The hip joint (HJ) is a complex joint formed by several bones: femur, pubis, ilium, and ischium.It is surrounded by periarticular pockets and a strong musculo-ligamentous corset, protected by subcutaneous fat and skin.
The ilium, ischium and pubis form the pelvic bone and are connected by hyaline cartilage in the acetabulum.These bones fuse before the age of 16.
A characteristic feature of the femoral joint is the structure of the acetabulum, which is only partially covered with cartilage, on the top and side.The middle and lower parts are occupied by adipose tissue and the femoral ligament, enclosed in a synovial membrane.
Reasons
Pain in the hip joint can be caused by damage to intra-articular elements or nearby structures:
- skin and subcutaneous tissue;
- muscles and ligaments;
- synovial pockets?
- acetabular rim (cartilaginous rim extending along the edge of the acetabulum).
- articular surfaces of the femur or pelvis.
Pain in the joint area is caused by inflammation or violation of the integrity of the structures that make it up.Most often, pain occurs when infection enters the joint cavity (infectious arthritis) and autoimmune damage (rheumatoid and reactive arthritis).
Mechanical injuries are no less frequent, resulting in damage to bone epiphyses, ligaments, synovial membranes and other tissues.Active people and athletes who have high physical activity are more prone to injuries.
Elderly people who have pelvic bone pain due to degenerative-dystrophic changes in the cartilage are also at risk, 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 mellitus, gout and obesity.
The full list of possible diseases looks like this:
- Perthes disease?
- arthropathy;
- Koenig's disease?
- diabetic arthropathy;
- pseudoarthritis;
- intermittent hydroarthrosis (intermittent hydroarthritis of the joint).
- chondromatosis;
- reactive, rheumatoid and infectious arthritis.
- juvenile epiphysiolysis?
- injuries.
Perthes disease
With Perthes disease, the blood supply to the femoral head is disrupted, which leads to aseptic necrosis (death) of the cartilage tissue.Children under the age of 14 are mainly affected, mainly boys.
The main symptom of Perthes disease is constant pain in the hip joint, which increases with walking.Children often complain that their leg hurts from the hip and begin to limp.
In the initial stages, the symptoms are mild, which leads to a late diagnosis, when an impression (intra-articular) fracture has already appeared.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.Moving the foot to the side is also difficult.
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 hypothermic levels.
Note: in Perthes disease, the lesion may be unilateral or bilateral.In most cases, one of the joints suffers less and recovers faster.
Arthritis
Osteoarthritis of the hip joint is called coxarthrosis and is diagnosed mainly in older people.The disease progresses slowly, but causes irreversible changes.The pathological process begins with damage to the cartilage, which becomes thinner as a result of the increased thickness and viscosity of the synovial fluid.
The development of coxarthrosis leads to deformation of the joint, muscle atrophy and significant limitation of movements up to complete immobility.Arthritis pain syndrome is undulating (unstable) in nature and is located on the outer side of the thigh, but can spread to the groin, buttocks and lower back.
In the second stage of arthropathy, painful sensations cover the inner side of the thigh and sometimes go down to the knee.As the disease progresses, hip pain intensifies and only sometimes subsides into a state of rest.
Coxarthrosis can be primary and secondary.Primary coxarthrosis develops against the background of osteochondrosis or arthropathy of the knee.Secondary coxarthrosis can be caused 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 the death of cartilage tissue (necrosis) - Koenig's disease.This disease is most often found in young men aged 16-30, who complain of pain, reduced range of motion and periodic "blockage" of 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 shed and enters the joint cavity.This causes a build-up of fluid (fluid), stiffness of movement and blockage 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 seen in diabetes mellitus and is characterized by progressive deformity accompanied by pain of varying intensity.Painful sensations are expressed rather weakly or are 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 more often in women who did not receive full treatment or it was ineffective.It is worth noting that hip joints are extremely rarely affected.
Pseudogout
As a result of calcium metabolism disorders, calcium crystals begin to accumulate in joint tissues and chondrocalcification or pseudogout develops.The disease received this name due to the similarity of the symptoms with gout, which is distinguished by its paroxysmal course.
Sharp and sharp pain occurs suddenly: the affected area becomes red and swollen and becomes warm to the touch.An attack of inflammation lasts from several hours to several weeks, then everything subsides.With chondrocalcification, the pain is strong 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 identify disorders of calcium metabolism.Probably, the cause of the disease lies in a local metabolic disorder inside the joint.In one patient out of a hundred, chondrocalcification develops against the background of existing systemic diseases - diabetes, renal failure, hemochromatosis, hypothyroidism, etc.
articular chondromatosis
Chondromatosis of the joints, or synovial cartilage islet metaplasia, 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 degenerates into cartilage or bone tissue, resulting in the formation of chondromatous 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, the mobility of the leg is limited, and a characteristic cracking sound is heard when moving.
Since chondromatosis is a dysplastic process with the formation of chondromatous bodies, the appearance of a "joint 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 involvement of the joint can cause the development of coxarthrosis.Complications of chondromatosis are stiffness (contraction) and muscle atrophy.
Arthritis
Arthritis is an inflammation found in the joint surfaces of the acetabulum and femur.Damage to the hip joint is called coccyx, which is accompanied by a 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?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 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;
- reduced mobility.
- increase in body temperature.
At the onset of the disease, patients experience severe pain, especially when standing 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 wear and tear, destruction of the articular surface of the bone or more precisely the cartilage that covers it.A characteristic feature of such a lesion 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 tear of the epiphysis.The destruction of the pineal gland in the growth zone is possible only in adolescence, which is why the disease is called juvenile.
Juvenile epiphysiolysis is an endocrine-orthopedic pathology, which is based on an imbalance between 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 extreme part of the bone is below and behind the acetabulum.
Typical symptoms of epiphysiolysis include pain on the right or left side of the thigh (depending on the joint affected), lameness, and an abnormal foot position.The painful leg turns outward, the muscles of the buttocks, thighs and legs atrophy.
Treatment
For the treatment of Perthes disease, chondroprotectants are prescribed to promote cartilage regeneration and angioprotectants necessary to improve blood circulation.Complex treatment also includes massage, exercise therapy, physiotherapy - UHF, calcium and phosphorus electrophoresis, mud and ozokerite applications.
In patients with Perthes disease, it is recommended to unload the limb and use orthopedic devices (plaster casts), as well as special beds to avoid deformation of the femoral head.
What to do and what medicines to take for arthropathy depends on the stage of the disease.The following treatments help relieve pain and slow down the pathological process in stages 1-2:
- non-steroidal anti-inflammatory drugs (NSAIDs).
- Vasodilators?
- Muscle relaxants for muscle relaxation.
- chondroprotectors;
- hormonal (for severe pain).
- ointments and compresses with anti-inflammatory or chondroprotective action.
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, use of special unloading bandages and medication.All patients, regardless of the stage of the disease, are prescribed antiabsorptive drugs - bisphosphonates, as well as products with vitamin D and calcium.To relieve 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 gout.during exacerbations, anti-inflammatory drugs are prescribed.A large amount of fluid that has accumulated in the joint is an indication for an intra-articular puncture, in which the fluid is drawn off and corticosteroid drugs are administered.
Chondromatosis of the hip joint requires mandatory surgery, the volume of which depends on the scale of the damage.If the number of chondromatous bodies is small, they are removed by partial arthrectomy (excision of the synovium) or minimally invasive arthroscopy (through three punctures).The surgical treatment of the progressive form of chondromatosis can only be radical and is done by open arthrotomy or complete (total) arthrectomy.
Treatment for acute infectious arthritis includes the mandatory application of plaster in the area of the hip joint, taking drugs of different groups (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 the operation, closed bone repositioning 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 attention.Any injuries after falls or impact accompanied by severe pain, limited mobility and changes in joint configuration require urgent medical attention.If there were no traumatic injuries, but pain of varying intensity regularly occurs in the joint, you should make an appointment with a therapist or rheumatologist and undergo an examination.