The hip joint (HJ) is a complex joint made up of several bones: the femur, pubis, ilium, and ischium. It is surrounded by periarticular bags and a powerful muscle-ligamentous corset, protected by fat and subcutaneous skin.
The ilium, ischium, and pubis form the pelvic bone and are connected by hyaline cartilage in the acetabulum. These bones fuse 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, on top 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 (cartilage rim that runs along the rim 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 autoimmune injury (rheumatoid and reactive arthritis).
No less common are mechanical injuries, as a result of which the epiphyses of the bones, ligaments, synovial membranes and other tissues are damaged. Traumatization is more prone to active people and athletes who experience great physical exertion.
Also at risk are 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;
- osteoarthritis;
- Koenig's disease;
- diabetic arthropathy;
- pseudogout;
- intermittent hydrarthrosis (intermittent dropsy of the joint);
- chondromatosis;
- reactive, rheumatoid and infectious arthritis;
- juvenile epiphyseolysis;
- injury.
perthes disease
With Perthes disease, the blood supply to the femoral head is interrupted, which leads to aseptic necrosis (death) of cartilage tissue. Most children under the age of 14, mostly boys, suffer.
The main symptom of Perthes disease is constant pain in the hip joint, which increases when walking. Very often, children complain that their leg hurts from the hip, and they begin to limp.
In the early stages, symptoms are mild, leading to a late diagnosis, when an impression (intra-articular) fracture is already present. The destructive process is accompanied by increased pain, swelling of soft tissues and stiffness of limb movements. The patient cannot turn the thigh outward, rotate it, bend it, 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 profusely sweating. 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.
osteoarthritis
Osteoarthritis of the 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, muscular atrophy and a significant limitation of movement up to total immobility. The pain syndrome in osteoarthritis has a wavelike (non-permanent) character and is located on the outside of the thigh, but can spread to the groin, buttocks and lower back.
In the second stage of osteoarthritis, the pain covers the inner thigh and sometimes reaches the knee. As the disease progresses, hip pain increases and only sometimes disappears 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 common in young men ages 16 to 30 who complain of pain, decreased range of motion, and periodic "stuck" of the leg.
Koenig's disease develops in several stages: first, the cartilage softens, then it thickens 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 is due to the accumulation of effusion (fluid), stiffness of movement and locking of the left or right joints.
Reference: the presence of an "articular mouse" in the hip joint leads to the development of coxarthrosis.
diabetic arthropathy
Osteoarthropathy, or Charcot's joint, is seen in diabetes mellitus and is characterized by a progressive deformity accompanied by pain of variable intensity. Pain sensations are expressed rather weakly or are completely absent, since sensitivity is sharply reduced in this disease due to pathological changes in nerve fibers.
Diabetic arthropathy occurs with a long course of diabetes and is one of its complications. It occurs more often in women who have not received a complete treatment or it was not effective. It should be noted that the hip joints are very rarely affected.
pseudogout
As a result of a violation of calcium metabolism, calcium crystals begin to accumulate in the joint tissues, and chondrocalcinosis or pseudogout develops. The disease got its name due to the similarity of symptoms with gout, which is characterized by a paroxysmal course.
Acute, sharp pain appears suddenly: the affected area reddens and swells, becomes hot to the touch. An attack of inflammation lasts from several hours to several weeks, then everything passes. With chondrocalcinosis, there may be pain 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, calcium metabolism disorders cannot be detected. Presumably, the cause of the disease lies in a local metabolic disorder within the joint. In one patient in a hundred, chondrocalcinosis develops against the background of existing systemic diseases: diabetes, renal failure, hemochromatosis, hypothyroidism, etc.
synovial chondromatosis
Chondromatosis of the joints, or metaplasia of the cartilaginous islands of the synovial membrane, primarily affects the large joints, including 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, the mobility of the legs is limited, and a characteristic crunch is heard during movements.
Since chondromatosis is a dysplastic process with the formation of chondromic bodies, the appearance 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 blockage of the joint. The joint remains locked until the chondromic body enters the lumen of the capsule, and only after this the movements are fully restored.
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 localized inflammation of the joint surfaces of the acetabulum and femur. The defeat of the hip joint is called coxitis, which is accompanied by a 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 seen 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;
- increased body temperature.
At the beginning of the disease, patients experience severe pain, especially when getting up from a sitting position. The joint hurts almost constantly, 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, of the cartilage that covers 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, for which 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 final 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 side (depending on the affected joint), 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 applications of calcium and phosphorus, mud and ozokerite.
Patients with Perthes disease are advised to offload the limb and use orthopedic devices (casts) as well as special beds to prevent femoral head deformity.
What to do and what medications to take for osteoarthritis depends on the stage of the disease. The following remedies help relieve pain and slow down the pathological process at stages 1-2:
- nonsteroidal anti-inflammatory drugs (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, the use of special unloading bandages and taking medication. 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 accumulated fluid 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 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 by open arthrotomy or complete (total) synovectomy.
Therapy of acute infectious arthritis includes the mandatory application of a plaster cast to the hip joint area, taking drugs of various groups (NSAIDs, antibiotics, steroids). With the development of a purulent process, a course of therapeutic punctures is carried out to disinfect the joint.
The treatment of juvenile epiphysiolysis is only surgical. During the operation, a closed repositioning 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 post-fall or impact injury, accompanied by severe pain, limited mobility, and changes in joint configuration, requires emergency medical attention. 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 a rheumatologist and undergo an examination.