Diagnosis of hip joint disease. Diagnosing pain in the hip joint: how to understand the pain Exercises and gymnastics

Which examinations must be carried out for the patient for arthrosis of the hip joint (with coxarthrosis)?

In our time to clarify the diagnosis coxarthrosis most often resort to clinical and biochemical blood tests, radiography and magnetic resonance or computed tomography. Somewhat less often, the patient is prescribed an ultrasound (ultrasound examination) of the joints.

Clinical blood test. For this test, blood is taken from a finger. With arthrosis, a clinical blood test, as a rule, does not show any specific changes. Only in some cases may there be a very slight increase in the erythrocyte sedimentation rate (ESR or ROE): up to 20 mm.

On the contrary, a significant increase in ESR (higher) in combination with night pain in the joint should prompt us to think about the rheumatic, inflammatory origin of these pains.
That is, perhaps the patient has arthritis. Or ankylosing spondylitis.

If the patient also has an increased number of leukocytes, then this circumstance confirms the presence in the body of some kind of infectious-inflammatory process, which is reflected in particular in the joints.

However, in any case, a clinical blood test does not give clear answers; it only indicates trends and narrows the circle of diagnostic search.

Blood chemistry. Analysis for rheumatic tests. When performing this test, blood is taken from a vein, and always on an empty stomach. A blood test taken from a vein can provide significant assistance to the doctor in making a differential diagnosis of joint damage: arthrosis or arthritis? Thus, with rheumatic diseases (arthritis), the level of so-called inflammatory markers in the blood increases significantly: C-reactive protein, seromucoid, some globulins and immunoglobulins.

With arthrosis, these biochemical parameters, on the contrary, remain normal.

True, there are cases when certain types of arthritis also do not lead to a significant change in biochemical parameters. But still, such an analysis, as a rule, helps to make a clear distinction between inflammatory and metabolic-dystrophic diseases of the joints (between arthritis and arthrosis).

Attention! In cases where we detect “inflammatory” changes in blood parameters taken from a finger or from a vein in a patient with arthrosis, we should be wary - after all, arthrosis does not cause any changes in the tests. And if inflammation indicators are elevated, there is a high probability that we are dealing not with arthrosis, but with arthritis. Then it is necessary to continue examining the patient until the diagnosis is finally confirmed or refuted.

X-ray of joints. Radiography is the most common and one of the most important methods for diagnosing coxarthrosis. In most cases, even the stage of arthrosis is established solely on the basis of an x-ray: after all, x-rays clearly show changes in the shape of the joint and bone deformations; compaction of the bones under the damaged cartilage is noticeable and osteophytes (“spikes”) are clearly visible. In addition, an X-ray image can be used to judge the width of the joint space, that is, the distance between the articulating bones.

But X-ray examination has a serious disadvantage: only the bones are captured on the X-ray image. But we will not be able to see the soft tissues of the joint (cartilage, joint capsule, etc.) on an x-ray. Therefore, using only X-rays, we will not be able to assess with one hundred percent accuracy the degree of damage to the articular cartilage and joint capsule. Fortunately, in recent years, magnetic tomography has become increasingly widespread.

Magnetic resonance imaging (MRI, or MRI). The research uses, as the name suggests, magnetic waves. They are able to reflect the smallest details of the joint in the resulting image. The magnetic resonance imaging method is very accurate: it allows you to detect the earliest changes in cartilage tissue (which are not yet visible on a regular x-ray), and also helps to see the first signs of the onset of aseptic necrosis (joint infarction), when it exists. Therefore, I often recommend that my patients, in addition to X-rays, carry out magnetic resonance imaging of the joint to clarify the diagnosis.

Although here one thing must be kept in mind. Usually, having received tomographic examination data, doctors are so confident in their infallibility that they do not consider it necessary to double-check the research results and conduct a personal examination of the patient. It is not right.

Firstly, the specialist in the tomography department who interprets the images is also a person and can make mistakes. In particular, I have repeatedly encountered situations where ordinary age-related changes or other diseases similar in picture to arthrosis were mistaken for arthrosis. It happens Often.

Secondly, coxarthrosis detected on a tomogram may not be the patient’s only disease. And the main cause of pain, even in the presence of coxarthrosis, may be another disease: for example, a herniated intervertebral disc, which will need to be treated in parallel with coxarthrosis.

In general, even after receiving a “full package” of patient examinations (X-rays, tests, tomogram), the doctor must still first conduct a personal examination of the patient and only then prescribe treatment.

Computed tomography (CT). In addition to magnetic resonance imaging, some hospitals still use computed tomography. In essence, computed tomography is the most advanced version of x-ray: computed tomography uses the same x-rays as in a conventional x-ray examination. The only difference is that with computed tomography, the tomograph “shreds” the joint with a series of x-rays, and as a result, the image is more voluminous and detailed than with x-rays. But it is still an order of magnitude inferior in information content to a magnetic resonance imaging scan. Therefore, CT should be used only in cases where for some reason we cannot perform magnetic resonance imaging on the patient (for example, if the patient has a pacemaker, a pacemaker, and magnetic waves can disrupt its operation).

Ultrasound of joints (ultrasound examination). In recent years, ultrasound has been actively used to diagnose joint diseases. After all, ultrasound, like magnetic resonance imaging, allows you to see changes in the soft tissues of the joint - for example, using ultrasound you can detect thinning of cartilage tissue in arthrosis or an increase in the amount of joint fluid in arthritis; it is possible to detect damage to the menisci in the knee, etc. However, the method has a significant drawback - it is very subjective, and the data obtained depend entirely on the qualifications of the specialist conducting the study.

Of course, this does not mean that joint ultrasound specialists are always wrong. But even if such an accurate method as tomography leaves room for discrepancies in the interpretation of the data obtained and disagreements in the diagnosis, then the data from ultrasound examination of joints raises questions especially often.

Therefore, I am not inclined to blindly trust the diagnosis obtained by ultrasound of the joints, and I always double-check such conclusions (through a personal examination of the patient, as well as using X-rays or magnetic resonance imaging).

An article by Dr. Evdokimenko for the book “Arthrosis”, published in 2003.
Edited in 2011.

The most complete answers to questions on the topic: “diagnosis of hip joint disease.”

The advanced age of many patients, the burden of concomitant diseases, the often observed excess body weight, physical inactivity caused by the underlying pathology - all this dictates the need for a comprehensive examination of patients. A careful approach to determining indications and contraindications for surgical treatment is due to the fact that most operations on hip joint are very traumatic and are accompanied by significant blood loss. In addition, it must be remembered that the cause of some lesions of the hip joint, for example, avascular necrosis of the femoral head, can be systemic diseases (systemic lupus erythematosus, scleroderma, etc.) or taking hormonal drugs.

General examination of patients is usually carried out on an outpatient basis and includes: examination by a therapist and, if indicated, a neurologist, cardiologist, endocrinologist, pulmonologist, urologist, gastroenterologist, as well as other specialists; performing a clinical analysis of blood and urine, determining the duration of bleeding and blood clotting time; biochemical blood test with determination of levels of sugar, bilirubin, creatinine, transaminases, prothrombin index, Australian antigen and carriage of HIV infection. Instrumental research includes ECG, fluorography; If indicated, X-rays or MRIs of the lumbosacral spine are performed. Based on a comprehensive examination and expert opinion, preoperative preparation is carried out, upon completion of which the anesthesiologist, together with the surgeon, based on the scope of the proposed operation, determines the degree of anesthetic and surgical risk, as well as the strategy for medicinal perioperative protection.

Examination of the function of the hip joint is based on assessing the severity of pain, position and supportability of the limb, range of motion, state of the muscular system, shortening of the limb, functional state of the contralateral hip and knee joints, and lumbar spine. The most important complaint among patients is pain, which is the reason for visiting a doctor. Pain in the hip joint with coxarthrosis intensifies with load or movement and is felt primarily in the groin area. However, it can radiate along the anterior and lateral surfaces of the thigh to the gluteal region, to the anterior part of the knee joint and along the anterior surface of the lower leg to the ankle joint. Sometimes the only manifestation of damage to the hip joint may be pain in the knee joint, for example, in the initial stages of avascular necrosis of the femoral head (AFH).

Pain caused by diseases of the hip joint has a wide and variable irradiation (often in the initial stages of ANFH patients are treated for a long time and unsuccessfully for radiculitis or gonarthrosis), and it must be differentiated from the pain syndrome that occurs with other diseases: sacroiliitis, trochanteric bursitis, adductor enthesopathy muscles, neuropathy of the lateral cutaneous nerve of the thigh, prolapse of intervertebral discs with the appearance of radicular pain, symphysitis. There are anterior (inguinal), lateral (trochanteric) and posterior (gluteal) localizations of the pain syndrome. The most important and prognostically unfavorable is groin pain, which is usually associated with intra-articular pathology. Lateral pain is most often caused by bursitis of the trochanteric region and less often by coxarthrosis. Pain in the gluteal region is associated with spinal pathology or changes in the muscles. Difficulties in determining the source of pain are due to a number of anatomical and physiological features of the structure of the lumbar spine and hip joint. Firstly, the joint is innervated by the LIV (LIII) root of the spinal cord, so its irritation in vertebrogenic pathology and diseases of the hip joint can cause a similar pain syndrome. Secondly, there is a commonality of autonomic innervation of the structural elements of the lumbar motor segments and the tissues of the hip joint. Thirdly, with lumbar osteochondrosis, spondyloarthrosis and spondylolisthesis, zones of neuroosteofibrosis often form, due to the common autonomic innervation of the elements of the lumbar spine and hip joint. Fourthly, degenerative-dystrophic diseases (DDD) of the spine are characterized by the presence of myotonic reflex syndromes, many of which resemble symptoms of coxarthrosis.

From the anamnesis, we find out the intensity and nature of the pain, its presence at rest, whether it goes away with rest, whether the patient needs analgesics, whether the pain affects his lifestyle, whether it forces him to give up his usual activities, and how it affects his professional activity. At the end of the conversation, it is necessary to ask the patient to formulate a request: what would he like to receive as a result of surgical treatment.

Assessment of joint function consists of determining the degree of daily activity and gait. The concept of daily activity includes the ability to climb stairs and use public transport, freedom and time of movement, the use of additional support when walking, the ability to put on socks and boots. Gait is characterized by the degree of support on the leg, lameness and the distance that the patient can walk. The data obtained are entered into the examination protocol of a patient with pathology of the hip joint.

The patient is examined in an upright position, while walking and lying down. When examining in an upright position, you need to pay attention to the following signs:

Pelvic tilt, which is determined by the different levels of the anterior superior spines. The cause of the tilt may be damage to the hip joint with the development of adduction or abduction contracture, shortening of the leg, or primary scoliosis.
Rotational deformity, which is determined by the rotation of the patella and foot. The most common cause of external placement of the leg is unresolved anterior hip dislocation and dysplastic coxarthrosis in the later stages of the disease. Internal rotation is observed in the consequences of a fracture of the posterior parts of the acetabulum, as well as in posterior hip dislocation.
Emphasized lumbar lordosis, which may be caused by a fixed flexion contracture of one or both hip joints.
Muscle atrophy: secondary when the hip joint is damaged due to physical inactivity of the limb and primary when there is muscle damage or a neurological disease. Its degree is determined by measuring with a measuring tape at three levels of the hip.
The Trendelenburg test reveals significant weakness of the hip abductors (gluteus medius and minimus). Ask the patient to lift one leg off the floor. Normally, to maintain balance, the abductor muscles on the weight-bearing side contract and lift the opposite side (Figure 1). If the abductors are weak, the pelvis may “collapse” on the opposite side, and the patient loses balance/

Fig.1. Trendelenburg test:
a – normal; b – with pathology.

The most common causes of a positive Trendelenburg test are diseases of the hip joint, damage to the Lv. When examining a patient while walking, two types of nonspecific gait disturbances are usually observed:

an antiphagic gait usually indicates a painful hip joint - the patient shortens the time of the phase of transferring body weight to the affected joint, as if jumping over the affected side, to avoid painful contraction of the hip abductor muscles;
Trendelenburg gait (abductor lameness) indicates weakness of the abductor muscles on the part of the pathologically altered hip joint. During walking, when transferring the body to the affected side, the opposite side of the pelvis goes down, and the body tilts to the healthy side. When affected bilaterally, it resembles a “duck walk.”

When examining a patient in a supine position, it is necessary to make sure that both anterior superior spines are located at the same level and that the legs lie parallel. Please pay attention to the following violations.

1. Deformity, especially fixed flexion contracture, external rotation or adduction contracture. They often develop sequentially as hip disease progresses (Fig. 2a). With significant flexion contracture, the patient cannot fully straighten the leg until he sits on the couch. With a fixed adduction contracture, the affected limb may cross the healthy leg; any attempt to abduct the hip is accompanied by pain and leads to pelvic distortion. Decreased hip flexion may be compensated by increased lumbosacral lordosis, which masks a fixed flexion contracture. If this contracture is not clearly identified, then the Thomas test can be used. Lumbar lordosis is eliminated by bending the second leg at the hip joint to an angle of 90° (the position of the spine is controlled by placing a hand under the back), and at the same time the position of the test leg is monitored (Fig. 2b).

Ultrasound research is a method of functional examination of a patient and occupies one of the leading positions in clinical medicine due to the accuracy of the data obtained. The result of ultrasound of the hip joints in adults and children with diseases of the corresponding nature is especially important, as well as for monitoring the health status of newborns to identify congenital dysplasias, subluxations and dislocations.

Indications for the procedure

There are many diseases of the musculoskeletal system that require an ultrasound of the hip joint, especially when the doctor has doubts about the etiology of the changes.

The most common indications for ultrasound examination include:

synovitis, arthritis;
osteoarthrosis, hemarthrosis;
necrotic changes in the femoral head;
ruptures, bruises, sprains of ligaments and tendons;
tumor formations, tendonitis, bursitis;
osteomyelitis, etc.

An ultrasound procedure in the hip joint is included in standard clinical diagnostics, including a pediatric examination to obtain more accurate information about the development of a possible pathological process.

Standard ultrasound techniques

The procedure for performing an ultrasound examination of the hip joint is characterized by speed and simplicity. As a rule, no special preparation is required, so ultrasound can be performed immediately, as the need arises. Speed and efficiency make such an examination indispensable for urgent diagnosis of emergency conditions that pose a threat to the patient’s life.

Before the procedure begins, the examination area is lubricated with a special gel in order to better conduct sound and image, which is based on the reflection of the echo signal from the tissues. Due to the fact that tissues have different densities and sound absorption, the image is visualized and allows one to draw a certain conclusion about the development of pathology.

Depending on the diagnostic task, ultrasound can be performed in various ways:

Front. The patient is placed on his back with his legs straightened, installing the sensor along the axis on the femur. In this position, the femoral head, wing of the pelvic bone, inguinal lymph nodes and tissues are clearly visible.
Medial. The starting position is lying down, with the leg extended outward and bent at the knee. In this position, you can view the condition of the adductor muscles and periarticular ligaments.
Rear. The patient should be placed on his side and his knees should be pulled toward his stomach. This position allows you to more accurately examine the sciatic nerve and buttock area.
Lateral. In the lateral position, the thigh must be rotated inward, which allows for more accurate visualization of the state of the trochanteric bursa.

The choice of examination method depends on the preliminary diagnosis, as well as the location of the affected areas.

Results of the study in adults

Ultrasound of the hip joint in adults allows us to evaluate not only the structure of the tissues, but also their size, shape, and vascular blood flow. The results of the study are assessed by the doctor and entered into a special card.

The ultrasound image shows the following changes:

with arthritis, the thickened joint capsule is clearly visible;
synovitis and hemarthrosis are detected on ultrasound in the form of minimal fluid accumulation;
protrusion and osteoarthritis are diagnosed by unevenness of cartilage tissue and osteophyte formations;
violation of tissue integrity indicates extra-articular damage (trauma, etc.);
the image clearly identifies subluxations and dislocations of the femoral head;
examination indicates malignant neoplasms and metastasis;
the procedure allows you to detect effusion into the joint cavity, which is manifested by an increase in the distance between the capsule and the femur;
the inflammatory process in the synovial membranes is characterized by thickening of the joint capsule.

Often, ultrasound reveals hematomas in the gluteal and femoral areas, resulting from severe bruises, falls and injuries, which makes it possible to determine further treatment tactics with a clear identification of the area of pathological changes.

However, it must be borne in mind that there are cases when the doctor cannot make a final verdict based on ultrasound diagnostics alone. In this case, a number of additional procedures are required, including laboratory tests and sampling of material for a biopsy if the development of malignant tumors is suspected. Sometimes a radiation examination using a contrast agent is prescribed.

After the final diagnosis, the doctor, together with other specialists directly related to the disease, prescribes adequate treatment using drug therapy or surgery. Quite often the problem requires the participation of physiotherapy. In complicated cases, as well as in chronic processes, the patient is prescribed constant medication to maintain the vital functions of the body.

Indications for the procedure in children

In the first few months of life, the baby is often prescribed an ultrasound examination to detect pathology in the hip joints. In this case, a timely procedure can prevent complications and avoid surgical intervention. The first ultrasound of the hip joint in children is performed at 1 month, during a routine examination by an orthopedist.

Direct indications for a child to be examined using ultrasound are:

illnesses of the mother that made it difficult for the child to move (fibroids, uterine adhesions, etc.);
high and low water levels during pregnancy;
breech or pelvic presentation;
severe toxicosis in the first 2 trimesters of pregnancy;
premature or rapid labor;
large fruit size;
multiple pregnancy;
injuries during labor.

Ultrasound results indicate that 4% of infants have dysplasia, especially if the disease is present in the parents. This condition is manifested by an incorrect position of the femoral bone, the head of which is displaced or completely removed from the acetabulum of the pelvic bone. This process provokes a slowdown in the turnover of cartilage and joint tissue and, as a result, leads to the development of coxarthrosis (changes in bone joints and muscle atrophy). If dysplasia is not diagnosed in a timely manner in infants, it becomes necessary to undergo a major operation with implantation of an artificial joint.

Tactics for performing the procedure

To perform the procedure, the doctor places the baby on his side so that the angle of joint flexion is from 20 to 30 degrees. Next, the examination area is lubricated with gel (hypoallergenic) and the sensor is tightly applied to it.

The photo is taken in 5 positions: natural state, extended and bent position of the limb, abduction and adduction to the body. A similar procedure is performed on the other side. Pictures from the monitor are printed in black and white on special paper. In this case, the result is assessed based on the comparative characteristics of graphic lines and angles. This technique is called the Graf ultrasound method.

The result is deciphered based on key points:

there is no hip dysplasia if the outer portion of the ilium and the gluteus minimus muscle (base) lie horizontally (straight) and a bend forms in the place where the transition to the cartilaginous tissue of the acetabulum is observed;
the degree of growth of the cartilage zone is determined by the angles alpha (should not exceed 60) and beta (the normal angle is 55). In the case when changes are observed in a newborn, angles 1 and 2 are deviated from the norm (alpha is increased, beta is decreased). The severity of the pathological process is assessed using a special table;
Ultrasound assessment of the hip joints in children is carried out by an orthopedist to exclude errors in diagnosis. It is important to take into account that changes in bone tissue depend on the age of the baby.

Each age group has its own scoring table. The result of the examination is entered into the form.

Benefits of Ultrasound

The positive properties of ultrasound examination are determined by the following advantages:

the ability to study blood flow using a special sensor;
non-invasive procedure;
the ability to assess the condition of organs and tissues with high accuracy;
no negative effects of ions;
absolute safety for the patient.

The positive qualities of the ultrasound technique completely cover the possible disadvantages, which are quite difficult to identify. However, in comparison with MRI, there is less clarity and clarity of the resulting image, which often leads to different diagnostic results. In this case, the responsibility for making the correct diagnosis falls on the doctor.

It must be remembered that ultrasound, like other diagnostic methods, for example, x-rays, laboratory tests, etc. have their pros and cons. When choosing a technique, the patient’s condition and the safety of the procedure are primarily assessed. In each case, the doctor evaluates the optimal balance of all the features of the course of the disease, but the capabilities of ultrasound allow it to be used as widely as possible.

The hip joint is the largest in the human body. In addition, it plays a very important role: it is responsible for connecting the pelvic bones with the femurs.

In appearance, it resembles a hinge - the round head of the femur is inserted into the socket of the pelvic bone; the normal functioning of the joint is ensured by elastic cartilage, which completely covers the surfaces of the connecting bones and ensures their mobility and shock-absorbing function.

The bones do not press on each other or rub against each other, which allows a person to move, run, and dance easily.

Coxarthrosis of the hip joint is diagnosed when old cartilage tissue is destroyed faster than new ones are created, that is, the cartilage becomes thinner or even turns into a dry, rough coating that does not promote movement at all.

This leads not only to friction between bone and bone, but also to inflammation of their surfaces; the joint capsule and ligaments begin to stretch due to filling with inflammatory exudate.

The method is based on the ability of different body tissues to reflect ultrasonic waves differently. This ability is called echogenicity.

More dense structures, such as bone tissue or calcifications, do not transmit sound waves and completely reflect them at any power of the ultrasound machine.

Therefore they are hyperechoic. Air layers also have increased echogenicity.

Liquid homogeneous formations are anechoic, that is, ultrasound passes through them freely. Tissues such as muscle or connective tissue have a moderate degree of echogenicity.

These differences in the ability to reflect ultrasound waves become visible on the ultrasound machine screen. When examining hip joints in adults, the doctor visualizes all the anatomical features of the area being studied and determines normal or pathological signs.

Not only the joint with its internal structure is examined, but also all periarticular formations: muscles, ligaments, lymph nodes, nerve and vascular trunks.

Conservative treatment of grade 3 coxarthrosis is practically meaningless: fragments of cartilaginous tissue are continuously “thrown” into the joint capsule by the flow of overproduced but physiologically immature synovial fluid. The latter becomes inflamed. The swollen tissue immobilizes the joint. Surgical “restoration” is required.

You can “overhaul” a joint in the following ways:

Endoprosthesis replacement is the replacement of a joint with an identical endoprosthesis. Prosthetics of all its “structural” elements or head is performed. The endoprosthesis “holds” the load well and is often the only way to maintain the ability to move;
You can find out about the cost of endoprosthetics here...
Arthrodesis - the functionality of the articular bones is partially restored using a specific “attachment”. This technique does not allow you to completely restore mobility; the leg serves only as a support;
Arthroplasty is a method of a kind of reconstruction of a destroyed “shock absorber”;
Arthrosis of the 3rd degree of the hip joint is also treated by osteotomy, which involves cutting the deformed bones with subsequent “cleaning” and their fastening, which preserves the functionality and mobility of the limb.

Is it possible to cure grade 3 coxarthrosis without surgery? Let’s not get our hopes up in vain: even healthy cartilage is devoid of sensitive nerve fields and an extensive vascular network. The thinned, thread-like “canvas” of shriveled, destroyed cartilage sandwiched by fused bones is practically deprived of blood supply. There can be no question of delivering “nourishing” chondroprotectors through the bloodstream.

The negligible likelihood of drug delivery through the bloodstream is further reduced by the presence of an insurmountable barrier of swollen joint tissue.

And yet, a group of people who have cured grade 3 coxarthrosis without surgery exists. Of course, they did not grow a new joint, but thanks to many years of effort, their quality of life has changed. More on this in the following sections.

Development mechanism

The first question that patients ask when they see a diagnosis of coxarthrosis is what it is and how to treat the disease. The answer can only be obtained by understanding the mechanism of development of pathology.

The joints of the skeletal apparatus are in constant motion. Normally, this produces a lubricant that prevents friction. But for various reasons, this liquid becomes thick and there is not enough of it. As a result, the interarticular cartilage dries out and begins to deteriorate. This occurs in the first stages of deforming coxarthrosis.

If the disease is not treated, destruction of cartilage tissue occurs and the hip joints begin to touch. The pressure of the pelvis on the heads of the femurs increases and their deformation occurs.

Note! But the disease is not limited to changes in bone tissue. Prolonged compression reduces blood supply to joints and muscles. Metabolic processes are disrupted, and atrophy of the femoral and gluteal muscles occurs.

The main causes of the disease

The main cause of coxarthrosis of the hip joint is a malnutrition of the interarticular cartilage. Lack of blood supply and improper metabolism gradually lead to destructive changes.

Among the physiological reasons, the main one is old age. Patients in this category experience hormonal changes in the body that disrupt bone structure. A sedentary lifestyle also has an impact.

Mechanical factors are associated with prolonged compression of the joint and poor circulation. Among the common reasons:

pelvic bone fractures and traumatic dislocations;
necrotic lesion of the femoral head;
skeletal deformities (scoliosis, varus and valgus curvatures, flat feet);
hereditary joint dysplasia;
congenital hip dislocation in children.

Arthrosis of the hip joints also develops due to the following diseases and conditions:

obesity;
pregnancy;
long-term inflammation in the joints;
sedentary lifestyle;
congenital weakness of the ligamentous apparatus.

The degree of hip dislocation and types of dysplasia

According to the international classification, coxarthrosis has an ICD 10 code - M16 and several varieties. Depending on the causes, arthrosis of the hip joints can be either primary or secondary.

When the disease has an unclear etiology and is not caused by other pathologies, we speak of primary coxarthrosis. It is sometimes diagnosed in absolutely healthy middle-aged people who are not overweight and lead an active lifestyle. Secondary coxarthrosis develops as a consequence of concomitant diseases, as well as injuries and inflammation of the hip joint.

Note! Based on localization, a right-sided lesion is distinguished from a left-sided lesion. In rare cases, coxarthrosis is bilateral. This severe form quickly leads to immobility and disability.

In newborn children, the bones and cartilage are still fragile and not fully developed. The head of the femur is fixed in place by ligaments and a cartilaginous rim surrounding the acetabulum.

If the baby has anatomical disorders, the cartilaginous rim is underdeveloped, the acetabulum is flat and not spherical.

Dysplasia can be of varying degrees of severity. Actually, joint dysplasia, that is, the inferiority of their functioning, is revealed only after a thorough diagnosis.

Nature of pain and stage

Pain with coxarthrosis of the hip joint can be constant or associated with exercise. They are often aching and pulling. During an exacerbation, the pain becomes sharp and jerking. It prevents you from falling asleep and cannot be removed by external means. In medical practice, there are three degrees of damage, which directly affect the intensity of symptoms.

First degree

Symptoms and treatment of coxarthrosis of the hip joint are interrelated. The more intense the pain, the more serious the therapy. In the first and second degree of damage, arthrosis of the hip joints can be treated conservatively. For this purpose, physiotherapy, pharmaceutical drugs and gymnastics are used. In the third stage, surgical intervention is indicated.

Medicines

To relieve pain and inflammation, external ointments and gels are used (Dolgit, Diclofenac, Nise, Ketonal, Viprosal, Gevkamen). In case of exacerbation, tablets and injections from the NSAID group (Ibuprofen, Ortofen, Amelotex, Movalis) are used.

If the pain does not subside, hormonal and anti-inflammatory drugs are prescribed, which are injected into the joint (blockade). This method works quickly and improves the condition until the acute inflammation decreases.

Note! At the same time, complex treatment with chondroprotectors is being carried out. They promote the regeneration of cartilage tissue and improve metabolic processes in the joints.

Gymnastics and massage

Treatment of coxarthrosis of the hip joint is ineffective without physical activity and massage. Classes begin at the first signs of illness. Sets of exercises are aimed at improving the elasticity of ligaments, increasing mobility and reducing pain. You can replace gym classes with swimming and skiing.

Massage promotes blood flow to cartilage tissues and normalizes trophism. The procedure is performed daily. You need to massage the area of the back, buttocks and thighs.

Physiotherapy

Aimed at restoring general health and relieving pain. For arthrosis of the hip joints, the following procedures are indicated:

electrophoresis with drugs;
magnetic therapy;
paraffin and ozokerite applications;
balneotherapy.

The initial stages of arthrosis of the first and second degrees are insidious due to the insignificance of symptoms. The pain that appears in the knee joint or hip goes away quickly after a short rest.

The muscles remain strong, the gait remains springy. The disease does not prevent a person from living, however, small bone growths covering the outer or inner edges of the articular surface become a “trigger” for narrowing of the joint space and deformation of the femoral head.

As the disease progresses, it affects cartilage tissue, deforms bones and causes atrophy of some muscle groups, significantly complicating the functioning of the entire joint system.

The most severe manifestation of the pathology, grade 3 coxarthrosis of the hip joint, is characterized by almost complete destruction of cartilage, a large area of bone growth and the disappearance of the joint space. The bones of the joint fuse into a solid structure, depriving it of mobility.

Rarely, destructive processes affect both joints. Bilateral coxarthrosis of the 3rd degree “ties” the legs, hindering their movements, and in the advanced form of the disease, it completely makes it impossible to walk.

What does an x-ray of the hip joint show in a child and an adult?

One of the non-invasive research methods that allows us to diagnose the development of pathological processes in the pelvic area in adults and children is an X-ray of the hip joint. The patient’s long-term well-being depends on the accuracy of the diagnosis.

In addition to fractures and bruises, characterized by acute symptoms, radiography reveals hidden diseases: arthritis, malignant tumors, congenital anomalies, degenerative processes, which, if not treated in a timely manner, worsen a person’s quality of life, lead to disability or death.

External manifestations of coxarthrosis are a consequence of changes in the shape of the joints. Deformation affects skeletal mobility. Muscle fiber atrophy occurs and one leg becomes shorter. This causes at first a slight lameness and then forces the use of a cane.

Pain also affects the manifestation of signs of coxarthrosis of the hip joint. The inability to perform movements in full leads to persistent contractures. The pain intensifies when walking, and patients try to lie or sit more. This is the biggest mistake. A passive lifestyle contributes to muscle drying and further progression of the disease.

Gradually, pain begins to appear not only in the pelvic area, but also in the knees, which makes diagnosis difficult. Many patients mistake coxarthrosis for gonarthrosis and try to treat their legs on their own. As a result, when visiting a doctor, the disease is already in an advanced stage.

Important! Conservative treatment of coxarthrosis should begin at the first symptoms before external signs appear.

Arthritis, or inflammation of the joint, is a very common disease in adults, characterized by certain changes in the joint tissues. When performing an ultrasound of the hip joints, these changes are quite specific.

Due to the active inflammatory process, thickening and swelling of the synovial membrane occurs, the amount of intra-articular fluid increases, and muscles and ligaments react.

As a result, the diagnosis of arthritis is confirmed by ultrasound in the form of the presence of free fluid, thinning of the cartilaginous layer, its unevenness with the formation of growths and erosive areas.

Coxarthrosis is characterized by striking degenerative-dystrophic changes in the joint, occurring in several stages. In each of them, ultrasound of the hip joints shows the degree of degeneration and loss of hyaline cartilage, the growth of bone tissue in the form of osteophytes, a decrease in the amount of joint fluid, and fibrosis of the synovial membrane.

Bursitis, or inflammation of the joint capsule, has typical ultrasound signs. This is a thickening of the hyperechoic stripe (wall of the bag) and an increase in the volume of fluid that has low echogenicity. With chronic inflammation, fibrosis of the bursa and calcification deposits are noted.

Symptoms and signs of grade 3 coxarthrosis

The first signs of this disease are pain. They are caused by a decrease in the elasticity of damaged cartilage. At the first recurring pain in this area, you need to contact a practitioner who can make an accurate diagnosis.

Coxarthrosis of the hip joint, treatment of which will need to begin immediately, can also be recognized by discomfort in the groin area and stiffness in movement. During physical activity, discomfort will turn into pronounced pain. After the end of the exercise, the pain may completely subside.

Arthrosis of the hip joints begins to manifest itself intensively only in the second stage. In the initial stages, it is almost impossible to feel the changes. In rare cases, patients may complain of a pathological crunching sound in the pelvic area when moving.

The main symptoms of coxarthrosis of the hip joint begin to appear as it progresses. The stronger the degree of cartilage damage, the more intense the following manifestations:

stiffness in the joints;
decreased motor activity;
intermittent or continuous pain in the hips, knees and groin;
discomfort when changing body position;
Pain increases with exercise and decreases with rest.

In the last stages of coxarthrosis, symptoms intensify. The nature of the pain and its duration changes. The deformation leads to immobility and disability.

Important! Coxarthrosis develops over several years. But the pain syndrome often manifests itself only in the second or third stage, when it is no longer possible to stop the destruction of cartilage.

The disease arthrosis refers to a progressive and chronic disease, which, without appropriate examination and treatment, ends in joint immobility. A change in cartilage tissue with subsequent destruction and deformation of the bone is called arthrosis of the hip joint. Symptoms initially manifest themselves mildly, in the form of slight discomfort when moving or doing physical work.

Characteristics of the disease
- Causes of arthrosis
- Symptoms and indicators of a developing disease
Degrees of hip arthrosis
- First degree of disease
- Second degree of femoral arthrosis
- Third degree arthrosis
- Deforming type of arthrosis
Making a diagnosis for hip arthrosis
Treatment methods
Treatment in the first two stages of difficulty
Treatment after diagnosis of the third degree
Complications after surgery
Recommendations for preparing a diet
Prevention to prevent disease

The further stage intensifies the pain, which appears not only in the thigh area, but also moves to the gluteal side and radiates to the knee. Most often, women and men over the age of 40 are affected, but there are cases of joint damage in young people.

Characteristics of the disease

Hip dysplasia refers to the inferiority of the hip bone joint, which is observed when there is a violation of the structure of the joint. Basically, the cause is incorrect placement of the femoral head in the acetabulum.

When dysplasia appears, the joint capsule begins to stretch, the ligamentous apparatus does not fully develop, and the acetabulum takes on a flat elliptical shape.

Usually, the head of the femur retains its normal contours, however, sometimes it can acquire pathological shapes and outlines.

Hip dysplasia provokes limited function of the affected limbs. If you do not take timely medical measures, then over time the symptoms of secondary coxarthrosis will form.

The incidence in infants living in environmentally unfavorable areas is up to 12%. The risk of developmental disorders of the hip joints is higher among those children who were born in the breech position.

Bilateral joint damage is considered a fairly rare phenomenon.

Causes of the disease

The genetic factor plays a major role in the formation of dysplasia. Up to 40% of cases of childhood dysplasia are cases where the parents had symptoms of congenital hip dislocation.

There are certain causes of genetic disorders of the anatomical structure and functioning of the joint:

birth injury,
incorrect position of the child during childbirth,
use of certain medications during pregnancy,
severe toxicosis,
mother's age is above average,
maintaining pregnancy with medications,
thyroid disease in the expectant mother,
infections that the mother suffered while carrying a child,
vitamin deficiency during pregnancy,
suboptimal environmental conditions,
harmful working conditions for pregnant women,
hormonal imbalances in a pregnant woman.

Sometimes dysplasia can be combined with a host of various developmental anomalies of the child, for example, torticollis, hydrocephalus or myelodysplasia.

There are three main types of dysplasia:

Acetabular dysplasia. These are anomalies in the formation of the acetabulum.
Mayer's dysplasia or epiphyseal dysplasia. It affects the proximal femur. Pathological disorders of the neck-diaphyseal angle are observed; it determines the appearance of the femoral head.
Rotational dysplasia. These are various deformations of the mutual localization of bones in the horizontal plane.

There are 2 types of epiphyseal dysplasia:

a disease in which the neck-shaft angle increases,
a disease in which the neck-shaft angle decreases.

In addition, there is a condition in which the development of the joint slows down. In this case, there are no significant disturbances in the localization of bones; the phenomenon is not recognized as dysplasia, but this is a borderline condition in which there is a possibility of transition to a disease of the hip joints.

Currently, modern medicine differentiates three stages of dysplasia, which differ from each other in the severity of the pathological process:

The first stage is “mild dysplasia” - pre-luxation. There are some deviations in the formation of the hip joint. The head of the femur is located in the sloping acetabulum.
Second degree – subluxation. There is some mixing of the femoral neck and head upward and outward in relation to the glenoid cavity.
Third degree - dislocation. The femoral head moves completely upward from the acetabulum.

Incorrect treatment or insufficient therapeutic agents leads to the transition of a mild stage of the disease to a severe stage, which is characterized by hip dislocation.

Signs and symptoms

Asymmetrical skin folds. They are identified during examination of the hips from behind and in front with their preliminary extension in the upper part, while the feet should be together. Normally, there are three folds on the thigh, and their location should be the same. If there is dysplasia, then the number of folds increases on one thigh, this is visible both when examining the gluteal and when examining the anterior surface.

Limited limb abduction. In normal condition, the child’s legs are separated by 90 degrees; with dysplasia, this can be done to a maximum of 60 degrees. This symptom is characteristic of dislocation and subluxation of the hip joint.

Marx-Ortolani slip or clicking sign. The test is performed by placing the child on his back.

It is necessary to cover the knee joints so that the thumbs are under the child’s knee, and all the rest are on the outer surface of the leg. When pressure is applied to the axis of the thighs and the limb is moved to the side, a small click is heard.

This can only happen in the first weeks of the child’s life, then the click disappears.

Shortening of the diseased limb, which is determined by the height of the knees. This sign is most often determined after one year of age. It is observed in newborns only with severe forms of dysplasia.

Additional symptoms of dysplasia:

torticollis,
softness of the cranial bones,
varus or valgus foot placement,
violation of the searching and sucking reflex.

Consequences of childhood dysplasia

Children with dysplasia, compared to the norm, begin to walk later. As a rule, their gait is unstable, there is:

clubfoot,
lameness,
transshipment.

The lordosis of the lower back and the compensatory formation of kyphosis of the thoracic region often increases. Disability can occur at an early age in a sick child.

If there is no adequate and timely treatment in childhood, then in the future a person will have a lot of diseases that are caused by the development of dysplasia and osteochondrosis. If the hip joints are malfunctioning, the limbs cannot withstand prolonged loads.

Hypermobility of the hip joints leads to “looseness” of the musculoskeletal system itself. If congenital dislocation of the hip is not corrected in a timely manner, the joint, adapting to this functioning, forms new shapes, both from the side of the femoral head and from the side of the acetabulum.

The new forms of the joint formed are not complete; the joint cannot normally support support or abduct the limbs. This human condition is called “neoarthrosis”.

The most negative complication is dysplastic coxarthrosis - this is a disease that begins to develop already at the age of 25-35 years and may require surgical intervention.

Diagnostics

When the disease is severe, the diagnosis is always easy to identify. It is based on an external examination, research, and in later childhood, gait and limb shape are assessed. Dysplasia is often diagnosed in the maternity hospital.

One of the following studies must be carried out:

X-ray (from three months),
Ultrasound of the joints of the lower extremities (from birth of the child).

An additional method that will confirm the diagnosis is MRI or ultrasonography of the joint.

Treatment of hip dysplasia

The earlier treatment measures are started, the better the prognosis for restoring joint function in a child.

Conservative treatment has a main principle: subluxation and dislocation of the hip can be corrected independently by fixing and positioning the limbs in an abducted state.

Until the child is six months old, rigid structures cannot be used, which can severely limit joint mobility or cause necrosis of the femoral head.

Important therapeutic measures are:

Freyka pillow,
Pavlik stirrups,
Baker's pants,
Physiotherapy,
Wide swaddling (with legs separated to 80 degrees, two diapers are placed between them and secured on top with a third one),
Therapeutic splinting using elastic splints: Vilensky or Volkov splints,
A spreading tire that is used when walking.

Can be used as an additional treatment:

massage,
applications with paraffin,
mud therapy,
dry heat;
electrophoresis of calcium chloride or lidase.

Other diagnostic methods

To make an accurate diagnosis, a practitioner needs only a visual examination of the patient and information about complaints and pain. It will be necessary to conduct a clinical and biochemical blood test, as well as magnetic resonance or computed tomography. In rare cases, an x-ray is enough to make a diagnosis.

Tests for joint diseases are prescribed for the differential diagnosis of arthrosis and arthritis. Minimum set: general and biochemical blood tests, general urine test.

With arthrosis, no abnormalities in the blood picture are detected, and a urine test is normal. Severe signs of inflammation (significant increases in ESR and white blood cell levels) indicate arthritis.

Biochemical analysis and rheumatic tests help determine the nature of inflammation. A microscopic examination of the synovial fluid, for the collection of which a puncture is performed, is highly informative.

This procedure is usually resorted to in cases of severe inflammation of a presumably infectious nature in order to identify the pathogen.

CT (computed tomography) and MRI (magnetic resonance therapy) are more informative compared to x-rays. CT allows you to obtain images of the joint from different angles, in the form of many sections.

This way you can identify changes that go unnoticed with x-rays. CT and X-ray are designed to examine the hard tissues of the joint, and MRI allows you to visualize changes in the cartilage, synovium and outer layer of the joint capsule, muscles, ligaments, and tendons.

Ultrasound is the most informative in inflammatory processes, since it allows one to assess the volume of inflammatory effusion and changes in the characteristics of synovial fluid.

There is also an invasive method for diagnosing joint diseases - arthroscopy. A type of endoscope is inserted into the joint cavity through a small incision or puncture. Such diagnostics are resorted to in complex cases when other methods are not sufficiently informative, as well as before arthroscopic operations.

Contraindications: presence of damaged skin and open wounds.

Ultrasound scanning helps diagnose all kinds of pathologies in the tissues surrounding the hip joint. The speed and information content of the study is especially relevant for injuries of the periarticular area, ruptures of muscles, ligaments and tendons.

Ultrasound is used to diagnose damage to vascular and nerve trunks in the groin area, aneurysms, hemorrhages in the soft tissues of the buttocks and thighs, phlegmons and abscesses.

The importance of ultrasound is also important in the study of inguinal lymph nodes. Tumors, tuberculosis, mycoses, inflammation and abscesses change the structure of lymphoid tissue, which increases echogenicity.

As a result, tissue compaction and heterogeneity can be recorded during ultrasound scanning.

Ultrasound of the hip joints is a fast, absolutely safe research method. In some cases, it becomes the only diagnostic method that provides the most complete information about the pathology.

During an ultrasound examination of the connective tissue between the femur and pelvis, the newborn baby must be placed on its side.

Then the child needs to be helped to bend his legs and hold them in this position while the doctor conducts an examination.

Certain areas of the child's thigh will be treated with a gel that does not cause allergies, and then an ultrasound equipment sensor will be moved over them.

After examining one hip, the newborn is shifted to the other side and the same steps are repeated.

In order to see on the monitor screen whether the head of the joint is shifted from the center, the child’s thigh is raised, pressed to the tummy and rotated.

Thus, ultrasound of the hip joints in children makes it possible to accurately diagnose congenital inferiority of the joint.

It is advisable to do an ultrasound half an hour after feeding the baby so that he does not accidentally regurgitate milk during the procedure.

An ultrasound examination will be more effective if the newborn baby feels comfortable and calm, that is, he is well-fed and healthy.

During an ultrasound of the hip joints in children, the doctor takes a picture that reflects the condition of the joint in the anteroposterior projection. Based on the resulting image, the doctor will measure the alpha and beta angles.

The alpha angle indicates the degree of mobility and inclination of the bone tissue of the acetabulum.

The beta angle reflects the same thing, but regarding cartilage tissue. The norm for the first indicator is more than 60 degrees, the second is less than 55.

The interpretation of the ultrasound protocol, if a subluxation is detected, includes other angle indicators.

Angles α and β will deviate from the norm by more than 20 degrees, that is, α will be more than 43 degrees, and β will be more than 77.

When a child has a dislocation, the decoding contains the following angle indicators: α - exactly 43 degrees, β - from 78 degrees.

But if the acetabulum of the joint in newborns is not yet beveled, but semicircular, then what is observed is not subluxation or dislocation, but dysplasia. For dysplasia, special angle values are determined. The alpha angle will be 43 - 59 degrees, and the beta angle will be 55 - 77.

In addition, the doctor must indicate in the examination report the degree of damage to the connective tissue of the hip. The marks “I type A” or “I type B” in the ultrasound report are the norm.

The letter A indicates that the joint is formed normally, and B means the limbus is slightly shortened, but the center is not displaced.

If the normal development of joints in newborns is disturbed, the doctor will put in the protocol type II A (developmental delay), III type A (the roof of the acetabulum is flat, but the cartilage structure is normal) or III type B (serious structural changes).

Type IV dysplasia is the most severe. In this case, the bony roof is strongly bent inward, and the cartilage is deformed and shortened.

You can do an ultrasound of the joints of a newborn twice in one month. This type of examination is useless to do after the baby is 2 months old, because from this moment the head of the femur begins to ossify.

A newborn who is at risk for joint dysplasia or who has obvious signs of this disease should be urgently examined by ultrasound. This examination method will not harm him and will provide accurate information.

Basic methods for diagnosing coxarthrosis of the hip joint:

Radiography. Detects the presence of bone growths and a decrease in the space between joints. Allows you to detect compactions under the cartilage in bone tissue and cartilaginous ossification.
Magnetic resonance imaging. Its purpose is to identify pathology of bone structures.
CT scan. Provides an opportunity to study changes in soft tissues in detail.

The rocky road to recovery

So that it doesn't hurt excruciatingly

Surgical treatment of grade 3 coxarthrosis of the hip joint is energy-intensive and expensive. Often it is impossible due to the patient’s predisposition to bleeding or thrombosis. It is difficult for older people to tolerate anesthesia. And even a successfully installed prosthesis is sometimes rejected by the body.

How to treat grade 3 coxarthrosis of the hip joint if surgery is not possible? The solution will be symptomatic therapy in combination with the mandatory development of motor rehabilitation techniques.

Coxarthrosis, or arthrosis of the 3rd degree of the hip joint, involves symptomatic treatment, initially aimed at relieving pain and inflammation. The following will help you deal with them:

Naklofen, olfen, indomethacin - first aid" in case of exacerbation. However, due to a sufficient number of side effects, their long-term use should be excluded;
Curantyl, acetylsalicylic acid, pentoxifylline. Their effectiveness is lower, but in order to avoid thrombosis of a practically immobilized limb, taking “blood thinning” drugs is necessary;
The best option for long-term use is meloxicam rectal suppositories. They help “curb” pain and inflammation well, side effects are minimal.
Arthrosis of the 3rd degree of the hip joint requires symptomatic treatment with medications

Painkillers are used for grade 3 coxarthrosis and during application therapy. Its advantages - ointments, gels, aerosols containing menthol, salicylates, as well as snake and bee venom, red pepper extracts, help minimize the need for systemic use of drugs.

Voltaren has a long-term clinical effect; gels diklak, olfen, ibuprofen; Chondroxide ointment.

You can prepare the joint for further treatment by relieving acute pain with intra-articular injections of corticosteroids: hydrocortisone, diprospan, metipred, etc.

Deforming arthrosis of the hip joint “spasms” the muscles, so treatment of grade 3 disease involves the use of muscle relaxants and drugs that improve peripheral blood circulation: mydocalma, no-shpa, sirdaluda; ascorutin, upsavit or cavinton.

Chondoprotective drugs for grade 3 coxarthrosis are practically useless, unlike hyaluronic acid, which is injected into the joint in the absence of an inflammatory process. By kind of “replacing” the joint fluid, hyaluronic acid “lubricates” the surfaces of the joint, reducing their friction.

The most effective in this regard is the concentrated drug coxartrum, intended for use in degenerative processes specifically in the hip joint.

Stem cell treatment is considered a unique way to alleviate the condition of patients diagnosed with grade 3 arthrosis of the hip joint.

Their introduction, which is advisable at all stages of the disease, significantly improves metabolic processes in articular tissues.

Physiotherapy and mud therapy

Drug treatment provides only short-term relief. How to treat grade 3 coxarthrosis in order to improve the trophism of articular tissues?

Improving blood supply and trophism of all joint components is the goal of physiotherapeutic procedures, including mud therapy.

What happens if you don’t start treatment?

Coxarthrosis of the hip joint of the 2nd degree is characterized by the fact that rest will no longer bring relief to the patient. As a result, you will need to visit the doctor immediately. In this case, the joint not only begins to ache, but patients also experience stiffness of movement.

In order not to feel pain, people begin to move less, but the disease itself progresses. That is, the cartilage completely disappears, the muscles weaken and atrophy, and the patient may remain disabled due to a frivolous attitude towards his own health.

Also, coxarthrosis of the hip joint, the treatment of which was not started on time, leads to lameness.

Many people are interested in how to treat coxarthrosis of the hip joint at home so that the result is immediate. But the truth is that if the disease has already entered the second or third stage, then the only way out is to maintain the condition and prevent further damage to the joint.

In many cases, surgery is not possible. This is due to the fact that at this moment the cartilage has already been destroyed by at least 40-70%, which means that it is completely impossible to restore it.

And timely surgery will be the best and least painful solution.

But the answer to the question of how to treat coxarthrosis of the hip joint at the first stage is more positive. So, in this case, it is quite possible to overcome the disease without surgical intervention. However, treatment should be started immediately and only after a complete examination by a doctor.

The patient must be prepared to take medications prescribed by the doctor and to work long and painstakingly on the condition of the joint. Regular gymnastics for coxarthrosis of the hip joint of the first degree is simply mandatory, otherwise you may not even dream of results, but immediately start preparing for surgery, the post-rehabilitation period and life with an artificial joint.

Conservative treatment methods

The treatment course is prescribed by the doctor in accordance with the current stage of the disease. To treat coxarthrosis of the hip joint of the first and second degrees, conservative therapy is used.

To relieve pain syndromes in the treatment of coxarthrosis, anti-inflammatory non-steroidal drugs, such as diclofenac or ketorol, are prescribed. They provide partial relief of swelling and are effective in relieving pain.

In turn, it is worth noting that long-term use of this group of drugs for the treatment of coxarthrosis of the hip joint will entail unwanted side effects. One of them is the body’s inability to restore the previous regenerative function of cartilage tissue.

If there is an urgent need to take anti-inflammatory drugs for a long period, then you should pay attention to Movalis. Despite the impressive list of side effects, it has nevertheless established itself as the most gentle drug from this group of tablets.

Good blood circulation and, accordingly, restoration of cartilage is ensured by vasodilating drugs (trental, cinoresin). The main role of these medications in the complex treatment of coxarthrosis is to relax the smooth muscles of small vessels, increasing their capacity for good blood microcirculation.

By relieving muscle spasms, vasodilators help fight, among other things, debilitating night pain.

A healthy skeleton has strength, flexibility, and hardness. These vital qualities for normal life largely depend on the sufficient content of calcium, phosphorus and other substances in the bones.

Features of therapy at different stages

Many patients who have been diagnosed with coxarthrosis of the hip joint are in a hurry to abandon attempts at recovery, justifying their decision by the fact that surgery cannot be avoided too early. They see no point in postponing it and prefer, as they say, to quickly suffer and live a normal life.

But the problem is that the artificial joint is not as good as the one given to a person by nature. It cannot recover on its own, and even the best and most expensive joint, which will be installed by a surgeon with “golden hands,” will become loose within ten years, resulting in the need for repeated surgery.

In addition, purely technically, the operation is very complex, and high performance is not always observed.

That is why people aged 45-50 years are not recommended to rush to the surgeon. It makes sense to spend time on intensive rehabilitation therapy. Only patients over sixty years of age will not be denied immediate surgery.

In addition, any surgical intervention is a great stress for the body. That is why the patient himself should be interested in treating the joints, which will lead to a serious slowdown in the development of the disease or even a temporary complete stop in its progression.

Coxarthrosis is a disease that can affect anyone today. But if a person takes care of his physical and emotional health, he may not fear that he will be included in the list of those who suffer from a similar illness.

It is worth avoiding excessive physical activity, not allowing problems in life to develop into a constant state of stress, and simply engaging in physical activities so that both the muscular and circulatory systems are in good shape, which will positively affect the condition of cartilage.

And most importantly, you should carefully monitor your well-being and do not ignore any symptoms. Coxarthrosis of the hip joint, treatment of which is started on time at an early stage, will not cause you problems in the future and will not result in the need to go under the surgeon’s knife.

Progress of the procedure

The first ultrasound of the hip joint in children is performed at 1 month, during a routine examination by an orthopedist.

Direct indications for a child to be examined using ultrasound are:

illnesses of the mother that made it difficult for the child to move (fibroids, uterine adhesions, etc.);
high and low water levels during pregnancy;
breech or pelvic presentation;
severe toxicosis in the first 2 trimesters of pregnancy;
premature or rapid labor;
large fruit size;
multiple pregnancy;
injuries during labor.

The photo is taken in 5 positions: natural state, extended and bent position of the limb, abduction and adduction to the body. A similar procedure is performed on the other side.

Pictures from the monitor are printed in black and white on special paper. In this case, the result is assessed based on the comparative characteristics of graphic lines and angles.

This technique is called the Graf ultrasound method.

The result is deciphered based on key points:

there is no hip dysplasia if the outer portion of the ilium and the gluteus minimus muscle (base) lie horizontally (straight) and a bend forms in the place where the transition to the cartilaginous tissue of the acetabulum is observed;
the degree of growth of the cartilage zone is determined by the angles alpha (should not exceed 60) and beta (the normal angle is 55). In the case when changes are observed in a newborn, angles 1 and 2 are deviated from the norm (alpha is increased, beta is decreased). The severity of the pathological process is assessed using a special table;
Ultrasound assessment of the hip joints in children is carried out by an orthopedist to exclude errors in diagnosis. It is important to take into account that changes in bone tissue depend on the age of the baby.

Each age group has its own scoring table. The result of the examination is entered into the form.

The patient is placed on the couch, and a special gel is applied to the area being examined. The doctor runs a special sensor over the area under study and examines the image on the screen.

During the procedure, it may be necessary to examine the joint from different points; for this you need to change position.

The procedure takes from 15 to 20 minutes.

Forecast

In the first stages, with timely diagnosis and compliance with doctor’s recommendations, the disease can be completely defeated. At the second stage, conservative methods can achieve long-term remission and improve the condition for a long time.

Important! In advanced cases, the prognosis without surgery is unfavorable. The pathology leads to complete immobility of the hip joints. But timely surgical intervention gives a chance for a full life. Many patients not only return to work, but also actively engage in sports.

megan92 2 weeks ago

Tell me, how does anyone deal with joint pain? My knees hurt terribly ((I take painkillers, but I understand that I’m fighting the effect, not the cause... They don’t help at all!

Daria 2 weeks ago

I struggled with my painful joints for several years until I read this article by some Chinese doctor. And I forgot about “incurable” joints a long time ago. That's how things are

megan92 13 days ago

Daria 12 days ago

megan92, that’s what I wrote in my first comment) Well, I’ll duplicate it, it’s not difficult for me, catch it - link to professor's article.

Sonya 10 days ago

Isn't this a scam? Why do they sell on the Internet?

Yulek26 10 days ago

Sonya, what country do you live in?.. They sell it on the Internet because stores and pharmacies charge a brutal markup. In addition, payment is only made after receipt, that is, they first looked, checked and only then paid. And now everything is sold on the Internet - from clothes to TVs, furniture and cars

Editor's response 10 days ago

Sonya, hello. This drug for the treatment of joints is indeed not sold through the pharmacy chain in order to avoid inflated prices. Currently you can only order from Official website. Be healthy!