The hip joint (HJ) is a complex joint made up of several bones: the femur, lobe, ilium, and ischium.It is surrounded by periarticular bursae and a strong muscular corset, protected by subcutaneous fat and skin.
The ilium, ischium, and pubis make up the pelvis and are connected to the hyaline cartilage of the acetabulum.These bones unite until the age of 16.
A distinctive feature of the femoral joint structure is the acetabulum, which is only partially covered with cartilage, in the upper part and on the side.The middle and lower segments are occupied by the femoral ligament surrounded by fatty tissue and synovial membrane.
Reasons
Pain in the hip joint can cause damage to intra-articular elements or nearby structures:
- skin and subcutaneous tissue;
- muscles and ligaments;
- synovial bursae;
- oral lip (passing along the edge of the cartilage);
- articular surfaces of the hip or pelvis.
The disease is caused by inflammation in the joint area or damage to the integrity of its constituent structures.Most often, the disease occurs when an infection enters the joint cavity (infectious arthritis) and autoimmune disorders (rheumatoid and reactive arthritis).
Mechanical injuries are no less common, as a result of which epiphyses of bones, ligaments, synovial membranes and other tissues are damaged.Active people and athletes who experience high physical activity are more prone to injury.
Also, the risk group includes elderly people with pelvic bone pain due to degenerative-dystrophic changes of the cartilage, as well as children and adolescents during the period of hormonal changes.
Pain in the hip joint on the left or right side is caused by metabolic diseases - for example, diabetes, pseudogout and obesity.
A complete list of possible diseases is as follows:
- Perthes disease;
- arthrosis;
- Koenig's disease;
- diabetic arthropathy;
- pseudogout;
- Intermittent hydrarthrosis (continuous drop of the joint);
- chondromatosis;
- reactive, rheumatoid and infectious arthritis;
- juvenile epiphysiolysis;
- injuries.
Perthes disease
With Perthes' disease, the blood supply to the femoral head is disrupted, which leads to aseptic necrosis (death) of cartilage tissue.Children under the age of 14, mostly boys, are affected.
The main symptom of Perthes disease is constant pain in the hip joint, which increases when walking.Children often complain of leg pain and lameness.
At the initial stage, the symptoms are mild, which leads to late diagnosis, when an imaginary (intra-articular) fracture appears.The destructive process is accompanied by increased pain, swelling of soft tissues and stiffness of leg movements.The patient cannot externally rotate, rotate, flex, or straighten the pelvis.It is also difficult to move the leg to the side.
Violation of the autonomic nervous system is also observed: during heavy sweating, the feet become cold and pale.Sometimes the body temperature rises to subfebrile.
Note: In Perthes disease, the lesion may be unilateral or bilateral.In most cases, one of the joints is less affected and heals faster.
Arthrosis
Osteoarthritis of the hip joint is called coxarthrosis and is diagnosed mainly in elderly people.The disease develops slowly, but causes irreversible changes.The pathological process begins with the destruction of cartilage, which becomes thinner as a result of increased thickness and viscosity of the synovial fluid.
Development of coxarthrosis leads to joint deformation, muscle atrophy, and significant limitation of movements up to complete immobility.Arthritis pain syndrome has a wave-like (irregular) nature and is localized on the outer side of the thigh, but can spread to the hip, pelvis and lower back.
In the second stage of arthrosis, painful sensations cover the inner side of the thigh and sometimes go down to the knee.As the pain worsens, the pain in the hip gets worse and only sometimes subsides with rest.
Coxarthrosis can be primary and secondary.Primary coxarthrosis develops against the background of osteochondrosis or knee arthrosis.Medial coxarthrosis can be caused by hip dysplasia, congenital hip dislocation, Perthes disease, arthritis, and traumatic injuries (dislocations and fractures).
Koenig's disease
If there is pain on the side of the hip joint, cartilage death (necrosis) - Koenig's disease - may occur.Young men of 16-30 years of age often suffer from this disease, they complain of pain, reduced mobility and periodic "clogging" of the legs.
Koenig's disease develops in several stages: first, cartilage tissue softens, then hardens, and begins to separate from the joint surface of the bone.In the third or fourth stage, the necrotic area is rejected and enters the joint cavity.This leads to effusion (fluid) accumulation, stiffness of movement, and blockage of the left or right joint.
Reference: the presence of a "joint mouse" in the hip joint leads to the development of coxarthrosis.
Diabetic arthropathy
Osteoarthropathy or Charcot joint is observed in diabetes and is characterized by progressive deformity accompanied by various intensity of pain.Painful sensations are expressed, rather weak or completely absent, because the sensitivity of this disease to pathological changes in nerve fibers decreases sharply.
Diabetic arthropathy occurs during long-term diabetes and is one of its complications.It usually occurs in women whose treatment is incomplete or ineffective.It should be noted that hip joints are rarely affected.
Pseudogout
As a result of calcium metabolism disorders, calcium crystals begin to accumulate in joint tissues and chondrocalcinosis or pseudogout occurs.This disease got its name due to the similarity of symptoms with gout, which is distinguished by its paroxysmal course.
Acute and acute pain occurs suddenly: the affected area becomes red, swollen, and hot to the touch.An inflammatory attack lasts from a few hours to a few weeks, and then everything goes away.Chondrocalcinosis can cause pain on the left or right side of the pelvis.
In most cases, pseudogout occurs without an obvious cause, and even during the examination it is not possible to detect a disorder of calcium metabolism.Probably, the cause of the disease lies in the disturbance of local metabolism in the joint.In one hundred patients, chondrocalcinosis develops against the background of systemic diseases - diabetes, kidney failure, hemochromatosis, hypothyroidism, etc.
Synovial chondromatosis
Chondromatosis of the joints, or islet metaplasia of synovial cartilage, mainly affects the large joints of the hip.Most often, this pathology occurs in middle-aged and elderly men, but there are cases of congenital chondromatosis.
In chondromatosis, the synovial membrane becomes cartilage or bone tissue, resulting in the formation of 5 cm chondroma or bone bodies in the joint cavity.
The clinical manifestation of insular metaplasia is similar to arthritis: the patient is worried about pain in the pelvic bones, the mobility of the legs is limited, and a characteristic creaking sound is heard when moving.
Since chondromatosis is a dysplastic process with the formation of chondroma bodies, the occurrence of "articular mouse" cannot be ruled out.In this case, the "mouse" can get stuck between the articular surfaces of the bones, which leads to partial or complete blockage of the joint.The joint remains blocked until the chondromic body enters the capsule, and only after this movement is restored to its full extent.
Help: frequent or prolonged joint congestion can lead to the development of coxarthrosis.Complications of synovial chondromatosis are stiffness (contracture) and muscle atrophy.
Arthritis
Arthritis is a localized inflammation of the acetabulum and the articular surface of the femur.The damage to the hip joint is called coxitis, which is accompanied by a dull, aching pain in the back of the thigh and the color of the hip.
There are several types of arthritis, the most common type of arthritis in the hip joint is the infectious type.Other types are diagnosed more rarely.Why does infectious arthritis occur?The development of pathology begins after bacteria and viruses enter the joint cavity.
The clinical presentation of infectious arthritis may differ depending on the type of microorganism that causes it.However, there are 5 characteristic symptoms observed in all patients:
- pain in the joint of the right or left foot (bilateral damage may also occur);
- Swelling and swelling above the joint;
- redness of the skin;
- decreased motor skills;
- increase in body temperature.
At the beginning of the disease, patients experience severe pain, especially when standing up.The joint almost always hurts;pain makes it impossible to stand or sit.It should be noted that the infectious form of arthritis is always accompanied by fever, chills, headache, weakness and nausea.
Juvenile epiphysiolysis
The term epiphysiolysis literally means decay and destruction of the articular surface of the bone, more precisely, the cartilage covering it.A distinctive feature of this damage is the cessation of bone growth in length, which leads to asymmetry of the lower leg.
In adults, epiphysiolysis occurs when the epiphysis is fractured by displacement or rupture.Damage to the pineal gland in the growth zone is possible only in adolescence, so this disease is called juvenile.
Juvenile epiphysiolysis is an endocrine-orthopedic pathology based on an imbalance between growth hormones and sex hormones.These two groups of hormones are necessary for the normal functioning of cartilage tissue.
Predominance of growth hormones over sex hormones reduces the mechanical strength of the growth zone of the femur and leads to displacement of the epiphysis.The last part of the bone is located under and behind the acetabulum.
Typical symptoms of epiphysiolysis include pain on the right or left side of the thigh (depending on which joint is affected), lameness, and an unnatural foot position.The affected leg is turned outward, and the muscles of the hip, thigh, and leg atrophy.
Treatment
For the treatment of Perthes disease, chondroprotectors are prescribed, which promote the regeneration of cartilage, and angioprotectors, which are necessary for improving blood circulation.Complex therapy also includes massage, physical education, physiotherapy - UHF, electrophoresis with calcium and phosphorus, mud and ozokerite applications.
Patients with Perthes' disease are advised to lower the leg and use orthopedic devices (cast), as well as special beds to prevent deformation of the femoral head.
What to do and what medicines for arthrosis depend on the stage of the disease.The following remedies help relieve pain and slow down the pathological process in stages 1-2:
- non-steroidal anti-inflammatory drugs (NSAIDs);
- vasodilators;
- muscle relaxant to relax the muscles;
- chondroprotectors;
- hormonal (for severe pain);
- Ointments and compresses with anti-inflammatory or chondroprotective effect.
In stages 3-4, surgery is recommended for patients.
Koenig's disease can only be treated surgically;During arthroscopic surgery, the affected area of the cartilage is removed.
Treatment of diabetic arthropathy includes correcting the underlying disease – diabetes, wearing a special compression bandage, and taking medications.All patients, regardless of the stage of the disease, are prescribed antiresorptive drugs - bisphosphonates, as well as foods containing vitamin D and calcium.NSAIDs and corticosteroids are prescribed to reduce pain and inflammation.If there are infectious diseases, a course of antibacterial therapy is carried out.
There is no specific treatment for pseudogout;In case of exacerbation, anti-inflammatory drugs are prescribed.A large amount of fluid in the joint is an indication for an intra-articular puncture, during which the fluid is drained and corticosteroids are administered.
Chondromatosis of the hip joint requires mandatory surgical intervention, its size depends on the extent of the damage.If the number of chondromic bodies is small, they are removed by partial synovectomy (removal of the synovial membrane) or minimally invasive arthroscopy (through three punctures).Surgical treatment of advanced type of chondromatosis is possible only radical and is carried out with the help of open arthrotomy or complete (total) synovectomy.
Therapy of acute infectious arthritis includes the mandatory use of plaster in the area of the hip joint, the reception of various groups (NSAIDs, antibiotics, steroids).When a purulent process appears, a course of medical punctures is performed to sanitize the joint.
Treatment of minor epiphysiolysis is carried out only by surgery.During the operation, the closed reposition of the bones is carried out with the help of skeletal traction.Then the joint parts of the bones are fixed with pins and plastics.
In particular, all pathologies of the hip joint are serious diseases that require mandatory medical supervision.Any injury after a fall or impact accompanied by severe pain, limited movement, and changes in joint configuration require immediate medical attention.If there is no traumatic trauma, but the pain occurs regularly in the joints of different intensity, it is necessary to make an appointment with a therapist or a rheumatologist and undergo an examination.