The hip joint (HJ) is a complex joint formed by several bones: the femur, pubis, ilium and ischium.It is surrounded by a periarticular bursa and a strong muscular-ligamentous corset, protected by fat and subcutaneous skin.
The ilium, ischium and pubis make up the pelvic bones and are connected by hyaline cartilage in the acetabulum.These bones unite 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, on top and on the sides.The middle and lower segments are occupied by adipose tissue and the femoral ligament, enclosed in a synovial membrane.
Reason
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 rim running along the edge of the acetabulum);
- articular surface of the femur or pelvis.
Pain in the joint area is caused by inflammation or violation of the structural integrity of its constituents.Often, pain occurs when infection enters the joint cavity (infectious arthritis) and autoimmune damage (rheumatoid and reactive arthritis).
Mechanical injuries are no less common, resulting in damage to the bone epiphysis, ligaments, synovial membrane and other tissues.Active people and athletes who experience high physical activity are more susceptible to injury.
Also at risk are the elderly who experience pain in the 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 hip joint on the left or right side is caused by metabolic diseases - for example, diabetes mellitus, pseudogout and obesity.
A complete list of possible diseases looks like this:
- Perthes disease;
- arthrosis;
- Koenig's disease;
- diabetic arthropathy;
- pseudogout;
- intermittent hydrarthrosis (intermittent dropsy in the joints);
- chondromatosis;
- reactive, rheumatoid and infectious arthritis;
- juvenile epiphysiolysis;
- injury.
Perthes disease
With Perthes disease, the blood supply to the femoral head is disrupted, which leads to aseptic necrosis (death) of cartilage tissue.Most children under the age of 14, mostly boys, are affected.
The main symptom of Perthes disease is constant pain in the hip joint, which increases with walking.Children often complain that their legs hurt from the hips and begin to limp.
In the early stages, the symptoms are mild, which leads to a late diagnosis, when an impact fracture (intra-articular) has occurred.The destruction process is accompanied by increased pain, swelling of soft tissues and stiffness of limb movements.The patient should not rotate the hip outward, twist, bend or straighten it.Moving the legs to the side is also difficult.
Disturbances in 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 lesions can be unilateral or bilateral.In most cases, one of the joints suffers less and recovers faster.
Arthrosis
Osteoarthritis of the hip joint is called coxarthrosis and is diagnosed mainly in the elderly.The disease develops slowly, but causes irreversible changes.The pathological process begins with damage to the cartilage, which becomes thinner due to an increase in the thickness and viscosity of the synovial fluid.
The development of coxarthrosis leads to joint deformation, muscle atrophy and significant movement limitations until complete immobility.Pain syndrome with arthrosis has a wave-like nature (not constant) and is localized on the outer part of the thigh, but can spread to the groin, buttocks and lower back.
In the second stage of arthrosis, painful sensations cover the inner part of the thigh and sometimes go down to the knee.As the disease progresses, the pain in the hip gets stronger and only sometimes subsides during rest.
Coxarthrosis can be primary and secondary.Primary coxarthrosis develops against the background of osteochondrosis or knee arthrosis.Prerequisites for secondary coxarthrosis may be hip dysplasia, congenital dislocation of the hip, Perthes disease, arthritis and traumatic injuries (dislocations and fractures).
Koenig's disease
If the thigh hurts next to the joint, the cause may be cartilage tissue death (necrosis) - Koenig's disease.This disease is most often encountered by young men aged 16-30 years, who complain of pain, decreased range of motion and periodic "jamming" of the legs.
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 causes accumulation of effusion (fluid), stiffness of movement and blockage in the left or right joint.
Reference: the presence of "joint mice" 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 expressed rather weak or completely absent, because with this disease the 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 most often occurs in women who do not receive full treatment or it does not work.Keep in mind that the hip joint is rarely affected.
Pseudogout
As a result of calcium metabolism disorders, calcium crystals begin to accumulate in the joint tissue, and chondrocalcinosis, or pseudogout, develops.This disease received this name because of the similarity of symptoms with gout, which is distinguished by its paroxysmal course.
Acute and sharp pain appears suddenly: the affected area becomes red and swollen, and becomes hot to the touch.An inflammatory attack lasts from a few hours to a few weeks, then everything disappears.With chondrocalcinosis, the pain may be on the left or right side of the pelvis.
In most cases, pseudogout occurs for no apparent reason, and even during the examination it is not possible to detect a disorder of calcium metabolism.Presumably, the cause of this disease lies in local metabolic disorders in the joints.In one patient out of a hundred, chondrocalcinosis develops against the background of existing systemic diseases - diabetes, kidney failure, hemochromatosis, hypothyroidism, etc.
Synovial chondromatosis
Joint chondromatosis, or metaplasia of synovial cartilage islands, affects mainly 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 a chondromic body or bone up to 5 cm 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 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 occurrence of "articular mice" cannot be ruled out.In this case, the "rat" may 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 prolonged joint congestion can trigger the development of coxarthrosis.Complications of synovial chondromatosis are stiffness (contraction) and muscle atrophy.
Joint pain
Arthritis is a localized inflammation of the articular surface of the acetabulum and femur.Damage to the hip joint is called coxitis, which is accompanied by a dull ache and pain in the back of the thigh and groin area.
There are several types of arthritis, the most common type affecting the hip joint is the infectious form.Other types are diagnosed more rarely.Why does infectious arthritis occur?Pathological development begins after bacteria and viruses enter the joint cavity.
The clinical picture of infectious arthritis may vary depending on the type of microorganism that causes it.However, there are 5 characteristic signs observed in all patients:
- pain in the joints of the right or left leg (there may also be bilateral damage);
- swelling and swelling in the joints;
- redness of the skin;
- decreased motor ability;
- increased body temperature.
At the beginning of the disease, the patient experiences severe pain, especially when standing up from a sitting position.Joint pain almost always;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, the destruction of the articular surface of a bone, or more precisely, the cartilage that covers it.A characteristic feature of such damage is the cessation of growth of long bones, which leads to asymmetry of the lower part.
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 only possible 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 important for the normal functioning of cartilage tissue.
The dominance of growth hormone over sex hormone leads to a decrease in the mechanical strength of the growth zone of the femur bone, and epiphyseal displacement occurs.The end of the bone is located below and behind the acetabulum.
Common symptoms of epiphysiolysis include pain on the right or left side of the thigh (depending on which joint is affected), lameness, and unusual foot position.The painful leg turns outward, the muscles of the back, thighs and legs atrophy.
Treatment
To treat Perthes disease, chondroprotectors are prescribed to promote cartilage regeneration and angioprotectors are necessary to improve blood circulation.Complex therapy also includes massage, exercise therapy, physiotherapy - UHF, electrophoresis with the application of calcium and phosphorus, mud and ozokerite.
Patients with Perthes disease are recommended to unload the limbs and use orthopedic devices (plaster cast), as well as special beds to prevent deformation of the femoral head.
What to do and what medicine to take for arthrosis depends on the stage of the disease.The following remedies help relieve pain and slow down the pathological process at stage 1-2:
- non-steroidal anti-inflammatory drugs (NSAIDs);
- vasodilators;
- muscle relaxants to relax muscles;
- chondroprotector;
- hormones (for severe pain);
- ointments and compresses with anti-inflammatory or chondroprotective effects.
At stage 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, 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 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 pseudogout;during exacerbation, anti-inflammatory drugs are prescribed.A large amount of fluid accumulated in the joint is an indication for intra-articular puncture, where the fluid is pumped out and corticosteroid medication is administered.
Chondromatosis of the hip joint requires mandatory surgical intervention, the amount of which depends on the scale of the lesion.If the number of chondromic bodies is small, they are removed through partial synovectomy (removal of the synovial membrane) or minimally invasive arthroscopy (through three punctures).Surgical treatment of progressive forms of chondromatosis can only be radical and performed using open arthrotomy or complete (total) synovectomy.
Therapy for acute infectious arthritis includes the mandatory application of plaster to the hip joint area, taking drugs of different groups (NSAIDs, antibiotics, steroids).When the purulent process develops, a course of medical puncture is carried out to clean the joint.
Treatment of juvenile epiphysiolysis is only surgical.During the operation, closed repositioning of the bone is performed using skeletal traction.Then the joint part of the bone is fixed with pins and grafts.
Absolutely all pathologies of the hip joint are serious diseases that require mandatory medical supervision.Any injury after a fall or impact accompanied by severe pain, limited mobility and changes in joint configuration requires emergency medical attention.If there is no traumatic injury, but pain of varying intensity often occurs in the joints, you need to make an appointment with a therapist or rheumatologist and undergo an examination.