaxants also reduce muscular spasm, stimulate blood flow, and cartilage protectors contribute to restoration of defected cartilage tissue.
These medications can be used as pills and injections depending on the degree of pain and doctor’s prescriptions.
Physical therapeutic methods are also important for coxarthrosis treatment (laser therapy, medicinal baths, acupuncture, mud treatment, massage, and gymnastics).
Exercises should be figured out very accurately by a specialist only so that not to traumatize the damaged joint.
At the first and the second stages of disease, arthroscopic debridement is used – it’s a surgical invasion during which tiny destroyed cartilage particles are removed. It allows reducing pain and constraint in the joint.
Juxtarticular osteotomy is a surgical invasion when the hip bone is cut in certain places and is re-joined under some certain angle, which allows decelerating development of coxarthrosis.
Surgical treatment of coxarthrosis
When the disease reaches the third stage, joint tissues hardly react to restorative therapy. Patient experiences permanent pains, and the ability to move is almost lost. At this stage, there’s no point to use cartilage protectors for treatment – it cannot be cured with conservative methods. In such cases, the doctor can decide to treat coxarthrosis with the help of an operation.
Why the operation cannot be avoided in 99% cases? As a rule, pain appears when the joint already has the 2nd stage of destruction. This is when nothing except joint removal can help. In other words, the main peculiarity of hip joint arthrosis is that it isn’t usually diagnosed at early stages, because a patient has no complaints.
Surgical treatment of coxarthrosis presupposes performing one of the following operations:
- Arthroplastics – modeling of joint surfaces. To perform this operation, a doctor needs to make an interlay that replicates cartilage tissue. It can be made either of synthetic materials, or with patient’s own tissues.
- Endoprosthetics. This operation is made in case of bilateral arthrosis of hip joint. During the operation, the hip joint is fully replaced. This surgery doesn’t imply cutting of muscles, so restoration after it is relatively quick. This and the above mentioned variants allow saving movement of the hip joint. Osteotomy is an operation that presupposes cutting bones, eliminating deformations and joining them the most beneficial way. In some cases, partial movement of joints can be preserved.
- Arthrodesia is the operation during which joint surfaces are interconnected rigidly with the help of plates and screws. This way, movement of the joint is reduced or fully eliminated. It is performed to restore at least the supporting function of legs and joints. This method is used in cases when all other options are impossible, for instance, if there’re no contraindications, or when the hip joint is seriously deformed.
Endoprosthetics for coxarthrosis
After endoprostetics operation for coxarthrosis, movement of joints is totally restored, pain subsides, and life quality is improved considerably. At the same time, the artificial joint cannot totally replicate the real one, and a patient has to face some restrictions. For example, it’s prohibited to do squats – it increases the risk of joint misplacement. Besides, one out of ten patients faces weak or moderate pain after the operation, but it can be helped with pain-killers, compresses and other means. Unfortunately, doctors cannot always understand why some patients still face pain after surgical treatment. However, the vast majority of people feel much better after the operation.
Sometimes, after surgical treatment of coxarthrosis, one leg becomes longer than another, but it can be corrected with the help of special inner soles.
Most often, artificial joints made of metal and plastics are used – it can be a metal sphere and a plastic jack socket (hip joint is a ball and socket joint where one surface is ball-like, and another is incurvate and is often called “socket”). More active young patients can have ceramic and plastic joints implanted (a ceramic ball and plastic socker), or joints made of ceramics only, or (in rare cases) – made of metal only.
Preparation for surgery
Prior to the operation, a doctor decides which joint should be implanted. Besides, two-three weeks before the surgery, the patient should go through detailed examination. For example, blood analysis, X-ray of the hip damaged by coxarthrosis, urine analysis and electrocardiography.
Besides, a patient should also be examined by a dentist and, if necessary, go through dental treatment. Some dental problems are connected with a high risk of developing an infection after the operation.
In some clinics, patients also can consult with their physicians and ask how to put clothes on, wash oneselves and perform daily activities at home. Before the operation, a specialist can recommend patient bying some devices that will help to move around and perform usual tasks.
Since this operation is usually performed under general anesthesia, a patient isn’t allowed to drink and eat in the morning before it.
After the operation
After the surgery, most patients stay in the hospital for 4-8 days. During this time, they start walking and learn to climb the stairs and perform simple exercises which will promote recovery process. In 6-12 weeks after the surgery, a patient will have to go through examination for the doctor to make sure that recovery process is going well.
Possible side effects after coxarthrosis operation:
- Thrombosis of deep veins. The risk of thrombosis can be reduced with the help of compression stockings, blood thinners and some other means;
- embolia of lungs – a disease during which the blood clots formed in veins advance into lung vessels. Luckily, this is a rare complication that can be easily dealt with by anticoagulants;
- Misplacement of artificial joint happens less often than in one case out of twenty. These patients need one more operation to put the joint on its place;
- Infection. Although doctors take all necessary measures to perform the operation in safe and sterile conditions, one patient out of hundred develops infection after hip joint replacement. Infection diseases are easily treated, but artificial joints have to be removed and re-implanted after treatment of infection;
- Weakening of the artificial joint. Most often, it takes place 10-15 years after the operation. Weakening of the new joint is typically connected with thinning of bone around the implant, which reduces the risk of fractures;
- Bleeding and hematomas. As a rule, bleeding ceases two days after the operation, but sometimes it continues, and blood collects under the skin. In some cases, simple operations are required to remove the collected blood.
First two-three months after the operation a patient should move accurately to avoid misplacement of the new joint. However, it doesn’t mean that the patient should move as less as possible – vice versa, muscles should be strengthened to make the joint more flexible. During 4-6 weeks after the operation, patients usually walk resting against a walking pole or crutches. During first few months, patients aren’t recommended to use bicycle, run over solid surfaces and perform sports that require sudden turns and squats – such as tennis and squash. Those who have hip joints replaced should obtain from sports connected with a high risk of falling – for instance, mountain skis.
Generally, people with a new joint can live active and fully-fledged lives without experiencing pain for years. In 80% of patients, artificial joints serve for at least twenty years.