Hip arthritis is a pathological inflammatory reaction that develops in the articular surfaces of the acetabulum and the femoral head. With hip arthritis, patients are concerned about pain in the groin, hip or buttocks, stiffness and limited range of motion, difficulty walking, limping gait. The type of arthritis is established by ultrasound, X-ray, MRI of the hip joints, diagnostic puncture, and blood tests. The general therapeutic algorithm for hip arthritis includes immobilization, drug therapy, physical therapy, massage, physiotherapy; in case of inefficiency, optimal surgical treatment.
ICD 10
M13.8 Other refined arthritics
Meaning
Hip arthritis (coxitis) is an inflammatory process of various etiologies, which involves connective tissue in the area of articulation of the pelvic and femoral bones. In arthritis, inflammation develops in the synovial membrane lining the joint cavity. However, without timely and adequate treatment, coxitis quickly transforms into osteoarthritis of the hip joint, in which degenerative and destructive changes of articular cartilage and subchondral bone occur.
Chronic pain syndrome and dysfunction of the hip joint in arthritis not only limits the physical activity of patients, but can also cause acquired disability. Since hip arthritis can be part of joint syndromes of various etiologies, the true prevalence of the disease remains unknown. It is believed that the frequency of development of coxitis is second only to knee arthritis.
Causes
Inflammation of the hip joints can be caused by infectious agents, mechanical injuries, immune mechanisms. According to the leading etiological factor , there are:
- Purulent arthritis. They can be a complication of injuries, wounds, diagnostic punctures of the joint, operations, as a result of which there is a direct infection of the joint cavity. In other cases, septic coxitis can develop with a breakthrough of a purulent focus from neighboring tissues (with phlegmon, osteomyelitis, etc.) or metastatic infection of the joint cavity from remote inflammatory foci (with furunculosis, tonsillitis, otitis, pneumonia, etc.).
- Specific arthritis. In addition to infectious arthritis caused by nonspecific pyogenic flora, there are specific coxitis associated with tuberculosis, brucellosis, gonorrhea, syphilis.
- Secondary aseptic arthritis. They may be associated with diseases such as psoriasis, systemic lupus erythematosus, Crohn’s disease, ankylosing spondylitis, etc.
- Reactive arthritis. They occur after intestinal (salmonellosis, dysentery, yersiniosis) or urogenital infections (chlamydia, ureaplasmosis, mycoplasmosis) and are also aseptic.
- Rheumatoid arthritis. It is characterized by a complex autoimmune mechanism of development; it is more common in individuals carrying the HLA-DR1, DR4 antigen. The triggering factor in this case can be viruses – herpes simplex, cytomegaly, mumps, measles, Epstein-Barr, respiratory syncytial, hepatitis, etc.
At risk for the development of arthritis are children with hip dysplasia, people with burdened heredity, obesity, bad habits, traumatic hip dislocations, experiencing excessive physical exertion.
Anatomy
The hip joint is formed by the articulation of the cup-shaped acetabulum of the pelvic bone and the femoral head. By the type of connection, it refers to spherical joints. The acetabulum cavity and the femoral head are covered with hyaline cartilage. In the center of the articular cavity there is a zone of loose connective tissue, which serves as a place of attachment of the ligament of the femoral head. A powerful ligamentous apparatus plays an important role in the stabilization and functioning of the hip joint. The hip joint performs complex functions of support and movement (flexion and extension, retraction and reduction of the lower limb, rotation in and out).
Classification
There is no generally accepted classification of coke. In modern rheumatology, traumatology and orthopedics, hip arthritis is usually classified depending on the etiological and pathogenetic mechanisms, distinguishing the following types:
- rheumatoid arthritis;
- reactive arthritis (urogenital and postenterocolitic);
- infectious arthritis (viral, bacterial, fungal, parasitic, post-traumatic, infectious and allergic);
- psoriatic arthritis, etc.
According to the clinical course, hip arthritis joint can be acute (with a duration of primary joint attack of less than 2 months), prolonged (up to 1 year), chronic (longer than 1 year), recurrent (if a repeated joint attack occurs after a period of remission lasting at least 6 months).
Coxites can be primary bone or primary synovial. Examples of primary synovial hip arthritis joint are rheumatoid and reactive arthritis. Primary bone arthritis is spoken of in the case when the bone tissue is initially affected, and then the synovial membrane (for example, in tuberculosis arthritis).
Symptoms of hip arthritis
The most common forms of hip arthritis found in clinical practice are tuberculous and acute purulent coxitis. Other forms are observed much less frequently.
With purulent coxitis, there is a rapid onset of the disease with a predominance of symptoms of general intoxication: fever, weakness, sweating, loss of appetite, headache. Local changes are significantly pronounced: the skin over the joint area becomes tense, hyperemic and hot to the touch. There is a sharp pain (shooting, pulsating), which is even more intense when moving. Due to inflammatory infiltration and the formation of purulent effusion in the joint cavity, the shape of the latter changes significantly.
Other forms of hip arthritis are characterized by gradual development. In the initial stages, dull, aching pains prevail in the groin area, on the outside of the thigh, buttocks, which limit the scope of movement or make walking difficult. Due to the stiffness of the hip joints, the movements become constrained, uncertain, and the gait is limping (Trendelenburg gait). Most often, pain and stiffness in the hip joint occurs after its prolonged fixation in one position in an uncomfortable position, for example, when sitting or standing for a long time. Over time, patients may develop atrophy of the femoral and inguinal muscles, fibrous or bony ankylosis.
Manifestations of tuberculosis arthritis are usually preceded by symptoms of tuberculosis intoxication. In the outcome of specific inflammation, pathological dislocation of the hip, immobility of the hip joint, muscle atrophy and shortening of the limb often develops. In children, hip arthritis is more acute, with more pronounced local and general symptoms of inflammation.
Psoriatic coxitis is accompanied by the appearance of a characteristic bluish-purple staining of the skin over an inflamed joint, pain in the lower spine. In rheumatoid arthritis, the hip joints are affected symmetrically. Progressive dystrophic changes in the joint eventually lead to the development of secondary coxarthrosis.
Diagnostics
When examining a patient with an inflammatory lesion of the hip joints, one cannot limit oneself to making a syndromic diagnosis; it is imperative to determine the root cause of arthritis. To this end, the nature and intensity of pain, the duration of the course of the disease, and concomitant pathology are revealed from the anamnesis. The examination of the patient is carried out in a lying, standing and walking position. At the same time, special attention is paid to the shape of the joints and the position of the limbs, the presence of muscle atrophy and contractures, gait, the ability to perform and the amplitude of passive and active movements.
Along with clinical examination, the crucial role in the diagnosis of arthritis is played by:
- Methods of radiation diagnostics: hip x-ray, hip ultrasound; MRI; contrast arthrography, etc.
- Invasive research. To assess the nature of inflammation, a diagnostic puncture of the hip joint is performed under ultrasound guidance. In some cases, in order to confirm the diagnosis, there is a need for diagnostic arthroscopy and biopsy of the synovial membrane of the hip joint.
- Laboratory tests. With the help of laboratory methods (blood ELISA, determination of CRP and RF, studies of synovial fluid), the origin of hip arthritis is clarified.
- Other methods. If tuberculosis arthritis is suspected, a consultation with a phthisiologist and a tuberculin diagnosis is indicated.
Treatment of hip arthritis
Depending on the cause and stage of hip arthritis, its treatment can be carried out by a rheumatologist, surgeon, orthopedic traumatologist, phthisiologist. In the acute stage, a plaster cast is applied to ensure maximum relief and rest of the hip joint. To facilitate movement, it is recommended to use canes, crutches, walkers and other devices. Treatment includes:
- Pharmacotherapy. It is carried out taking into account the etiology of coxitis and may include taking NSAIDs, specific chemotherapy (for tuberculosis arthritis), antibiotic therapy (for infectious arthritis), etc.
- Intra-articular manipulations. According to the indications, intra-articular injections of corticosteroids, blockades are performed. With purulent coxitis, a series of therapeutic punctures, lavage of the joint with antiseptic solutions, flow drainage of the joint is carried out.
- Physiotherapy. After the relief of acute manifestations of hip arthritis joint, massage, therapeutic gymnastics and swimming, physiotherapy (magnetotherapy, ultrasound, UHF, paraffin therapy, mud therapy, etc.) are prescribed.
- Operations. If attempts at conservative therapy of arthritis are unsuccessful, in case of chronic pain and persistent limitation of joint function, the issue of surgical intervention (synovectomy, total hip replacement, arthroplasty, arthrodesis, arthrotomy, etc.) is resolved.
Prognosis and prevention
The outcome of arthritis can be both mild stiffness and complete ankylosis of the hip joint. A complication of purulent arthritis can be an infectious-toxic shock or sepsis. Timely and full-fledged treatment allows to minimize hip joint dysfunction, prevent the development of osteoarthritis. In order to prevent arthritis, it is necessary to monitor weight, take seriously the treatment of any infections and concomitant diseases, and carry out PHO of penetrating wounds of the joints.