The hip joint (HJ) is a complex joint formed by several bones: femur, pubis, ilium and ischium.It is surrounded by periarticular bursae and a powerful muscular-ligamentous corset, which is protected by fat and subcutaneous skin.
The ilium, ischium and pubis form the pelvic bone and are attached to hyaline cartilage in the acetabulum.These bones come together 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 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 bursae;
- acetabular lip (cartilaginous edge 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 its component structure.Pain often occurs when infection enters the joint cavity (infectious arthritis) and autoimmune damage (rheumatoid and reactive arthritis).
Mechanical injuries are less common, causing damage to bone epiphyses, ligaments, synovial membranes and other tissues.Active people and athletes with high physical activity are more susceptible to injury.
Also at risk are elderly people who have pain in the pelvic bones due to degenerative-dystrophic changes in 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 - for example, diabetes mellitus, pseudogout and obesity.
The full list of possible diseases looks like this:
- Perthes disease;
- arthritis;
- Koenig's disease;
- diabetic arthritis;
- pseudogout;
- Intermittent hydrarthrosis (intermittent dropsy 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, resulting in aseptic necrosis (death) of cartilage tissue.Children under the age of 14 are affected, mostly boys.
The main symptom of Perthes disease is constant pain in the hip joint, which increases with walking.Children often complain that their legs tighten from the hip and start to get worse.
In the initial stages, the symptoms are mild, which leads to a late diagnosis, when a fracture is understood (intra-articular).The destructive process is accompanied by increased pain, swelling of soft tissues and stiffness of limb movements.The patient cannot rotate out, rotate, flex or straighten the hip.It is also difficult to move the leg to the side.
Disturbance of the autonomic nervous system is also observed: the foot becomes cold and pale, and sweating 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 faster.
Arthritis
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 damage to cartilage, which becomes thinner as a result of 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.Arthritis pain syndrome has a wave-like (unstable) nature and is localized on the outer side of the thigh, but can spread to the groin, buttocks and lower back.
At the second stage of arthrosis, painful sensations cover the inner thigh and sometimes go down to the knee.As the disease progresses, the pain in the hip increases and sometimes does not appear at rest.
Coxarthrosis can be primary and secondary.Primary coxarthrosis develops against the background of osteochondrosis or arthritis of the knee.The prerequisite 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.Young men between the ages of 16-30 years old most often suffer from this disease, who complain of pain, reduced range of motion and periodic "jamming" 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.At the third or fourth stage, the necrotic area is rejected and enters the articular cavity.This causes the accumulation of effusion (fluid), stiffness of movement and blocking of the left or right joint.
Reference: having a "joint mouse" in the hip joint causes coxarthrosis to develop.
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 expressed rather weak or completely absent, since with this disease the sensitivity is sharply reduced due to pathological changes in the nerve fibers.
Diabetic arthritis occurs during long-term diabetes and is one of its complications.It often occurs in women who have not received full treatment or it was ineffective.It is worth noting that the hip joints are very 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 got this name because of the similarity of the symptoms with gout, which is distinguished by its paroxysmal course.
A sharp and sharp pain suddenly appears: the affected area turns red and swollen, and it becomes warm under your hand.An attack of inflammation lasts from several hours to several weeks, then everything goes away.With chondrocalcinosis, pain is possible on the left or right side of the pelvis.
In the vast majority of cases, pseudogout occurs without a clear reason, and even during an examination it is not possible to detect calcium metabolism disorders.The cause of the disease probably lies in a local metabolic disorder within the joint.In one patient out of every hundred, chondrocalcinosis develops against the background of existing systemic diseases - diabetes, renal failure, hemochromatosis, hypothyroidism, etc.
Synovial chondromatosis
Chondromatosis of the joints, or metaplasia of the cartilaginous islands of the synovium, mainly affects large joints, including the hip.This pathology often 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 chondromic bodies or bone up to 5 cm in size in the joint cavity.
The clinical picture of insulin metaplasia is similar to arthritis: the patient has pain in the hip bone, the 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 chondromic bodies, the occurrence of "articular mouse" cannot be ruled out.In this case, the "mouse" can get stuck between the articular surfaces of the bones, resulting in a 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 jam can stimulate the development of coxarthrosis.Complications of synovial chondromatosis are stiffness (contraction) and muscle atrophy.
Arthritis
Arthritis is inflammation localized to the articular surfaces of the acetabulum and femur.Damage to the hip joint is called coxitis, which is accompanied by severe pain in the back of the thigh and groin.
There are different types of arthritis, the most common type affecting the hip joint is the infectious type.Other types are diagnosed much 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 may differ 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;
- decreased motor ability;
- increase in body temperature.
At the beginning of the disease, patients experience severe pain, especially when standing up from sitting.The joint pain almost always;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, or more precisely, the cartilage that covers it.A characteristic feature of such damage is the cessation of long bone growth, resulting in asymmetry of the lower extremities.
In adults, epiphysiolysis occurs when there is a fracture with displacement or rupture of the epiphysis.The destruction of the epiphysis in the growth zone is possible only in adolescence, which is why the disease is called juvenile.
Adolescent epiphysiolysis is an endocrine-orthopedic pathology, based on an imbalance between growth hormones and sex hormones.These two groups of hormones are essential for the normal functioning of cartilage tissue.
As a result of the excess of growth hormones over sex hormones, the mechanical strength of the growth zone of the femur bone is reduced, and displacement of the epiphysis occurs.The last part of the bone is located below and behind the acetabulum.
Typical symptoms of epiphysis 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 sore leg turns out, the muscles of the buttocks, thighs and legs atrophy.
Treatment
To treat Perthes disease, chondroprotectors are prescribed to regenerate cartilage and angioprotectors 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 advised to unload the limb and use orthopedic devices (plaster casts), as well as special beds to prevent deformation of the femoral head.
What to do and what medicines to take for arthritis depends on the stage of the disease.The following medicines help to relieve pain and slow down the pathological process at stages 1-2:
- non-steroidal anti-inflammatory drugs (NSAIDs);
- vasodilators;
- muscle relaxants to relax the muscles;
- chondroprotectors;
- hormonal (for severe pain);
- ointments and compresses with anti-inflammatory or chondroprotective effects.
At stages 3-4, patients are advised to undergo surgery.
Koenig's disease can only be treated with surgery;during arthroscopic surgery, the affected cartilage area is removed.
Treatment of diabetic arthritis includes correcting the underlying disease – diabetes mellitus, wearing special unloading bandages and taking medication.All patients, regardless of the stage of the disease, are prescribed antiresorptive drugs - bisphosphonates, as well as products with vitamin D and calcium.To relieve pain and inflammation, drugs from the NSAID group and corticosteroids are prescribed.If there are infectious complications, a course of antibacterial therapy is carried out.
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 an intra-articular puncture, in 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 scale of the lesion.If the number of chondromic bodies is small, they are removed by partial synovectomy (excision of the synovial membrane) or minimally invasive arthroscopy (through punctures).Surgical treatment of the progressive form of chondromatosis is only radical and is done using open arthrotomy or complete (complete) synovectomy.
Therapy for acute infectious arthritis includes the mandatory application of a plaster on the hip joint area, taking medications of different groups (NSAIDs, antibiotics, steroids).When a purulent process develops, a course of medical punctures is performed to heal the joint.
Adolescent epiphysiolysis is treated only surgically.During the operation, closed repositioning of the bones is performed using skeletal traction.The joined parts of the bones are then fixed with pins and grafts.
All pathologies of the hip joint are serious diseases that require mandatory medical supervision.Any fall or impact injuries accompanied by severe pain, limited mobility and changes in joint configuration require emergency medical attention.If there were no traumatic injuries, but pain of varying intensity occurs regularly in the joint, you must make an appointment with a therapist or rheumatologist and undergo an examination.