The hip joint (HJ) is a complex joint formed by several bones: the femur, pubis, ilium, and iscium. It is surrounded by a periarticular bag and a strong muscle-ligament corset, protected by fat and subcutaneous skin.
The ilium, ischium, and pubis form the pelvic bone and are connected by hyaline cartilage in the acetabulum. These bones are united before the age of 16 years.
A distinctive feature of the femoral joint is the structure of the acetabulum, which is only partially covered with cartilage, at the top and at the sides. The middle and lower segments are occupied by adipose tissue and femoral ligaments, enclosed in synovial membranes.
cause
Pain in the hip joint can cause damage to intra-articular elements or nearby structures:
- skin and subcutaneous tissue;
- muscles and ligaments;
- synovial beg;
- acetabular lip (cartilaginous rim running along the edge of the acetabulum);
- articular surface of the femur or pelvic bone.
Pain in the joint area is caused by inflammation or violation of the integrity of its constituent structures. Often, pain occurs when infection enters the joint cavity (infectious arthritis) and autoimmune lesions (rheumatoid and reactive arthritis).
No less common are mechanical injuries, as a result of which the bone epiphysis, ligaments, synovial membranes and other tissues are damaged. Traumatization is more prevalent in active people and athletes who experience high levels of physical exercise.
Also at risk are the elderly who experience pain in the pelvic bones as a result of degenerative-dystrophic changes in cartilage, as well as children and adolescents during periods of hormonal changes.
Pain in the hip joint on the left or right is caused by metabolic diseases - for example, diabetes mellitus, pseudogout and obesity.
The full list of possible diseases is as follows:
- Perthes disease;
- arthrosis;
- Koenig's disease;
- diabetic arthropathy;
- pseudogout;
- intermittent hydrarthrosis (intermittent dropsy of the joints);
- chondromatosis;
- reactive, rheumatoid and infectious arthritis;
- juvenile epiphiseolysis;
- injuries.
Perthes disease
With Perthes disease, the blood supply to the femoral head is disrupted, leading to aseptic necrosis (death) of cartilage tissue. Most children under the age of 14, mostly boys, suffer.
The main symptom of Perthes disease is persistent pain in the hip joint, which increases with walking. Often, children complain that the legs hurt from the hips, and begin to drown.
In the early stages, symptoms are mild, leading to late diagnosis, when impact fractures (intra-articular) have already occurred. The process of destruction is accompanied by increased pain, swelling of soft tissues and stiffness of limb movements. The patient should not turn the thigh outward, twist, bend or bend it. It is also difficult to move the legs to the side.
Violations of the autonomic nervous system are also observed: the feet become cold and pale, while sweating profusely. Sometimes the body temperature rises to subfebrile values.
References: with Perthes disease, the lesions can be unilateral and bilateral. In most cases, one of the joints suffers less and recovers faster.
Arthrosis
Osteoarthritis of the hip joint is called coxarthrosis and is diagnosed primarily in the elderly. The disease progresses slowly, but causes irreversible changes. The pathological process begins with damage to the cartilage, which becomes thinner as a result of increased density and viscosity of synovial fluid.
The development of coxarthrosis leads to joint deformity, muscle atrophy and significant limitation of movement until complete immobility. The pain syndrome in arthrosis has a wave -like (non -permanent) character and is localized on the outside of the thigh, but can spread to the groin, buttocks and lower back.
In the second stage of arthrosis, the pain covers the inside of the thigh and sometimes goes down to the knee. As the disease progresses, hip pain increases and only occasionally subsides during rest.
Coxarthrosis is primary and secondary. Primary coxarthrosis develops against a background of osteochondrosis or knee arthrosis. Prerequisites for secondary coxarthrosis may be hip dysplasia, congenital hip dislocation, Perthes disease, arthritis, and traumatic injuries (dislocations and fractures).
Koenig's disease
If the thigh hurts on the side in the joint area, the cause may be the death of cartilage tissue (necrosis) - Koenig's disease. The disease is most often found in young men aged 16-30 years who complain of pain, decreased range of motion and periodic "jamming" of the legs.
Koenig’s disease develops in several stages: first, the cartilage softens, then thickens and begins to separate from the articular surface of the bone. In the third or fourth stage, the necrotic area is rejected, and it enters the articular cavity. This is due to accumulation of effusion (fluid), stiffness of movement and blockage in the left or right joint.
Reference: the presence of "joint rats" in the hip joint leads to the development of coxarthrosis.
diabetic arthropathy
Osteoarthropathy, or Charcot’s joint, is observed in diabetes mellitus and is characterized by progressive deformity accompanied by pain of varying intensity. Pain sensations are expressed rather weakly or completely absent, as sensitivity is sharply reduced in the disease due to pathological changes in nerve fibers.
Diabetic arthritis occurs with prolonged diabetes and is one of its complications. It most often occurs in women who do not receive full treatment, or it is ineffective. It should be noted that the hip joint is affected very rarely.
pseudogout
As a result of violations of calcium metabolism, calcium crystals begin to accumulate in the articular tissues, and chondrocalcinosis, or pseudogout, develops. The disease gets its name because of the similarity of symptoms with gout, which is characterized by a paroxysmal course.
Acute and sharp pain appears suddenly: the affected area becomes red and swollen, becoming hot when touched. The attack of inflammation lasts from a few hours to a few weeks, then it all passes. With chondrocalcinosis, pain may be on the left or right side of the pelvis.
In most cases, pseudogout occurs for no apparent reason, and even during examination, disturbances of calcium metabolism go undetected. Presumably, the cause of the disease lies in local metabolic disorders in the joints. In one patient out of a hundred, chondrocalcinosis develops against the background of pre -existing systemic diseases - diabetes, renal failure, hemochromatosis, hypothyroidism, etc.
Synovial chondromatosis
Joint chondromatosis, or metaplasia of small islets of synovial membrane cartilage, affects primarily large joints, including the hip. Most often, this pathology occurs in middle -aged and elderly men, but there are cases of congenital chondromatosis.
With chondromatosis, the synovial membrane degenerates into cartilage or bone tissue, as a result of which chondromic bodies or bones up to 5 cm in size are formed in the joint cavity.
The clinic of insular metaplasia is similar to that of arthritis: the patient is concerned about pain in the hip area, leg mobility is limited, and characteristic irritation is heard during movement.
Since chondromatosis is a dysplastic process with chondromic body formation, the occurrence of "articular rats" is not excluded. In this case, the "rat" can get stuck between the articular surfaces of the bone, which will lead to partial or complete blockage of the joint. The joint remains blocked until the chondromic body enters the lumen of the capsule, and only after this the movement is fully restored.
References: frequent or prolonged joint congestion can trigger the development of coxarthrosis. Complications of synovial chondromatosis are stiffness (contraction) and muscle atrophy.
Joint pain
Arthritis is a localized inflammation of the articular surfaces of the acetabulum and femur. Defeat of the hip joint is called coxitis, which is accompanied by dull aches and pains in the back of the thighs and groin.
There are several types of arthritis, often the hip joint is affected by its infectious form. Other species are diagnosed less frequently. Why does Infectious Arthritis Occur? The development of pathology begins after bacteria and viruses enter the joint cavity.
The clinical picture of infectious arthritis may differ depending on the type of microorganism that causes it. However, there were 5 hallmarks observed in all patients:
- pain syndrome in the joints of the right or left leg (there are also bilateral lesions);
- swelling and puffiness in the joints;
- redness of the skin;
- decreased motor ability;
- increase in body temperature.
At the onset of the disease, the patient experiences severe pain, especially when getting up from a sitting position. The joints are almost always sore, because the pain is impossible to stand or sit. It should be noted that this form of infectious arthritis is always accompanied by fever, chills, headache, weakness and nausea.
Juvenile epiphysis
The term epiphysiolysis literally means the rupture, destruction of the articular surface of the bone, or rather, the cartilage that covers it. A special feature of such damage is the cessation of long bone growth, which leads to asymmetry of the lower extremities.
In adults, epiphysiolysis occurs with fractures with displacement or rupture of the epiphysis. Destruction of the epiphysis in the growth zone is only possible in adolescence, so the disease is called juvenile.
Juvenile epiphysiolysis is an endocrine-orthopedic pathology, which is based on an imbalance between growth hormone and sex hormones. Both of these groups of hormones are essential for the normal functioning of cartilage tissue.
The dominance of growth hormone over sex hormones leads to a decrease in the mechanical strength of the femoral bone growth zone, and the epiphysis is displaced. The tip portion of the bone is below and behind the acetabulum.
Common symptoms of epiphysiolysis are pain in the right side of the thigh or on the left side (depending on the joint affected), lameness, and unusual foot position. The diseased leg turns outward, the muscles of the back, thighs and lower legs atrophy.
Treatment
To treat Perthes disease, chondroprotectors are prescribed to promote cartilage regrowth, and angioprotectors are needed to improve blood circulation. Complex therapy also includes massage, exercise therapy, physiotherapy - UHF, electrophoresis with application of calcium and phosphorus, mud and ozocerite.
Patients with Perthes disease are recommended to unload the limbs and use orthopedic devices (plaster casts), as well as special beds to prevent femoral head deformities.
What to do and what medications to take for arthrosis depends on the stage of the disease. The following remedies help relieve pain and slow down the pathological process at stages 1-2:
- nonsteroidal anti-inflammatory drugs (NSAIDs);
- vasodilator;
- muscle relaxants to relax muscles;
- chondroprotector;
- hormones (with severe pain);
- ointments and compresses with anti-inflammatory or chondroprotective action.
At stage 3-4, the patient is shown surgery.
Koenig’s disease is treated only surgically, during arthroscopic surgery, the affected cartilage area is removed.
Treatment of diabetic arthropathy includes correction of the underlying disease - diabetes mellitus, wearing a special unloading bandage and taking medication. All patients, regardless of the stage of the disease, are prescribed antiresorptive drugs - bisphosphonates, as well as drugs with vitamin D and calcium. To relieve pain and inflammation, medications from the NSAID and corticosteroid groups are prescribed. If there are infectious complications, a course of antibiotic therapy is carried out.
There is no specific treatment for pseudogout; anti-inflammatory drugs are prescribed for exacerbations. A large amount of fluid accumulated in the joint is an indication for intra-articular puncture, in which fluid is pumped out and corticosteroid medication is given.
Chondromatosis of the hip joint requires mandatory surgical intervention, the amount of which depends on the extent of the lesion. With a small number of chondromic bodies, it is removed with partial synovectomy (removal of the synovial membrane) or minimally invasive arthroscopy (through three punctures). Surgical treatment of progressive forms of chondromatosis can only be radical and is performed using open arthrotomy or complete synvectomy (total).
The therapy of acute infectious arthritis includes the mandatory use of plasters on the hip joint area, taking drugs of various groups (NSAIDs, antibiotics, steroids). With the development of the purulent process, a course of therapeutic punctures is carried out to clean the joints.
Treatment of juvenile epiphysiolysis is only through surgery. During surgery, closed repositioning of the bone is performed, for which skeletal traction is applied. Then the joint portion of the bone is fixed with pins and grafts.
Absolutely all pathologies of the hip joint are serious diseases that require mandatory medical supervision. Any injury after a fall or impact, which is accompanied by severe pain, limited mobility and changes in joint configuration, requires emergency medical treatment. In the absence of traumatic injuries, and pain of varying intensity frequently occurs in the joints, it is necessary to make an appointment with a general practitioner or rheumatologist and undergo an examination.