The hip joint (HJ) is a complex joint formed by several bones: femur, pubis, ilium, and ischium.It is surrounded by a strong musculo-ligamentous corset protected by periarticular bursae and subcutaneous fat and skin.
The ilium, ischium, and pubis form the pelvis and are connected by hyaline cartilage at the acetabulum.These bones fuse before the age of 16.
A distinctive feature of the femoral joint is the structure of the acetabulum, which is only partially covered with cartilage in the upper part and on the side.The middle and lower segments are occupied by the femoral ligament, which is surrounded by fatty tissue and 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 bursa;
- acetabular lip (cartilaginous ring extending 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 space (infectious arthritis) and autoimmune damage (rheumatoid and reactive arthritis).
Mechanical injuries are not less common, resulting in damage to the epiphyses of bones, ligaments, synovial membranes and other tissues.Active people and athletes with high physical activity are more susceptible to injuries.
Elderly people with pain in the pelvic bones as a result of degenerative-dystrophic changes in the cartilage, as well as children and adolescents during the period of hormonal changes are also included in the risk group.
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;
- false speech;
- intermediate hydarthrosis (intermediate drop of the joint);
- chondromatosis;
- reactive, rheumatoid and infectious arthritis;
- young epiphysiosis;
- injuries.
Perthes disease
With Perthes disease, the blood supply of the femoral head is disturbed, which leads to aseptic necrosis (death) of the cartilage tissue.Children under the age of 14, mostly boys, are affected.
The leading symptom of Perthes' disease is constant pain in the hip joint, which increases with walking.Children often complain that their legs hurt from the hip and start to limp.
In the initial stages, the symptoms are mild, which leads to a late diagnosis when an impression (intra-articular) fracture already occurs.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: feet become cold and pale when sweating profusely.Sometimes body temperature rises to subfebrile level.
Note: In Perthes disease, the lesion can be unilateral or bilateral.In most cases, one of the joints suffers less and heals faster.
Arthrosis
Osteoarthritis of the hip joint is called coxarthrosis and is mainly diagnosed in elderly 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 an increase in the 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 arthrosis has a wavelike (unstable) nature and is localized on the outer side of the thigh, but can spread to the groin, hip 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 decreases during rest.
Coxarthrosis can be primary or secondary.Primary coxarthrosis develops against the background of osteochondrosis or knee arthrosis.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, the cause may be the death of cartilage tissue (necrosis) - Koenig's disease.This disease is most common among young men aged 16-30 who complain of pain, reduced range of motion, and occasional "stuckness" in the 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 articular cavity.This leads to accumulation of effusion (fluid), stiffness of movement and blocking of the left or right joints.
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 mellitus and is characterized by progressive deformation accompanied by pain of varying intensity.Pain sensations are extremely weak or completely absent, because in 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 often occurs in women who have not received full or ineffective treatment.It should be noted that hip joints are rarely affected.
Pseudogut
As a result of the disturbance of calcium metabolism, calcium crystals begin to accumulate in joint tissues and chondrocalcinosis or pseudogout develops.The disease received this name due to the similarity of symptoms with gout, characterized by its paroxysmal course.
Sharp and sharp pain appears suddenly: the affected area is red and swollen, warm to the touch.The inflammatory attack lasts from several hours to several weeks, then everything disappears.With chondrocalcinosis, pain in the pelvic bone on the left or right side is possible.
In most cases, pseudogout occurs without an obvious cause, and even during examination it is not possible to detect a disturbance of calcium metabolism.Probably, the cause of the disease is a local metabolic disorder within 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 cartilaginous island metaplasia of the synovium, mainly affects large joints, including 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 turns into cartilage or bone tissue, resulting in the formation of chondromic or bone bodies up to 5 cm in size in the joint space.
The clinical picture of insular metaplasia is similar to arthritis: the patient is worried about pain in the femur, the mobility of the legs is limited, and a characteristic crackling sound is heard when moving.
Since chondromatosis is a dysplastic process with the formation of chondromic bodies, the formation of "articular mouse" cannot be excluded.In this case, the "mouse" can get stuck between the articular surfaces of the bones, which will cause 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-term joint congestion can lead to the development of coxarthrosis.Complications of synovial chondromatosis are stiffness (contracture) and muscle atrophy.
Arthritis
Arthritis is localized inflammation in the articular 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 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 differ depending on the type of microorganisms that cause it.However, there are 5 characteristic symptoms 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;
- redness of the skin;
- decreased motor ability;
- increase in body temperature.
At the beginning of the disease, patients feel severe pain, especially when standing up from a sitting position.Joint pain 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 and destruction of the articular surface of the bone, more precisely, the cartilage surrounding it.A distinctive feature of such damage is the cessation of long bone growth, which causes asymmetry of the lower limbs.
In adults, epiphysiolysis occurs when there is a fracture with displacement or tearing of the epiphysis.The destruction of the pineal gland in the growth zone is possible only during adolescence, so 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 important 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 last part 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 outward, the muscles of the hips, thighs and legs atrophy.
Treatment
To treat 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 and phosphorus, mud and ozokerite applications.
Patients with Perthes disease are recommended to loosen the circumference and use orthopedic devices (plasters), as well as special beds, to prevent deformation of the femoral head.
What to do and what drugs to take for arthrosis depends on the stage of the disease.The following tools help relieve pain and slow down the pathological process in 1-2 stages:
- 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.
At stage 3-4, surgical intervention is recommended for patients.
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 main disease - diabetes mellitus, wearing special draining bandages and taking medications.Regardless of the stage of the disease, all patients are prescribed antiresorptive drugs - bisphosphonates, as well as products containing vitamin D and calcium.Drugs from the NSAID group 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;anti-inflammatory drugs are prescribed during exacerbations.A large amount of fluid in the joint is an indication for intra-articular puncture, during which the fluid is removed and corticosteroid drugs are administered.
Chondromatosis of the hip joint requires mandatory surgical intervention, the volume depends on the extent of the lesion.If the number of chondromic bodies is small, they are removed by partial synovectomy (cutting the synovial membrane) or minimally invasive arthroscopy (through three punctures).Surgical treatment of the advanced form of chondromatosis can only be radical and is performed using open arthrotomy or complete (total) synovectomy.
Therapy for acute infectious arthritis includes taking drugs of various groups (NSAIDs, antibiotics, steroids) and forced application of plaster to the area of the hip joint.When a purulent process develops, a course of medical punctures is carried out to sanitize the joint.
Treatment of juvenile epiphysiolysis is carried out only surgically.During the operation, the closed displacement of the bones is carried out by stretching the skeleton.Then the joined 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 caused by falls or blows accompanied by severe pain, limited mobility and joint configuration changes require immediate medical attention.If there is no traumatic injury, but pain of varying intensity regularly occurs in the joint, you should make an appointment with a therapist or rheumatologist and undergo an examination.