Osteoarthritis of the hip joint, medically known as coxarthrosis, is a degenerative disease of the hip joint, which lies between the pelvis and the thigh bone.
The head of the thigh bone lies in a hollow, the hip joint socket (acetabulum), which is formed by the ilium , ischium and pubic bone.
Cartilage is a whitish, shiny and water-rich tissue that ensures that movements are smooth, fluid and painless and that there is no direct friction between the bones. With wear and tear and over time, this layer of cartilage tends to become thinner and thinner, which the human body reacts to with bone changes:
- Formation of bony outgrowths (osteophytes) on the outer edge of the joint to increase the contact area between bones;
- Change in bone consistency: locally increased calcium content, while other sites remain almost calcium-free.
In the early stages of the disease, the cartilage is still present but has become thinner, while in the advanced stages it is almost completely absent and the bones “rub” together with movement. In this situation, the friction of the bones creates an extremely painful inflammation of the joint, which limits movements because it can be felt with every step. This disease mainly affects older people, especially women over the age of 50 and men over the age of 65-70. It rarely affects people younger than 40. The hip joint is a nut joint (subtype of ball joint) and has remarkable range of motion; the possible range of motion is even greater with a bent knee and the following values can be achieved:
- Diffraction: up to approx. 140-150°
- Elongation: up to 20°
- Abduction movement: up to 80°
- Outward rotation: up to 90°
- Inward rotation: up to 35-40°
Osteoarthritis usually occurs on both sides, but joint wear is greater on one side of the hip.
What are the causes of coxarthrosis?
There is no real cause of coxarthrosis, but there are a variety of factors that favor the onset of the disease:
- Age is certainly one of the most important aspects, because osteoarthritis of the hip is practically non-existent in healthy young people.
- The characteristic of the hip joint, i.e. its enormous mobility, makes it extremely susceptible to wear and tear; in addition, body weight increases bone compression.
- Hereditary predisposition represents another important risk factor, because patients suffering from osteoarthritis have at least one parent who also suffers from it.
- Obesity creates increased pressure on the joints; in fact, those with osteoarthritis between the ages of 50 and 60 are overweight.
- Intense sporting activities or physically demanding activities can put undue stress on the joint and cause premature wear and tear.
- Anatomical deformities, such as knock knees or bowlegs, can cause uneven weight distribution, which means that some points are subjected to greater stress than others.
- A drop in estrogen can promote the occurrence of this disease, which is why osteoarthritis of the hip often develops in women going through the menopause .
- A traumatic fracture at the level of the acetabulum or femoral head results in: a long period of immobilization, during which the cartilage is starved of nutrients, and increased stiffness, which in turn means excessive stress on the cartilage .
What are the symptoms of hip osteoarthritis?
The main symptoms include hip pain, which can radiate from the groin area through the inner front of the thigh to the knee. The painful twinges are felt at the beginning of the movement (start-up pain), subside after a few steps, and finally disappear completely when the movement stops. During longer walks, it can happen that the pain becomes acute again after 20-30 minutes, which can also happen with long periods of standing or physical exertion. In more advanced hip arthrosis, the pain also occurs at rest and especially at night. The patient has difficulty walking and sitting correctly; in fact, people suffering from arthrosis often sit in a pain-avoiding relieving posture on the healthy hip. Climbing down stairs is becoming increasingly problematic, Putting on your shoes, crossing your legs, getting up from the toilet. The pain is particularly intense in the morning after the patient gets up, but should subside after about half an hour. The patient suffering from osteoarthritis of the hip assumes an oblique relieving posture to avoid the pain, which overloads the healthy hip and pelvis on the other side; he also walks with his back bent to the side.
How is hip arthrosis diagnosed?
Based on a detailed questioning of the patient (anamnesis) and a thorough physical examination, the doctor must analyze exactly where the pain occurs, what movements it is triggered by and on what occasions and times of the day it becomes noticeable. Tests to detect osteoarthritis of the hip involve passive inward rotation and extension of the joint, i.e. bringing the knee behind the body. If there is osteoarthritis of the hip joint, mobility and strength are limited because of the sometimes terrible pain. An X-ray examination is particularly recommended as an imaging method for diagnosing hip arthrosis, because it shows the size of the joint space, i.e. the distance between the femur and the hip socket. The X-ray also shows bone changes, such as:
- Bone protrusions (osteophytes);
- Densification of the bone tissue under the cartilage layer (subchondral sclerotherapy);
- bone thinning.
Differential diagnosis The doctor must rule out the following diseases:
- Cruralgie ,
- groins ,
- inguinal hernia,
- hip fracture ,
- hip dislocation,
- muscle tear of the straight thigh muscle (rectus femoris),
Which therapy helps with hip arthrosis?
There are many treatment options for osteoarthritis of the hip, depending on the stage of the disease. Responsible specialists are physiatrists and orthopaedists; the latter has the advantage that it can also be used surgically. Over time, the arthrosis can stop or deteriorate, but the anatomical situation cannot improve spontaneously. Medicine has the task:
- to relieve the pain;
- improve the range of motion of the joint;
- enable the patient to carry out all daily activities.
If the cartilage has been worn away but is still present, conservative therapy can prevent or slow down the progression of the degenerative process; In this phase, a change in lifestyle is advisable if these are responsible for the occurrence of the disease:
- if the patient leads a sedentary life and sits a lot, he should start regular physical activity;
- those who work physically hard jobs should do less strenuous work;
- Overweight people should start a diet to lose weight.
Physiotherapy can help improve joint mobility, reduce or eliminate pain, and help the patient return to daily activities. When the cartilage is completely worn away and the bones rub against each other, the only remedy is surgery, in which an artificial hip joint is inserted. Physiotherapy and rehabilitation for osteoarthritis of the hip Physiotherapy is essential for successful treatment of osteoarthritis. This includes:
- physical therapies such as magnetic therapy , ultrasound therapy and Tecar therapy that penetrate into the interior of the joint,
- active and passive mobilization ,
- heat and cold treatment,
- Physiokinesiotherapy or gymnastic exercises to improve strength, flexibility and balance,
- water aerobics ,
- Crutches or other aids
- dietary supplements (glucosamine and chondroitin),
- weight loss.
In some cases, a visit to an orthotist (to purchase orthotics that correct foot position) or a nutritionist (to lose weight) may be beneficial. Some sports are not recommended because they make hip problems worse, such as running.
Medicines and natural remedies
The so-called non-steroidal anti-inflammatory drugs , NSAIDs for short, are the first choice in the treatment of osteoarthritis of the hip; they relieve pain and reduce inflammation. Today, the gastrointestinal symptoms that occur as a side effect of NSAIDs can be significantly reduced by taking a gastric protective agent, a proton pump inhibitor (eg misoprostol), at the same time. By using selective inhibitors of the enzyme COX – 2 instead of other NSAIDs, gastrointestinal complications decrease. Natural remedies include hyaluronic acid infiltrations . These injections are injected into the joint using an ultrasound display because the hip is very low.
Surgery may be considered for advanced hip osteoarthritis with severe, disabling pain. The procedure involves replacing a new joint or performing arthroscopy of the hip.
The physiotherapist or treating doctor can make a recommendation for surgery. In this case, an orthopedist must be consulted, who will assess the case and give his expert advice. Newer procedures include transplanting growth factors and stem cells into the joint. The platelets contain growth factors that can be injected into the hip. There, the production of cells that promote joint repair is stimulated. The stem cells work in a similar way, they also stimulate the production of cells that can repair hip damage (e.g. cartilage cells or chondrocytes).
Nutrition plays a fundamental role in preventing the joint from being overstressed; a light and balanced diet will help reduce body weight.
To reduce the chance of osteoarthritis, one should maintain a normal body weight and avoid repetitive movements and risky activities that can lead to joint trauma, especially after the age of 40.
As you get older, certain activities should be discontinued or adjusted, but you should still remain active.
- Hip prosthesis implantation
- Risks and complications of a hip prosthesis
- Osteoarthritis or joint wear