The hip joint (HJ) is a complex joint formed by several bones: the femur, pubis, ilium, and ischium.It is surrounded by periarticular bursae and a powerful muscular corset, protected by fat and subcutaneous tissue.
The ilium, ischium and pubis form the pelvic floor and are connected by hyaline cartilage in the acetabulum.These bones fuse before the age of 16.
The peculiarity 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 cause damage to the joint or surrounding structures:
- skin and subcutaneous tissue;
- muscles and ligaments;
- synovial bursae;
- acetabulum lip (cartilaginous edge that runs 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 structures.Most often, pain occurs when infection enters the joint cavity (infectious arthritis) and autoimmune damage (rheumatism and reactive arthritis).
Mechanical injuries are no less common, resulting in damage to the epiphyses of bones, ligaments, synovial membranes and other tissues.Active people and athletes who do a lot of exercise are more susceptible to injury.
Also in the risk group are elderly people who have pain in the pelvic bones due to degeneration and muscular changes in the cartilage, as well as children and teenagers 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, pseudoprolapse and obesity.
The full list of possible diseases looks like this:
- Perthes disease;
- arthritis;
- Koenig's disease;
- diabetic arthropathy;
- artificial exit;
- with intermittent hydrops (periodic joint problems);
- chondromatosis;
- reactive arthritis, rheumatoid arthritis and infectious arthritis;
- infantile damage;
- injury.
Perthes disease
With Perthes disease, blood flow to the femoral head is interrupted, leading 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 the leg hurts from the hip and begins to limp.
In the initial stages, symptoms are mild, leading to late diagnosis, when a fracture (intra-joint) has already occurred.The destruction process is accompanied by increased pain, swelling in the soft tissues and stiffness in the movements of the limbs.The patient cannot externally rotate, twist, bend or straighten the hip.It is also difficult to move the leg to the side.
Disturbances in the autonomic nervous system are also observed: the foot becomes cold and pale while sweating profusely.Sometimes the body temperature rises to fever.
Note: in Perthes disease, the lesion may be unilateral or bilateral.In most cases, one joint suffers less and recovers faster.
Arthritis
Osteoarthritis of the hip joint is called coxarthrosis and is diagnosed mainly in the elderly.The disease progresses slowly, but causes irreversible changes.The pathological process begins with damage to the cartilage, which becomes thinner due to the increased thickness and viscosity of the synovial fluid.
The development of coxarthrosis leads to deformation of the joints, muscle atrophy and significant limitation of movement up to complete immobility.Arthritic pain syndrome has a wave-like (unstable) nature and is localized on the outside of the thigh, but can spread to the groin, buttocks and lower back.
In the second stage of arthritis, 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 disappears with rest.
Coxarthrosis can be primary and secondary.Primary coxarthrosis develops against the background of osteochondrosis or knee arthritis.Hip dysplasia, congenital hip dislocation, Perthes disease, arthritis and trauma (dislocation and fracture) can be the cause of upper cervical arthrosis.
Koenig's disease
If the thigh hurts on the side of the joint, the cause may be dead cartilage tissue (necrosis) - Koenig's disease.This disease most often affects young men between the ages of 16-30, who complain of pain, reduced mobility and periodic "stopping" in 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 rejected and enters the joint cavity.This causes fluid (fluid) build-up, stiffness in movement, and locking of the left or right joint.
Reference: the presence of a "joint mouse" in the hip joint leads to the development of gout.
Diabetes is a joint disease
Osteoarthritis, or Charcot joint, occurs in diabetes and is characterized by progressive deformity with pain of varying intensity.Painful sensations are expressed rather weakly or completely absent, since with this disease sensitivity is significantly reduced due to pathological changes in nerve fibers.
Diabetic arthritis occurs with chronic diabetes and is one of its complications.It occurs most often in women who did not receive full treatment or it was ineffective.It is worth noting that the hip joints are very rarely affected.
Pseudogout
As a result of disturbances in calcium metabolism, calcium crystals begin to accumulate in the joint tissues and chondrocalcinosis, or pseudoexcretion, develops.The disease got this name because the symptoms are similar to gout, which is characterized by a concurrent process.
Acute and sharp pain appears suddenly: the affected area becomes red and swollen and feels warm to the touch.A flare-up lasts from a few hours to a few weeks, then it all goes away.With chondrocalcinosis, pain on the left or right side of the pelvis is possible.
In the vast majority of cases, artificial outflow occurs for no apparent reason, and even during examination, it is not possible to detect disturbances in calcium metabolism.Presumably, the cause of the disease 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 cartilaginous 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 pneumonia.
With chondromatosis, the synovial membrane degenerates into cartilage or bone tissue, leading to the formation of chondromas or bone fragments up to 5 cm in size in the joint cavity.
The clinical picture of insular metaplasia is similar to arthritis: pain in the hip bone disturbs the patient, the mobility of the legs is limited, and a characteristic crunching sound is heard during movement.
Since chondromatosis is a dysplastic process with 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 will lead to partial or complete blockage of the joint.The joint is closed until the chondroma body enters the capsule cavity and only after movement is fully restored.
Help: frequent or prolonged joints can cause the development of coxarthrosis.Complications of osteoarthritis include stiffness (contraction) and muscle wasting.
Arthritis
Arthritis is localized inflammation of 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 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 symptoms that are seen in all patients:
- pain in the joints of the right or left leg (there can also be bilateral damage);
- swelling and inflammation over the joint;
- redness of the skin;
- decreased mobility;
- increase in body temperature.
At the onset of the disease, patients experience severe pain, especially when getting 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 contagious form of arthritis is always accompanied by fever, chills, headache, weakness and nausea.
Adolescent physiology
The term epiphysiolysis literally means decay, destruction of the articular surface of the bone, or more specifically, the cartilage that covers it.A characteristic feature of such damage is the cessation of bone growth in length, which leads to asymmetry of the lower limbs.
In adults, epiphysiolysis occurs when there is a fracture with displacement or rupture of the epiphysis.Destruction of the epiphysis in the growth zone is possible only in adolescence, that is why the disease is called juvenile.
Juvenile epiphysiolysis is an endocrine-orthopedic pathology, based on an imbalance between growth hormones and sex hormones.It is these two groups of hormones that are necessary 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 bone and displacement of the epiphysis occurs.The end of the bone is located below and behind the acetabulum.
Typical symptoms of epiphysiolysis are pain on the right or left side of the thigh (depending on which joint is affected), lameness, and abnormal leg position.The sore leg turns out, the muscles of the buttocks, thighs and legs atrophy.
Treatment
To treat Perthes disease, chondroprotectors are prescribed to promote the regeneration of cartilage and anti-angiogenic drugs, which are necessary to improve blood circulation.Complex treatment also includes massage, exercise therapy, physiotherapy - UHF, electrophoresis with calcium and phosphorus, mud and ozokerite application.
Patients with Perthes' disease are recommended to unload the limb and use an orthopedic device (plaster), as well as special beds to prevent deformation of the femoral head.
What to do and what medicine to take for arthritis 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 (for severe pain);
- ointments and compresses with anti-inflammatory or chondroprotective effects.
In stages 3-4, patients are advised to undergo surgery.
Koenig's disease can only be treated with surgery;during arthroscopy, the affected area of the cartilage is removed.
Treatment of diabetic arthritis includes correcting the underlying disease - diabetes, wearing a special bandage and taking medication.All patients, regardless of the stage of the disease, are prescribed resorbable drugs - bisphosphonates, as well as products with vitamin D and calcium.To relieve pain and inflammation, anti-inflammatory drugs and corticosteroids are prescribed.If there are infectious complications, antibiotic therapy is performed.
There is no specific treatment for pseudoreduction;during an exacerbation, anti-inflammatory drugs are prescribed.A large amount of fluid that collects in the joint is an indication of a joint injection, where the fluid is pumped out and corticosteroids are administered.
Chondromatosis of the hip joint requires mandatory surgery, the volume of which depends on the extent of the lesion.If the number of chondroma bodies is small, they are removed by partial synovectomy (excision of the synovial membrane) or minimally invasive arthroscopy (with three punctures).Surgery for the progressive form of chondromatosis can only be radical and is performed with open joint surgery or full (total) synovectomy.
Treatment of acute infectious arthritis includes the mandatory use of plaster on the hip joint area, taking drugs of different groups (NSAIDs, antibiotics, steroids).When a purulent process develops, a medical puncture is made to clean the joint.
Treatment of infantile lesions is only surgical.During the procedure, a closed direct realignment is performed using a skeleton.Then the joined parts of the bones are attached with pins and implants.
Absolutely all pathologies of the hip joint are serious diseases that require mandatory medical supervision.Any fall or impact injury that is accompanied by severe pain, limited mobility, and changes in joint alignment requires emergency medical attention.If there have been no injuries, but varying degrees of pain occur regularly in the joints, you need to make an appointment with a therapist or rheumatologist and undergo an examination.