The hip joint (HJ) is a complex joint made up of several bones: the femur, pubis, ileum, and ischium. It is surrounded by periarticular bags and a powerful musculo-ligament corset, protected by subcutaneous fat and skin.
The ileum, ischium and pubis form the pelvic bone and are connected by hyaline cartilage to 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 with cartilage, in the upper and lateral parts. The middle and lower segments are occupied by adipose tissue and the femoral ligament, enclosed in 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 bags;
- acetabular labrum (cartilaginous border running along the edge of the acetabulum);
- articular surfaces of the femur or pelvic bone.
Pain in the joint area is caused by inflammation or a violation of the integrity of its constituent structures. Most often, pain occurs when an infection enters the joint cavity (infectious arthritis) and an autoimmune lesion (rheumatoid and reactive arthritis).
No less common are mechanical injuries, as a result of which 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.
Elderly people who have pain in the pelvic bones due to degenerative-dystrophic changes in the cartilage are also at risk, as are 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 mellitus, pseudogout, and obesity.
The full list of possible diseases is as follows:
- Perthes disease;
- arthrosis;
- Koenig's disease;
- diabetic arthropathy;
- pseudogout;
- intermittent hydarthrosis (intermittent dropsy of the joint);
- chondromatosis;
- reactive, rheumatoid and infectious arthritis;
- juvenile epiphiseolysis;
- injury.
Perthes disease
With Perthes disease, the blood supply to the femoral head is cut off, which leads to aseptic necrosis (death) of the cartilage tissue. Mostly children under the age of 14 suffer, mostly boys.
The main symptom of Perthes disease is constant pain in the hip joint, which increases with walking. Quite often, children complain that the leg hurts in the hip and begin to limp.
In the early stages, symptoms are mild, which leads to late diagnosis, when an impression (intra-articular) fracture already occurs. 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 it, bend it or straighten 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: With Perthes disease, the injury 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 mainly diagnosed in the elderly. The disease progresses slowly, but causes irreversible changes. The pathological process begins with damage to the cartilage, which becomes thinner due to the increase in the density and viscosity of the synovial fluid.
The development of coxarthrosis leads to joint deformities, muscle atrophy and significant limitation of movement up to complete immobility. Pain syndrome in osteoarthritis has an undulatory (non-permanent) character and is localized on the outer side of the thigh, but can spread to the groin, buttocks and lower back.
In the second stage of osteoarthritis, the pain covers the inside of the thigh and sometimes goes down to the knee. As the disease progresses, the pain in the hip increases and only sometimes subsides at rest.
Coxarthrosis is primary and secondary. Primary coxarthrosis develops against the background of osteochondrosis or osteoarthritis 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 in 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 between the ages of 16 and 30 who complain of pain, reduced mobility and periodic "blocking" of the leg.
Koenig's disease develops in several stages: first the cartilage softens, then thickens and begins to separate from the articular surface of the bone. At the third or fourth stage, the necrotic area is pushed back and enters the joint cavity. This is due to the accumulation of effusion (liquid), stiffness of movement and blockage of the left or right joints.
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 seen in diabetes mellitus and is characterized by progressive deformity accompanied by pain of varying intensity. Pain sensations are expressed rather weakly or are completely absent, since sensitivity is strongly 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 full treatment or has been ineffective. It should be noted that the hip joints are very rarely affected.
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 from the similarity of symptoms with gout, which is characterized by a paroxysmal course.
Sharp and sharp pain appears suddenly: the affected area turns red and swells, becomes hot to the touch. A bout of inflammation lasts from a few hours to several weeks, then everything passes. With chondrocalcinosis, pain is possible on the left or right side of the pelvis.
In the vast majority of cases, pseudogout occurs without an obvious cause, and even during the examination it is not possible to detect disorders of calcium metabolism. Presumably, 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, renal failure, hemochromatosis, hypothyroidism, etc.
Synovial chondromatosis
Joint chondromatosis, or metaplasia of the cartilaginous islands of the synovial membrane, primarily affects 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 cartilage or bone tissue, as a result of which chondromic or bony 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 worried about pain in the hip area, the mobility of the legs is limited, and a characteristic crunch is heard during movements.
Since chondromatosis is a dysplastic process with the formation of chondromic bodies, the presence of an "articular 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 locked until the chondromic body enters the lumen of the capsule, and only after this the movements are fully restored.
Reference: Frequent or prolonged binding of the joint can provoke the development of coxarthrosis. Complications of synovial chondromatosis are stiffness (contracture) and muscle atrophy.
Arthritis
Arthritis is inflammation localized in 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 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 can vary depending on the type of microorganisms that cause it. However, there are 5 characteristic signs that are observed in all patients:
- pain syndrome in the joint of the right or left leg (there is also a bilateral lesion);
- swelling and swelling over the joint;
- redness of the skin;
- reduced motor ability;
- increase in body temperature.
At the onset of the disease, patients experience severe pain, especially when rising from a sitting position. The joint hurts almost constantly, due to 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, the 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, epiphysis occurs with a fracture with displacement or rupture of the epiphysis. The destruction of the epiphysis in the growth zone is possible only in adolescence, therefore the disease is called juvenile.
Juvenile epiphysiolysis is an endocrine-orthopedic disease, 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 terminal section 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 the affected joint), lameness, and an unnatural position of the leg. The diseased leg turns outward, the muscles of the buttocks, thighs and lower legs atrophy.
Treatment
To treat Perthes disease, chondroprotectors are prescribed to promote cartilage regeneration, and angioprotectors are needed to improve blood circulation. Complex therapy also includes massage, physical therapy, physiotherapy - UHF, electrophoresis with applications of calcium and phosphorus, mud and ozokerite.
Patients with Perthes disease are recommended to unload the limb and use orthopedic devices (plaster casts), as well as special beds to prevent deformity of the femoral head.
What to do and what medicines to drink for osteoarthritis depends on the stage of the disease. The following remedies help relieve pain and slow down the disease process in stages 1-2:
- non-steroidal anti-inflammatory drugs (NSAIDs);
- vasodilators;
- muscle relaxants to relax the muscles;
- chondroprotectors;
- hormonal (with severe pain);
- ointments and compresses 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 the cartilage is removed.
Treatment of diabetic arthropathy includes correction of the underlying disease: diabetes mellitus, the use of special discharge bandages, and taking medications. 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, drugs from the group of NSAIDs and corticosteroids are prescribed. 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 an intra-articular puncture, during which fluid is pumped out and corticosteroid medications are given.
Chondromatosis of the hip joint requires mandatory surgical intervention, the volume of which depends on the extent of the lesion. 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 cast to 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 performed to sanitize the joint.
Treatment of juvenile epiphysiolysis is surgical only. During the operation, a closed repositioning 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 after falls or bumps, which are accompanied by severe pain, reduced mobility, and changes in joint configuration, require emergency medical attention. If there have been no traumatic injuries and joint pains of varying intensity occur regularly, it is necessary to make an appointment with a general practitioner or rheumatologist and undergo an examination.