The hip joint (HJ) is a complex joint consisting of several bones: femur, pubic bone, ilium and ischium.It is surrounded by periarticular bursae and a strong muscle-ligament corset, which is protected by subcutaneous fat and skin.
The ilium, ischium and pubic bone form the pelvic bone and are connected by hyaline cartilage in the hip socket.These bones fuse before the age of 16.
A special feature of the femoral joint is the structure of the hip socket, 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, which is surrounded by a synovial membrane.
Reasons
Pain in the hip joint can lead to damage to intra-articular elements or adjacent structures:
- skin and subcutaneous tissue;
- muscles and ligaments;
- synovial bursa;
- 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 a violation of the integrity of the joint structures.Most often, pain occurs when infection invades the joint cavity (infectious arthritis) and autoimmune damage occurs (rheumatoid and reactive arthritis).
No less common are mechanical injuries that lead to damage to the epiphyses of bones, ligaments, synovial membranes and other tissues.Active people and athletes with high levels of physical activity are more susceptible to injuries.
Older people who have pain in the pelvic bone due to degenerative-dystrophic cartilage changes are also at risk, as are children and adolescents during 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;
- osteoarthritis;
- 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 femoral head is disrupted, leading to aseptic necrosis (death) of cartilage tissue.Children under the age of 14, mostly boys, are particularly affected.
The main symptom of Perthes disease is constant pain in the hip joint, which increases when walking.Children often complain that their leg hurts from the hip and begins to limp.
In the initial stage, symptoms are mild, leading to late diagnosis when an impression fracture (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 extend the hip.Moving the leg sideways is also difficult.
Disturbances of the autonomic nervous system are also observed: the foot becomes cold and pale and sweats 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 more quickly.
Osteoarthritis
Osteoarthritis of the hip joint is called coxarthrosis and is primarily diagnosed in older people.The disease progresses slowly but causes irreversible changes.The pathological process begins with damage to the cartilage, which becomes thinner due to the increasing thickness and viscosity of the synovial fluid.
The development of coxarthrosis leads to joint deformation, muscle loss and significant restrictions in movement, including complete immobility.Pain syndrome with arthrosis has a wavy (unsteady) 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 arthrosis, painful sensations cover the inner thigh and sometimes extend to the knee.As the disease progresses, hip pain increases 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.Prerequisites for secondary coxarthrosis can be hip dysplasia, congenital hip dislocation, Perthes disease, arthritis and traumatic injuries (dislocations and fractures).
Koenig's disease
If the side of the thigh hurts at the joint, the cause may be the death of cartilage tissue (necrosis) - König's disease.This disease most often occurs in young men aged 16 to 30 years who complain of pain, limited mobility and periodic “pinching” of the leg.
Koenig's disease develops in several stages: first, the cartilage tissue softens, then it hardens and begins to separate from the articular surface of the bone.In the third or fourth stage, the necrotic area is shed and enters the joint cavity.This leads to accumulation of effusion (fluid), stiffness of movement and blockages in the left or right joint.
Note: 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.Pain sensations are rather weak or completely absent, since in this disease sensitivity is greatly reduced due to pathological changes in the nerve fibers.
Diabetic arthropathy occurs in long-term diabetes and is one of its complications.It occurs most often in women who have not received full treatment or who have been ineffective.It is noteworthy that the hip joints are extremely rarely affected.
Pseudogout
As a result of disorders in calcium metabolism, calcium crystals begin to accumulate in the joint tissue and chondrocalcinosis or pseudogout develops.The disease received this name due to the similarity of symptoms to gout, which is characterized by its paroxysmal course.
Acute and stabbing pain suddenly occurs: the affected area becomes red and swollen and feels hot.A flare-up of inflammation lasts from several hours to several weeks, then everything goes away.With chondrocalcinosis, pain on the left or right side of the pelvis is possible.
In the vast majority of cases, pseudogout occurs without any apparent cause and the examination does not reveal any disorders of calcium metabolism.The cause of the disease is probably a local metabolic disorder in the joint.In one patient out of a hundred, chondrocalcinosis develops against the background of existing systemic diseases – diabetes, renal failure, hemochromatosis, hypothyroidism, etc.
Synovial chondromatosis
Chondromatosis of the joints or cartilaginous island metaplasia of the synovium mainly affects large joints, which include the hip.Most often, this pathology occurs in middle-aged and older men, but there are also cases of congenital chondromatosis.
In chondromatosis, the synovial membrane breaks down into cartilage or bone tissue, resulting in the formation of cartilage 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, mobility of the legs is limited and a characteristic crunching sound is heard when moving.
Since chondromatosis is a dysplastic process with the formation of chondromas, the occurrence of a “joint mouse” cannot be ruled out.In this case, the “mouse” can get stuck between the articular surfaces of the bones, which leads to partial or complete blockage of the joint.The joint remains blocked until the cartilaginous body enters the lumen of the capsule and only after this movement is completely restored.
Help: Frequent or prolonged pinching of the joints can lead to the development of coxarthrosis.Complications of synovial chondromatosis include stiffness (contracture) and muscle atrophy.
arthritis
Arthritis is an inflammation localized to the articular surfaces of the hip socket 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.
There are different types of arthritis.The most common form that affects the hip joint is the infectious form.Other types are diagnosed much less frequently.Why does infectious arthritis occur?The development of pathology begins after bacteria and viruses penetrate 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 (damage can also occur on both sides);
- swelling and swelling over the joint;
- redness of the skin;
- reduced 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 decay, destruction of the articular surface of the bone, more precisely the cartilage that covers it.A characteristic feature of such damage is the cessation of bone length growth, which leads to asymmetry of the lower extremities.
In adults, epiphysiolysis occurs when there is a fracture with displacement or rupture of the epiphysis.Destruction of the epiphysis in the growth zone is only possible in adolescence, which is why the disease is called juvenile.
Juvenile epiphysiolysis is an endocrine-orthopedic pathology caused by an imbalance between 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 leads to a decrease in the mechanical strength of the growth zone of the femoral bone and displacement of the epiphysis occurs.The end part of the bone is located below and behind the hip socket.
Typical symptoms of epiphysiolysis include 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 outwards, the muscles of the buttocks, thighs and legs atrophy.
Treatment
To treat Perthes disease, chondroprotectors are prescribed to promote cartilage regeneration and angioprotectors 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 unload the limb and use orthopedic devices (casts) and special beds to prevent deformation of the femoral head.
What to do and what medication to take for osteoarthritis depends on the stage of the disease.The following remedies will 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 effects.
In stage 3-4, patients are recommended surgery.
Koenig's disease can only be treated surgically;During arthroscopic surgery, the affected area of cartilage is removed.
Treatment of diabetic arthropathy includes correcting the underlying disease, diabetes mellitus, wearing special offloading bandages and taking medication.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.In case of infectious complications, antibacterial therapy is carried out.
There is no specific treatment for pseudogout;In case of exacerbations, anti-inflammatory drugs are prescribed.A large accumulation of fluid in the joint is an indication for an intra-articular puncture, during which the 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 extent of the lesion.If the number of cartilaginous bodies is small, they are removed by partial synovectomy (removal 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.
Therapy for acute infectious arthritis includes the mandatory application of a plaster in the hip joint area, as well as taking medications of various groups (NSAIDs, antibiotics, steroids).If a purulent process develops, medical punctures are performed to disinfect the joint.
The treatment of juvenile epiphysiolysis is exclusively surgical.The operation involves a closed reduction of the bones using skeletal traction.The connected bone parts are then fixed with pins and transplants.
Absolutely all diseases of the hip joint are serious diseases that require mandatory medical supervision.Injuries following falls or impacts that result in severe pain, limited mobility, and changes in joint configuration require emergency medical treatment.If there are no traumatic injuries, but pain of varying intensity occurs regularly in the joint, you need to make an appointment with a therapist or rheumatologist and undergo an examination.