The hip joint (HJ) is a complex joint formed by several bones: the femur, pubis, ilium and ischium.It is surrounded by the periarticular bursa 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 to the acetabulum.These bones fuse together 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 the top and sides.The middle and lower segments are occupied by adipose tissue and the femoral ligament, enclosed in a synovial membrane.
reason
Pain in the hip joint can cause damage to intra-articular elements or nearby structures:
- skin and subcutaneous tissue;
- muscles and ligaments;
- synovial bursa;
- acetabular rim (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 a violation of the integrity of its constituent structures.Most often, pain occurs when infection enters the joint cavity (infectious arthritis) and autoimmune damage (rheumatoid and reactive arthritis).
Mechanical injuries are no less common, resulting in damage to bone epiphyses, ligaments, synovial membranes and other tissues.Active people and athletes who experience high physical activity are more susceptible to injuries.
At risk are the elderly who have pain in the pelvic bones due to degenerative-dystrophic cartilage changes, as well as children and teenagers 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;
- arthrosis;
- Koenig's disease;
- diabetic arthropathy;
- pseudogout;
- intermittent hydroarthrosis (permanent joint spot);
- chondromatosis;
- reactive, rheumatoid and infectious arthritis;
- epiphysiolysis of minors;
- injuries.
Perthes disease
With Perthes disease, the blood supply to the femoral head is interrupted, which leads to aseptic necrosis (death) of cartilage tissue.Most affected are children under 14, mainly boys.
The main 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 late diagnosis, when an impressive (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 laterally is also difficult.
Disturbances in the autonomic nervous system are also observed: the leg becomes cold and pale, while sweating profusely.Sometimes the body temperature rises to subfebrile levels.
Note: in Perthes disease, the lesion can be unilateral or bilateral.In most cases, one of the joints suffers less and heals faster.
arthrosis
Osteoarthritis of the hip joint is called coxarthrosis and is mainly diagnosed 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 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.The pain syndrome with arthrosis has an undulating (not constant) nature 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 part of the thigh and sometimes go down to the knee.As the disease progresses, the pain in the groin intensifies and only sometimes decreases with 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 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 of the joint, the cause may be the death of cartilage tissue (necrosis) - Koenig's disease.Most often this disease is encountered by young people aged 16-30 years, who complain of pain, reduced range of motion and periodic "swelling" 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 rejected and enters the articular cavity.This causes the accumulation of effusion (fluid), stiffness of movement and blockage of the left or right joint.
Reference: the presence of a "joint 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 are completely absent, since with this disease sensitivity is significantly reduced due to pathological changes in nerve fibers.
Diabetic arthropathy appears during long-term diabetes and is one of its complications.It most often occurs in women who have not received full treatment or it has been ineffective.It is worth noting that the hip joints are extremely rarely affected.
Pseudogout
As a result of calcium metabolism disorders, calcium crystals begin to accumulate in joint tissues and chondrocalcinosis or pseudogout develops.The disease got this name because of the similarity of the symptoms with gout, which is distinguished by its paroxysmal course.
Acute and sharp pain appears suddenly: the affected area becomes red and swollen and becomes hot to the touch.An attack of inflammation lasts from a few hours to a few 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 appears without an obvious cause, and even during the examination it is not possible to detect disorders of calcium metabolism.Apparently, 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, kidney failure, hemochromatosis, hypothyroidism, etc.
Synovial chondromatosis
Chondromatosis of the joints, or cartilaginous metaplasia of the island of the synovium, mainly affects the 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 chondromic 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 thigh bone, the mobility of the leg is limited, and a characteristic cracking sound is heard when moving.
Since chondromatosis is a dysplastic process with the formation of chondromic bodies, the appearance of an "articular rat" 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 blockage 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 locking of the joints can provoke the development of coxarthrosis.Complications of synovial chondromatosis are stiffness (contracture) and muscle atrophy.
Arthritis
Arthritis is a localized inflammation in the articular surfaces of the acetabulum and femur.Damage to the hip joint is called coccyx, which is accompanied by a dull and aching pain in the back of the thigh and in the hip area.
There are several types of arthritis, the most common type affecting the hip joint is the infectious form.Other types are diagnosed much less often.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 vary 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 over the joints;
- skin rash;
- decreased motor skills;
- increase in 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;pain makes standing or sitting impossible.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 breakdown, destruction of the articular surface of the bone, or more precisely, the cartilage that covers it.A distinctive feature of such an injury is the interruption of bone growth in length, which leads to asymmetry of the lower extremities.
In adults, epiphysiolysis occurs when there is a displaced fracture or tear of the epiphysis.The destruction of the pineal gland 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 area of the femur bone 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), lameness, and an unnatural leg position.The injured 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 are necessary to improve blood circulation.Complex therapy also includes massage, exercise therapy, physiotherapy - UHF, electrophoresis with calcium and phosphorus, applications of mud and ozokerite.
Patients with Perthes disease are recommended to unload their limbs and use orthopedic devices (plaster), 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 tools 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 (for severe pain);
- ointments and compresses with anti-inflammatory or chondroprotective effects.
In stages 3-4, 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 correcting the underlying disease - diabetes mellitus, wearing special discharge bandages and taking medications.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 NSAID group 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 and corticosteroid medications are administered.
Chondromatosis of the hip joint requires mandatory surgical intervention, the volume of which depends on the degree of the lesion.If the number of chondromic 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 the mandatory application of plaster in the area of the hip joint, taking medications of various groups (NSAIDs, antibiotics, steroids).When a purulent process develops, a course of medical punctures is performed 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.Any fall or impact injury that is accompanied by severe pain, limited mobility, and changes in joint configuration requires immediate medical attention.If there were no traumatic injuries, but pains of varying intensity regularly appear in the joints, you should make an appointment with a therapist or rheumatologist and undergo an examination.