Arthritis of the hip joint is a disease associated with the destruction of the cartilage that covers the surface of the femoral head. With arthritis of the hip joint, patients are concerned about pain in the groin, hip or buttocks, stiffness and limited range of motion, difficulty walking, limping gait. A type of arthritis is diagnosed using ultrasound, X-ray, MRI of the hip joints, diagnostic puncture, and blood counts.
Arthritis of the hip joint (coxitis) is an inflammatory process, in which connective tissue is involved in the joint of the hip and femur. In arthritis, inflammation develops in the synovial membrane lining the articular cavity. However, if the patient does not receive timely and adequate treatment, coxitis quickly transforms into osteoarthritis of the hip joint, in which degenerative and destructive changes in the articular cartilage and subchondral bone occur. Chronic pain syndrome and dysfunction of the hip joint in arthritis not only limit the physical activity of patients but can also cause disability. Since arthritis of the hip joint can be part of articular syndromes of various etiologies, the true prevalence of the disease remains unknown. It is believed that the incidence of coxitis is second only to arthritis of the knee joint.
The hip joint is formed by the articulation of the cup-shaped acetabulum of the pelvic bone and the head of the femur. By the type of connection, it belongs to the spherical joints. The acetabular cavity and the femoral head are covered with hyaline cartilage. In the center of the glenoid cavity, there is a zone of loose connective tissue, which serves as a place of attachment of the ligament of the femoral head. A powerful ligamentous apparatus plays an important role in the stabilization and functioning of the hip joint. The hip joint performs complex functions of support and movement (flexion and extension, abduction and adduction of the lower limb, inward and outward rotation).
The generally accepted classification of coxitis has not been developed. In rheumatology, traumatology and orthopedics, arthritis of the hip joint is usually classified depending on the etiological and pathogenetic mechanisms, highlighting the following types:
According to the clinical course, arthritis of the hip joint can be acute (with the duration of the primary articular attack less than 2 months), protracted (up to 1 year), chronic (more than 1 year), recurrent (if a repeated joint attack occurs after a period of remission lasting at least 6 months).
Coxitis can be primary bone or primary synovial. Examples of primary synovial arthritis of the hip joint are rheumatoid and reactive arthritis.
Purulent arthritis of the hip and other joints can be a complication of injuries, wounds, diagnostic punctures of the joint, operations, as a result of which there is a direct infection of the joint cavity. In other cases, septic coxitis can develop with a breakthrough of a purulent focus from adjacent tissues (with phlegmon, osteomyelitis, etc.) or joint cavity metastatic infection from remote inflammatory foci (with furunculosis, tonsillitis, otitis media, pneumonia, etc.). In addition to infectious arthritis caused by nonspecific pyogenic flora, there are specific coxitis associated with tuberculosis, brucellosis, gonorrhea, syphilis.
Secondary aseptic arthritis of the hip joint can be associated with diseases such as psoriasis, systemic lupus erythematosus, Crohn’s disease, ankylosing spondylitis, etc. and are also aseptic.
Rheumatoid arthritis is characterized by a complex autoimmune mechanism of development; it is more common in individuals who are carriers of the HLA-DR1, DR4 antigen. The triggering factor can be viruses – herpes simplex, cytomegaly, mumps, measles, Epstein-Barr, respiratory syncytial, hepatitis, etc. Children with hip dysplasia, patients with hereditary heredity, obesity, are at risk for the development of arthritis. bad habits, traumatic dislocations of the hip, experiencing excessive physical exertion.
The most common forms of hip arthritis encountered in clinical practice are tuberculous and acute purulent coxitis. The rest of the forms are observed much less frequently.
With purulent coxitis, there is a rapid onset of the disease with a predominance of signs of general intoxication: fever, weakness, loss of appetite, sweating, headache. Local changes are significantly pronounced: the skin over the joint area becomes tense, hyperemic and hot to the touch. There is a sharp pain (shooting, throbbing), which increases even more with movement. Due to inflammatory infiltration and the formation of purulent effusion in the joint cavity, the shape of the latter changes significantly.
For other forms of arthritis of the hip joint, gradual development is characteristic. In the initial stages, dull, aching pains prevail in the groin area, on the outer side of the thigh, buttocks, which limit the range of motion or make it difficult to walk. Due to the stiffness of the hip joints, movements become stiff, uncertain, and the gait becomes limp (Trendelenburg gait). Most often, pain and stiffness in the hip joint occur after prolonged fixation in one position in an uncomfortable position, for example, when sitting or standing for a long time. Over time, patients may develop atrophy of the femoral and inguinal muscles, fibrous or bone ankylosis.
The manifestation of tuberculous arthritis is usually preceded by symptoms of tuberculous intoxication. As a result of specific inflammation, pathological dislocation of the hip, immobility of the hip joint, muscle atrophy and shortening of the limb often develop. In children, arthritis of the hip joint is more acute, with more pronounced inflammation symptoms.
Psoriatic coxitis is accompanied by a characteristic bluish-purple staining of the skin over the inflamed joint, pain in the lower spine. In rheumatoid arthritis, the hip joints are affected symmetrically. Progressive dystrophic changes in the joint eventually lead to secondary coxarthrosis.
When examining a patient with inflammatory lesions of the hip joints, one should not be limited to the formulation of a syndromic diagnosis; it is necessary to determine the root cause of arthritis. For this purpose, the nature and intensity of pain, the duration of the disease, and concomitant pathology are determined from the anamnesis. Besides, doctors should pay attention to the shape of the joints and the position of the limbs, muscle atrophy and contractures, gait, the ability to perform, and the amplitude of passive and active movements.
In addition, the methods of radiological diagnostics play a decisive role in the diagnosis of arthritis: X-ray of the hip joint, ultrasound, MRI, contrast arthrography, etc. To assess the nature of the inflammation, a diagnostic puncture of the hip joint under ultrasound guidance is performed. In some cases, in order to confirm the diagnosis, it becomes necessary to conduct diagnostic arthroscopy and biopsy of the synovial membrane of the hip joint.
With the help of laboratory methods, the origin of arthritis of the hip joint is clarified. If you suspect tuberculous arthritis, the patient needs to get take a tuberculin diagnosis.
Depending on the cause and stage of hip arthritis, its treatment can be carried out by a rheumatologist, surgeon, orthopedic traumatologist, phthisiatrician. In the acute stage, a plaster cast is applied to ensure maximum unloading and rest of the hip joint. During pharmacotherapy, it’s necessary to take into account the etiology of coxitis and may include taking NSAIDs, specific chemotherapy (for tuberculous arthritis), antibiotic therapy (for infectious arthritis), etc. According to indications, intra-articular injections of corticosteroids are performed. With purulent coxitis, a series of therapeutic punctures, lavage of the joint with antiseptic solutions, and flow drainage of the joint are performed.
After the relief of acute manifestations of hip joint arthritis, massage, therapeutic exercises and swimming, physiotherapy (magnetotherapy, ultrasound, UHF, paraffin therapy, mud therapy, etc.) are prescribed. It is recommended to use special devices to facilitate movement.
If conservative therapy is ineffective, surgical intervention (synovectomy, total hip replacement, arthroplasty, arthrodesis, arthrotomy, etc.) may be required.
The outcome of arthritis can be both slight stiffness and complete ankylosis of the hip joint. A complication of purulent arthritis can be infectious-toxic shock or sepsis. Timely and complete treatment minimizes dysfunction of the hip joint and prevents the development of osteoarthritis. In order to prevent arthritis, it is necessary to monitor the weight and to take seriously the treatment of any infections and concomitant diseases.
During the past 4 weeks……
1. How would you describe the pain you usually have in your hip?
2. Have you been able to put on a pair of socks, stockings or tights?
3. Have you been troubled by pain from your hip in bed at night?
4. After a meal (sat at a table), how painful has it been for you to stand up from a chair because of your hip?
5. Have you had any sudden, severe pain (shooting, stabbing, or spasms) from your affected hip?
6. Have you had any trouble getting in and out of a car or using public transportation because of your hip?
7. Have you been limping when walking because of your hip?
8. For how long have you been able to walk before the pain in your hip becomes severe (with or without a walking aid)?
9. Could you do the household shopping on your own?
10. Have you been able to climb a flight of stairs?
11. How much has pain from your hip interfered with your usual work, including housework?
12. Have you had any trouble with washing and drying yourself (all over) because of your hip?
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