The hip joint (HJ) is a complex joint consisting of several bones: femur, pubis, ilium, and ischium.It is surrounded by a periarticular bursa and a strong muscular-ligamentous corset protected by subcutaneous fat and skin.
The ilium, ischium, and pubis form the pelvic bone and are connected by the 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 in the upper part and on the side.The middle and lower segments are occupied by fatty tissue and the femoral ligament, surrounded by synovial membrane.
Reasons
Pain in the hip joint may result from damage to intra-articular elements or nearby structures:
- skin and subcutaneous tissue;
- muscles and ligaments;
- synovial bursa;
- acetabular lip (cartilaginous edge running along the edge of the acetabulum);
- articular surfaces of the femur or pelvis.
Pain in the joint area occurs due to 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 and cause damage to the epiphyses of bones, ligaments, synovial membranes and other tissues.Active people and athletes with high physical activity are more susceptible to injury.
Also at risk are children and adolescents during the period of hormonal changes, as well as the elderly who suffer from pain in the pelvic bones due to degenerative-dystrophic changes in cartilage.
Pain in the hip joint on the left or right side is caused by metabolic diseases, for example, diabetes, pseudogout and obesity.
The full list of possible diseases looks like this:
- Perthes disease;
- arthrosis;
- Koenig's disease;
- diabetic arthropathy;
- pseudogout;
- intermittent hydroarthrosis (intermittent collection of water in the joint);
- chondromatosis;
- reactive, rheumatoid and infectious arthritis;
- juvenile epiphysiolysis;
- injuries.
Perthes disease
In Perthes disease, blood flow to the femoral head is impaired, leading to aseptic necrosis (death) of cartilage tissue.Children under the age of 14 are mostly affected, mostly boys.
The leading symptom of Perthes disease is persistent pain in the hip joint that increases with walking.Children often complain that their legs hurt from the hip and that they begin to limp.
In the initial stages, symptoms are mild, leading to late diagnosis when an impression (intra-articular) fracture occurs.The destructive process is accompanied by increasing pain, swelling of soft tissues and stiffness of limb movements.The patient cannot externally rotate, rotate, flex, or straighten the hip.It is also difficult to move the leg sideways.
Disturbances are also observed in the autonomic nervous system: the feet become cold and pale while sweating profusely.Sometimes body temperature rises to subfebrile levels.
Note: In Perthes disease, the lesion may be unilateral or bilateral.In most cases, one of the joints will hurt less and heal faster.
arthrosis
Osteoarthritis of the hip joint is called coxarthrosis and is most often 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 the thickness and viscosity of the synovial fluid.
The development of coxarthrosis leads to joint deformation, muscle atrophy and significant restriction of movements, up to complete immobility.Pain syndrome with arthrosis has a wave-like (non-constant) structure and is localized on the outer side of the thigh, but can radiate to the groin, hips and lower back.
In the second stage of arthrosis, the pain covers the inner side of the thigh and sometimes goes down to the knee.As the disease progresses, the pain in the hip intensifies and only sometimes subsides with 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, it may be due to the death (necrosis) of cartilage tissue - Koenig's disease.This disease is most often encountered in young men aged 16-30 years, who complain of pain, decreased range of motion and periodic "jamming" of the leg.
Koenig's disease develops in several stages: first the cartilage 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 effusion (fluid) buildup, stiffness of movement, and blockage of the left or right joints.
Reference: The presence of "joint rat" in the hip joint leads to the development of coxarthrosis.
diabetic arthropathy
Osteoarthropathy, or Charcot joint, is observed in diabetes and is characterized by progressive deformation accompanied by pain of varying intensity.Painful sensations are expressed rather weakly or are 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 is mostly seen in women who do not receive full treatment or are ineffective.It is worth noting that hip joints are affected extremely rarely.
pseudo output
As a result of disorders in calcium metabolism, calcium crystals begin to accumulate in the joint tissues and chondrocalcinosis or pseudogout develops.The disease received this name due to its similarity to gout, which is distinguished by the paroxysmal course of symptoms.
Acute and sharp pain occurs suddenly: the affected area becomes red and swollen and feels warm to the touch.An attack of inflammation lasts from several hours to several weeks, then everything disappears.With chondrocalcinosis, pain in the left or right side of the pelvis is possible.
In the vast majority of cases, pseudogout occurs for no apparent reason, and even during examination it is not possible to detect calcium metabolism disorders.Probably the cause of the disease lies in a local metabolic disorder within the joint.Chondrocalcinosis occurs in one in a hundred patients as a result of existing systemic diseases - diabetes, renal failure, hemochromatosis, hypothyroidism, etc.- develops against its background.
Synovial chondromatosis
Chondromatosis of the joints, or cartilaginous island metaplasia of the synovium, mainly affects large joints, including the hip.Most often, this pathology occurs in middle-aged and elderly men, but there are also cases of congenital chondromatosis.
With chondromatosis, the synovial membrane degenerates into cartilage 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 clinical picture of insular metaplasia is similar to arthritis: the patient is bothered by pain in the hip bone, leg mobility is limited, and a characteristic crunching sound is heard when moving.
Since chondromatosis is a dysplastic process with the formation of chondromic bodies, the formation of "joint rat" cannot be excluded.In this case, the “mouse” can get stuck between the articular surfaces of the bones, which can lead to partial or complete blockage of the joint.The joint remains occluded until the chondromic body enters the lumen of the capsule, and only after this movement is fully restored.
Help: Frequent or prolonged joint compression can trigger the development of coxarthrosis.Complications of synovial chondromatosis are stiffness (contracture) and muscle atrophy.
Arthritis
Arthritis is an inflammation localized on the joint surfaces of the acetabulum and femur.Damage to the hip joint is called coccitis, which is accompanied by a dull, aching pain in the back of the thigh and in the groin area.
There are various types of arthritis;The most common type affecting the hip joint is the infectious one.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 may differ depending on the type of microorganism that causes it.However, there are 5 characteristic symptoms seen in all patients:
- pain in the joint of the right or left leg (there may also be bilateral damage);
- swelling and swelling over the joint;
- redness of the skin;
- decreased motor ability;
- increase in body temperature.
At the beginning of the disease, patients feel severe pain, especially when standing up from a sitting position.The joint hurts almost constantly;The pain makes standing or sitting impossible.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 covering it.A distinctive feature of this type of damage is the cessation of bone growth in length, leading to asymmetry in 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, therefore the disease is called juvenile.
Juvenile epiphysiolysis is an endocrine-orthopedic pathology based on the imbalance between growth hormones and sex hormones.It is these two groups of hormones that are necessary 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 tip 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 which joint is affected), lameness and unnatural position of the leg.The painful leg turns outward, the hip, thigh and leg muscles atrophy.
Treatment
To treat Perthes disease, chondroprotectors are prescribed to stimulate cartilage regeneration and angioprotectors, which are necessary to improve blood circulation.Complex therapy also includes massage, exercise therapy, physiotherapy - UHF, electrophoresis with calcium and phosphorus, application of mud and ozokerite.
Patients with Perthes disease are recommended to unload their limbs and use orthopedic devices (plaster) and special bearings to prevent deformation of the femoral head.
What to do for arthrosis and what medications to take depends on the stage of the disease.The following remedies will help relieve the pain and help with steps 1-2.It helps to slow down the pathological process in stages:
- 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.
3-4.At stages, 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, wearing special unloading bandages and taking medications.All patients, regardless of the stage of the disease, are prescribed antiresorptive drugs - bisphosphonates, as well as products containing 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 treatment is carried out.
There is no specific treatment for pseudogout;During exacerbations, anti-inflammatory drugs are prescribed.Large amounts of fluid accumulation in the joint is an indication of intra-articular perforation, in which fluid is pumped out and corticosteroid medications 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 punctures).Surgical treatment of the advanced form of chondromatosis can only be radical and is carried out using 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 from different groups (NSAIDs, antibiotics, steroids).When a purulent process develops, a series of medical punctures are performed to sterilize the joint.
The treatment for juvenile epiphysiolysis is surgery only.During the operation, closed repositioning of the bones is performed using skeletal traction.Then, the joined 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.Post-fall or impact injuries accompanied by severe pain, limited mobility, and changes in joint configuration require immediate medical attention.If there is no traumatic injury, but pain of varying intensity occurs regularly in the joint, you need to make an appointment and be examined by a therapist or rheumatologist.