The hip joint (HJ) is a complex joint formed by several bones: the femur, pubis, ilium, and ischium.It is surrounded by periarticular bursae and a strong muscular-ligamentous corset protected by subcutaneous fat and skin.
The ilium, ischium, and pubis form the pelvic bone and are connected to the hyaline cartilage in the acetabulum.These bones fuse together until the age of 16.
A distinctive feature of the hip joint is the structure of the acetabulum, which is only partially covered by cartilage, in the upper part and on the side.The middle and lower segments are occupied by adipose tissue and the femoral ligament, which is embedded in the synovial membrane.
reasons
Pain in the hip joint can cause damage to the intra-articular elements or adjacent structures:
- skin and subcutaneous tissue;
- muscles and ligaments;
- synovial bursa;
- acetabular lip (cartilage ring passes along the edge of the acetabulum);
- articular surfaces of the femur or pelvis.
Pain in the joint area is caused by inflammation or a 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, as a result of which epiphyses of bones, ligaments, synovial membranes and other tissues are damaged.Active people and athletes who experience high physical activity are more susceptible to injury.
Also at risk are the elderly 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;
- pseudogogite;
- Intermittent hydrarthrosis (intermittent drop 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 disrupted, which leads to aseptic necrosis (death) of cartilage tissue.Children under the age of 14, mostly boys, get sick.
The leading symptom of Perthes' disease is constant pain in the hip joint, which increases when walking.Children often complain that the leg hurts from the hip and they begin to limp.
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 movement.The patient cannot externally rotate, rotate, flex, or straighten the hip.It is also difficult to move the foot to the side.
Disturbances in the autonomic nervous system are also observed: the leg becomes cold and pale, sweating profusely.Sometimes the body temperature rises to a subfebrile level.
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 the elderly.The disease progresses slowly, but causes irreversible changes.The pathological process begins with damage to the cartilage, which thins as a result of the increased thickness and viscosity of the synovial fluid.
The development of coxarthrosis leads to joint deformation, muscle atrophy and significant limitation of movements to complete immobility.The pain syndrome in arthrosis has a wave-like (non-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 side of the thigh and sometimes go down to the knee.As the disease progresses, the pain in the thigh increases and only sometimes disappears during rest.
Coxarthrosis can be primary and secondary.Primary coxarthrosis develops against the background of osteochondrosis or knee arthrosis.Secondary coxarthrosis can be caused by hip dysplasia, congenital hip dislocation, Perthes disease, arthritis, and traumatic injuries (dislocations and fractures).
Koenig's disease
If you have pain on the side of the hip joint, the cause may be cartilage tissue death (necrosis) - Koenig's disease.Young people aged 16-30 are most often faced with this disease, who complain of pain, decreased range of motion, and occasional "stuck" 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 fluid (fluid) build-up, stiffness of movement and blockage of left or right joints.
Reference: the presence of "joint mice" 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 completely absent, because in this disease the sensitivity is sharply reduced due to pathological changes in nerve fibers.
Diabetic arthropathy develops during long-term diabetes and is one of its complications.It occurs most often in women who have not received full treatment or it has been ineffective.It should be noted that hip joints are rarely injured.
Pseudogogite
As a result of the disturbance of calcium exchange, calcium crystals begin to accumulate in the joint tissues and chondrocalcinosis or pseudogogue develops.The disease received this name due to the similarity of symptoms with gout, which is characterized by a paroxysmal course.
Acute and sharp pain occurs suddenly: the affected area becomes red and swollen and hot to the touch.An attack of inflammation lasts from several hours to several weeks, then everything passes.In case of chondrocalcinosis, pain is possible on the left or right side of the pelvis.
In the vast majority of cases, pseudogout occurs without an obvious reason, and even during the examination, it is impossible to detect disorders of calcium metabolism.Most likely, the cause of the disease is a local metabolic disorder inside the joint.In one hundred patients, chondrocalcinosis develops against the background of existing systemic diseases - diabetes, kidney failure, hemochromatosis, hypothyroidism, etc.
Synovial chondromatosis
Chondromatosis of the joints, or islet metaplasia of synovial cartilage, affects mainly large joints, including 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 cartilaginous or bony tissue, resulting in the formation of chondromic 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 suffers from pain in the femur, leg mobility is limited, and a characteristic crackling sound is heard when moving.
Since chondromatosis is a dysplastic process with the formation of chondromatous bodies, the occurrence of a "joint mouse" is not excluded.In this case, the "mouse" may 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 chondromic body enters the capsule lumen and only after this movement is fully restored.
Help: frequent or prolonged straining of the joint can provoke the development of coxarthrosis.Complications of synovial chondromatosis are stiffness (contracture) and muscle atrophy.
Arthritis
Arthritis is an inflammation localized on 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 thigh and groin area.
There are several types of arthritis, the most common type affecting the hip joint is the infectious form.Other types are diagnosed much less frequently.Why does infectious arthritis occur?Pathology development begins after bacteria and viruses enter the joint cavity.
The clinical picture of infectious arthritis may 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 can also be bilateral damage);
- Swelling and swelling in the joint;
- skin redness;
- reduced motor skills;
- increase in body temperature.
At the onset of the disease, patients have 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 the breakdown of the bone, the destruction of the articular surface, more precisely, the cartilage covering it.A distinctive feature of such damage is the cessation of bone growth in length, which causes asymmetry of the lower limbs.
In adults, epiphysiolysis occurs when there is a fracture by displacement or tear of the epiphysis.Epiphysis in the growth zone can be destroyed only 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.These two groups of hormones 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 femoral bone and the displacement of the epiphysis.The last part of the bone is located 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), lameness and an unnatural position of the leg.The painful leg turns outward, the muscles of the buttocks, hips and legs atrophy.
treatment
For the treatment of Perthes disease, chondroprotectors, which promote cartilage regeneration, and angioprotectors, which are necessary to improve blood circulation, are prescribed.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 unload the limb and use orthopedic devices (plaster plaster), as well as special beds to prevent deformation of the femoral head.
What to do and what medicines to take during arthrosis depends on the stage of the disease.The following means help relieve pain and slow down the pathological process in stages 1-2:
- Nonsteroidal anti-inflammatory drugs (NSAIDs);
- vasodilators;
- muscle relaxants for muscle relaxation;
- chondroprotectors;
- hormonal (for severe pain);
- Ointments and compresses with anti-inflammatory or chondroprotective effect.
At stage 3-4, patients are recommended for surgery.
Koenig's disease can only be treated surgically;During arthroscopic surgery, the affected area of the cartilage is removed.
Treatment of diabetic arthropathy includes correction of the main disease - diabetes mellitus, wearing special relief 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.NSAIDs and corticosteroids are prescribed to relieve pain and inflammation.If there are infectious complications, a course of antibacterial therapy is carried out.
There is no specific treatment for pseudogout;During exacerbation, 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 extent of which depends on the extent of the damage.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 progressive form of chondromatosis can be only radical and is carried out using open arthrotomy or complete (total) synovectomy.
The therapy of acute infectious arthritis includes mandatory application of plaster in the hip joint area, taking different groups of drugs (non-steroidal anti-inflammatory drugs, antibiotics, steroids).When the purulent process develops, a course of medical puncture is carried out to clean the joint.
Treatment of juvenile epiphysiolysis is only surgical.During surgery, closed bone repositioning 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 injury after a fall or blow, accompanied by severe pain, limited mobility and changes in joint configuration, requires immediate medical attention.If there were no traumatic injuries, but pain of varying intensity appears regularly in the joint, you should make an appointment with a therapist or rheumatologist and undergo an examination.