Osteoarthritis of the hip is the most common type of osteoarthritis.Since the hip joint (HJ) is larger than all others and has a multi-vector axis of rotation, it experiences enormous load throughout a person's life - when walking, running, jumping, climbing stairs, playing sports and everyday activities.
Often, patients need to worry about the symptoms and treatment of hip osteoarthritis from the age of 25-35.The disease can progress quickly under the influence of injuries, decompensated physical activity (non-compliance with sports exercise technique, "standing" work, excess weight), hereditary factors, infectious and chronic diseases.
However, effective treatment of hip osteoarthritis can preserve mobility and prevent bone breakdown.In old age, this helps avoid even more dangerous pathologies, such as necrosis or fracture of the femoral head.
Symptoms of osteoarthritis of the hip joint
The symptoms and treatment of hip osteoarthritis depend on the stage of the disease.
- Stage 1. Patients experience mild pain in the groin area, which occurs after physical activity, prolonged standing or sudden movements of the joint, and then disappears completely upon rest.
- Stage 2. The pain syndrome intensifies and bothers the patient even in normal household activities.The pain may radiate to the lower back or inner thigh.Stiffness and cracking appear and the range of movement of the joint is reduced.The musculo-ligamentous system begins to weaken, leading to increased fatigue.
- Stage 3. Pain is felt constantly and it is difficult for patients to move around without a cane or walker.Movement in the joint is severely limited.Climbing the stairs is a big challenge.There are walking problems (lameness, falling on one or both legs).In cases of unilateral coxarthrosis, pelvic distortion and curvature of the spine are visible to the naked eye.
- Stage 4. The joint space closes due to the proliferation of osteophytes and any movement of the joint is almost impossible.It loses its functions and becomes severely deformed due to bone destruction.
Hip osteoarthritis prognosis
With successful lifelong treatment, pain from osteoarthritis of the hip joint may be completely absent or rarely bother the patient.The prospects of this therapy depend on the patient's compliance with the rules of the rheumatologist and his personal self-discipline.Please note that the most accurate prognosis of the disease can only be established by the attending physician.
With timely and regular treatment
If chronic diseases do not contribute to the progression of the disease and treatment of hip osteoarthritis has started at stage 1 or 2, hip replacement can be avoided.Disability and loss of ability to work, if the doctor's recommendations are followed, shifts by 20 years, and sometimes the patient retains almost unlimited range of motion in the joint until old age.The best prognosis is possible with the so-called.benign osteoarthritis - when the wear of the cartilage depends on external factors (professional activity, health violations).In this case, it is worth excluding them and undergoing restorative therapy to slow down further degeneration of the joint.
Timely surgical treatment of grade 3 hip arthrosis will help avoid joint immobility, consequences for the entire musculoskeletal system and many years of pain.In the absence of contraindications, prostheses will help you return to your former activity.
In self-medication
When choosing a method of treating osteoarthritis of the hip, the doctor takes into account the patient's age, constitution, physical fitness, state of health, specific symptoms of the disease and its stage.In this case, the narrowing of the lumen of the joint space, the presence of osteophytes, the rate of progression of osteoarthritis, the quality of synovial fluid and other indicators are examined.
Self-treatment of hip arthrosis with traditional methods does not take into account these individual indicators and, instead of the desired result, can lead to serious exacerbation, metabolic disorders and worsening of the stage of the disease.But the worst thing is the time devoted to the illusion that such a serious chronic disease as osteoarthritis of the hip can only be cured with traditional methods.Avoid taking anti-inflammatories without a doctor's prescription, this can cause serious problems with the digestive and endocrine systems!
No treatment
If left untreated, hip osteoarthritis progresses on average 2 to 4 times faster.A deterioration in the quality of life and the appearance of disability in this case is possible already at a relatively young age - approximately 45-50 years old.Patients' sleep deteriorates, physical activity decreases, and psycho-emotional disorders are observed.The pain prevents them from getting up in the morning, walking with their grandchildren or going to work.
Treatment of hip osteoarthritis
The priority direction of treatment of grade 1 hip arthrosis is conservative outpatient treatment.It includes drug treatment of hip arthrosis, physiotherapy, diet therapy, wearing bandages and adjustable orthotics.This approach helps relieve pain, maintain muscle function and increase joint mobility.Treatment of grade 2 hip arthrosis is carried out in the same way.
If conservative treatment of hip osteoarthritis is delayed or ineffective, cartilage degeneration progresses rapidly and surgical intervention is performed.Sometimes the doctor may decide on osteotomy or arthrodesis, but in most cases, when treating grade 3 osteoarthritis of the hip joint, endoprostheses are prescribed - partial or complete replacement of the diseased joint.A prosthesis made of metal and with a ceramic or polymer coating lasts 15 to 25 years, after which it must be replaced.Total joint replacement (total joint replacement) is the most effective treatment for hip osteoarthritis.It allows you to fully restore its functionality with a minimum incision of up to 8 cm in length and the ability to walk with support in one day.Complete rehabilitation lasts 1 to 3 months.
Physiotherapeutic methods for treating hip osteoarthritis
Physiotherapy for hip osteoarthritis is carried out ongoing, according to the doctor's instructions.Almost all techniques, with the exception of magnetotherapy and cryotherapy, are allowed only during the period of remission, in the complete absence of inflammatory symptoms.The following measures are used to treat hip osteoarthritis:
- ultra high frequency therapy;
- ultrasound therapy;
- laser therapy;
- magnetic therapy;
- therapeutic exercises (therapeutic gymnastics);
- therapeutic massage and manual therapy;
- ozone therapy;
- cryotherapy;
- acupuncture;
- traction therapy (traction);
- paraffin applications and wraps;
- balneotherapy and mud therapy;
- hydromassage.
Treatment of hip osteoarthritis with exercise therapy
Physiotherapy for hip arthrosis aims to strengthen the muscles and ligaments - this is a natural orthosis that reduces the load on the joint and keeps it in the physiologically correct position.Thus, treating hip osteoarthritis with exercises helps relieve pain and inflammation, improve mobility, slow down the wear of cartilage and ensure the supply of nutrients to the synovial fluid.The following exercises will help you strengthen your legs:
- Starting position - sitting on the floor, focusing on your arms extended behind you.Legs straight in front of you.We bend and straighten our toes.
- The starting position is the same.Alternately bend and straighten your feet (toes toward you, toes away from you).
- The starting position is the same.Bend your leg at the knee, pulling it toward you along the mat or over a weight.It is advisable to touch the ground only with your toe after completing the movement.
- Starting position - lying on your back, legs bent at the knees, feet on the floor.We do the “frog” exercise - we spread our bent knees and hold them for 20 seconds.Then we put it together again.
- Starting position - lying on your back, one leg straight, the other bent and placed on the side.We lie down like this for a minute, then we change legs.
- Starting position - lying on your back, legs straight, lying freely.We bring the socks in, touch them, then move them aside.Repeat at a pace 10 times.
- Starting position - lying on your back, one leg (on the side of the affected joint) crossed over the other.We move the foot of the lower leg as in the exercise above.
- Starting position - lying on your back.We pull the knee towards the stomach while holding the back of the thigh with the fingers together.Perform for 30 seconds on each leg.
- The starting position is the same.We pull our legs bent at the knees towards the stomach and hold them under the knees with fingers together.Perform for at least 30 seconds.
- The starting position is the same.We move the straight leg to the side above the floor.20 to 30 times on each leg.
- Starting position - standing.Place a chair on its side with the back facing you.Holding the back of a chair and standing on one leg, swing the other back and forth like a pendulum.20 to 30 times.
Massage in the treatment of hip osteoarthritis
Massage is an effective relaxation and restorative technique for the treatment of early-stage hip osteoarthritis.As a treatment for osteoarthritis of the hip of the 1st degree (as well as the 2nd - in the absence of pain and swelling), it can prolong remission, relieve discomfort and pain without drugs, improve tissue trophism and slow down cartilage degeneration.It also eliminates spasms that interfere with sleep and movement, strengthens ligaments, normalizes gait and allows you to quickly warm up when transitioning from rest to active activity and vice versa.
For hip osteoarthritis, professional therapeutic massage is desirable (at least 10 to 12 sessions).But gentle self-massage at home also helps improve the condition.It is important to avoid severe pain and discomfort.At the slightest sign of inflammation of the joint, the manipulations are temporarily stopped - they can be resumed with the permission of the attending physician, after anti-inflammatory treatment.
Even in cases where the patient suffers from unilateral coxarthrosis, the massage is performed on both sides.How to do it correctly?
- To start, get into a comfortable position that will help relieve stress on your hips and lower back.For example, lying on your back, side or stomach.
- Begin to gently massage the area around the affected joint.If you have an assistant, ask them to stroke your back for 7 to 10 minutes, from your shoulder blades to your sacrum, to improve blood circulation.
- Proceed with slow caresses of the lower back, then a circular warm-up of the sacrolumbar region with two fingers.
- Massage the spine with your thumbs, as much as the pose allows, gradually moving down to the lower back.
- Press your palms on the sacrogluteal area and start rubbing and stretching the muscles.This completes the preparation.
- Rub your thighs with your palms then massage them well in a circle with your thumbs.
- Knead the inside of the thigh without applying pressure (so as not to compress the blood vessels).It is best to grab the fatty crease between your thumb and other fingers and knead it well.
- Important!Finish the procedure with relaxing stroking and patting.
In the massage of the thighs, transverse, longitudinal, gripping and compressing movements are used.Rubbing is performed with different parts of the palm or with fingers bent towards the groin area.
After surgical treatment of grade 3 hip arthrosis and removal of sutures, massage is used for rehabilitation and restoration of motor functions.
Treatment of hip osteoarthritis with diet
The main principle of nutrition in the treatment of hip osteoarthritis is its diversity and balance of key indicators (vitamins, minerals, proteins, including essential amino acids).It is important to eat foods rich in calcium, sulfur, zinc, magnesium and selenium.Among the vitamins, vitamins A and group B (give an anti-inflammatory effect), C, D, E are of primary importance.Diets low in protein are contraindicated in the treatment of hip osteoarthritis.Therefore, be sure to include in the menu:
- Dietary meat, poultry, fish.
- Eggs.
- Milk and dairy products.
- Fruits, vegetables and fresh herbs.
- Whole grains and oilseeds (like flax), as well as nuts.
- Dishes and products with natural chondroprotectors (jelly, jelly, cartilage, pork legs, ears, etc.).
But it is better to reduce the consumption of carbohydrates - after all, even a slight excess weight creates a colossal load on the painful joint.It’s not for nothing that rehabilitation experts joke that losing a few pounds is the most effective treatment for hip osteoarthritis.You should also exclude salty, spicy, sweet and fried foods, which cause the body to retain water.Reduce your consumption:
- fast food and semi-finished products;
- bakery products, sweets and confectionery;
- sausages and marinades.
Don't forget to drink at least 2.5 liters of water per day!
Drug treatment of hip osteoarthritis
Drug treatment of hip arthrosis is carried out strictly according to the doctor's prescriptions.In case of exacerbation and severe pain, it is allowed to take classic pain relievers or mild anti-inflammatory drugs (ibuprofen), but not more than 10 days before contacting a specialist.Otherwise, the picture of the disease will be blurred and it will be difficult for the doctor to choose adequate treatment for osteoarthritis of the hip.
There are several medicinal groups of drugs for the treatment of hip osteoarthritis.In the complex treatment of hip arthrosis with medications, 5 main pharmaceutical groups are used.
Anti-inflammatory drugs in the treatment of osteoarthritis of the hip
Swelling, stagnation of blood and other fluids, local fever and pain - these common symptoms of inflammation in osteoarthritis not only poison the patient's life, but also worsen the course of the disease.Over time, they lead to tissue starvation, depletion of synovial fluid that “feeds” the cartilage and disruption of its viscosity (due to which friction destroys the surface of the joint membrane!), muscular dystrophy and persistent deterioration of mobility.
But the main danger of inflammation is the death of cartilage cells - chondrocytes.When they break down in large quantities, they create a buildup of enzymes that “eat away” at the surface of the joint cartilage.
Therefore, to relieve inflammatory symptoms and restore tissue metabolism, 2 groups of anti-inflammatories are used: nonsteroidal drugs (NSAIDs, NSAIDs) and glucocorticoids.
NSAIDs are considered milder, although they can also affect the digestive system.This is why they are named first.In the treatment of grade 2 hip osteoarthritis - ongoing or as needed.
These include: nimesulide, ibuprofen, meloxicam, ketoprofen, indomethacin, diclofenac.
If NSAIDs fail, rheumatologists prescribe “heavy artillery”: corticosteroids.They immediately relieve even severe pain and inflammation, but they cannot be taken for a long time and in large doses.Like all hormonal drugs, they can affect the weight and condition of internal organs and, if the therapeutic dose is exceeded, they can worsen the course of osteoarthritis.
The drugs of choice for the treatment of grade 3 hip osteoarthritis are: hydrocortisone, prednisolone, methylprednisolone.
Chondroprotectors for hip osteoarthritis
Although anti-inflammatory drugs relieve symptoms, they do not solve the problem: they do not restore the damaged surface of the cartilage and do not enrich the synovial fluid with glycosaminoglycans.Therefore, effective treatment of osteoarthritis of the hip is unthinkable without the drugs chondroitin and glucosamine sulfate, which provide the body with the necessary building materials for the formation of new cartilage cells.
Since metabolism in cartilage tissue is very slow, chondroprotectors should be taken for a long time - 3-6 months a year.But, with lifelong preventive use, they help achieve drug-free remission.
Chondroprotectors include: glucosamine, chondroitin.
Angioprotectors and microcirculation correctors
The inflammation and microtrauma that accompany osteoarthritis disrupt the blood supply around the affected joint.But it is the capillaries that bring nutrients to the limits of the joint capsule.
The following help relieve swelling and improve tissue trophism: Troxerutin, horse chestnut extract, Diosmin in combination with other drugs, Pentoxifylline.
Muscle relaxers
When the supportive function of a joint is impaired, the body attempts to compensate by using muscles and ligaments that are not designed for such continuous loading.Due to chronic overwork, pain and spasms appear in the muscles.These cramps can interfere with sleeping or walking.
To eliminate them, in the treatment of hip osteoarthritis, the following are prescribed: Baclofen, Tizanidine, Tolperisone.
External and heating agents
Drugs in this group have a vasodilator effect.They help relieve swelling, reduce pain, and psychologically divert discomfort from the joints.
Usually, to treat osteoarthritis of the hip, products based on animal poisons or extracts of pungent plants are used.
Release form of drugs for the treatment of osteoarthritis of the hip
Depending on the clinical manifestations of osteoarthritis and the patient's lifestyle, the rheumatologist prescribes medications for the treatment of hip osteoarthritis in various forms.
Tablets, capsules, powders
These products for the treatment of hip osteoarthritis are easy to dose and take with you.All you need is a glass of water.In addition, the blister or packaging lets you know how many days the course has already lasted.These drugs have good bioavailability.But anti-inflammatory tablets can have a negative effect on the mucous membranes of the stomach and intestines - for gastritis, ulcers, colitis, it is better to give preference to injections for the treatment of osteoarthritis of the hip.
Injections for intramuscular and intra-articular administration
Anti-inflammatories, muscle relaxants and chondroprotectants are usually administered by injection.This ensures maximum bioavailability and is gentle on the gastric mucosa, but usually requires the presence of a healthcare professional.Performing intra-articular injections without special qualifications is strictly prohibited!
Ointments, gels and creams
External agents for the treatment of hip osteoarthritis have low bioavailability (approximately 5%), which limits their use in therapy to an auxiliary role.But there are far fewer contraindications to their use.
Liquid preparations for the treatment of osteoarthritis of the hip are less common - in the form of balms, solutions for compresses.