The hip joint (HJ) is a complex joint formed by several bones: femur, pubis, ilium and ischium. It is surrounded by periarticular pouches and a powerful musculoligamentous corset, protected by subcutaneous fat and skin.
The ilium, ischium, and pubis form the pelvic bone and are connected by hyaline cartilage in the acetabulum. These bones fuse together before age 16.
A distinctive feature of the femoral joint is the structure of the acetabulum, which is only partially covered by cartilage, on the top and sides. The middle and lower segments are occupied by adipose tissue and femoral ligament, surrounded by a synovial membrane.
Causes
Pain in the hip joint can cause damage to intra-articular elements or nearby structures:
- skin and subcutaneous tissue;
- muscles and ligaments;
- synovial pouches;
- acetabular labrum (cartilaginous rim that runs along the edge of the acetabulum);
- articular surfaces of the femur or pelvic bone.
Pain in the joint area is caused by inflammation or violation of the integrity of its constituent structures. Most often, pain occurs when an infection enters the joint cavity (infectious arthritis) and an autoimmune injury (rheumatoid and reactive arthritis).
No less common are mechanical injuries, whereby the epiphyses of bones, ligaments, synovial membranes, and other tissues are damaged. Traumatization is more prone to active people and athletes who experience high physical exertion.
Also at risk are the elderly who experience pelvic bone pain due to degenerative-dystrophic changes in cartilage, as well as children and adolescents during the period of hormonal changes.
Pain in the left or right hip joint is caused by metabolic diseases - for example, diabetes mellitus, pseudogout and obesity.
The complete list of possible diseases is as follows:
- Perthes disease;
- arthrosis;
- Koenig's disease;
- diabetic arthropathy;
- pseudogout;
- intermittent hydrathrosis (intermittent dropsy of the joint);
- chondromatosis;
- reactive, rheumatoid and infectious arthritis;
- juvenile epiphysiolysis;
- wound.
Perthes disease
With Perthes disease, the blood supply to the femoral head is disrupted, which leads to aseptic necrosis (death) of the cartilaginous tissue. Mainly children under 14, mainly boys, suffer.
The main symptom of Perthes disease is constant pain in the hip joint, which increases with walking. Often children complain that the leg is hurting in the hip and they start to limp.
In the early stages, symptoms are mild, which leads to late diagnosis, when an impression fracture (intra-articular) already occurs. The destructive process is accompanied by an increase in pain, swelling of soft tissues and stiffness of limb movements. The patient cannot turn the thigh outwards, rotate it, bend it or unfold it. It is also difficult to move the leg to the side.
Violations of the autonomic nervous system are also observed: the foot becomes cold and pale, while sweating profusely. Sometimes the body temperature rises to subfebrile values.
Reference: in Perthes disease, the lesion can be unilateral and bilateral. In most cases, one of the joints suffers less and recovers more quickly.
osteoarthritis
Osteoarthritis of the hip joint is called coxarthrosis and is mostly diagnosed in the elderly. The disease progresses slowly but causes irreversible changes. The pathological process begins with damage to 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 to complete immobility. Osteoarthritis pain syndrome is wavelike (non-permanent) and is located on the outside of the thigh, but can spread to the groin, buttocks, and lower back.
In the second stage of osteoarthritis, the pain covers the inner thigh and sometimes goes down to the knee. As the disease progresses, hip pain increases and only sometimes lessens at rest.
Coxarthrosis is primary and secondary. Primary coxarthrosis develops against the background of osteochondrosis or arthrosis of the knee. A prerequisite for secondary coxarthrosis can 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 of the joint area, the cause may be the death of cartilage tissue (necrosis) - Koenig's disease. This disease is most often encountered by young men aged 16 to 30 who complain of pain, decreased range of motion, and periodic "blocking" of the leg.
Koenig's disease develops in several stages: first, the cartilage softens, then it thickens and begins to separate from the articular surface of the bone. In the third or fourth stage, the necrotic area is rejected and enters the joint cavity. This is due to the accumulation of effusion (fluid), stiffness of movement and blockage of the left or right joints.
Reference: the presence of a "common mouse" in the hip joint leads to the development of coxarthrosis.
diabetic arthropathy
Osteoarthropathy, or Charcot joint, is seen in diabetes mellitus and is characterized by progressive deformity accompanied by pain of varying intensity. Pain sensations are expressed quite weakly or are completely absent, since sensitivity is drastically reduced in this disease due to pathological changes in the nerve fibers.
Diabetic arthropathy occurs with a long course of diabetes and is one of its complications. It occurs more often in women who have not received complete treatment or have been ineffective. It should be noted that the hip joints are affected extremely rarely.
pseudogout
As a result of a violation of calcium metabolism, calcium crystals begin to accumulate in the joint tissues, and chondrocalcinosis or pseudogout develops. The disease got its name because of the similarity of symptoms to gout, characterized by a paroxysmal course.
Sharp, sharp pain appears suddenly: the affected area turns red and swells, feels hot to the touch. A bout of inflammation lasts from several hours to several weeks, then everything passes. With chondrocalcinosis, pain is possible on either the left or right side of the pelvis.
In the vast majority of cases, pseudogout occurs without an obvious cause, and even during examination, disturbances of calcium metabolism cannot be detected. Presumably, the cause of the disease lies in a local metabolic disorder within the joint. In one patient in a hundred, chondrocalcinosis develops against the background of existing systemic diseases - diabetes, renal failure, hemochromatosis, hypothyroidism, etc.
synovial chondromatosis
Chondromatosis of the joints, or metaplasia of the cartilaginous islets of the synovial membrane, mainly affects the large joints, which include 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 cartilaginous or bony tissue, resulting in the formation of chondromic or bony bodies up to 5 cm in size in the joint cavity.
The clinic of insular metaplasia is similar to arthritis: the patient is concerned about pain in the hip area, mobility of the legs is limited, and a characteristic noise is heard during movements.
As chondromatosis is a dysplastic process with formation of chondromic bodies, the occurrence of an "articular rat" cannot be excluded. In this case, the "mouse" can get stuck between the articular surfaces of the bones, 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, after which movements are fully restored.
Reference: Frequent or prolonged joint blockage can lead to the development of coxarthrosis. Complications of synovial chondromatosis are stiffness (contracture) and muscle atrophy.
Arthritis
Arthritis is localized inflammation on the joint surfaces of the acetabulum and femur. The defeat of the hip joint is called coxitis, which is accompanied by dull, aching pain in the back of the thigh and in the groin.
There are several varieties of arthritis, most often the hip joint is affected by its infectious form. Other species are diagnosed much 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 are 5 characteristic signs that are seen in all patients:
- pain syndrome in the right or left leg joint (there is also a bilateral lesion);
- swelling and swelling over the joint;
- skin redness;
- decreased motor capacity;
- increase in body temperature.
Early in the disease, patients experience severe pain, especially when getting up from a sitting position. The joint almost constantly hurts, because of the pain it is 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 the disintegration, destruction of the articular surface of the bone, or rather, the cartilage that covers it. A distinctive feature of such damage is the cessation of bone growth in length, which leads to asymmetry of the lower extremities.
In adults, epiphysiolysis occurs with fracture with displacement or rupture of the epiphysis. Destruction of the epiphysis in the growth zone is possible only in adolescence, so the disease is called juvenile.
Juvenile epiphysiolysis is an endocrine-orthopedic pathology, which is based on an imbalance between growth hormones and sex hormones. It is these two groups of hormones that are essential for the normal functioning of cartilage tissue.
The predominance of growth hormones over sex hormones leads to a decrease in the mechanical strength of the growth zone of the femoral bone, and the epiphysis is displaced. The final section of bone is below and behind the acetabulum.
Typical symptoms of epiphysiolysis are pain on the right side of the thigh or on the left side (depending on which joint is affected), lameness, and an unnatural position of the leg. The diseased leg turns out, the muscles of the buttocks, thighs and legs atrophy.
Treatment
To treat Perthes disease, chondroprotectors are prescribed to promote cartilage regeneration, and angioprotectants are needed to improve blood circulation. Complex therapy also includes massage, exercise therapy, physiotherapy - UHF, electrophoresis with calcium and phosphorus applications, mud and ozokerite.
Patients with Perthes disease are recommended to unload the limb and use orthopedic devices (cast), as well as special beds to prevent femoral head deformity.
What to do and which medications to drink for osteoarthritis depends 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 relaxants to relax muscles;
- chondroprotectors;
- hormonal (with severe pain);
- ointments and compresses with anti-inflammatory or chondroprotective action.
In stages 3-4, patients undergo surgery.
Koenig's disease is only treated surgically, during arthroscopic surgery, the affected area of cartilage is removed.
Treatment of diabetic arthropathy includes correction of the underlying disease - diabetes mellitus, use of special discharge bandages and use of medication. All patients, regardless of the stage of the disease, receive antiresorptive drugs - bisphosphonates, in addition to drugs with vitamin D and calcium. To relieve pain and inflammation, drugs from the group of NSAIDs and corticosteroids 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 an intra-articular puncture, during which fluid is pumped out and corticosteroids are administered.
Chondromatosis of the hip joint requires mandatory surgical intervention, the volume of which depends on the extent of the injury. With a small number of chondromic bodies, they are removed by partial synovectomy (excision of the synovial membrane) or minimally invasive arthroscopy (through three punctures). Surgical treatment of a progressive form of chondromatosis can only be radical and is performed by open arthrotomy or complete (total) synovectomy.
Therapy of acute infectious arthritis includes the mandatory application of a plaster in the area of the hip joint, taking drugs of various groups (NSAIDs, antibiotics, steroids). With the development of a purulent process, a course of therapeutic punctures is carried out to sanitize the joint.
The treatment of juvenile epiphysiolysis is only surgical. During the operation, a closed replacement of the bones is performed, for which skeletal traction is used. Then the combined parts of the bones are fixed with pins and grafts.
Absolutely all pathologies of the hip joint are serious diseases that require mandatory medical supervision. Any injuries following falls or impacts, accompanied by severe pain, limited mobility, and changes in joint configuration, require emergency medical attention. If there have been no traumatic injuries and pain of varying intensity regularly occurs in the joint, it is necessary to make an appointment with a general practitioner or rheumatologist and have an examination.