The hip joint (HJ) is a complex joint made up of several bones: the femur, pubis, ilium and ischium.It is surrounded by periarticular bursae and a powerful musculo-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 before the age of 16.
A special 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 neighboring structures:
- skin and subcutaneous tissue;
- muscles and ligaments;
- synovial bursae;
- acetabular lip (cartilaginous edge running along the edge of the acetabulum);
- articular surfaces of the femur or pelvis.
Pain in the joint area is caused by inflammation or violation of the integrity of its constituent structures.Most often, pain occurs when infection enters the joint cavity (infectious arthritis) and during autoimmune damage (rheumatoid and reactive arthritis).
Mechanical injuries are no less common, leading to damage to the epiphyses of bones, ligaments, synovial membranes and other tissues.Active people and athletes subjected to intense physical activity are more likely to be injured.
Also at risk are elderly people who suffer from 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 hydroarthrosis (intermittent dropsy of the joint);
- chondromatosis;
- reactive, rheumatoid and infectious arthritis;
- juvenile epiphysiolysis;
- injuries.
Perthes disease
With Perthes disease, the blood supply to the femoral head is disrupted, which leads to aseptic necrosis (death) of cartilage tissue.It is mainly children under 14 years old, mainly boys, who are affected.
The main symptom of Perthes disease is constant pain in the hip joint, which increases with walking.Children often complain of leg pain from the hip and begin to limp.
In the early stages, symptoms are mild, which leads to 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 cannot rotate the hip outward, rotate it, flex it, or straighten it.Moving the leg to the side is also difficult.
Autonomic nervous system disorders are also observed: the foot becomes cold and pale, while sweating profusely.Sometimes body temperature reaches subfebrile levels.
Note: in Perthes disease, the lesion can be unilateral or bilateral.In most cases, one of the joints suffers less and recovers more quickly.
Osteoarthritis
Osteoarthritis of the hip is called coxarthrosis and is diagnosed mainly 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 increased thickness and viscosity of the synovial fluid.
The development of coxarthrosis leads to deformation of the joints, muscle atrophy and significant limitation of movements up to complete immobility.Pain syndrome with osteoarthritis has a wave (not constant) 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 osteoarthritis, painful sensations cover the inner side of the thigh and sometimes go down to the knee.As the disease progresses, hip pain intensifies and sometimes only improves with rest.
Coxarthrosis can be primary and secondary.Primary coxarthrosis develops against the background of osteochondrosis or arthrosis of the knee.Prerequisites 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 from the side of the joint, the cause may be the death of cartilaginous tissue (necrosis) - Koenig's disease.This disease most often affects young men aged 16 to 30, who complain of pain, decreased range of motion and periodic “jamming” of the leg.
Koenig's disease develops in several stages: first, the cartilaginous tissue softens, then hardens 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 a build-up 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
Osteoarthritis, or Charcot joint, is observed in diabetes mellitus and is characterized by progressive deformation accompanied by pain of varying intensity.Painful sensations are expressed rather weakly or completely absent, since in this disease sensitivity is sharply reduced due to pathological changes in nerve fibers.
Diabetic arthropathy occurs in long-term diabetes and is one of its complications.This most often occurs in women who have not received comprehensive treatment or it has been ineffective.It should be noted that the hip joints are extremely rarely affected.
Pseudogout
Due to disorders of calcium metabolism, calcium crystals begin to accumulate in joint tissues and chondrocalcinosis, or pseudogout, develops.The disease received this name due to the similarity of symptoms with gout, which is distinguished by its paroxysmal course.
A sharp, sharp pain appears suddenly: the affected area becomes red and swollen, and becomes hot to the touch.An attack of inflammation lasts from several hours to several weeks, then everything goes away.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 calcium metabolism disorders.Presumably, the cause of the disease lies in a local metabolic disorder inside the joint.In every 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 metaplasia of the synovial islands, mainly affects 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 cartilage or bone tissue, leading to the formation of chondromic or bony bodies measuring up to 5 cm in the joint cavity.
The clinical picture of insular metaplasia is similar to that of arthritis: the patient is bothered by pain in the hip bone, mobility of the legs is limited, and a characteristic crunching sound is heard when moving.
Since chondromatosis is a dysplastic process with the formation of chondromic bodies, the appearance 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 blocking of the joint.The joint remains blocked until the chondromic body enters the lumen of the capsule, and only after this movement is fully restored.
Help: Frequent or prolonged joint blockages can cause the development of coxarthrosis.Complications of synovial chondromatosis are stiffness (contracture) and muscle atrophy.
Arthritis
Arthritis is localized inflammation in the joint surfaces of the acetabulum and femur.Damage to the hip joint is called coxitis and is accompanied by dull, aching pain in the back of the thigh and groin.
There are several types of arthritis, with the most common type affecting the hip joint being the infectious form.Other types are diagnosed much less frequently.Why does infectious arthritis appear?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 that causes it.However, there are 5 characteristic signs that are observed in all patients:
- pain in the right or left leg joint (there may also be bilateral lesions);
- swelling and swelling of the joint;
- redness of the skin;
- decreased motor ability;
- increase in body temperature.
At the beginning of the disease, patients experience intense pain, especially when getting up from a sitting position.The joint is painful 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 of the cartilage which covers it.A distinctive feature of this damage is the cessation of bone growth in length, which leads 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, therefore 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 bone and displacement of the epiphysis occurs.The terminal part 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 the affected joint), lameness, and abnormal leg position.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 applications of calcium and phosphorus, mud and ozokerite.
Patients with Perthes disease are recommended to unload the limb and use orthopedic appliances (casts), as well as special beds to prevent deformation of the femoral head.
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 in stages 1-2:
- non-steroidal anti-inflammatory drugs (NSAIDs);
- vasodilators;
- muscle relaxants to relax muscles;
- chondroprotectors;
- hormonal (in case of severe pain);
- ointments and compresses with anti-inflammatory or chondroprotective effects.
In stages 3 and 4, patients are advised to undergo surgery.
Koenig's disease can only be treated 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 relieving 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 group of NSAIDs and corticosteroids are prescribed.In case of infectious complications, antibacterial treatment is carried out.
There is no specific treatment for pseudogout;during exacerbations, anti-inflammatory drugs are prescribed.A large amount of fluid accumulated in the joint is an indication for an intra-articular puncture, during which fluid is pumped out and corticosteroids are administered.
Chondromatosis of the hip joint requires compulsory surgical intervention, the volume of which depends on the extent of the lesion.If the number of chondromic bodies is low, they are removed by partial synovectomy (excision of the synovial membrane) or minimally invasive arthroscopy (by three punctures).Surgical treatment of the progressive form of chondromatosis can only be radical and is carried out by open arthrotomy or complete (total) synovectomy.
Treatment of acute infectious arthritis includes the obligatory application of plaster to the hip joint area and taking drugs of different groups (NSAIDs, antibiotics, steroids).When a purulent process develops, a series of medical punctures is carried out to sanitize the joint.
The treatment of juvenile epiphysiolysis is only surgical.During the operation, closed repositioning of the bones is achieved by 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 monitoring.Any injury resulting from a fall or impact accompanied by severe pain, limited mobility and changes in joint configuration requires emergency medical attention.If there were no traumatic injuries, but pain of varying intensity occurs regularly in the joint, you should make an appointment with a therapist or rheumatologist and undergo an examination.