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 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 together before the age of 16.
A distinctive feature of the hip joint is the structure of the acetabulum, which is only partially covered with cartilage, on the top and sides.The middle and lower segments are occupied by adipose tissue and femoral ligament, enclosed in a 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 bursae;
- acetabular lip (cartilaginous rim 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 structures.Most often, pain occurs when infection enters the joint cavity (infectious arthritis) and autoimmune damage (rheumatoid and reactive arthritis).
No less common are mechanical injuries that lead to damage to the epiphyses of bones, ligaments, synovial membranes and other tissues.Active people and athletes with high physical activity are more prone to injuries.
Also at risk are the elderly who have pain in the pelvic bones due to degenerative-dystrophic changes in the cartilage, 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, pseudogout and obesity.
The full list of possible diseases looks like this:
- Perthes disease;
- arthrosis;
- Koenig's disease;
- diabetic arthropathy;
- pseudogout;
- intermittent hydrarthrosis (intermittent dropsy of the joint);
- chondromatosis;
- reactive, rheumatoid and infectious arthritis;
- juvenile epiphysiolysis;
- injuries.
Perthes disease
In Perthes disease, the blood supply to the femoral head is impaired, leading to aseptic necrosis (death) of cartilage tissue.Children under the age of 14, mostly boys, are mostly affected.
The leading symptom of Perthes' disease is constant pain in the hip joint, which is aggravated by walking.Children often complain that their leg hurts from the thigh and they begin to limp.
In the initial stages, the symptoms are poorly expressed, which leads to a late diagnosis, when an impression (intra-articular) fracture has already occurred.The destructive process is accompanied by increased pain, swelling of soft tissues and stiffness of limb movements.The patient cannot externally rotate, rotate, bend or straighten the hip.Moving the leg to the side is also difficult.
Disturbances in the autonomic nervous system are also observed: the foot becomes cold and pale, while 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.
Arthrosis
Osteoarthritis of the hip joint is called coxarthrosis and is mostly diagnosed in the elderly.The disease progresses slowly, but leads to irreversible changes.The pathological process begins with damage to the cartilage, which thins as a result of an increase in the thickness and viscosity of the synovial fluid.
The development of coxarthrosis leads to deformation of the joint, muscle atrophy and significant limitation of movements to complete immobility.Pain syndrome with arthrosis has a wave-like (inconstant) nature and is localized on the outer side of the thigh, but can spread to the groin, buttocks 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 joint intensifies and only sometimes subsides at rest.
Coxarthrosis can be primary and secondary.Primary coxarthrosis develops against the background of osteochondrosis or arthrosis of the knee.A prerequisite for secondary coxarthrosis can be dysplasia of the hip joint, congenital luxation of the hip joint, Perthes disease, arthritis and traumatic injuries (dislocations and fractures).
Koenig's disease
If the hip hurts on the side of the joint, the cause may be the death of cartilage tissue (necrosis) - Koenig's disease.This disease most often occurs in young men aged 16-30 years who complain of pain, reduced range of motion and periodic "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.At the third or fourth stage, the necrotic area is rejected and enters the joint cavity.This causes a build-up of effusion (fluid), stiffness of movements and blocking of the left or right joint.
Reference: the presence of a "joint mouse" in the hip joint leads to the development of coxarthrosis.
Diabetic arthropathy
Osteoarthropathy or Charcot's joint is observed in diabetes mellitus and is characterized by progressive deformation accompanied by pain of varying intensity.Painful sensations are expressed rather weakly or completely absent, since in this disease the sensitivity is sharply reduced due to pathological changes in the nerve fibers.
Diabetic arthropathy occurs with prolonged diabetes and is one of its complications.It is most common in women who have not received full treatment or it has been ineffective.It is worth noting that the hip joints are extremely rarely affected.
Pseudogout
As a result of disorders 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 the symptoms with gout, which is characterized by a paroxysmal course.
Sharp and sharp pain appears suddenly: the affected area becomes red and swollen, becomes hot to the touch.An attack of inflammation lasts from several hours to several weeks, after which everything disappears.With chondrocalcinosis, pain on the left or right side of the pelvis is possible.
In the majority of cases, pseudogout occurs without an obvious reason, and even during an examination it is not possible to detect disorders of calcium metabolism.It is assumed that the cause of the disease is a local metabolic disorder inside 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 island metaplasia of the synovium, mainly affects the large joints, including the hip joint.Most often, this pathology occurs in men of middle and old age, but there are cases of congenital chondromatosis.
In chondromatosis, the synovial membrane degenerates into cartilage or bone tissue, which leads to the formation of chondroma 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 worried about pain in the hip bone, mobility of the leg is limited, a characteristic crunch is heard when moving.
Since chondromatosis is a dysplastic process with the formation of chondroma 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 blocking of the joint.The joint remains blocked until the chondroma body enters the lumen of the capsule and only after this movement is fully restored.
Help: frequent or prolonged joint congestion can provoke the development of coxarthrosis.Complications of synovial chondromatosis are stiffness (contracture) and muscle atrophy.
Arthritis
Arthritis is an inflammation localized in the articular surfaces of the acetabulum and femur.Damage to the hip joint is called coxitis, which is accompanied by a dull, aching pain in the back of the thigh and groin area.
There are several types of arthritis, with the most common type affecting the hip joint being the infectious form.Other types are diagnosed much less frequently.Why does infectious arthritis occur?The development of the pathology begins after the entry of bacteria and viruses into 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 that are 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 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 decay, destruction of the articular surface of the bone, or more precisely the cartilage covering it.A distinctive 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 displaced fracture or tear of the epiphysis.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 based on an imbalance between growth hormones and sex hormones.It is these two groups of hormones that 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 end 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 leg position.The sick leg curves outward, the muscles of the buttocks, thighs and legs atrophy.
Treatment
For the treatment of Perthes disease, chondroprotectors are prescribed to promote cartilage regeneration and angioprotectors, which are necessary to improve blood circulation.Complex therapy also includes massage, physical therapy, physiotherapy - UHF, electrophoresis with calcium and phosphorus, mud and ozokerite applications.
Patients with Perthes disease are recommended to unload the limb and use orthopedic devices (plaster bandages), as well as special beds to prevent deformation of the femoral head.
What to do and what medicines to take for arthrosis depends on the stage of the disease.The following means help relieve pain and slow down the pathological process at 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.
At 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 main disease - diabetes mellitus, wearing special unloading bandages and taking drugs.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 exacerbations, anti-inflammatory drugs are prescribed.A large amount of fluid accumulated in the joint is an indication for an intra-articular puncture, during 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 chondroma bodies is small, they are removed by partial synovectomy (excision of the synovial membrane) or minimally invasive arthroscopy (through three punctures).Surgical treatment of the progressive form of chondromatosis can only be radical and is performed by open arthrotomy or complete (total) synovectomy.
Therapy for acute infectious arthritis includes the mandatory placement of a plaster cast in the area of the hip joint, taking drugs from various groups (NSAIDs, antibiotics, steroids).When a purulent process develops, a course of medical punctures is conducted to disinfect the joint.
Treatment of juvenile epiphysiolysis is only surgical.During the operation, closed bone repositioning is performed using skeletal traction.The combined parts of the bones are then fixed with pins and grafts.
Absolutely all pathologies of the hip joint are serious diseases that require mandatory medical supervision.All injuries after a fall or impact, which are accompanied by severe pain, limited mobility and changes in the configuration of the joints, require urgent medical attention.If there were no traumatic injuries, but pain of varying intensity regularly appears in the joint, you should make an appointment with a therapist or rheumatologist and undergo an examination.