The hip joint (HJ) is a complex joint formed by several bones: femur, pubis, ilium and ischium.It is surrounded by periarticular bursae and a powerful muscular-ligamentous 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 with cartilage, in the upper part and on the side.The middle and lower segments are occupied by fatty tissue and the femoral ligament, enclosed in 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 bursae;
- acetabular lip (cartilaginous edge that runs along the edge of the acetabulum);
- articular surface of the femur or pelvis.
Pain in the joint area is caused by inflammation or damage to the integrity of its components.Most often, pain occurs when infection enters the joint (infectious arthritis) and autoimmune damage (rheumatoid and reactive arthritis).
Mechanical injuries are no less common, resulting in damage to the epiphyses of bones, ligaments, synovial membranes and other tissues.Active people and athletes who experience high physical activity are more prone to injuries.
Also at risk are elderly people who have pain in the pelvic bones due to degenerative-dystrophic changes in the 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 complete list of possible diseases looks like this:
- Perthes disease;
- arthrosis;
- Koenig's disease;
- diabetic arthropathy;
- pseudogout;
- intermittent hydrathrosis (intermittent dropsy of the joint);
- chondromatosis;
- reactive, rheumatoid and infectious arthritis;
- Juvenile epiphysiolysis;
- injuries.
Perthes disease
With Perthes disease, the blood supply to the femoral head is disrupted, leading to aseptic necrosis (death) of the cartilage tissue.Children under the age of 14, mostly boys, are mostly affected.
The leading symptom of Perthes disease is constant pain in the hip joint that rises with the foot.Children often complain that their legs hurt from the hip and start to hang.
In the initial stages, the symptoms are mild, which leads to a late diagnosis when an impression (intra-articular) fracture has already occurred.The destructive process is accompanied by increased pain, swelling of soft tissues and stiffness of limb movements.The patient cannot externally rotate, rotate, flex, or straighten the hip.Moving the legs to the side is also difficult.
Disturbances in the autonomic nervous system are also observed: the foot becomes cold and pale, with profuse sweating.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 faster.
Arthrosis
Osteoarthritis of the hip joint is called coxarthrosis and is mainly diagnosed in elderly people.The disease progresses slowly, but causes irreversible changes.The pathological process begins with damage to cartilage, which becomes thinner as a result of an increased thickness and viscosity of the synovial fluid.
The development of coxarthrosis leads to joint deformation, muscle atrophy and significant limitation of movements up to complete immobility.Pain syndrome with arthrosis has a wave-like (non-constant) nature and is located on the outer side of the thigh, but can spread to the liver, buttocks and lower back.
At the second stage of arthrosis, painful sensations cover the inner side of the thigh and sometimes down to the knee.As the disease progresses, the pain in the hip is intensified and only sometimes 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 can be hip dysplasia, congenital hip dislocation, Perthes disease, arthritis and traumatic injuries (dislocations and fractures).
Koenig's disease
If the thigh is injured on the side of the joint, the cause may be the death of cartilage tissue (necrosis) - Koenig's disease.This disease is most often encountered by young men aged 16-30 years who complain of pain, reduced range of motion and periodic "jamming" of the leg.
König's disease develops in several stages: first the cartilage tissue becomes soft, then hardens and begins to separate from the joint surface of the bone.In the third or fourth stage, the necrotic area is discarded and enters the articular cavity.This causes the accumulation of effusion (fluid), 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 joint, is observed in diabetes mellitus and is characterized by progressive deformation accompanied by pain of varying intensity.Painful sensations are rather weak or completely absent, because with this disease the sensitivity is greatly reduced due to pathological changes in the nerve fibers.
Diabetic arthropathy occurs during long-term diabetes and is one of its complications.It occurs mostly in women who have not received full treatment or it has not been effective.It is worth noting that the hip joints are extremely rarely affected.
Pseudogout
As a result of calcium metabolism disorders, calcium crystals begin to accumulate in the joint tissue, and chondrocalcinosis, or pseudogout, develops.The disease got this name because of the similarity of the symptoms with gout, which is distinguished by its paroxysmal course.
Acute and sharp pain appears suddenly: the affected area becomes red and swollen, and becomes warm to the touch.An attack of inflammation lasts from a few hours to a few weeks, then everything goes away.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 it is not possible to detect calcium metabolism disorders.Probably the cause of the disease lies in a local metabolic disorder in the joint.In one patient out of a hundred, chondrocalcinosis develops against the background of existing systemic diseases - diabetes, kidney failure, hemochromatosis, hypothyroidism, etc.
Synovial chondromatosis
Chondromatosis of the joints, or cartilage 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.
With chondromatosis, the synovial membrane degenerates into cartilage or bone tissue, resulting in the formation of chondromic or bone bodies up to 5 cm in size in the joint cavity.
The clinical picture of isolated metaplasia is similar to arthritis: the patient is bothered by pain in the hip bone, the mobility of the legs is limited, and a characteristic cracking sound is heard when moving.
Since chondromatosis is a dysplastic process with the formation of chondromic bodies, the occurrence of an "articular mouse" cannot be excluded.In this case, the "mouse" can get stuck between the articular surfaces of the bones, which leads to a partial or complete blockage of the joint.The joint remains blocked until the chondromic body enters the lumen of the capsule, and only after this movement is fully restored.
Help: frequent or prolonged jomm disorders can provoke the development of coxarthrosis.Complications of synovial chondromatosis are stiffness (contracture) and muscle atrophy.
Arthritis
Arthritis is an inflammation located in the articular surfaces of the acetabulum and femur.Damage to the hip joint is called coxitis, which is accompanied by a dull, aching pain in the back of the thigh and groin.
There are different types of arthritis, the most common type affecting the hip joint is the infectious form.Other types are diagnosed much less often.Why does infectious arthritis occur?The development of the pathology begins after bacteria and viruses enter the common cavities.
The clinical picture of an infectious arthritis can be different 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 can also be bilateral damage);
- Swelling and swelling over the joint;
- redness of the skin;
- reduced motor skills;
- Increase in body temperature.
At the beginning of the disease, patients experience severe pain, especially when they stand 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 decay, destruction of the articular surface of the bone, or more precisely, the cartilage that covers it.A distinctive feature of such damage is the disruption 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 only possible in adolescence, which is why the disease is called juvenile.
Juvenile epiphysiolysis is an endocrine-orthopedic pathology 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 femur bone, and the displacement of the epiphysis occurs.The end of the bone is below and behind the acetabulum.
Typical symptoms of epiphysiolysis are pain on the right or left side of the thigh (depending on which joint is affected), paralysis and an unnatural position of the leg.The painful leg turns outward, 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 calcium and phosphorus, mud and ozokerite applications.
Patients with Perthes disease are recommended to relieve the limb and use orthopedic devices (plaster cast), as well as special beds to prevent deformation of the femoral head.
What to do and what medicines to take for arthrosis 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 (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.
The treatment of diabetic arthropathy includes correcting the underlying disease – diabetes mellitus, wearing special relief bandages and taking medication.All patients, regardless of the stage of the disease, are prescribed 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 intra-articular puncture, during which the fluid is pumped out and corticosteroid drugs are administered.
Chondromatosis of the hip joint requires mandatory surgical intervention, the volume of which depends on the scale of the lesion.If the number of chondromic bodies is small, they are removed by partial synovectomy (excision of the synovial membrane) or minimally invasive arthroscopy (through three points).Surgical treatment of the progressive form of chondromatosis can only be radical and is performed with open arthrotomy or complete (total) synovectomy.
Therapy for acute infectious arthritis includes the mandatory application of plaster to the hip joint area, taking drugs from different groups (NSAIDs, antibiotics, steroids).If a purulent process develops, a course of medical points is carried out to sanitize the joint.
The treatment of juvenile epiphysiolysis is only surgical.During the operation, closed repositioning of the bones is done by 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.All injuries following falls or impacts that are 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 occurs regularly in the joint, you must make an appointment with a therapist or rheumatologist and undergo an examination.