The hip joint (HJ) is a complex joint made up of several bones: the femur, pubis, ilium, and ischium.It is surrounded by periarticular bursae and a strong musculo-ligamentous corset protected by subcutaneous fat and skin.
The ilium, ischium, and pubis make up the pelvic bone and are connected by hyaline cartilage in the acetabulum.These bones fuse together before the age of 16.
A distinctive feature of the femur joint is the structure of the acetabulum, which is only partially covered with cartilage, in the upper part and on the sides.The middle and lower segments are occupied by adipose tissue and femoral ligaments, which are enclosed in a synovial membrane.
Reasons
Pain in the hip joint can cause damage to intra-articular elements or adjacent structures:
- skin and subcutaneous tissue;
- muscles and ligaments;
- synovial bursae;
- acetabular lip (margin of cartilage 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 the structures that make it up.Most often, the pain occurs when the 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 bone epiphyses, ligaments, synovial membranes and other tissues are damaged.Active people and athletes who have a lot of physical activity are more prone to injuries.
The risk group also includes the elderly, who have pain in the pelvic bones due to degenerative-dystrophic cartilage changes, as well as children and adolescents 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, pseudogout and obesity.
The full list of possible diseases looks like this:
- Perthes disease;
- arthrosis;
- Koenig's disease;
- diabetic arthropathy;
- pseudogout;
- intermittent hydratrosis (intermittent joint dripping);
- chondromatosis;
- reactive, rheumatoid and infectious arthritis;
- minor epiphysiolysis;
- injuries.
Perthes disease
With Perthes' disease, the blood supply to the femoral head is disrupted, leading to aseptic necrosis (death) of the cartilage tissue.Children under the age of 14 are mostly affected, mostly boys.
The main symptom of Perthes' disease is constant pain in the hip joint that increases with walking.Children often complain that their leg hurts from the hip and begins to limp.
In the initial stages, the 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 turn the hip outward, rotate, bend or straighten it.It is also difficult to move the leg to the side.
Disturbances of the autonomic nervous system are also observed: the foot becomes cold and pale, and at the same time it sweats 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 mainly diagnosed in the elderly.The disease progresses slowly, but causes irreversible changes.The pathological process begins with cartilage damage, which becomes thinner as the thickness and viscosity of the synovial fluid increases.
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 (unsteady) 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 hip increases and only sometimes subsides at rest.
Coxarthrosis can be primary and secondary.Primary coxarthrosis develops against the background of osteochondrosis or arthrosis of the knee.Secondary coxarthrosis can be preceded by 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, the cause may be cartilage tissue death (necrosis) - Koenig's disease.This disease is most often encountered by young men aged 16-30 years, who complain of pain, reduced range of motion and periodic "stuckness" of the leg.
Koenig's disease develops in several stages: first, the cartilage tissue softens, then hardens and begins to separate from the joint surface of the bone.In the third or fourth stage, the necrotic area is rejected and enters the joint cavity.This causes a build-up of effusion (fluid), stiffness of movement and locking 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
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 not at all, because with this disease sensitivity is drastically reduced due to pathological changes in nerve fibers.
Diabetic arthropathy occurs during prolonged diabetes and is one of its complications.This most often occurs 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 joint tissues, chondrocalcinosis or pseudogout develops.The disease received this name due to the similarity of the symptoms with gout, which is characterized by a paroxysmal course.
Sharp and sharp pain suddenly appears: the affected area becomes red and swollen, 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 most cases, pseudogout occurs without an obvious reason, and even during the examination it is not possible to detect calcium metabolism disorders.It is thought that the cause of the disease is a local metabolic disorder inside the joint.One patient out of a hundred develops chondrocalcinosis against the background of existing systemic diseases - diabetes, kidney failure, hemochromatosis, hypothyroidism, etc.
Synovial chondromatosis
Joint chondromatosis, or islet metaplasia of synovial cartilage, mainly affects the large joints, including the hips.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, resulting in the formation of chondromas 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 suffers from pain in the hip bone, the mobility of the legs is limited, a characteristic cracking sound is heard when moving.
Since chondromatosis is a dysplastic process with the formation of chondroma bodies, the occurrence of a "joint mouse" cannot be excluded.In this case, the "mouse" can get stuck between the joint surfaces of the bones, which will lead to partial or complete blocking of the joint.The joint remains locked until the body of the chondroma enters the lumen of the capsule, and only after this movement is fully restored.
Help: frequent or long-term joint congestion can lead to the development of coxarthrosis.Complications of synovial chondromatosis include stiffness (contracture) and muscle atrophy.
Arthritis
Arthritis is an inflammation localized in the joint surfaces of the acetabulum and femur.Damage to the hip joint is called coxitis, which is accompanied by dull, aching pain in the back of the thigh and groin.
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 can vary depending on the type of microorganism that causes it.However, there are 5 characteristic features that are observed in all patients:
- pain in the joint of the right or left leg (there may also be bilateral lesions);
- swelling and swelling above the joint;
- redness of the skin;
- decreased motor ability;
- increase in body temperature.
At the beginning 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 the breakdown, the destruction of the joint surface of the bone, more precisely, the cartilage covering it.A distinctive feature of such a lesion is the cessation of bone growth in length, which causes asymmetry of the lower limbs.
In adults, epiphysiolysis occurs when there is a fracture with displacement or tear of the epiphysis.The destruction of the pineal gland in the growth zone is possible only in adolescence, so the disease is called juvenile.
Juvenile epiphysiolysis is an endocrine orthopedic pathology based on an imbalance of 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 causes a decrease in the mechanical strength of the growth zone of the femur and displacement of the epiphysis occurs.The end 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 the affected joint), lameness and an unnatural position of the leg.The painful leg turns outward, the muscles of the buttocks, thighs and legs atrophy.
Treatment
For the treatment of Perthes disease, chondroprotectors are prescribed, which 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 Perthes disease are recommended to relieve the limb and use orthopedic devices (plaster), as well as special beds to prevent deformation of the femoral head.
What to do and what medications to take in case of arthrosis depends on the stage of the disease.Such means help reduce pain and slow down the pathological process 1.-2.stage:
- 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.
At stage 3-4, patients are recommended to undergo surgery.
Koenig's disease can only be treated surgically;during arthroscopic surgery, the affected cartilage area is removed.
Treatment of diabetic arthropathy includes correction of the underlying disease – diabetes mellitus – wearing special unloading bandages and using medication.All patients, regardless of the stage of the disease, are prescribed antiresorption drugs - bisphosphonates, as well as products with vitamin D and calcium.To reduce pain and inflammation, drugs from the group of NSAIDs 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 exacerbations.A large amount of fluid accumulated in the joint is an indication for an intra-articular puncture, during which the fluid is drained and corticosteroid drugs are administered.
Chondromatosis of the hip joint requires mandatory surgical intervention, the extent of which depends on the scale of the damage.If the number of chondroma 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 carried out using open arthrotomy or complete (total) synovectomy.
Treatment of acute infectious arthritis includes the mandatory application of plaster in the hip joint area, the use of different groups of medications (NSAIDs, antibiotics, steroids).When a purulent process develops, a course of medical punctures is performed to disinfect the joint.
Treatment of juvenile epiphysiolysis is only surgical.During surgery, a closed bone transfer 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 after falls or impacts accompanied by severe pain, limited mobility and changes in joint configuration require emergency medical attention.If there have been no traumatic injuries, but pain of varying intensity occurs regularly in the joint, it is necessary to make an appointment with a therapist or rheumatologist and undergo an examination.