The hip joint (HJ) is a complex joint made up of several bones: femur, pubis, ilium and ischium.It is surrounded by periarticular bags and a powerful musculo-ligament corset, protected by subcutaneous fat and skin.
The ilium, ischium, and pubis form the pelvic bone and are connected via hyaline cartilage in 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, at the top and laterally.The middle and lower segments are occupied by adipose tissue and the femoral ligament, enclosed in a synovial membrane.
Reasons
Hip joint pain can cause damage to intra-articular elements or nearby structures:
- skin and subcutaneous tissue;
- muscles and ligaments;
- synovial bags;
- acetabular lip (cartilaginous rim 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).
No less common are mechanical injuries, which cause damage to the epiphyses of bones, ligaments, synovial membranes and other tissues.Active people and athletes who perform high 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 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 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 head of the femur is interrupted, which leads to aseptic necrosis (death) of the cartilaginous tissue.Children under 14, mostly boys, are especially affected.
The main symptom of Perthes' disease is constant pain in the hip joint, which increases with walking.Children often complain that their leg hurts from the side and begin to limp.
In the initial stages the symptoms are mild, which leads to late diagnosis, when an imprint (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 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 faster.
Arthrosis
Osteoarthritis of the hip joint is called coxarthrosis and is diagnosed mainly in older adults.The disease progresses slowly, but causes irreversible changes.The pathological process begins with damage to the cartilage, which becomes thinner due to the increased thickness and viscosity of the synovial fluid.
The development of coxarthrosis leads to joint deformation, muscle atrophy and significant limitation of movement up to complete immobility.Pain syndrome with arthrosis has a wave-like (not constant) nature 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 arthrosis, painful sensations cover the inner thigh and sometimes go down to the knee.As the disease progresses, hip pain intensifies and only sometimes disappears 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 dislocation of the hip, 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 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, decreased mobility and periodic "jamming" of the leg.
Koenig's disease develops in several stages: first the cartilaginous tissue softens, then it hardens and begins to separate from the articular surface of the bone.At the third or fourth stage the necrotic area is rejected and enters the joint cavity.This causes the accumulation of effusion (fluid), stiffness of movement and locking 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 expressed rather weakly or completely absent, since with 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 comprehensive treatment or which has been ineffective.It is worth noting that the hip joints are affected extremely rarely.
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 received this name due to the similarity of symptoms with gout, which is distinguished by its paroxysmal course.
Sharp, sharp pain appears suddenly: the affected area becomes red and swollen and becomes hot to the touch.An inflammatory attack lasts from several hours to several weeks, then everything disappears.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 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 metaplasia of the cartilaginous islands of the synovium, primarily affects 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 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 disturbed by pain in the hip bone, the mobility of the legs is limited, and a characteristic creaking sound is heard during movement.
Since chondromatosis is a dysplastic process with the formation of chondromal bodies, the presence of an “articular mouse” cannot be excluded.In this case, the "mouse" may get stuck between the articulating surfaces of the bones, causing 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 it fully restored.
Help: Frequent or prolonged joint jamming can provoke the development of coxarthrosis.Complications of synovial chondromatosis are stiffness (contracture) and muscle atrophy.
Arthritis
Arthritis is localized inflammation in the articular surfaces of the acetabulum and femur.Damage to the hip joint is called coxitis and is accompanied by a dull, aching pain in the back of the thigh and groin area.
There are different types of arthritis, the most common one affecting the hip joint is the infectious form.Other types are diagnosed much less frequently.Why does infectious arthritis occur?The development of the 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 right or left leg joint (there may also be bilateral damage);
- swelling and swelling on the joint;
- skin redness;
- decreased motor skills;
- increase in body temperature.
At the onset of the disease, patients experience 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 tooth decay, destruction of the articular surface of the bone or, more precisely, of 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, epiphysiolysis occurs when a fracture occurs 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, which is based on an imbalance between growth hormones and sexual 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 displacement of the epiphysis occurs.The terminal 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 affected joint), lameness, and an unnatural position of the leg.The sore 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, physical therapy, physiotherapy - UHF, electrophoresis with calcium and phosphorus, mud and ozokerite applications.
Patients suffering from Perthes disease are recommended to unload the limb and use orthopedic devices (plaster casts), as well as special beds to prevent deformation of the femoral head.
What to do and what drugs 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.
Treatment of diabetic arthropathy includes correction of the underlying disease, diabetes mellitus, the use of special unloading bandages and taking medications.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;Anti-inflammatory drugs are prescribed during flare-ups.A large amount of fluid accumulated in the joint is an indication for intraarticular 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 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 performed by open arthrotomy or complete (total) synovectomy.
Therapy for acute infectious arthritis involves the mandatory application of plaster on the hip joint area, taking drugs of different groups (NSAIDs, antibiotics, steroids).When a purulent process develops, a course of medical punctures is carried out to disinfect the joint.
The treatment of juvenile epiphysiolysis is exclusively surgical.During the operation, closed repositioning of the bones 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 due to falls or impacts accompanied by severe pain, limited mobility and changes in joint configuration require emergency medical attention.If no traumatic injuries have occurred, but pain of varying intensity regularly occurs in the joint, it is necessary to make an appointment with a therapist or rheumatologist and undergo an examination.