The hip joint (HJ) is a complex joint made up of several bones: femur, pubis, ilium and ischium.It is surrounded by periarticular bags and a powerful musculoligamentous 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 distinctive feature of the femoral joint is the structure of the acetabulum, which is only partially covered with cartilage, on top and laterally.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 nearby structures:
- skin and subcutaneous tissue;
- muscles and ligaments;
- synovial bags;
- acetabular lip (cartilaginous edge 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 an infection enters the joint cavity (infectious arthritis) and autoimmune damage (rheumatoid and reactive arthritis).
No less common are mechanical injuries that cause damage to the epiphyses of bones, ligaments, synovial membranes and other tissues.Active people and athletes who engage in intense physical activity are more susceptible to injuries.
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 complete list of possible diseases looks like this:
- Perthes disease;
- osteoarthritis;
- Koenig's disease;
- diabetic arthropathy;
- pseudogout;
- intermittent hydrarthrosis (intermittent dropsy of the joint);
- chondromatosis;
- reactive, rheumatoid and infectious arthritis;
- juvenile epiphysiolysis;
- injuries.
perthes disease
In Perthes disease, the blood supply to the femoral head is impaired, causing aseptic necrosis (death) of the cartilage tissue.The majority of those affected are children under 14 years of age, mostly boys.
The main symptom of Perthes disease is constant pain in the hip joint, which increases when walking.Children often complain that their leg hurts from the hip and begin to limp.
In the initial stages, the symptoms are mild, which leads 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 of limb movements.The patient cannot outwardly rotate the hip, rotate it, flex it, or straighten it.It is also difficult to move the leg to the side.
Alterations are also observed in the autonomic nervous system: the foot becomes cold and pale, while sweating profusely.Sometimes 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.
osteoarthritis
Osteoarthritis of the hip joint is called coxarthrosis and is mainly diagnosed in elderly 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 up to complete immobility.Pain syndrome with osteoarthritis has a wave-like nature (not constant) and is localized on the outer part of the thigh, but can spread to the groin, buttocks and lower back.
In the second stage of osteoarthritis, painful sensations cover the inner thigh and sometimes go down to the knee.As the disease progresses, hip pain intensifies and only sometimes disappears at rest.
Coxarthrosis can be primary and secondary.Primary coxarthrosis develops against the background of osteochondrosis or osteoarthritis of the knee.The prerequisite for secondary coxarthrosis may be hip dysplasia, congenital hip dislocation, Perthes disease, arthritis and traumatic injuries (dislocations and fractures).
koenig's disease
If your thigh hurts on the side of the joint, the cause may be the death of cartilage tissue (necrosis), Koenig's disease.This disease is most commonly suffered by young men between the ages of 16 and 30, who complain of pain, decreased range of motion and periodic "stuckness" of the leg.
Koenig's disease develops in several stages: first, the cartilage tissue softens, then it 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 fluid (fluid) buildup, stiffness of movement, and locking of the left or right joints.
Reference: the presence of a "articular mouse" in the hip joint leads to the development of coxarthrosis.
diabetic arthropathy
Osteoarthropathy, or Charcot joint, is seen in diabetes mellitus and is characterized by progressive deformation accompanied by pain of varying intensity.Painful sensations are expressed quite weakly or are completely absent, since with this disease sensitivity is sharply reduced due to pathological changes in the nerve fibers.
Diabetic arthropathy occurs during long-term diabetes and is one of its complications.It occurs more often in women who did not receive complete treatment or it was ineffective.It is worth noting that the hip joints are rarely affected.
pseudogout
As a result of disorders of calcium metabolism, calcium crystals begin to accumulate in the tissues of the joints and chondrocalcinosis or pseudogout develops.The disease received this name due to the similarity of symptoms with gout, which is characterized by its paroxysmal course.
Sharp, sharp pain appears suddenly: the affected area becomes red, swollen and warm to the touch.An attack of inflammation lasts from several hours to several weeks, then everything goes away.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 it is not possible to detect disturbances in calcium metabolism.Presumably, the cause of the disease lies in a local metabolic disorder within the joint.In one in a hundred patients, 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 island of the synovium, primarily affects large joints, including the hip.Most often, this pathology occurs in middle-aged and elderly men, but there are cases of congenital chondromatosis.
In chondromatosis, the synovial membrane degenerates into cartilage 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 clinical picture of insular metaplasia is similar to that of arthritis: the patient is bothered by pain in the hip bone, the mobility of the legs is limited, and a characteristic crunch is heard when moving.
Since chondromatosis is a dysplastic process with the formation of chondromic bodies, the appearance of a "joint mouse" cannot be ruled out.In this case, the "mouse" may become trapped 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 movement is fully restored.
Help: Frequent or prolonged joint blockage can lead to the development of coxarthrosis.Complications of synovial chondromatosis are stiffness (contracture) and muscle atrophy.
arthritis
Arthritis is a localized inflammation of the articular surfaces of the acetabulum and femur.Damage to the hip joint is called coxitis and is accompanied by a dull, aching pain in the back of the thigh and in the groin area.
There are several types of arthritis, the most common type that affects 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 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 joint of the right or left leg (there may also be bilateral damage);
- swelling and swelling over the joint;
- skin redness;
- decreased motor ability;
- increased body temperature.
At the onset of the disease, patients experience severe pain, especially when standing up from sitting.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 decay, destruction of the articular surface of the bone or, more precisely, of the cartilage that covers it.A distinctive feature of this type of 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 resistance of the growth zone of the femur and a displacement of the epiphysis occurs.The final portion 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), limping, and an unnatural position of the leg.The sore 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, physiotherapy, 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 devices (cast), 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 (for severe pain);
- ointments and compresses with anti-inflammatory or chondroprotective effects.
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, the use of special relief 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 group of NSAIDs and corticosteroids are prescribed.If there are infectious complications, treatment with antibiotics 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 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 chondromic bodies is small, they are removed by partial synovectomy (excision of the synovial membrane) or minimally invasive arthroscopy (using 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.
Therapy for acute infectious arthritis includes the mandatory application of a plaster cast in the hip joint area and the reception of drugs from different groups (NSAIDs, antibiotics, steroids).When a purulent process develops, a course of medical punctures is performed to disinfect the joint.
The treatment of juvenile epiphysiolysis is only surgical.During the operation, closed repositioning of the bones is performed using skeletal traction.The combined parts of the bones are then fixed with pins and grafts.
Absolutely all pathologies of the hip joint are serious diseases that require mandatory medical supervision.Any injury after falls or impacts that is accompanied by severe pain, limited mobility, and changes in joint configuration requires emergency medical attention.If there have been no traumatic injuries, but pain of varying intensity in the joint regularly occurs, it is necessary to make an appointment with a therapist or rheumatologist and undergo an examination.