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, 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 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 segments are occupied by adipose tissue and the 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;
- acetabulum lip (cartilage 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 constituent structures.Most often, pain occurs when an 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 epiphyses of bones, ligaments, synovial membranes and other tissues.Active people and athletes who experience high physical activity are more susceptible to injuries.
Also the elderly are at risk of 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.
The full list of possible diseases looks like this:
- Perthes disease;
- osteoarthritis;
- 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 disrupted, leading to aseptic necrosis (death) of cartilage tissue.Most often, children under 14 years of age, especially boys, are affected.
The main symptom of Perthes disease is constant pain in the hip joint, which increases when walking.Children often complain that their leg hurts from the hip and starts to limp.
In the initial stages, the symptoms are mild, leading 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 is unable to externally rotate, rotate, bend, or extend the hip.Moving the leg sideways 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.
Osteoarthritis
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 the cartilage, which becomes thinner due to the increased thickness and viscosity of the joint fluid.
The development of coxarthrosis leads to joint deformity, muscle atrophy and significant limitation of movement up to complete immobility.The pain syndrome in osteoarthritis has a wavy (non-constant) character and is localized on the outside of the thigh, but can spread to the groin, buttocks and lower back.
In the second stage of osteoarthritis, painful sensations cover the inside of the thigh and sometimes up to the knee.As the disease progresses, hip pain becomes more severe and sometimes decreases with rest.
Coxarthrosis can be primary or secondary.Primary coxarthrosis develops against the background of osteochondrosis or arthrosis of the knee.The condition for secondary coxarthrosis can 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.This disease occurs most often in young men between the ages of 16 and 30, who complain of pain, decreased range of motion, and periodic "seizing" of the leg.
Koenig's disease develops in several stages: first the cartilage tissue becomes soft, then hard 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 joint cavity.This causes the accumulation of effusion (fluid), stiffness of movement and locking 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 observed in diabetes mellitus and is characterized by progressive deformity accompanied by pain of varying intensity.Painful sensations are expressed rather weakly or completely absent, because in this disease sensitivity is sharply reduced due to pathological changes in the nerve fibers.
Diabetic arthropathy occurs during long-term diabetes and is one of its complications.It occurs most often in women who did not receive full treatment or treatment that was ineffective.It is worth noting that the hip joints are affected extremely rarely.
Pseudo-out
As a result of disorders in calcium metabolism, calcium crystals begin to accumulate in the joint tissues and chondrocalcinosis, or pseudogout, develops.The disease received this name due to the similarity of its symptoms with gout, which is distinguished by its paroxysmal course.
Acute and sharp pain occurs suddenly: the affected area becomes red and swollen and feels warm to the touch.An inflammatory attack lasts from a few hours to a few weeks, then everything disappears.With chondrocalcinosis, pain is possible 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 detect disorders in calcium metabolism.The cause of the disease is probably due to a local metabolic disorder in the joint.In one in a hundred patients, chondrocalcinosis develops against the background of existing systemic diseases - diabetes, renal failure, hemochromatosis, hypothyroidism, etc.
Synovial chondromatosis
Chondromatosis of the joints, or cartilaginous island metaplasia of the synovium, mainly affects large joints, including the hip.Most often, this pathology occurs in middle-aged and older men, but there are cases of congenital chondromatosis.
In chondromatosis, the synovial membrane degenerates into cartilage or bone tissue, resulting in the formation of chondromic 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 suffers from pain in the hip bone, leg mobility is limited, and a characteristic cracking sound is heard during movement.
Since chondromatosis is a dysplastic process with the formation of chondromic bodies, the occurrence 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 completely restored.
Help: Frequent or prolonged joint disturbances can cause the development of coxarthrosis.Complications of synovial chondromatosis include stiffness (contracture) and muscle atrophy.
Arthritis
Arthritis is an inflammation localized to the joint 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, 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 may differ depending on the type of microorganism causing the arthritis.However, there are 5 characteristic symptoms 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;
- reduced motor ability;
- 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 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 distinctive feature of such damage is the cessation of longitudinal bone growth, leading to asymmetry of the lower extremities.
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, 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.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 terminal portion 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 position of the leg.The painful leg turns outward, the muscles of the buttocks, thighs and legs atrophy.
Treatment
To treat Perthes disease, chondroprotectors are prescribed to promote cartilage regeneration, and angioprotectors 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 recommended to unload the limb and use orthopedic devices (plaster casts), as well as special beds to prevent deformity of the femoral head.
What you should do and which medications you should take for osteoarthritis depends on the stage of the disease.The following remedies will help relieve pain and slow down the pathological process in stages 1-2:
- nonsteroidal 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.
In phase 3-4, patients are advised to undergo surgery.
Koenig's disease can only be treated surgically;during arthroscopic surgery, the affected cartilage area is removed.
The treatment of diabetic arthropathy involves correction of the underlying disease – diabetes mellitus, wearing special discharge bandages and taking medications.All patients, regardless of the stage of the disease, are prescribed antiresorptive drugs - bisphosphonates, as well as products containing vitamin D and calcium.To relieve pain and inflammation, drugs from the NSAID group and corticosteroids are prescribed.If there are infectious complications, antibacterial therapy is carried out.
There is no specific treatment for pseudogout;during exacerbations, anti-inflammatory drugs are prescribed.A large amount of fluid accumulating in the joint is an indication for an intra-articular puncture, during which the fluid is pumped out and corticosteroids are administered.
Chondromatosis of the hip joint requires mandatory surgical intervention, the volume of which depends on the size 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 three punctures).Surgical treatment of the progressive form of chondromatosis can only be radical and is carried out via open arthrotomy or complete (total) synovectomy.
Therapy for acute infectious arthritis involves the mandatory application of a plaster cast to the hip joint, during which drugs of different groups are taken (NSAIDs, antibiotics, steroids).When a purulent process develops, a series of medical punctures is performed to disinfect the joint.
The treatment of juvenile epiphysiolysis is surgical only.During the operation, a closed reduction of the bones 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 supervision.Any injuries from falls or impacts that are associated with severe pain, limited mobility and changes in joint configuration require emergency medical attention.If there is no traumatic injury, but pain of varying intensity occurs regularly in the joint, you should make an appointment with a therapist or rheumatologist and undergo an examination.