The hip joint (HJ) is a complex joint made up of several bones: femur, pubis, ilium, and ischium.It is surrounded by a periarticular bursa and a strong musculo-ligamentous corset, protected by subcutaneous fat and skin.
The ilium, ischium, and pubis make up the pelvis and are connected by hyaline cartilage in the acetabulum.These bones fuse before the age of 16.
The distinguishing feature of the femoral joint is the structure of the acetabulum, which is only partially covered by cartilage, in the upper and lateral parts.The middle and lower segments are occupied by adipose tissue and the femoral ligament, which are enclosed in a synovial membrane.
Reasons
Pain in the hip joint can damage intra-articular elements or nearby structures:
- skin and subcutaneous tissue;
- muscles and ligaments;
- synovial bursae;
- acetabular lip (cartilaginous rim running 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 constituent structures.Most often, pain occurs when infection enters the joint cavity (infectious arthritis) and autoimmune damage (rheumatoid and reactive arthritis).
Mechanical injuries resulting in damage to the epiphyses of bones, ligaments, joint membranes and other tissues are no less common.Active people and athletes practicing high physical activity are more prone to injuries.
Also at risk are the elderly, who have pain in their 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 left or right hip joint is caused by metabolic diseases such as diabetes mellitus, pseudogout and obesity.
The full list of possible diseases looks like this:
- Perthes disease;
- arthrosis;
- Koenig's disease;
- diabetic arthropathy;
- pseudogout;
- periodic hydrarthrosis (periodic dropsy of the joint);
- chondromatosis;
- reactive, rheumatic and infectious arthritis;
- juvenile epiphysiolysis;
- injuries.
Perthes disease
In Perthes' disease, the blood supply to the femoral head is interrupted, which leads to aseptic necrosis (death) of the cartilage tissue.Children under the age of 14, mainly boys, are most often affected.
The main symptom of Perthes disease is constant pain in the hip joint, which is aggravated by walking.Children often complain that their legs hurt from the hips and they start limping.
In the initial stage, 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 movements.The patient cannot externally rotate, rotate, bend or straighten the hip.Moving the leg to the side is also difficult.
Disturbances of the autonomic nervous system are also observed: the feet become cold and pale while 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 joint suffers less and recovers faster.
Arthrosis
Osteoarthritis of the hip joint is called coxarthrosis and is mainly diagnosed in elderly people.The disease progresses slowly, but causes irreversible changes.The pathological process begins with damage to the cartilage, which thins due to the 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.Arthritic pain syndrome 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 extend to the knee.As the disease progresses, the pain in the hips intensifies and only sometimes subsides at rest.
Coxarthrosis can be primary or secondary.Primary coxarthrosis develops against the background of osteochondrosis or arthrosis of the knee.Prerequisites 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 caused by cartilage tissue death (necrosis) - Koenig's disease.This disease is most often encountered by young men aged 16-30, 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 expelled and enters the joint cavity.This causes fluid accumulation, stiffness of movement, and blockage of the left or right joint.
Reference: the presence of "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.Painful sensations are rather weak or completely absent, since with 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 occurs most often in women who have not received full treatment or have not been effective.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 to gout, which is distinguished by its paroxysmal course.
Acute and sharp pain occurs suddenly: the affected area becomes red, swollen, and hot to the touch.The inflammatory attack lasts from several hours to several weeks, and then everything passes.In the case of chondrocalcinosis, pain is possible on the left or right side of the pelvis.
In the vast majority of cases, pseudogout appears for no apparent reason, and even during the examination, it is not possible to detect disorders of calcium metabolism.The cause of the disease presumably lies in a local metabolic disorder within 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 metaplasia of the synovial cartilaginous island mainly affects the 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 joint membrane degenerates into cartilage or bone tissue, resulting in the formation of 5 cm chondromic or bone bodies in the joint cavity.
The clinical picture of insular metaplasia is similar to arthritis: the patient is bothered by pain in the hip bone, the movement of the leg is limited, and a characteristic squeaking sound is heard during movement.
Since chondromatosis is a dysplastic process that involves the formation of chondromic bodies, the occurrence of "joint mouse" cannot be excluded.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 chondromic body enters the lumen of the capsule, and only after this movement is fully restored.
Help: frequent or long-lasting joint blockage can provoke the development of coxarthrosis.Complications of synovial chondromatosis are stiffness (contracture) and muscle atrophy.
Arthritis
Arthritis is localized inflammation on the joint surface of the acetabulum and femur.Damage to the hip joint is called coxitis, which causes dull, aching pain in the back of the thigh and in the 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?The development of pathology begins after bacteria and viruses enter the joint cavity.
The clinical picture of infectious arthritis can be different depending on the type of microorganism that causes it.However, there are 5 characteristic symptoms that can be observed in all patients:
- pain in the joint of the right or left leg (bilateral damage may also occur);
- swelling and swelling over the joint;
- skin redness;
- reduced motor skills;
- rise in body temperature.
At the beginning of the disease, patients experience severe pain, especially when standing up from a sitting position.The joint hurts almost constantly;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 destruction, the destruction of the articular surface of the bone, more precisely the cartilage covering it.A distinctive feature of such damage is the cessation of bone length growth, which leads to asymmetry of the lower limbs.
In adults, epiphysiolysis occurs when there is a fracture involving displacement or tearing of the epiphysis.The 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 the imbalance of growth hormones and sex hormones.These two groups of hormones 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 femur and displacement of the epiphysis occurs.The end 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 an unnatural position of the leg.The painful leg turns outwards, the muscles of the buttocks, thighs and legs atrophy.
Treatment
For the treatment of Perthes disease, chondroprotectors are prescribed to promote cartilage regeneration and angioprotectors, which are necessary to improve blood circulation.Complex therapy includes massage, exercise therapy, physiotherapy - UHF, electrophoresis with calcium-phosphorus, mud and ozokerite applications.
Patients suffering from Perthes' disease are recommended to relieve the limb and use orthopedic devices (casting), as well as special beds to prevent deformation of the femoral head.
What to do and what medicines to take for arthrosis depends on the stage of the disease.The following remedies 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 (in case of severe pain);
- ointments and poultices with anti-inflammatory or chondroprotective effects.
The 3-4.stage, patients must undergo 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 correcting the underlying disease – diabetes mellitus – 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.NSAIDs and corticosteroids are prescribed to relieve pain and inflammation.If there are infectious complications, antibacterial therapy is performed.
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, during which the fluid is pumped out and corticosteroid drugs 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 cartilage bodies is small, they are removed by partial synovectomy (excision of the joint membrane) or minimally invasive arthroscopy (three punctures).Surgical treatment of the progressive form of chondromatosis can only be radical and is performed with open arthrotomy or complete (full) synovectomy.
The therapy of acute infectious arthritis includes the mandatory application of plaster to the area of the hip joint, taking drugs of various groups (NSAIDs, antibiotics, steroids).When a purulent process develops, medical injections are performed to disinfect the joint.
The treatment of juvenile epiphysiolysis is only surgical.During the operation, the closed reposition of the bones is performed with skeletal traction.Then the united parts of the bones are fixed with pins and grafts.
Any pathology of the hip joint is a serious disease that requires mandatory medical supervision.Any injury after a fall or collision, accompanied by severe pain, limited movement and changes in the configuration of the joints, requires urgent medical attention.If there was no traumatic injury, but pain of varying intensity appears regularly in the joint, you should make an appointment with a therapist or rheumatologist and undergo an examination.