The treatment of coxarthrosis of the hip: conservative therapy or surgery

Лечение коксартроза тазобедренного сустава: консервативная терапия или операцияCoxarthrosis is destructive and degenerative disease of the joints, which occupies a leading position among the diseases of locomotor apparatus in its prevalence. Most often, the lesion affects the large joints of the human skeleton — knee and hip. The treatment of coxarthrosis of the hip joint is a long process and largely depends on how the patient is informed about the disease and is ready to cooperate with the doctor.
The exact cause of this disease is the subject of lively debate in scientific circles. A lot of theories, and many of them unfounded, but to date, scholars have managed to establish a number of predisposing factors that may affect the occurrence of this pathological process. Among others are the following:

  • physiological aging;
  • various hormonal changes, including menopause in women;
  • genetic predisposition;
  • congenital disease of the hip joints;
  • excess body weight of the patient;
  • sedentary lifestyle;
  • the metabolic disorders;
  • some infectious and autoimmune diseases;
  • various pathologies of the spine or feet (kyphosis, flat feet);
  • the dysplasia of various origins, etc.

Лечение коксартроза тазобедренного сустава: консервативная терапия или операция

In the diseased joint is depleted connective cartilage and bones are injured

Intrigue of the disease lies in the fact that in the opening stages of the disease a person is experiencing only minor discomfort, symptoms unmarked, and therefore patients rarely go to the doctor. The clinical course of the disease there are 3 stages:

  • The first stage is characterized by changes in the structure of synovial fluid, which changes its consistency and becomes more viscous. The joint cannot function normally, and the cartilage begins to slowly crumble. There are individual bone spurs named osteophytes. At this stage of the disease the patient is not experiencing intense pain or limitation of mobility in the joints. Can appear only some stiffness and discomfort when used for long periods.
  • The second stage cannot go unnoticed. The patient is experiencing severe pain, which occur even when the joint is at rest. Pain radiates to groin or thigh, and the amount of movement in the joint sharply limited.
  • The third stage is characterized by severe destructive lesions of the joint. There is atrophy of the muscles of the thighs, legs and buttocks, resulting in shortening of leg on affected side, change in centre of gravity and lameness. All this leads to the fact that the load on the joint even more, and the process of destruction becomes more intense. Pain syndrome reaches its maximum intensity and pain of the patient, even at night, at rest. This stage in the absence of adequate treatment ends in patient’s disability.
  • Thus, we can conclude that the sooner the patient noticing the first signs of coxarthrosis, will turn to qualified professionals, the more effective the treatment will be and the more favorable medical prognosis.

    It is customary to distinguish primary and secondary osteoarthritis of the hip joint. The most common form of primary coxarthrosis is a single — or double-sided dysplastic coxarthrosis.

    Лечение коксартроза тазобедренного сустава: консервативная терапия или операцияDysplastic coxarthrosis develops on the background of hip dysplasia, which can be either congenital or acquired. Of great importance for early diagnosis of dysplasia and its timely treatment. In children, the disease is treated by reduction of dislocation and the imposition of special koksetau bandage. This allows you to avoid the development of the baby deforming coxarthrosis.

    The diagnosis of «dysplastic coxarthrosis» put on the basis of x-ray examination and functional diagnostics. Adult patients coxarthrosis of the hip joint that often has a secondary character, while dysplastic osteoarthritis of the hip joint in children is often due to congenital dysplasia.


    Coxarthrosis of the hip joint in ICD 10

    There are certain regulations on an international scale, which sistematizirovat all existing diseases and conditions that affect human health. This approach ensures the unity of methodological approaches in the treatment of various diseases. International classification of diseases and related health is of statistical and classification-based health care. Once in 10 years, the world health organization revises and re-submits the document. Today there are 10 the editors of this document (ICD 10). This classification helps you to convert various diagnoses in a special notation (alphanumeric code), which greatly facilitates the organization and storage of data.

    ICD 10 includes 22 classes of diseases, among them diseases of the musculoskeletal system and connective tissue occupy the 13th place. Codes for ICD 10 from M-15 to M-19 indicate arthritis of different Genesis. Among them code is the M-16 belongs to coxarthrosis (arthrosis of hip joint). There is a certain classification of osteoarthritis of the hip joint according to the etiology of the disease, which is also reflected in the ICD 10. This information also displays when encode condition. According to the ICD 10, there are 9 forms of coxarthrosis of the hip joint:Лечение коксартроза тазобедренного сустава: консервативная терапия или операция

  • 16.0 m primary Coxarthrosis, bilateral.
  • M 16.1 Other primary coxarthrosis.
  • M 16.2 Coxarthrosis as a result of bilateral dysplasia.
  • M 16.3 Other dysplastic coxarthrosis.
  • M 16.4 bilateral post-Traumatic coxarthrosis.
  • M 16.5 Other post-traumatic coxartroz.
  • M 16.6 Other secondary coxarthrosis, bilateral.
  • 16.7 m Other secondary coxarthrosis.
  • M 16.8 Coxarthrosis unspecified.
  • This knowledge is very important for patients. Owning such information, they can decipher the code of the disease according to ICD 10 and to find out the cause of pathology.


    Methods of differential diagnostics

    The most affordable (but equally effective) method of diagnosing this disease was and remains radiography. On x-ray visible structural changes of bone tissue, which allows not only to establish the extent of the disease, but also with great precision to identify the cause of pathology.

    Лечение коксартроза тазобедренного сустава: консервативная терапия или операция

    CT scans of patient with coxarthrosis, which is clearly visible deformation of the femur

    If possible, the patient undergoes CT or magnetic resonance imaging. These progressive methods of research allow you to visualize, among other things, prelezhashie tissue and synovial fluid, which allows to obtain a more accurate picture of the clinical course of the disease.

    Requires differential diagnosis with osteoarthritis, ankylosing spondylitis, reactive arthritis and trochanteric bursitis. For accurate assessment of the etiology of the disease is prescribed a number of laboratory studies. Sometimes dysplastic coxarthrosis mistaken for osteoarthritis of the knee, as the pain radiates to the knee. Based on the above research and survey of the patient’s experienced podiatrist can make a reasonably accurate picture of the disease and to choose the most rational tactics of treatment.


    How to treat osteoarthritis of the hip

    There are a number of techniques that have been used successfully for the treatment of this disease. Conservative methods are very effective at the onset of the disease, when destructive processes are still reversible. Conservative therapy includes a number of activities aimed at reducing pain, improving mobility in the joint and inhibition of destructive processes. For this purpose, use medication and physiotherapy. Drug therapy is the use of nonsteroidal anti-inflammatory drugs prolonged action. These drugs effectively eliminate pain and reduce inflammation.
    Лечение коксартроза тазобедренного сустава: консервативная терапия или операцияVery effective is considered to be the use of chondroprotectors. Drugs in this group increase the effect of anti-inflammatory drugs and protect joint tissues from degenerative and destructive changes. Symptomatic therapy includes the use of muscle relaxants (drugs that relax the muscles in their hypertonicity) and vasodilator drugs.

    Perhaps the use of local therapy (various ointments, gels and creams). Such therapy is ineffective from the point of view of bioavailability, but has some advantages. Massage in coxarthrosis is used to improve blood circulation and metabolic processes. Rubbing creams and gels, you achieve the same results. Massage for the hip can be used only in the stage of stable remission.

    Also, the doctor may prescribe physical therapy and Spa treatment. Specially developed complexes of exercises help to improve mobility of the affected joint and restore its other functions. These exercises can be performed in special clinics in the out-patient clinics and at home.

    If the disease continues to progress, symptoms of coxarthrosis does not pass and become increasingly intense, and medical therapy does not bring the desired relief, the patient was prescribed analgesic intra-articular injections of funds and nonsteroidal anti-inflammatory drugs. To make such shots possible only in a specialized hospital.

    In any case it is impossible to carry out such manipulations at home, as the consequences of improper administration of the drug can be fatal for the patient.


    In some cases, hip surgery shown

    Лечение коксартроза тазобедренного сустава: консервативная терапия или операция

    When critical destruction of bone is necessary to resort to the installation of the artificial joint

    If you treat the disease conservatively fails and the disease progresses, make the decision about surgical intervention (total or partial hip replacement implant). There are several methods by which surgical intervention is performed in coxarthrosis:

    • the endoprosthesis of the hip joint (indication — bilateral coxarthrosis) the operation is a complete replacement of the damaged joint with an implant;
    • arthroplasty — this operation allows you to replace some damaged parts of the joint;
    • osteotomy — the operation for the destruction of the bone, the partial replacement implant and the fastening joints in the most favorable position;
    • arthrodesis is a surgical procedure in which bones are held together with special screws and plates.

    Joint replacement and arthroplasty are the most progressive methods of surgical treatment of coxarthrosis of the hip joint. Such intervention allows you to save not only the function of the damaged limb, but her motor function. Any surgery is a complicated process that requires continuous postoperative monitoring specialists and a long course of rehabilitation. In most cases, such operations are performed successfully and patients can return to normal life.

    Often carry out such an operation in coxarthrosis in children. However, parents should know that in 40% of cases after surgery in children still developed the hip, and often the disease takes a more threatening form. These children showed a significant narrowing of the joint space, gait disturbance and pain during movement.

    In the treatment of children is important for early diagnosis, as the most effective method of treatment of the disease is a conservative therapy.


    Prevention and treatment at home

    Each patient should understand that to treat such severe pathology in the home folk remedies is a waste of precious time. Another thing, when traditional methods are used in conjunction with traditional therapy.
    After consulting with your doctor, you can apply various auxiliary treatment methods. But the self can not only bring you the desired relief, but also cause irreparable damage to your health. Coxarthrosis and self — incompatible concepts.

    Great value in coxarthrosis of the hip joint has diet. It is important to adhere to the principles of rational and healthy eating. Better to eat 5-6 times a day in small portions. The diet should be aimed at correcting body mass and improving metabolism. You should avoid fatty and fried foods, bakery products, sugar and whole milk. Preference should be given fruits and vegetables and foods containing iron and calcium. Food in coxarthrosis of the hip joint should be balanced to ensure that the patient receive all the necessary nutrients in the right quantities.

    It is very important for water-salt balance. You should completely eliminate alcohol, strong tea and coffee and carbonated drinks. As a suitable drink non-carbonated mineral water, green tea without sugar and various decoctions of herbs. Fit tea of chamomile, calendula, leaves of currant or other herbs that have anti-inflammatory properties.

    With an integrated approach to the treatment of coxarthrosis of the hip joint forecast blahopreji.

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