The hip joint (HJ) is a complex joint formed by several bones: the femur, the pubic bone, the pelvis, and the ischial bones.It is surrounded by a periarticular synovium and a strong ligament-muscle layer, protected by subcutaneous fat and skin.
The ilium, ilium, and pubic bone form the pelvis and are connected by hyaline cartilage in the acetabulum.These bones fuse together before age 16.
A distinctive feature of the femoral joint is the structure of the acetabulum, which is only partially covered with cartilage, on the upper and lateral parts.The middle and lower parts are occupied by fatty tissue and femoral ligaments, which are enclosed in synovial membrane.
Reason
Hip pain can cause damage to components within the joint or nearby structures:
- skin and subcutaneous tissue;
- muscles and ligaments;
- synovium;
- acetabular lip (cartilaginous rim running along the rim of the acetabulum);
- articular surface of the femur or pelvis.
Pain in the joint area is caused by inflammation or violation of the integrity of its constituent structures.Typically, pain occurs when infection enters the joint cavity (septic arthritis) and autoimmune damage (rheumatoid arthritis and reactive arthritis).
Mechanical injuries are no less common, leading to damage to the ends of bones, ligaments, synovium and other tissues.Active people and athletes who undergo high physical activity are more susceptible to injury.
Also at risk are elderly people with pelvic pain due to degeneration-dystrophy of cartilage, as well as children and adolescents during periods of hormonal changes.
Left or right hip pain is caused by metabolic diseases - for example diabetes, pseudogout and obesity.
The full list of possible diseases looks like this:
- Perthes disease;
- arthritis;
- Koenig's disease;
- diabetic joint disease;
- pseudogout;
- intermittent hydrarthrosis (intermittent joint relaxation);
- enchondroma;
- reactive, rheumatic and infectious arthritis;
- juvenile epithelial lysis;
- injury.
Perthes disease
With Perthes disease, the blood supply to the femoral head is interrupted, leading to aseptic necrosis (death) of the cartilage tissue.Most children under 14 years of age, mainly boys, are affected.
The leading symptom of Perthes disease is constant pain in the hip joint, which increases when walking.Children often complain that their legs hurt from the hips and begin to limp.
In the early stages, symptoms are mild, leading to a 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 when moving the limbs.The patient is unable to externally rotate, rotate, bend, or straighten the hip.Moving the leg sideways is also difficult.
The autonomic nervous system is also disturbed: the feet become cold and pale, sweating profusely.Sometimes body temperature rises to levels below fever.
Note: in Perthes disease, the lesions can be unilateral or bilateral.In most cases, one of the joints is less damaged and recovers faster.
Arthritis
Hip osteoarthritis 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 due to increased thickness and viscosity of the synovial fluid.
The development of coxarthrosis leads to joint deformation, muscle atrophy and significant limitation of movements up to complete immobility.Arthritis pain is wavelike (intermittent) and localized to the outer thighs, but can radiate to the groin, buttocks, and lower back.
In the second stage of arthritis, pain covers the inside of the thigh and sometimes spreads to the knee.As the disease progresses, the pain in the hip increases and sometimes only subsides with rest.
Coxarthrosis can be primary and secondary.Primary coxarthrosis develops against the background of osteoarthritis or osteoarthritis of the knee.Prerequisites for secondary coxarthrosis can be hip dysplasia, congenital hip dislocation, Perthes disease, arthritis and trauma (dislocations and fractures).
Koenig's disease
If the thigh hurts on one side of the joint, the cause may be death of cartilage tissue (necrosis) - Koenig's disease.This disease is most common in young men aged 16-30 years, who complain of pain, reduced range of motion, and periodically "stuck" their legs.
Koenig's disease develops in several stages: first, the cartilage tissue softens, then hardens and begins to separate from the joint surface of the bone.In the third or fourth stage, the necrotic area is eliminated and enters the joint cavity.This causes effusion (fluid) buildup, stiffness during movement, and blockage of the left or right joint.
Reference: the presence of “joint rat” in the hip joint leads to the development of coxarthrosis.
diabetic joint disease
Osteoarthritis, or Charcot arthropathy, is observed in diabetic patients and is characterized by progressive deformity accompanied by pain of varying intensity.The feeling of pain is expressed quite weakly or is completely absent, because in this disease the sensitivity is sharply reduced due to pathological changes in nerve fibers.
Diabetic arthropathy occurs during long-term diabetes and is one of the complications of the disease.It often occurs in women who receive inadequate or ineffective treatment.It is worth noting that the hip joint is extremely rarely affected.
pseudogout
Due to calcium metabolism disorders, calcium crystals begin to accumulate in joint tissues and chondrocalcinosis, or pseudogout, develops.The disease got its name from the similarity of symptoms with gout, which is distinguished by its paroxysmal course.
Acute and sharp pain appears suddenly: the affected area turns red, swells and becomes hot to the touch.An inflammation lasts from a few hours to a few weeks, then everything passes.With chondrocalcinosis, pain can occur on the left or right side of the pelvis.
In the majority of cases, pseudogout occurs without an obvious cause and even examination cannot detect calcium metabolism disorders.Perhaps the cause of the disease lies in a local metabolic disorder within the joint.In one out of a hundred patients, chondrocalcinosis develops against the background of existing systemic diseases - diabetes, kidney failure, hemochromatosis, hypothyroidism, etc.
Synovial chondromatosis
Articular chondromatosis, or cartilage island dysplasia of the synovial membrane, primarily affects large joints, including the hip.Usually, this disease occurs in middle-aged and elderly men, but there are also cases of congenital chondroma.
With enchondroma, the synovium degenerates into cartilage or bone tissue, leading to the formation of cartilage or bone bodies up to 5 cm in size in the joint cavity.
The clinical picture of visceral dysplasia is similar to arthritis: the patient feels discomfort due to pain in the hip bones, the ability to move the legs is limited, and a characteristic crunching sound is heard when moving.
Since enchondroma is a dysplastic process with the formation of cartilaginous bodies, the appearance of “arthritic rats” cannot be excluded.In this case, the “mouse” can get stuck between the articular surfaces of the bones, leading to partial or complete blockage of the joint.The joint remains blocked until the cartilaginous body enters the lumen of the capsule and only after this movement is completely restored.
Help: frequent or prolonged joint jamming can cause the development of coxarthrosis.Complications of synovial chondromatosis are joint stiffness (contractures) and muscle atrophy.
Arthritis
Arthritis is localized inflammation of the joint surfaces of the acetabulum and femur.Damage to the hip joint is called coxitis, which is accompanied by a dull aching feeling in the back of the thigh and groin area.
There are several types of arthritis, the most common type affecting the hip joint is the infectious form.Other types are diagnosed less frequently.Why does septic arthritis occur?The development of pathology begins after bacteria and viruses enter the joint cavity.
The clinical picture of septic arthritis can vary depending on the type of microorganism that causes the disease.However, there are 5 characteristic signs observed in all patients:
- pain in the right or left leg joints (bilateral damage is also possible);
- swelling on the joints;
- redness of the skin;
- reduced mobility;
- increased body temperature.
At the beginning of the disease, the patient feels severe pain, especially when standing up from a sitting position.Joints hurt almost constantly;the pain prevents you from standing or sitting.It should be noted that the infectious form of arthritis is always accompanied by fever, chills, headache, weakness and nausea.
Juvenile lysis
The term osteolysis literally means decay, the destruction of the articular surface of a bone, or more precisely, the cartilage that covers it.A distinctive feature of such damage is the cessation of bone growth in length, leading to imbalance of the lower limbs.
In adults, bone resorption occurs when there is a fracture accompanied by displacement or breakage of the bone ends.Destruction of the epithelial layer in the growth zone can occur only in adolescence, which is why this disease is called juvenile disease.
Juvenile epithelioid lysis is an endocrine-orthopedic pathology, based on an imbalance between growth hormones and sex hormones.These two groups of hormones are essential for the normal functioning of cartilage tissue.
The predominance of growth hormone 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 lies below and behind the acetabulum.
Typical symptoms of osteolysis include pain in the right or left side of the thigh (depending on which joint is affected), limping, and unnatural position of the leg.Leg pain points outward, muscles in the buttocks, thighs, and legs are atrophied.
Treatment
For the treatment of Perthes disease, chondroprotective drugs are prescribed to promote cartilage regeneration, and vasoprotective drugs are needed to improve blood circulation.Complex therapy also includes massage, therapeutic exercise, physiotherapy - UHF, electrophoresis with calcium and phosphorus, application of mud and ozokerite.
Patients with Perthes disease should remove 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 medications to use to treat arthritis depends on the stage of the disease.The following remedies help relieve pain and slow down the pathological process in stages 1-2:
- nonsteroidal anti-inflammatory drugs (NSAIDs);
- vasodilators;
- muscle relaxants to relax muscles;
- chondroprotector;
- Hormones (for severe pain);
- ointments and compresses have anti-inflammatory or cartilage-protecting effects.
At stages 3-4, patients are advised to have surgery.
Koenig's disease can only be treated with surgery;During arthroscopic surgery, the affected area of cartilage is removed.
Treatment of diabetic joint disease includes treating the underlying disease - diabetes, wearing a special bandage and taking medication.All patients, regardless of the stage of the disease, are prescribed anti-degenerative drugs - bisphosphonates, as well as products with vitamin D and calcium.To reduce pain and inflammation, drugs from the group of NSAIDs and corticosteroids are prescribed.If there are infectious complications, a course of antibacterial treatment is performed.
There is no specific treatment for pseudogout;During exacerbations, anti-inflammatory drugs are prescribed.A large amount of fluid accumulation in the joint is a sign of a joint puncture, in 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 scale of the lesion.If the number of cartilaginous bodies is small, they are removed by partial synovectomy (synovectomy) or minimally invasive arthroscopy (through three punctures).Surgical treatment of the advanced form of enchondroma can only be radical and is carried out by arthrotomy or complete (total) synovectomy.
Treatment of acute infectious arthritis includes mandatory application of plaster to the hip joint area, taking drugs of different groups (NSAIDs, antibiotics, steroids).As the purulent process develops, a medical puncture will be performed to clean the joint.
Treat osteolysis in adolescents with surgery alone.During surgery, closed bone repositioning is accomplished by bone traction.The combined bone parts are then fixed with pins and grafts.
Absolutely all pathologies of the hip joint are serious diseases that require mandatory medical supervision.Any injury following a fall or collision that is accompanied by severe pain, limited mobility, and changes in joint shape requires urgent medical attention.If there is no injury but pain of varying intensity frequently occurs in the joint, you need to make an appointment with a therapist or rheumatologist and undergo an examination.