The hip joint (HJ) is a complex joint made up of several bones: the femur, the pubis, the ilium and the ischium. It is surrounded by periarticular pockets and a powerful musculo-ligamentous corset, protected by subcutaneous fat and skin.
The ilium, ischium and pubis form the pelvic bone and are connected by hyaline cartilage at the level of the acetabulum. These bones fuse together 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 adipose tissue and the femoral ligament, enclosed in a synovial membrane.
causes
Pain in the hip joint can damage intra-articular elements or nearby structures:
- skin and subcutaneous tissue;
- muscles and ligaments;
- synovial bags;
- acetabular lip (cartilaginous rim 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 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.
Also at risk are older people who suffer from 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 full list of possible illnesses is as follows:
- Perthes disease;
- osteoarthritis;
- Koenig's disease;
- diabetic arthropathy;
- pseudogout;
- intermittent hydrarthrosis (intermittent dropsy of the joint);
- chondromatosis;
- reactive, rheumatoid and infectious arthritis;
- juvenile epiphyseolysis;
- injury.
Perthes disease
With Perthes disease, the blood supply to the femoral head is interrupted, resulting in aseptic necrosis (death) of cartilage tissue. Most children under 14, mainly boys, suffer.
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 at the hip and begin to limp.
In the early stages, the 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 in limb movements. The patient cannot turn the thigh outward, rotate it, bend it or unbend 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 reaches subfebrile values.
Reference: in Perthes disease, the lesion can be unilateral and bilateral. In most cases, one of the joints suffers less and recovers faster.
Osteoarthritis
Osteoarthritis of the hip joint is called coxarthrosis and is mainly diagnosed in older people. The disease progresses slowly, but causes irreversible changes. The pathological process begins with damage to the cartilage, which becomes thinner as a result of an increase in the density and viscosity of the synovial fluid.
The development of coxarthrosis leads to joint deformation, muscle atrophy and severe limitation of movements up to complete immobility. Arthrosis pain syndrome has a wave-like (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 inner 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 arthrosis 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 from 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, a decrease in range of motion and periodic "locking" 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. In the third or fourth stage, the necrotic area is rejected and enters the joint cavity. This is due to the accumulation of effusion (fluid), stiffness of movement and blockage of the left or right joints.
Reference: the presence of an "articular 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 deformation accompanied by pain of varying intensity. Pain sensations are expressed rather weakly or are completely absent, since sensitivity is sharply reduced in this disease due to pathological changes in nerve fibers.
Diabetic arthropathy occurs with a long course of diabetes and is one of its complications. It most often occurs in women who have not received full treatment, or it has proven ineffective. It should be noted that the hip joints are extremely rarely affected.
pseudogout
As a result of a violation of calcium metabolism, calcium crystals begin to accumulate in the tissues of the joints, 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, sharp pain suddenly appears: the affected area turns red and swells, becomes hot to the touch. An attack of inflammation lasts from several 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 on examination, disorders of calcium metabolism cannot be detected. Presumably, the cause of the disease lies in a local metabolic disorder within the joint. In every hundred patients, chondrocalcinosis develops against the background of existing systemic diseases - diabetes, renal failure, hemochromatosis, hypothyroidism, etc.
Synovial chondromatosis
Chondromatosis of the joints, or metaplasia of the cartilaginous islands of the synovial membrane, mainly affects the large joints, including 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 cartilaginous or bone tissue, as a result of 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 worried about pain in the hip area, the mobility of the legs is limited, and a characteristic creak is heard during movement.
Since chondromatosis is a dysplastic process with the formation of chondroma bodies, the occurrence 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 chondroma body enters the lumen of the capsule, and only after that the movements are fully restored.
Reference: frequent or prolonged jamming of the joint can cause the development of hip osteoarthritis. Complications of synovial chondromatosis are stiffness (contracture) and muscle atrophy.
Arthritis
Arthritis is localized inflammation in the joint surfaces of the acetabulum and femur. The defeat of the hip joint is called coxitis, which is accompanied by a 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 may differ 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 of the joint;
- redness of the skin;
- reduced motor ability;
- increase in body temperature.
Early in the disease, patients experience severe pain, especially when rising from a sitting position. The joint almost constantly hurts, 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.
Epiphysiolysis juvenile
The term epiphysiolysis literally means the disintegration, the destruction of the articular surface of the bone, or rather of the cartilage covering it. A distinctive feature of this damage is the arrest of bone growth in length, which leads to asymmetry of the lower limbs.
In adults, epiphysiolysis occurs with a fracture with displacement or rupture of the epiphysis. 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 pathology, 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 end 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 joint affected), lameness and abnormal leg position. The diseased leg turns outward, the muscles of the buttocks, thighs and lower legs atrophy.
Processing
To treat Perthes disease, chondroprotectors are prescribed to promote cartilage regeneration, and angioprotectors are needed to improve blood circulation. Complex therapy also includes massage, exercise therapy, physiotherapy - UHF, electrophoresis with applications of calcium and phosphorus, mud and ozocerite.
Patients with Perthes disease are recommended to unload the limb and use braces (plaster casts), as well as special beds to prevent deformation of the femoral head.
What to do and what drugs to drink for arthrosis depends on the stage of the disease. The following remedies help relieve pain and slow down the disease process in stages 1-2:
- nonsteroidal anti-inflammatory drugs (NSAIDs);
- vasodilators;
- muscle relaxants for relaxing muscles;
- chondroprotectors;
- hormonal (with severe pain);
- ointments and compresses with anti-inflammatory or chondroprotective action.
At 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 unloading bandages and taking medication. All patients, regardless of the stage of the disease, are prescribed anti-resorptive drugs - bisphosphonates, as well as drugs containing vitamin D and calcium. To relieve pain and inflammation, drugs from the group of NSAIDs and corticosteroids are prescribed. If there are infectious complications, antibiotic treatment is carried out.
There is no specific treatment for pseudogout, anti-inflammatory drugs are prescribed for exacerbations. A large amount of accumulated fluid in the joint is an indication for intra-articular puncture, during which 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. With a small number of chondromal bodies, they are removed by partial synovectomy (excision of the synovial membrane) or minimally invasive arthroscopy (by three punctures). Surgical treatment of a progressive form of chondromatosis can only be radical and is carried out by open arthrotomy or complete (total) synovectomy.
Treatment of acute infectious arthritis includes the mandatory application of a plaster cast to the hip joint area, taking drugs of various groups (NSAIDs, antibiotics, steroids). With the development of a purulent process, a series of therapeutic punctures are performed to sanitize the joint.
The treatment of juvenile epiphysiolysis is only surgical. 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 injury after a fall or impact, which is accompanied by severe pain, reduced mobility and changes in the configuration of the joint, requires emergency medical attention. If there were no traumatic injuries and pain of varying intensity regularly occurs in the joint, it is necessary to make an appointment with a general practitioner or rheumatologist and undergo an examination.