The hip joint (HJ) is a complex joint formed of several bones: femur, pubis, ilium and ischium. It is surrounded by periarticular sacs and a strong musculo-ligament 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 are joined before the age of 16.
A special feature of the femoral joint is the structure of the acetabulum, which is only partially covered with cartilage, in the upper part and on the sides. The middle and lower segments are occupied by adipose tissue and the femoral ligament, enclosed in the 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 sacs;
- acetabular lip (cartilaginous edge running along the edge of the acetabulum);
- articular surfaces of the femur or pelvis.
Pain in the joint area is caused by inflammation or violation of the integrity of its constituent structures. Pain most often occurs when the infection enters the joint cavity (infectious arthritis) and the autoimmune lesion (rheumatoid and reactive arthritis).
No less common are mechanical injuries, which have damaged bone epiphyses, ligaments, synovial membranes and other tissues. Active people and athletes who experience great physical effort are more prone to trauma.
Older people who have pelvic pain due to degenerative-dystrophic changes in cartilage, as well as children and adolescents in the period of hormonal changes, are also at risk.
Pain in the hip joint on the left or right side 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 hydrosis (occasional watery joint disease);
- chondromatosis;
- reactive, rheumatoid and infectious arthritis;
- juvenile epiphyseolysis;
- injury.
Perthes' disease
Perthes' disease disrupts the flow of blood to the head of the femur, which leads to aseptic necrosis (death) of cartilage tissue. Mostly children under 14 suffer, mostly boys.
The leading symptom of Perthes' disease is constant pain in the hip joint, which is intensified by walking. Often children complain that the leg hurts from the hip and start limping.
In the initial stages, the symptoms are mild, which leads to a late diagnosis, when there is already an intra-articular fracture. The destructive process is accompanied by increased pain, swelling of soft tissues and stiffness of limb movements. The patient cannot turn the thigh outward, rotate, bend or separate. It is also difficult to move the leg to the side.
Disorders of the autonomic nervous system are also noticed: the foot becomes cold and pale, while it sweats a lot. Sometimes body temperature rises to subfebrile values.
Reference: in Perthes' disease, the lesion may be unilateral or bilateral. In most cases, one of the joints suffers less and recovers faster.
Osteoarthritis
Osteoarthritis of the hip joint is called coxarthrosis and is diagnosed mainly 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 increasing the density and viscosity of the synovial fluid.
The development of coxarthrosis leads to joint deformity, muscle atrophy and significant restriction of movement to complete immobility. The pain syndrome in arthrosis has a wavy (non-permanent) character and is localized on the outside of the thigh, but it can spread to the groin, buttocks and lower back.
In the second stage of arthrosis, the pain covers the inner side of the thigh, and sometimes goes down to the knee. As the disease progresses, the pain in the hip intensifies and only sometimes disappears at rest.
Coxarthrosis is primary and secondary. Primary coxarthrosis develops on the background of osteochondrosis or osteoarthritis of the knee. 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 from the side in the area of the joint, the cause may be the death of the cartilage tissue (necrosis) - Koenig's disease. This disease is most often encountered by young people aged 16-30 who complain of pain, reduced range of motion and periodic "stuck" 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 phase, the necrotic area is rejected and enters the joint cavity. This is due to the accumulation of effusions (fluid), 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's joint, is observed in diabetes mellitus and is characterized by progressive deformity accompanied by pain of varying intensity. Painful feelings are expressed rather weakly or are completely absent, because the sensitivity in this disease is sharply reduced due to pathological changes in nerve fibers.
Diabetic arthropathy occurs in the long-term course of diabetes and is one of its complications. It most often occurs in women who have not received complete treatment, or have been ineffective. It should be noted that hip joints are extremely rarely affected.
pseudogout
As a result of violation of calcium metabolism, calcium crystals begin to accumulate in joint tissues and chondrocalcinosis or pseudogout develops. The disease got its name because of the similarity of symptoms with gout, which characterizes the paroxysmal course.
Acute and sharp pain appears suddenly: the affected area becomes red and swollen, it becomes hot to the touch. An attack of inflammation lasts from a few hours to a few weeks, then everything passes. With chondrocalcinosis, pain on the left or right side of the pelvis is possible.
In the vast majority of cases, pseudogout occurs without an obvious cause, and even during the examination, disorders of calcium metabolism cannot be detected. It is assumed that the cause of the disease lies in a local metabolic disorder within the joint. In one in a hundred patients, chondrocalcinosis develops against the background of existing systemic diseases - diabetes, kidney failure, hemochromatosis, hypothyroidism, etc.
Synovial chondromatosis
Chondromatosis of the joints, or metaplasia of the cartilaginous islets of the synovial membrane, mainly affects large joints, including the hip. This pathology most often occurs in middle-aged and older men, but there are cases of congenital chondromatosis.
In chondromatosis, the synovial membrane degenerates into cartilage or bone tissue, due to which chondromic or bone bodies up to 5 cm in size are formed in the joint cavity.
The clinic of insular metaplasia is similar to arthritis: the patient is concerned about pain in the hip area, the mobility of the legs is limited, and a characteristic squeak is heard during movement.
Since chondromatosis is a dysplastic process with the formation of chondromic bodies, the appearance of a "joint mouse" is not 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, and only after that the movements are fully restored.
Reference: Frequent or prolonged joint obstruction can cause coxarthrosis. Complications of synovial chondromatosis are stiffness (contracture) and muscle atrophy.
Arthritis
Arthritis is an inflammation localized on the articular surfaces of the acetabulum and femur. Defeat of the hip joint is called coxitis, which is accompanied by dull, aching pain in the back of the thigh and groin.
There are several variants of arthritis, most often the hip joint is affected by its infectious form. Other types 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 can vary depending on the type of microorganisms that cause it. However, there are 5 characteristic signs that are observed in all patients:
- right or left ankle pain syndrome (there is also a bilateral lesion);
- swelling and swelling over the wrist;
- redness of the skin;
- reduced motor ability;
- increase in body temperature.
At the beginning of the disease, patients feel severe pain, especially when getting up from a sitting position. The joint hurts almost constantly, 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 disintegration, destruction of the articular surface of the bone, ie the cartilage that covers it. The peculiarity of such damage is the cessation of bone growth in length, which leads to asymmetry of the lower extremities.
In adults, epiphysiolysis occurs with a fracture with displacement or rupture of the pineal gland. Destruction of the pineal gland 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 hormone and sex hormones. It is these two groups of hormones that are necessary for the normal functioning of cartilage tissue.
The predominance of growth hormone over sex hormones leads to a decrease in the mechanical strength of the growth zone of the femoral bone, and the pineal gland moves. The end part of the 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 unnatural position of the leg. The diseased leg is turned outwards, the muscles of the buttocks, thighs and lower legs atrophy.
Treatment
Chondroprotectors are prescribed to treat Perthes' disease to promote cartilage regeneration, and angioprotectors are necessary to improve blood circulation. Complex therapy includes massage, exercise therapy, physiotherapy - UHF, electrophoresis with calcium and phosphorus, mud and ozokerite applications.
Patients with Perthes' disease are recommended to relieve limb relief and use orthopedic aids (plaster), as well as special beds to prevent deformities of the femoral head.
What to do and what medications to take for osteoarthritis depends on the stage of the disease. The following drugs help relieve pain and slow down the pathological process in stages 1-2:
- nonsteroidal anti-inflammatory drugs (NSAIDs);
- vasodilators;
- muscle relaxants for muscle relaxation;
- chondroprotectors;
- hormonal (with severe pain);
- ointments and coatings with anti-inflammatory or chondroprotective action.
In stages 3-4, patients are shown surgery.
Koenig's disease is treated only surgically, during arthroscopic surgery the affected area of cartilage is removed.
Treatment of diabetic arthropathy includes correction of the underlying disease - diabetes mellitus, wearing special bandages to relieve stress 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. NSAIDs and corticosteroids are prescribed to relieve pain and inflammation. If there are infectious complications, a course of antibiotic therapy is performed.
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, during which fluid is pumped out and corticosteroid drugs are given.
Chondromatosis of the hip joint requires mandatory surgical intervention, the volume of which depends on the extent of the lesion. In 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 progressive chondromatosis can only be radical and is performed by open arthrotomy or complete (total) synovectomy.
Treatment of acute infectious arthritis includes mandatory placement of plaster on the hip joint, taking drugs of different groups (NSAIDs, antibiotics, steroids). With the development of the purulent process, a course of therapeutic punctures is performed to repair the joint.
Treatment of juvenile epiphysiolysis is surgical only. During the operation, a closed reposition of the bones is performed, for which skeletal traction is used. Then the joined parts of the bones are fixed with needles and a graft.
Absolutely all pathologies of the hip joint are serious diseases that require mandatory medical supervision. Any injuries after falls or blows, which are accompanied by severe pain, limited mobility and changes in the configuration of the joint, require urgent medical attention. If there were no traumatic injuries, and the joint regularly has pain of varying intensity, it is necessary to schedule an examination with a general practitioner or rheumatologist and perform an examination.