The hip joint (HJ) is a complex joint formed by several bones: femur, pubic bone, ilium and ischium.It is surrounded by periarticular bursae and a strong muscle-ligamentous corset, protected by subcutaneous fat and skin.
ilium, ischium and pubis form the pelvic bone and are connected by hyaline cartilage in the acetabulum.These bones fuse together before the age of 16.
A characteristic feature of the femoral 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, 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 ridge 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 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).
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 susceptible to injuries.
Older people who have pain in the pelvic bones due to degenerative-dystrophic cartilage changes are also at risk, as well as children and young people in 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:
- Perthe's disease;
- osteoarthritis;
- Koenig's disease;
- diabetic arthropathy;
- pseudogout;
- intermittent hydrarthrosis (intermittent swelling of the joint);
- chondromatosis;
- reactive, rheumatoid and infectious arthritis;
- juvenile epiphysiolysis;
- damages.
Perthe's disease
In Perthe's disease, the blood supply to the femoral head is disrupted, leading to aseptic necrosis (death) of cartilage tissue.For the most part, children under the age of 14, mostly boys, are affected.
The leading symptom of Perthe's disease is constant pain in the hip joint, which increases with walking.Children often complain that their legs hurt from the hip and begin to limp.
In the initial stages, symptoms are mild, which leads to 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.It is also difficult to move the leg to the side.
Disturbances in the autonomic nervous system are also observed: the foot becomes cold and pale, while it sweats profusely.Sometimes the body temperature rises to subfebrile levels.
Note: in Perthe's disease, the lesion can be unilateral or 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 develops slowly, but causes irreversible changes.The pathological process begins with damage to the cartilage, which becomes thinner as a result of 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 osteoarthritis has a wave-like (non-constant) character and is localized on the outside of the thigh, but can spread to the groin, buttocks and lower back.
In the second stage of osteoarthritis, painful sensations cover the inner side of the thigh and sometimes go down to the knee.As the disease progresses, the pain in the hip intensifies and only sometimes subsides at rest.
Coxarthrosis can be primary and secondary.Primary coxarthrosis develops against the background of osteochondrosis or osteoarthritis of the knee.The prerequisite for secondary coxarthrosis can be hip dysplasia, congenital hip dislocation, Perthe's 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 death of cartilage tissue (necrosis) - Koenig's disease.This disease is most often encountered by young men aged 16-30, who complain of pain, reduced mobility and periodic "jamming" of the leg.
Koenig's disease develops in several stages: first the cartilage tissue becomes soft, then it hardens and begins to separate from the joint surface of the bone.At the third or fourth stage, the necrotic area is rejected and enters the articular cavity.This causes accumulation of effusion (fluid), stiffness in movement, and blockage of the left or right joint.
Reference: the presence of a "joint mouse" in the hip joint leads to the development of coxarthrosis.
Diabetic arthropathy
Osteoarthritis, 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 the sensitivity with this disease 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 most often in women who did not receive full treatment or it was ineffective.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 tissues and chondrocalcinosis or pseudogout develops.The disease received this name because of the similarity of the symptoms with gout, which is characterized by its paroxysmal course.
Acute and sharp pain appears suddenly: the affected area becomes red and swollen and becomes warm to the touch.An inflammatory attack lasts from several hours to several weeks, then everything goes away.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 disturbances in calcium metabolism.Presumably, the cause of the disease lies in a local metabolic disorder inside 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 cartilaginous 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 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 occurrence of an "articular mouse" cannot be 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 blocked until the chondromic body enters the lumen of the capsule, and only after this movement is fully restored.
Help: frequent or prolonged joint stiffness can provoke the development of coxarthrosis.Complications of synovial chondromatosis are stiffness (contracture) and muscle atrophy.
Gout
Gout is an inflammation located in the joint surface 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 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 often.Why does infectious arthritis occur?The development of 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 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 onset of the disease, patients experience severe pain, especially when getting up from a sitting position.Joint pain almost constant;the pain makes it impossible to stand or sit.It should be noted that the contagious form of gout 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 characteristic feature of such an injury is the cessation of bone growth in length, which leads to asymmetry of the lower limbs.
In adults, epiphysiolysis occurs when there is a displaced fracture or fracture of the epiphysis.Destruction of the epiphysis in the growth zone is only possible during 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 function 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, and displacement of the epiphysis occurs.The end part of the bone is located below and behind the acetabulum.
Typical symptoms of epiphysiolysis include pain in the right or left side of the thigh (depending on which joint is affected), lameness and an unnatural position of the leg.The sore leg turns outwards, the muscles in the buttocks, thighs and legs atrophy.
Treatment
To treat Perthe's disease, chondroprotectors are prescribed to promote 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, mud and ozokerite applications.
Patients with Perthe's disease are advised to relieve 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 medicine to take for osteoarthritis depends on the stage of the disease.The following means 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 effect.
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, 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, where the fluid is pumped out and corticosteroid medication is 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 progressive form of chondromatosis can only be radical and is performed using open arthrotomy or complete (total) synovectomy.
Therapy for acute infectious arthritis includes mandatory application of a plaster cast to the hip joint, taking medications from various groups (NSAIDs, antibiotics, steroids).When a purulent process develops, a course of medical punctures is carried out to clean the joint.
Treatment of juvenile epiphysiolysis is surgical only.During the operation, closed reduction 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 injury after a fall or impact that is accompanied by severe pain, limited mobility and changes in joint configuration requires urgent medical attention.If there have been 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.