The hip joint (HJ) is a complex joint formed by several bones: the femur, pubis, ilium, and ischium. It is surrounded by periarticular bags 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 at the acetabulum. These bones fuse together before the age of 16 years.
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.
Causes
Pain in the hip joint can cause damage to intra-articular elements or nearby structures:
- skin and subcutaneous tissue;
- muscles and ligaments;
- synovial bags;
- acetabular lip (cartilaginous rim running along the edge of the acetabulum);
- articular surfaces of the femur or pelvic bone.
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 an autoimmune lesion (rheumatoid and reactive arthritis).
Mechanical injuries are no less common, as a result of which the epiphyses of bones, ligaments, synovial membranes and other tissues are damaged. Traumatization is more prone to active people and athletes experiencing high physical exertion.
At risk are also older people who have pain in the pelvic bones due to degenerative-dystrophic changes in 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 is as follows:
- Perthes disease;
- arthrosis;
- Koenig's disease;
- diabetic arthropathy;
- pseudogout;
- intermittent hydrarthrosis (intermittent dropsy of the joint);
- chondromatosis;
- reactive, rheumatoid and infectious arthritis;
- juvenile epiphysiolysis;
- injury.
Perthes disease
With Perthes disease, the blood supply to the femoral head is disrupted, which leads to aseptic necrosis (death) of cartilage tissue. Mostly children under the age of 14, mostly boys, suffer.
The leading symptom of Perthes disease is constant pain in the hip joint, which increases with walking. Quite often, children complain that the leg is aching from the hip, and begin to limp.
In the initial stages, the symptoms are mild, which leads to late diagnosis, when an impression (intra-articular) fracture already occurs. The destructive process is accompanied by an increase in pain, swelling of soft tissues and stiffness of limb movements. The patient cannot turn the thigh outward, rotate, bend or unbend it. It is also difficult to move the leg to the side.
Violations of the autonomic nervous system are also observed: the foot becomes cold and pale, while sweating profusely. Sometimes the body temperature rises to subfebrile values.
Reference: with Perthes disease, the lesion can be unilateral and bilateral. In most cases, one of the joints suffers less and recovers faster.
Arthrosis
Osteoarthritis of 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 as a result of an increase in the density and viscosity of the synovial fluid.
The development of coxarthrosis leads to joint deformity, muscle atrophy and a significant limitation of movement up to complete immobility. The pain syndrome in arthrosis has a wave-like (non-permanent) character 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, pain covers the inside of the thigh and sometimes goes down to the knee. As the disease progresses, hip pain increases and only sometimes subsides at rest.
Coxarthrosis is primary and secondary. Primary coxarthrosis develops against the background of osteochondrosis or arthrosis of the knee. A prerequisite for secondary coxarthrosis may 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 in the joint area, the cause may be the death of cartilage tissue (necrosis) - Koenig's disease. This disease is most often encountered by young men aged 16-30 years who complain of pain, decreased range of motion and periodic "jamming" of the leg.
Koenig's disease develops in several stages: first, the cartilage softens, then thickens and begins to separate from the articular surface of the bone. At the third or fourth stage, the necrotic area is rejected, and it enters the articular cavity. This is due to the accumulation of effusion (fluid), stiffness of movement and blocking 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's joint, is observed in diabetes mellitus and is characterized by progressive deformity accompanied by pain of varying intensity. Pain sensations are expressed rather weakly or are completely absent, since in this disease sensitivity is sharply reduced due to pathological changes in nerve fibers.
Diabetic arthropathy occurs with a long course of diabetes and is one of its complications. It most often occurs in women who have not received full treatment, or it was ineffective. It should be noted that the hip joints are affected extremely rarely.
pseudogout
As a result of a violation of calcium metabolism, calcium crystals begin to accumulate in the articular tissues, and chondrocalcinosis, or pseudogout, develops. The disease got its name because of the similarity of symptoms with gout, which is characterized by a paroxysmal course.
Acute and sharp pain appears suddenly: the affected area turns red and swells, becomes hot to the touch. An attack of inflammation lasts from several hours to several weeks, then everything passes. 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 the examination, calcium metabolism disorders cannot be detected. 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, renal failure, hemochromatosis, hypothyroidism, etc.
Synovial chondromatosis
Chondromatosis of the joints, or cartilaginous islet metaplasia of the synovial membrane, affects mainly large joints, which include the hip. Most often, this pathology occurs in middle-aged and elderly men, but there are cases of congenital chondromatosis.
With chondromatosis, the synovial membrane degenerates into cartilaginous or bone tissue, as a result of which chondromic or bone bodies up to 5 cm in size are formed in the joint cavity.
The clinic of insular metaplasia is similar to arthritis: the patient is worried about pain in the hip area, leg mobility is limited, and a characteristic crunch is heard during movements.
Since chondromatosis is a dysplastic process with the formation of chondromic bodies, the occurrence of an "articular mouse" is not excluded. In this case, the "mouse" can get stuck between the articular surfaces of the bones, which will lead to partial or complete blockade of the joint. The joint remains blocked until the chondromic body enters the lumen of the capsule, and only after this the movements are restored in full.
Reference: frequent or prolonged jamming of the joint 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. The defeat of the hip joint is called coxitis, which is accompanied by dull, aching pain in the back of the thigh and groin.
There are several varieties of arthritis, most often the hip joint is affected by its infectious form. Other species 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 microorganisms that cause it. However, there are 5 characteristic signs that are observed in all patients:
- pain syndrome in the joint of the right or left leg (there is also a bilateral lesion);
- 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 getting up from a sitting position. The joint almost constantly aches, because of the pain it is 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 the disintegration, destruction of the articular surface of the bone, or rather, 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 extremities.
In adults, epiphysiolysis occurs with a fracture with displacement or rupture of the epiphysis. The destruction of the epiphysis in the growth zone is possible only in adolescence, so 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 femoral bone, and the epiphysis is displaced. The end section of the bone is below and behind the acetabulum.
Typical symptoms of epiphysiolysis are pain on the right side of the thigh or on the left (depending on which joint is affected), lameness, and an unnatural position of the leg. The diseased leg turns outward, the muscles of the buttocks, thighs and lower legs atrophy.
Treatment
To treat Perthes disease, chondroprotectors are prescribed to promote cartilage regeneration, and angioprotectors are necessary to improve blood circulation. Complex therapy also includes massage, exercise therapy, physiotherapy - UHF, electrophoresis with calcium and phosphorus, mud and ozocerite 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 to do and what medicines to drink for arthrosis depends on the stage of the disease. The following remedies help relieve pain and slow down the pathological process at stages 1-2:
- non-steroidal anti-inflammatory (NSAIDs);
- vasodilators;
- muscle relaxants to relax muscles;
- chondroprotectors;
- hormonal (with severe pain);
- ointments and compresses with anti-inflammatory or chondroprotective action.
At stages 3-4, patients are shown surgery.
Koenig's disease is treated only surgically, during arthroscopic surgery, the affected area of cartilage is removed.
Treatment of diabetic arthropathy includes correction of the underlying disease - diabetes mellitus, wearing special unloading bandages and taking medications. All patients, regardless of the stage of the disease, are prescribed antiresorptive drugs - bisphosphonates, as well as drugs 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 antibiotic therapy is carried out.
There is no specific treatment for pseudogout; anti-inflammatory drugs are prescribed for 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 administered.
Chondromatosis of the hip joint requires mandatory surgical intervention, the volume of which depends on the extent of the lesion. With a small number of chondromic bodies, they are removed by partial synovectomy (excision of the synovial membrane) or minimally invasive arthroscopy (through three punctures). Surgical treatment of a progressive form of chondromatosis can only be radical and is performed using open arthrotomy or complete (total) synovectomy.
Therapy of acute infectious arthritis includes the obligatory application of a plaster cast on the hip joint area, taking medications of various groups (NSAIDs, antibiotics, steroids). With the development of a purulent process, a course of therapeutic punctures is carried out to sanitize the joint.
Treatment of juvenile epiphyseolysis is only surgical. During the operation, a closed reposition of the bones is performed, for which skeletal traction is used. 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 after falls or impacts, which are accompanied by severe pain, limited mobility and changes in the configuration of the joint, require emergency medical care. If there were no traumatic injuries, and pains of varying intensity regularly occur in the joint, it is necessary to make an appointment with a general practitioner or rheumatologist and undergo an examination.