The hip joint consists of two articulating bones, a femur and an ilium. The femoral head is inserted into the iliac cavity, thereby forming a movable hinge. This mechanism allows us to walk, squat and perform various movements, thanks to the rotational movements of the joint.
This is if a person is healthy. Normally, the contact points of the bones are covered with a layer of articular cartilage, consisting of strong, smooth and elastic tissue. This cartilage acts as a shock absorber when walking, and also distributes the load. It serves as a layer for perfect gliding of articulated bones. According to the type of Archimedes’ law, when a load arises on a joint, cartilage releases a lubricant called joint fluid. Once the load is eliminated, this grease is absorbed back by the cartilage.
And the stronger the load, the more lubrication will be released.
In order to provide the lubrication function for a long time, the cartilage must be elastic and stiff. Its stiffness is determined by the composition of collagen fibers.
They are quite elastic, intertwined in the form of a frame and contain molecules called proteoglycans (complex proteins). These molecules are responsible for the absorption and retention of water in the joint. There are also chondrocyte cells. All these components form a single complex, the basis of cartilage. Water, as part of cartilage, occupies about 80% of its mass.
With age, this figure decreases, which leads to a deterioration in the amortization properties of the joint. Joint fluid fills the entire free cavity of the joint and provides nutrition to the cartilage and its lubrication. Also, the joint cavity is surrounded by dense fibrous fibers, forming a capsule.
The role of muscle in joint control
Hip joints experience a lot of stress on themselves, so they are very susceptible to this disease. The surrounding muscles, the gluteal and femoral, also play a large role in the work of the hip joint.
With well-developed and strong these muscles, the proper functioning of the joint is ensured, since part of the load from the joint is redistributed to them. When running and walking, they also act as shock absorbers.
Therefore, the joints of people involved in sports, and strengthening the muscles of the buttocks and thighs, experience less stress. Also, a large amount of blood is pumped through the vessels of the muscles. The better it circulates around the joint, the more nutrients it receives.
The mechanism of the pathological process
Doa is not an inflammatory, dystrophic disease of the joints, of a chronic nature, with damage to the cartilage tissue of the bones articulating in it. The disease begins with thinning of the cartilage tissue. There is a gradual degeneration of cartilage tissue and premature aging of the joint. The elasticity of the tissues is lost, cracks and roughness appear on the articular surfaces. Sometimes the cartilage is erased, exposing the bone.
Then the articulating bones begin to rub against each other, without the presence of a “shock absorber”. With the loss of cartilage, bone tissue on the joint grows, and there is a persistent deformation with impaired functionality.
When the disease affects the hip bones, it is also called coxarthrosis, which is a pathological process leading to the destruction of the cartilage plates of the joint.
Distinctive features of DOA:
- cartilage destruction is degenerative-dystrophic in nature;
- bone tissue grows along the edges of the articular surfaces;
- the joint is deformed as a result of the above pathological processes.
Pathology can affect one joint, but both can be involved. Deforming osteoarthritis is primary and secondary. In the first case, the cause of the disease is possibly genetic, but is largely unknown to medicine. In the second case, doa occurs due to diseases of the musculoskeletal system.
Manifestation of the disease
The disease begins with the occurrence of pain during movement. It extends from the upper thigh to the knee. It manifests itself especially when walking. The pain increases with exertion, and after rest and rest subsides. In this case, after sleep, starting pain may occur.
Later, when a person spent some time in movement, she gradually subsides. If the disease is not treated, then a neglected state of the process and deformation of the joint will occur, in which it will lose its mobility. The pain syndrome will increase, it will be harder for a person to walk and have to take painkillers.
The disease is irreversible, therefore, it is impossible to restore the cartilage tissue. Usually, the pathological process develops slowly, but with time it can draw in other joints. Therefore, it is necessary to prescribe the right treatment in time.
Classification of the stages of the disease
Depending on the manifestation of the disease, it is divided into three stages:
- The first is when pain appears after physical exertion. After rest, pain in the joint goes away. The first symptoms of the disease, small bone growths around the outer or inner edge of the ilium, are visible on the x-ray. No visible deformations are visible. There is a slight and uneven narrowing of the joint space. The gait of a person is not broken, the hip joint is mobile.
- The second, when the pain intensifies and can give to the groin or thigh. The joint begins to bother even at rest. Lameness occurs when walking. This is a symptom characterizing that the disease is progressing. The function of limiting the abduction of the thigh is manifested. The strength of the femoral muscles decreases, and this leads to their malnutrition. The X-ray image shows more and more symptoms of DOA in the form of more bone growths that extend beyond the joint. The contours of the femur become uneven, it increases in size. The thigh neck expands and thickens. Bone cysts form in the hollow of the ilium. The femoral head moves up, and the joint space narrows by 25% of its height.
- The third stage is characterized by constant pain of an intense nature. Pain can bother even at night. A characteristic symptom is limited movement. Due to their inactivity, the muscles atrophy. The limb cannot be completely taken aside due to the limited mobility of the joint. Patients have to move with a cane. X-ray image shows strong growths of bone tissue, the neck of the femur is greatly expanded and shortened. The size of the joint space is significantly reduced.
Factors provoking the disease
According to statistics, the disease is more common in women after 45 years of age and occurs in almost every person after the age of 60.
Some doctors consider the cause of doa – a violation of the blood supply to the hip joint.
This is expressed by poor outflow of venous blood and impaired arterial flow. Tissue hypoxia occurs, that is, a lack of oxygen, as a result of which under-oxidized metabolic products accumulate. Some enzymes that have a destructive effect on cartilage lead to its degeneration.
Reasons for DOA:
- excess weight;
- work related to the load on the legs;
- incorrect posture;
- excessive load (weight lifting, running, jumping);
- metabolic disease;
- insufficient blood supply to the joint;
- hereditary factor;
- elderly age;
- joint inflammation;
- congenital dislocation of the hip;
- hip dysplasia;
Today, there are several types of diagnosis of DOA:
- X-rays . The most important and common diagnostic method. On the x-ray picture, the symptoms of changes and deformations of the hip joint are very clearly visible, damage to the cartilage and bone compaction underneath are noticeable. Shows the distance of the joint space. The downside of such an examination is that it is impossible to see soft tissues, such as the joint capsule, cartilage. Only bones are visible. This survey does not carry complete information.
- Ultrasound procedure. Actively used in the diagnosis of joints. Allows you to see the symptoms of changes in the soft tissues, which the x-ray does not see. Determines how thin the cartilage is.
- MR . Using the method of magnetic resonance imaging, you can get on the picture all the details of the joint. A very accurate method, therefore, is able to detect the disease in the early stages.
- Clinical blood test.
- Biochemistry . Includes analysis for rheumatic tests. It helps to distinguish between the inflammatory process and degenerative-dystrophic symptoms.
- Computed tomography . Advanced x-ray method. It is used when it is impossible to use magnetic resonance diagnostics, if there is, for example, an installed pacemaker.
- Reovasography . This is a method for diagnosing blood circulation in the limbs.
- Electromyography . A method for studying bioelectric potentials that occur in muscles when their fibers are excited, that is, registers muscle activity.
- Podography . This is a method of measuring the surface of the sole of the foot. Helps to identify disorders in the hip joint. With the wrong position of the joint and its pathology, a difference in the length of the legs is observed.
- Radionuclide scan of the joint. It determines the dynamics of the course of the disease and evaluates the blood supply.
Before making a diagnosis and prescribing treatment, the doctor must conduct a personal examination of the patient and analyze the data obtained from the prescribed examinations.
Basically, treatment is aimed at eliminating the pain syndrome and severe symptoms, which include a violation of the musculoskeletal system. When prescribing treatment, the age group of the patient, the features of the course of the disease, the general condition of the body and the stage of the disease are taken into account.
Patients are recommended a half-bed regimen during the period of exacerbation of the DOA. It is necessary to reduce the mechanical load on the affected hip joint. In the treatment of this disease, chondroprotectors are used that protect the cartilage and support its nutrition. Anti-inflammatory or analgesic drugs are prescribed to reduce pain. Also included in the diet are vitamins and various biostimulants that will stimulate metabolic processes in the tissues. The treatment may include compresses with dimexide on the area of the diseased joint. They have an analgesic effect. Therapeutic exercises and physical education are also useful.
Doa treatment includes physiotherapeutic procedures:
- ultrasound therapy;
- laser therapy;
Treatment is also aimed at improving blood circulation in the joint and normalizing its mobility. In the most neglected state, when the joint has lost its function, prosthetics are used.
Among all diseases of a degenerative-dystrophic nature, the pathology of the hip joint takes first place. The reason for this is a large load on the joints (long walking, running).