The hip joint (HJ) is a complex joint formed by several bones: the femur, pubis, ilium, and ischium.It is surrounded by periarticular bursae 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 in the acetabulum.These bones fuse before the age of 16.
A characteristic 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 the synovial membrane.
Reasons
Pain in the hip joint can cause damage to intra-articular elements or nearby structures:
- skin and subcutaneous tissue;
- muscles and ligaments;
- synovial bursae;
- acetabular lip (cartilaginous rim that runs along the edge of the acetabulum);
- articular surfaces of the femur or pelvis.
Pain in the joint area is caused by inflammation or disruption of the integrity of its component structures.Most often, pain occurs when infection enters the joint cavity (infectious arthritis) and autoimmune damage (rheumatoid and reactive arthritis).
Mechanical injuries are not uncommon, resulting in damage to bone epiphyses, ligaments, synovial membranes and other tissues.Active people and athletes who have high physical activity are more susceptible to injuries.
Elderly people who have pain in the pelvic bones due to degenerative-dystrophic changes in the cartilage are also at risk, as well as children and adolescents in 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;
- arthrosis;
- Koenig's disease;
- diabetic arthropathy;
- pseudogocht;
- intermittent hydrarthrosis (intermittent joint drop);
- chondromatosis;
- reactive, rheumatoid and infectious arthritis;
- juvenile epiphysiolysis;
- injuries.
Perthes disease
With Perthes' disease, the blood supply to the head of the femur is disrupted, which leads to aseptic necrosis (death) of the cartilage tissue.Mostly children under the age of 14, mostly boys, are affected.
The leading symptom of Perthes disease is constant pain in the hip joint, which increases with walking.Children often complain that their leg hurts from the hip and they begin to limp.
In the initial stages, the symptoms are mild, which leads to a late diagnosis, when an imprint (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, flex, or straighten the hip.Moving the leg to the side is also difficult.
Disturbances in the autonomic nervous system are also noted: the foot becomes cold and pale, while sweating profusely.Sometimes the body temperature rises to subfebrile levels.
Note: In Perthes disease, the lesion may be unilateral or bilateral.In most cases, one of the joints suffers less and recovers faster.
Arthrosis
Osteoarthritis of the hip joint 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 as a result of the 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 to complete immobility.Pain syndrome with arthrosis has a wavy (non-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 arthrosis, painful sensations cover the inner side of the thigh, and sometimes go down to the knee.As the disease progresses, hip pain intensifies 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.A prerequisite for secondary coxarthrosis can be hip dysplasia, congenital dislocation of the hip, Perthes disease, arthritis and traumatic injuries (dislocations and fractures).
Koenig's disease
If the thigh hurts on the side of the joint, the cause may be the death of cartilage tissue (necrosis) - Koenig's disease.This disease is mostly encountered by young men aged 16-30 years, who complain of pain, reduced range of motion and periodic "stuckness" of the leg.
Koenig's disease develops in several stages: first, the cartilage 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 shed and enters the articular cavity.This causes a build-up of effusion (fluid), stiffness of movement and blocking of the left or right joints.
Reference: the presence of a "common mouse" in the hip joint leads to the development of coxarthrosis.
Diabetic arthropathy
Osteoarthropathy, 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, because with 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.It occurs most often in women who have not received full treatment or it was ineffective.It is worth noting that the hip joints are extremely rarely affected.
Pseudogocht
As a result of calcium metabolism disorders, calcium crystals begin to accumulate in joint tissues and chondrocalcinosis or pseudogout develops.The disease received this name because of the similarity of the symptoms with gout, which is distinguished by its paroxysmal course.
Sharp and sharp pain appears suddenly: the affected area becomes red and swollen and becomes hot to the touch.The attack of inflammation lasts from several hours to several weeks, and 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 reason, and even during the examination it is not possible to detect disorders of calcium metabolism.Probably, the cause of the disease lies in a local metabolic disorder inside 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 island metaplasia of the synovium, mainly affects 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 cartilage or bone tissue, resulting in the formation of chondroma or bone bodies up to 5 cm in size in the joint cavity.
The clinical picture of insular metaplasia is similar to arthritis: the patient is bothered by pain in the hip bone, the mobility of the legs is limited, and a characteristic cracking sound is heard when moving.
Since chondromatosis is a dysplastic process with the formation of chondromic bodies, the occurrence of "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 chondroma body enters the lumen of the capsule and only after this movement is completely restored.
Help: frequent or prolonged jamming of the joints can cause the development of coxarthrosis.Complications of synovial chondromatosis are stiffness (contracture) and muscle atrophy.
Arthritis
Arthritis is inflammation localized in the articular surfaces of the acetabulum and femur.Damage to 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 types of arthritis, the most common type affecting the hip joint is the infectious form.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 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 joint of the right or left leg (there may also be bilateral damage);
- swelling and swelling above the joint;
- redness of the skin;
- reduced motor ability;
- increase in body temperature.
At the beginning of the disease, patients feel severe pain, especially when getting 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 the breakdown, destruction of the articular surface of the bone, or rather the cartilage that covers it.A characteristic feature of such damage is the cessation of bone growth in length, which leads to asymmetry of the lower limbs.
In adults, epiphysiolysis occurs when there is a displaced fracture or rupture of the pineal gland.The destruction of the pineal gland in the growth zone is possible only in adolescence, which is why the disease is called juvenile.
Juvenile epiphysiolysis is an endocrine-orthopedic pathology, which is based on an imbalance between growth hormones and sex hormones.These two groups of hormones are necessary for the normal functioning of the cartilage tissue.
The dominance of growth hormones over sex hormones leads to a decrease in the mechanical strength of the growth zone of the femur and displacement of the epiphysis occurs.The end 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 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
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 calcium and phosphorus, applications with mud and ozokerite.
Patients with Perthes' disease are recommended to unload the limb and use orthopedic aids (plasters), as well as special beds to prevent deformation of the femoral head.
What to do and which drugs to take for arthrosis depends on the stage of the disease.The following drugs help relieve pain and slow down the pathological process in stages 1-2:
- non-steroidal anti-inflammatory drugs (NSAIDs);
- vasodilators;
- muscle relaxants for muscle relaxation;
- chondroprotectors;
- hormonal (for severe pain);
- ointments and coatings with anti-inflammatory or chondroprotective effect.
In stages 3-4, patients are recommended 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 bandages for unloading and taking medication.All patients, regardless of the stage of the disease, are prescribed antiresorptive drugs - bisphosphonates, as well as products 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 antibacterial therapy 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 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.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 complete (total) synovectomy.
Therapy for acute infectious arthritis includes mandatory application of plaster in the area of the hip joint, taking drugs from different groups (NSAIDs, antibiotics, steroids).When a purulent process develops, a course of medical punctures is carried out to disinfect the joint.
Treatment of juvenile epiphysiolysis is only surgical.During surgery, closed bone repositioning is performed using 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 supervision.All injuries after falls or blows that are accompanied by severe pain, limited mobility and changes in joint configuration require immediate medical attention.If there were no traumatic injuries, but pain of varying intensity regularly occurs in the joint, you should make an appointment with a therapist or rheumatologist and undergo an examination.