Degeneration of the hip joint (coxarthrosis) is the leading cause of hip pain. Osteoarthritis is a chronic process of joint degeneration that results from an imbalance between the destruction and repair processes of joint cartilage. The development of coxarthrosis is determined by many factors, the most important of which are the abnormal anatomical conditions of the joint and mechanical overload of the hip. Degeneration of the hip joint leads to reduced mobility and pain that makes it difficult to walk or change body position. Treatment is mainly focused on relieving hip pain and reducing risk factors that accelerate hip degeneration. In the advanced stage of the disease, it is necessary to replace the damaged hip with an artificial implant (hip arthroplasty).
Anatomy
The articular surfaces of the hip joint are formed by the head of the femur and the acetabulum. The head of the femur is embedded in the acetabulum beyond the equator, therefore the hip joint is referred to as the spherical acetabular joint. An additional element is an articular limb attached to the edge of the acetabulum. The labrum is a fibrous-cartilaginous ring that adjusts both articular surfaces to each other and additionally acts as a shock absorber. The hip joint is surrounded by an articular capsule and ligaments.
What is hip joint degeneration?
The degeneration process begins in the articular cartilage. Due to the influence of various factors, it becomes thinner and loses its elasticity. The labrum of the acetabulum is also often found, which increases the risk of further injuries to the articular cartilage. The essence of degenerative changes is the gradual destruction of articular cartilage, which is associated with the loss of its thickness until the subcartilage layer of the bone is exposed. The degree of advancement of degenerative changes is determined using the Outerbridge scale:
0 - proper condition of cartilage,
1 - softening of the cartilage,
2 - the presence of incomplete cartilage defects,
3 - damage reaching the bone subcartilage layer, but not exposing it,
4 - bone-to-bone contact.
When cartilage ceases to act as a shock absorber and loads begin to be transferred through the subcartilage layer of bone, local areas of bone tissue thickening, known as sclerotization, arise. Over time, the bone begins to rub against the bone, which increases the extent of the damage. Gradually, the femoral head loses its round shape and cannot move freely in the pelvic socket. As a result of the resulting damage, secondary inflammation develops, which also affects the joint capsule and ligaments, leading to limited mobility in the joint. In addition, on the edges of the acetabulum, bone growths (osteophytes) develop, which additionally irritate the surrounding soft tissues.
Symptoms of degeneration of the hip joint
The most commonly reported symptoms of osteoarthritis of the hip include:
- groin pain
- hip pain when walking
- possible feeling of jumping and audible clicks when making movements in the hip joint,
-limiting the range of motion - internal rotation and extension in the hip,
-muscle weakness in the hip girdle, difficulty in maintaining position on one leg.
In advanced coking, the head collapses in the acetabulum and the femoral neck is deformed. As a result, the leg length is shortened, which may secondary to the curvature of the spine and cause back pain. Misalignment of the hip and limping can also lead to overstrain and pain in the knee joint.
The causes of hip osteoarthritis
Hip joint degeneration can be primary or secondary. Primary osteoarthritis develops without clear causes that can be proven by clinical trials. It seems that genetic factors and disturbances in the blood supply to the epiphyses of the bones may be the most important factors in its development.
People with an abnormal anatomy of the hip joint, inflammatory diseases of the locomotor system and people who overload their joints (athletes, manual workers) are mainly exposed to secondary degenerative disease. Among the causes of secondary degenerative changes, the following can be distinguished:
- femoroacetabular impingement (FAI) - mutual misalignment of the shape of the head and the acetabulum of the hip joint,
- acute injuries of the hip joint - fractures and dislocations leading to disturbance of the anatomical conditions of the hip,
- developmental disorders of the joint - hip dysplasia during childhood distorting the joint,
- juvenile exfoliation of the femoral head - deformity of the femoral head,
- inflammatory diseases, e.g. rheumatoid arthritis,
- infectious diseases, e.g. tuberculous arthritis,
- metabolic diseases, e.g. chondrocalcinosis, gout,
- overload - standing work, lifting loads, competitive sports,
- overweight and obesity.
Diagnosis of hip joint degeneration
An orthopedic doctor performs an examination during which:
- collects a detailed interview on:
the location and nature of your hip pain
the types of activities and positions that make hip pain worse
the presence of comorbidities, also in childhood,
past injuries and operations within the hip joint,
profession and the patient's level of activity, - assesses the range of motion in the hip joint,
- performs tests to assess the remaining structures of the joint, e.g. a test for the presence of acetabular-femoral conflict.
Then the symptoms of degeneration visible on the X-ray images are assessed:
- Joint space narrowing due to the loss of cartilage thickness,
Bone tissue thickening (sclerotization of the subchondral layer),
Bone growths (osteophytes) at the edges of the acetabulum,
Subchondral cysts - bone areas filled with joint fluid.
If necessary, your doctor will order an MRI of your hip. Magnetic resonance imaging (MRI) is the only non-invasive diagnostic method that allows for the accurate assessment of labrum and cartilage damage to the hip joint. MRI examination significantly facilitates the proper qualification of the patient for treatment. At the same time, it is worth noting that hip pain depends on the irritation of innervated tissues and the secondary inflammatory process. Final evaluation of hip degeneration and choice of treatment should be based on the correlation between patient-reported symptoms and the results of imaging tests. The level of activity and the patient's expectations as to the results of treatment are also of great importance in the choice of treatment.
Treatment of degeneration of the hip joint (coxarthrosis)
Conservative treatment
Conservative treatment of coxarthrosis includes:
Joint relief:
- home remedies: limiting the standing position, avoiding carrying heavy objects, daily gymnastics in the supine position,
- modification of physical activity, e.g. switching from running to cycling or swimming,
- weight reduction,
- using a crutch, cane or walking frame,
Rehabilitations:
- exercises for degeneration of the hip joint, strengthening the muscles stabilizing the hip joint,
-treatments in the field of physical therapy with analgesic and anti-inflammatory effects,
Medications for degeneration of the hip joints:
- hyaluronic acid injections to improve the quality of synovial fluid,
- plasma injections with concentrated plaques, Orthokine therapy - methods that inhibit inflammation and support the natural repair processes of the joint structures,
- painkillers and anti-inflammatory drugs by mouth or by injection (joint blockage).
More information on how to prevent further progression of joint degeneration can be found in the article Conservative treatment of cartilage defects
Surgery
Surgical treatment is undertaken in the event of failure of conservative treatment or in the case of diagnosis of joint damage, which should be treated surgically. The main surgical procedures performed in osteoarthritis of the hip are hip arthroscopy and hip arthroplasty. Early forms of degenerative disease and lesions leading to rapid development of degeneration can be treated arthroscopically. The indications for hip arthroscopy are:
Aceto-femoral conflict,
- The presence of free bodies in the pond,
- Treatment of lesions caused by chondrocalcinosis or gout,
- Rinsing the joint in case of purulent infection,
- Early forms of aseptic osteonecrosis.
If arthroscopy is not performed early in the disease, the risk of developing hip degeneration rapidly increases significantly. Advanced degenerative changes are ultimately treated with arthroplasty - that is, replacement of the damaged hip joint with an artificial implant.
Frequently asked questions about hip degeneration:
Coxarthrosis (coxae - hip, arthrosis - degeneration) is otherwise a degenerative disease of the hip joints. The essence of the degeneration is the gradual destruction of the hip articular cartilage until the subcartilage layer of the bone is exposed. The damage causes secondary inflammation in the joint, which also affects the capsule and ligaments, leading to their fibrosis. The result is a painful restriction of the range of motion and pain when loading the hip with body weight.
Degeneration of the hip joint is accompanied by pain in the groin when walking, limitation of the mobility of the hip joint and the possible feeling of jumping when making movements with the lower limb. Advanced forms of degeneration are characterized by severe pain, stiffening of the hip joint and shortening of the length of the lower limb, causing limp and even difficulty in changing position.
Treatment of osteoarthritis is mainly symptomatic - its aim is to relieve pain and prevent the joint deformation from getting worse. Treatment is aimed at limiting the factor accelerating the degenerative process. Conservative management includes: joint relief, modification of physical activity, rehabilitation, biological therapies (plasma with concentrated platelets), and the use of painkillers and anti-inflammatory drugs. In selected patients, it is recommended to perform hip arthroscopy, which allows to remove changes that could lead to rapid destruction of the joint. The advanced stage of coxarthrosis requires arthroplasty, i.e. implantation of an artificial hip prosthesis.
