The hip joint (AJ) is a complex joint formed by several bones: femur, pubis, ilium and ischium.It is surrounded by periarticular bursae 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 before the age of 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 the femoral ligament, surrounded by a synovial membrane.
Reasons
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 that runs 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.Most often, pain occurs when infection enters the joint cavity (infectious arthritis) and autoimmune damage (rheumatoid and reactive arthritis).
Mechanical injuries are no less common, resulting in damage to bone epiphyses, ligaments, synovial membranes and other tissues.Active people and athletes who do a lot of physical activity are more susceptible to injuries.
Also at risk are elderly people who have pain in the pelvic bones due to degenerative-dystrophic changes in cartilage, as well as 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 looks like this:
- Perthes disease;
- arthrosis;
- Koenig's disease;
- diabetic arthropathy;
- pseudogout;
- intermittent hydrarthrosis (intermittent dropsy of the joint);
- chondromatosis;
- reactive, rheumatoid and infectious arthritis;
- juvenile epiphysiolysis;
- injuries.
Perthes disease
In Perthes disease, the blood supply to the femoral head is interrupted, which leads to aseptic necrosis (death) of the cartilaginous tissue.Mainly children under 14 years of age, especially boys, are affected.
The main symptom of Perthes disease is constant pain in the hip joint, which increases with walking.Children often complain that their legs hurt at the hips and they begin to limp.
In the initial stages, symptoms are mild, which leads to late diagnosis, when an impression fracture (intra-articular) has already occurred.The destructive process is accompanied by increased pain, swelling of soft tissues and stiffness of limb movements.The patient is unable to rotate the hip outward, rotate it, flex it, or straighten it.Moving the leg to the side is also difficult.
Disturbances in the autonomic nervous system are also observed: the foot becomes cold and pale, while sweating profusely.Sometimes the body temperature rises to subfebrile levels.
Note: in Perthes disease the lesion can be unilateral or 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 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 as a result of the increase in thickness and viscosity of the synovial fluid.
The development of coxarthrosis leads to joint deformation, muscle atrophy and significant limitation of movement until complete immobility.Pain syndrome with arthrosis has a wave-like (inconstant) nature and is localized in the outer part of the thigh, but can spread to the groin, buttocks and lower back.
In the second stage of arthrosis, painful sensations cover the inner thigh and sometimes go down to the knee.As the disease progresses, hip pain intensifies and only sometimes subsides at rest.
Coxarthrosis can be primary and secondary.Primary Coxarthrosis develops against the background of osteochondrosis or arthrosis of the knee.The prerequisite 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 of the joint, the cause may be the death of cartilaginous tissue (necrosis) - Koenig's disease.This disease is most often found in young men aged 16 to 30, who complain of pain, decreased range of motion and periodic “locking” of the leg.
Koenig's disease develops in several stages: first, the cartilaginous tissue softens, then hardens 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 causes accumulation of effusion (fluid), stiffness of movement and blockage of the left or right joints.
Reference: the presence of a “joint rat” in the hip joint leads to the development of coxarthrosis.
Diabetic arthropathy
Osteoarthropathy, or Charcot joint, is observed in diabetes mellitus and is characterized by progressive deformation accompanied by pain of varying intensity.Painful sensations are expressed rather weakly or completely absent, since in this disease sensitivity is sharply reduced due to pathological changes in nerve fibers.
Diabetic arthropathy occurs during long-term diabetes and is one of its complications.It occurs more often in women who have not received complete treatment or it has been ineffective.It is important to note that the hip joints are rarely affected.
Pseudogout
As a result of disorders of calcium metabolism, calcium crystals begin to accumulate in the joint tissues and chondrocalcinosis, or pseudogout, develops.The disease got its name due to the similarity of symptoms with gout, which is distinguished by a paroxysmal course.
The sharp, stabbing pain appears suddenly: the affected area becomes red and swollen and feels hot to the touch.An attack of inflammation lasts from several hours to several weeks and then everything passes.In chondrocalcinosis, it is possible to feel pain on the left or right side of the pelvis.
In the vast majority of cases, pseudogout occurs without an obvious cause and even during 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
Chondromatosis of the joints, or cartilaginous island metaplasia of the synovium, mainly 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.
In chondromatosis, the synovial membrane degenerates into cartilage or bone tissue, resulting in the formation of chondromal or bony bodies up to 5 cm in size in the joint cavity.
The clinical picture of insular metaplasia is similar to arthritis: the patient is bothered by pain in the hip bone, mobility of the legs is limited, and a characteristic crunching sound is heard during movement.
As chondromatosis is a dysplastic process with the formation of chondromal bodies, the occurrence of “articular mouse” cannot be ruled out.In this case, the “mouse” can become trapped between the articular surfaces of the bones, which will lead to partial or complete blockage of the joint.The joint remains blocked until the chondromal body enters the lumen of the capsule, and only after this movement is fully restored.
Help: frequent or prolonged joint congestion can lead to the development of coxarthrosis.Complications of synovial chondromatosis are stiffness (contracture) and muscle atrophy.
Arthritis
Arthritis is localized inflammation of the articular surfaces of the acetabulum and femur.Damage to the hip joint is called coxitis, which is accompanied by a dull, dull pain in the back of the thigh and groin area.
There are several types of arthritis, the most common type that affects the hip joint is the 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 microorganism that causes it.However, there are 5 characteristic signs that are observed in all patients:
- pain in the joint of the right or left leg (there may also be bilateral damage);
- swelling and swelling in the joint;
- skin redness;
- decreased motor capacity;
- 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;the pain makes it 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 caries, destruction of the articular surface of the bone, or more precisely, of the cartilage that covers it.A distinctive feature of this damage is the cessation of bone growth in length, which leads to asymmetry of the lower extremities.
In adults, epiphysiolysis occurs when there is a fracture with displacement or rupture of the epiphysis.Destruction of the epiphysis in the growth zone is possible only in adolescence, which is why the disease is called juvenile.
Juvenile epiphysiolysis is an endocrine-orthopedic pathology that is based on an imbalance between growth hormones and sex hormones.These two groups of hormones are essential for the normal functioning of cartilage tissue.
The predominance of growth hormones over sex hormones leads to a decrease in the mechanical resistance of the growth zone of the femur bone and displacement of the epiphysis occurs.The final portion of the bone is located below and behind the acetabulum.
Typical symptoms of epiphysiolysis include pain on the right or left side of the thigh (depending on the joint affected), lameness, and an unnatural position of the leg.The sore leg turns outwards, the muscles of the buttocks, thighs and legs atrophy.
Treatment
To treat Perthes disease, chondroprotectors are prescribed to promote cartilage regeneration and angioprotectors necessary to improve blood circulation.Complex therapy also includes massage, exercise therapy, physiotherapy - UHF, electrophoresis with applications of calcium and phosphorus, mud and ozokerite.
Patients with Perthes disease are advised to unload the limb and use orthopedic appliances (plaster), as well as special beds to avoid deformation of the femoral head.
What to do and what medications to take for osteoarthritis depend on the stage of the disease.The following remedies help relieve pain and slow down the pathological process in stages 1-2:
- nonsteroidal anti-inflammatory drugs (NSAIDs);
- vasodilators;
- muscle relaxants to relax muscles;
- chondroprotectors;
- hormonal (for severe pain);
- ointments and compresses with anti-inflammatory or chondroprotective effects.
In stages 3-4, patients are advised to undergo surgery.
Koenig's disease can only be 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 unloading bandages and use of medications.All patients, regardless of the stage of the disease, receive antiresorptive drugs - bisphosphonates, as well as products with vitamin D and calcium.To relieve pain and inflammation, drugs from the NSAID group and corticosteroids are prescribed.If there are infectious complications, a course of antibacterial therapy is carried out.
There is no specific treatment for pseudogout;during exacerbations, anti-inflammatory drugs are prescribed.A large amount of fluid accumulated in the joint is an indication for an intra-articular puncture, during which the 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 lesion.If the number of chondromal bodies is small, they are removed by partial synovectomy (excision of the synovial membrane) or minimally invasive arthroscopy (through three punctures).Surgical treatment of the progressive form of chondromatosis can only be radical and is carried out using open arthrotomy or complete (total) synovectomy.
Therapy for acute infectious arthritis includes the mandatory application of a plaster cast to the hip joint area, taking medications from different groups (NSAIDs, antibiotics, steroids).When a purulent process develops, a series of medical punctures are performed to sanitize the joint.
The treatment of juvenile epiphysiolysis is surgical only.During the operation, closed bone reposition is performed using skeletal traction.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 were no traumatic injuries, but pain of varying intensity in the joint regularly occurs, it is necessary to make an appointment with a therapist or rheumatologist and undergo an examination.