The hip joint (HJ) is a complex joint composed of several bones: the femur, the pubis, the hip, and the buttock.It is surrounded by periarticular bursae and a powerful corset of muscles and ligaments, protected by subcutaneous fat and skin.
The ilium, humerus, and pubic bone make up the pelvic bone and are connected by hyaline cartilage in the acetabulum.These bones fuse until the age of 16.
A distinctive feature of the femur joint is the structure of the acetabulum, which is only partially covered by cartilage, on the top and side.The middle and lower segments are occupied by adipose tissue and the femoral ligament, covered by a synovial membrane.
Reasons
Pain in the hip joint can damage intra-articular elements or nearby structures:
- skin and subcutaneous tissue;
- muscles and ligaments;
- synovial bursa;
- acetabular lip (cartilaginous border running along the edge of the acetabulum);
- articular surfaces of the femur or pelvis.
Pain in the joint area is caused by inflammation or damage to the integrity of the structures that make it up.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 damage bone epiphyses, ligaments, synovial membranes and other tissues.Active people and athletes with high physical activity are more prone to injuries.
Also at risk are older people who suffer from pelvic bone pain due to degenerative-dystrophic cartilage changes, 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, such as diabetes, pseudogout and obesity.
The full list of possible diseases looks like this:
- Perthes disease;
- arthrosis;
- Koenig's disease;
- diabetic arthropathy;
- pseudogout;
- intermittent hydratrosis (joint dropsy with breaks);
- chondromatosis;
- reactive, rheumatoid and infectious arthritis;
- minor 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 up to 14 years of age, mostly boys, are the most affected.
The main symptom of Perthes disease is persistent pain in the hip joint that worsens with walking.Children often complain that the leg hurts from the hip and begins to limp.
In the initial stages, the symptoms are insignificant, so the diagnosis is made late, 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.It is also difficult to move the leg to the side.
Disturbances of the autonomic nervous system are also observed: the foot is cold and pale, and there is profuse sweating.Sometimes the body temperature rises to a subfebrile level.
Note: In Perthes disease, the lesion may be unilateral or bilateral.Usually one of the joints suffers less and recovers faster.
Arthrosis
Osteoarthritis of the hip joint is called coxarthrosis and is usually diagnosed in older people.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 causes joint deformation, muscle atrophy, and significant movement restriction to complete immobility.Pain syndrome with arthrosis is undulating (unstable) and 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, sometimes going down to the knee.As the disease progresses, hip pain increases 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 joint.Hip dysplasia, congenital hip dislocation, Perthes disease, arthritis, and traumatic injuries (dislocations and fractures) may be prerequisites for secondary coxarthrosis.
Koenig's disease
If the thigh hurts on the side of the joint, the cause may be cartilage tissue death (necrosis) - Koenig's disease.Young men aged 16-30 mostly encounter this disease, who complain of pain, reduced range of motion and periodic leg "stuckness".
Koenig's disease develops in several stages: first, the cartilage tissue softens, then hardens and begins to separate from the surface of the articular bone.In the third or fourth stage, the necrotic area is rejected and enters the joint cavity.This causes effusion (fluid) build-up, stiffness of movement and blocking of left or right joints.
Reference: the presence of a "joint mouse" in the hip joint causes the development of coxarthrosis.
Diabetic arthropathy
In diabetes, osteoarthropathy or Charcot joint is observed, which is characterized by progressive deformation accompanied by pains of varying intensity.Painful sensations are expressed relatively weakly or not at all, because in this disease sensitivity is significantly reduced due to pathological changes in nerve fibers.
Diabetic arthropathy occurs with long-term diabetes and is one of its complications.It occurs most often in women who have not received full or ineffective treatment.It is worth noting that hip joints are extremely rarely damaged.
Pseudogout
Due to calcium metabolism disorders, calcium crystals begin to accumulate in joint tissues, 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.
Acute and sharp pain occurs suddenly: the affected area becomes red and swollen, hot to the touch.An attack of inflammation lasts from several hours to several weeks, then everything passes.With chondrocalcinosis, pain on the left or right side of the pelvis is possible.
In the vast majority of cases, pseudogout occurs without an obvious cause, even during the examination it is impossible to determine calcium metabolism disorders.It is believed that the cause of the disease is a local metabolic disorder inside the joint.One patient out of a hundred develops chondrocalcinosis in the presence of existing systemic diseases - diabetes, kidney failure, hemochromatosis, hypothyroidism, etc.
Synovial chondromatosis
Joint chondromatosis, or metaplasia of the synovial cartilage island, mainly affects large joints, including the hip.Most often, this pathology occurs in middle-aged and older men, but there are also cases of congenital chondromatosis.
In chondromatosis, the synovial membrane degenerates into cartilage or osseous tissue, resulting in the formation of chondromatous or osseous bodies up to 5 cm in size in the joint cavity.
The clinical picture of insulin metaplasia is similar to arthritis: the patient suffers from pain in the hip bone, the mobility of the legs is limited, and a characteristic crackle is heard when moving.
Since chondromatosis is a dysplastic process with the formation of chondromatous bodies, the occurrence of a "joint mouse" cannot be ruled out.In this case, the "mouse" can get stuck between the surfaces of the articular bones, which will cause partial or complete blockage of the joint.The joint remains locked until the chondromic body enters the capsule lumen, and only after full restoration of this movement.
Help: frequent or long-term joint stiffness can provoke the development of coxarthrosis.Synovial complications of chondromatosis include 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 dull, aching pain in the back of the thigh and in the groin area.
There are several types of arthritis, the most common type affecting the hip joint is infectious.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 signs that are observed in all patients:
- pain in the joint of the right or left leg (there may be bilateral damage);
- swelling and swelling above the joint;
- skin redness;
- decreased motor capacity;
- increase in body temperature.
At the beginning of the disease, patients feel 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, the destruction of the articular surface of the bone, or rather, the cartilage covering it.A distinctive feature of such a lesion is the cessation of bone growth, which leads to asymmetry of the lower limbs.
In adults, epiphysiolysis occurs when there is a fracture with displacement or tearing of the epiphysis.The destruction of the pineal gland in the growth zone is possible only in adolescence, so the disease is called juvenile.
Juvenile epiphysiolysis is an endocrine-orthopedic pathology based on an imbalance of 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 reduces the mechanical strength of the growth zone of the femur and epiphyseal displacement occurs.The back part of the bone is 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), limping, and an unnatural leg position.The painful leg turns outward, the muscles of the buttocks, thighs and legs atrophy.
Treatment
For the treatment of Perthes disease, chondroprotectors are prescribed, which promote cartilage regeneration, and angioprotectors, which 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 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 in case of arthrosis depends on the stage of the disease.These measures help reduce 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 (from 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 surgically;during arthroscopic surgery, the damaged area of cartilage is removed.
Treatment of diabetic arthropathy includes correction of the underlying disease, diabetes mellitus, wearing special discharge bandages, and medication.All patients, regardless of the stage of the disease, are prescribed antiresorptive drugs - bisphosphonates, as well as products with vitamin D and calcium.NSAIDs and corticosteroids are prescribed to relieve pain and inflammation.If there are infectious complications, a course of antibacterial treatment is carried out.
There is no specific treatment for pseudogout;anti-inflammatory drugs are prescribed during exacerbations.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 injected.
Chondromatosis of the hip joint requires mandatory surgical intervention, the scope of which depends on the extent of the damage.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 using open arthrotomy or full (full) synovectomy.
Therapy of acute infectious arthritis includes mandatory application of plaster in the hip joint area, use of various groups of drugs (NSAIDs, antibiotics, steroids).When a purulent process develops, a course of medical punctures is performed to disinfect the joint.
Treatment of juvenile epiphysiolysis is only surgical.During the operation, a closed bone reduction is performed using skeletal traction.The joined bone parts are then fixed with pins and grafts.
Absolutely all pathologies of the hip joint are serious diseases that require mandatory medical care.Any injuries after falls or blows, accompanied by severe pain, limited mobility and changes in joint configuration, require urgent medical attention.If there were no traumatic injuries, but there is constant pain of varying intensity in the joint, you should register with a therapist or rheumatologist and undergo an examination.