The hip joint (HJ) is a complex joint composed of several bones: the femur, pubic bone, ilium, and ischium.It is surrounded by periarticular bursae and strong muscular ligaments, and protected by subcutaneous fat and skin.
The ilium, ischium, and pubis form the pelvic bones and are connected by hyaline cartilage in the acetabulum.These bones fuse together before age 16.
A distinctive feature of the femoral joint is the structure of the acetabulum, the upper and lateral parts of which are only partially covered by cartilage.The middle and lower segments are occupied by adipose tissue and femoral ligaments, and are surrounded by synovium.
reason
Hip pain may result in damage to elements within the joint or nearby structures:
- skin and subcutaneous tissue;
- muscles and ligaments;
- bursa;
- acetabular labrum (a rim of cartilage that extends along the rim of the acetabulum);
- The articular surface of the femur or pelvis.
Pain in the joint area is caused by inflammation or damage to the integrity of its constituent structures.Most commonly, pain occurs when infection enters the joint space (infectious arthritis) and autoimmune damage (rheumatoid arthritis and reactive arthritis).
Mechanical injuries are equally common, resulting in epiphyseal damage to bones, ligaments, synovium, and other tissues.Active people and athletes who perform high-intensity physical activities are more susceptible to injury.
Older adults with pelvic pain due to degenerative dystrophic changes in cartilage are also at risk, as are children and adolescents during hormonal changes.
Hip pain on the left or right side is caused by metabolic diseases such as diabetes, pseudogout, and obesity.
The complete list of possible illnesses is as follows:
- Perthes disease;
- joint;
- Koenig's disease;
- diabetic arthropathy;
- pseudogout;
- Intermittent hydroarthrosis (intermittent swelling of joints);
- chondromatosis;
- Reactive arthritis, rheumatoid arthritis, and infectious arthritis;
- Juvenile epiphyseolysis;
- Injuried.
Pethe's disease
In Perthes' disease, the blood supply to the femoral head is interrupted, causing aseptic necrosis (death) of the cartilage tissue.Affected are mainly children under the age of 14, mostly boys.
The main symptom of Perthes disease is persistent pain in the hip joint that worsens with walking.Children often complain of pain in their legs starting at the buttocks and begin limping.
In the initial stages, symptoms are mild, leading to a late diagnosis, when an impression (intra-articular) fracture has already occurred.The destructive process is accompanied by increased pain, soft tissue swelling, and stiffness of limb movement.The patient is unable to externally rotate, rotate, flex or straighten the hip.It is also difficult to move the legs to one side.
Disturbance of the autonomic nervous system was also observed: the feet became cold and pale, together with profuse sweating.Sometimes the body temperature rises below fever levels.
NOTE: Lesions in Perthes disease can be unilateral or bilateral.In most cases, one of the joints is less affected and recovers faster.
Arthropathy
Osteoarthritis of the hip is called coxarthrosis and is mostly diagnosed in older adults.The disease progresses slowly but causes irreversible changes.The pathological process begins with damage to the cartilage, which becomes thinner due to an increase in synovial fluid thickness and viscosity.
The development of hip arthrosis results in joint deformation, muscle atrophy, and significant limitation of movement to complete immobility.The joint pain syndrome has a wave-like (non-constant) nature and is localized to the outer thighs but can spread to the groin, buttocks, and lower back.
In the second stage of arthrosis, pain covers the inner thigh and sometimes extends down to the knee.As the disease progresses, the pain in the buttocks worsens, sometimes relieving only with rest.
Hip arthropathy can be primary and secondary.Primary hip arthropathy occurs in the context of osteochondrosis or knee arthropathy.Prerequisites for secondary hip arthropathy may be hip dysplasia, congenital hip dislocation, Perthes disease, arthritis and trauma (dislocations and fractures).
Koenig's disease
If you have pain on one side of your thigh joint, the cause may be the death (necrosis) of cartilage tissue - Koenig's disease.The disease most commonly affects young men aged 16 to 30 who complain of leg pain, reduced range of motion and periodic "getting stuck."
Koenig's disease develops in several stages: first, the cartilage tissue softens, then it hardens and begins to separate from the articular surface of the bone.In the third or fourth stage, the necrotic area is rejected and moves into the joint space.This can lead to a buildup of effusion (fluid), stiffness of movement, and blockage of the left and right joints.
Reference: The presence of "joint mice" in the hip joint can contribute to the development of hip arthropathy.
diabetic arthropathy
Osteoarthropathy or Charcot arthropathy is seen in diabetes and is characterized by progressive deformity accompanied by pain of varying intensity.The expression of pain sensation is rather weak or completely absent, since in this disease the sensitivity is sharply reduced due to pathological changes in nerve fibers.
Diabetic arthropathy occurs during long-term diabetes and is one of its complications.It occurs most often in women who receive inadequate treatment or who don't respond to treatment.Of note, the hip joint is rarely affected.
pseudogout
Due to disorders of calcium metabolism, calcium crystals begin to accumulate in joint tissue, and chondrocalcinosis or pseudogout occurs.The disease, named because its symptoms resemble those of gout, is characterized by a paroxysmal course.
Sudden onset of acute, severe pain: the affected area is red, swollen, and feels hot to the touch.Inflammatory attacks can last from a few hours to a few weeks and then all goes away.Chondrocalcinosis may cause pain on the left or right side of the pelvis.
In the vast majority of cases, pseudogout occurs for no apparent reason, and calcium metabolism disorders cannot be detected even during examination.It is hypothesized that the cause of the disease lies in local metabolic disturbances within the joints.Chondrocalcinosis occurs in one percent of patients, in the context of existing systemic diseases - diabetes, renal failure, hemochromatosis, hypothyroidism, etc.
synovial chondromatosis
Articular chondromatosis, or synovial cartilage island metaplasia, primarily affects large joints, including the hip.Most commonly, this pathology occurs in middle-aged and older men, but there are also cases of congenital enchondromatosis.
In enchondromatosis, the synovium degenerates into cartilage or bone tissue, resulting in the formation of cartilage or bony bodies within the joint cavity that can be up to 5 cm in size.
The clinical manifestations of insular metaplasia are similar to those of arthritis: patients have hip pain, limited leg movement, and a characteristic crunching sound when moving.
Since enchondromatosis is a dysplastic process accompanied by cartilaginous body formation, the occurrence of "articular mice" cannot be excluded.In this case, the "rat" may become lodged between the joint surfaces of the bones, causing the joint to be partially or completely blocked.The joint remains blocked until the cartilaginous body enters the capsule, and only after complete restoration of this movement.
Help: Frequent or prolonged joint interference can trigger hip arthritis.Complications of synovial chondromatosis are stiffness (contracture) and muscle atrophy.
arthritis
Arthritis is an inflammation of the joint surfaces of the acetabulum and femur.Hip joint injury is called hip arthritis and is accompanied by a dull pain in the back of the thigh and groin area.
There are many types of arthritis, and the most common type affecting the hip joint is infectious arthritis.Other types are diagnosed much less frequently.Why does septic arthritis occur?Pathology begins when bacteria and viruses enter the joint space.
The clinical manifestations of septic arthritis may vary depending on the type of microorganism causing the infection.However, 5 characteristic signs are observed in all patients:
- Joint pain in the right or left leg (bilateral injuries may also be present);
- swelling of joints;
- redness of skin;
- Decreased athletic ability;
- Increased body temperature.
During the onset of the disease, patients experience severe pain, especially when standing up from a sitting position.Almost constant pain in the joints; pain makes it impossible to stand or sit.It's important to note that septic arthritis is always accompanied by fever, chills, headache, weakness, and nausea.
juvenile epiphyseolysis
The term epiphysis literally means the decay, destruction of the articular surfaces of bones, or more accurately, of the cartilage covering them.A distinctive feature of this injury is the cessation of bone length growth, resulting in lower limb asymmetry.
In adults, epiphyseolysis occurs when the epiphysis fractures and becomes displaced or ruptured.Destruction of the epiphyses in the growth zone is possible only during adolescence, which is why this disease is called juvenile disease.
Juvenile epiphyseolysis is an endocrine orthopedic pathology based on an imbalance between growth and sex hormones.Both types of hormones are essential for the normal function of cartilage tissue.
The dominance of growth hormone over sex hormones results in a decrease in the mechanical strength of the femoral growth zone and epiphyseal displacement.The end portion of the bone is located below and behind the acetabulum.
Typical symptoms of epiphyseal dissection include pain on the right or left side of the thigh (depending on which joint is affected), lameness, and unnatural leg position.The sore legs turn outwards and the muscles in the buttocks, thighs, and calves atrophy.
treat
To treat Pethe's disease, chondroprotectants are used to promote cartilage regeneration and vasoprotectants are used to improve blood circulation.Integrated treatments also include massage, exercise therapy, physiotherapy (UHF), calcium phosphorus electrophoresis, mud and ozoke application.
Patients with Perthes' disease are advised to lighten their limbs and use orthopedic devices (plaster casts) as well as special beds to prevent deformation of the femoral head.
The methods and medications used to treat joint disease depend on the stage of the disease.The following therapies can help relieve pain and slow down the pathological process in stages 1-2:
- Nonsteroidal anti-inflammatory drugs (NSAIDs);
- Vasodilators;
- Muscle relaxants relax muscles;
- Chondroprotectant;
- Hormones (for severe pain);
- Ointments and dressings with anti-inflammatory or chondroprotective properties.
In stages 3-4, patients are recommended to undergo surgery.
Koenig's disease can only be treated surgically; during arthroscopic surgery, the affected area of cartilage is removed.
Treatment for diabetic arthropathy includes correcting the underlying disease - diabetes, wearing special off-loading bandages and taking medications.All patients, regardless of the stage of the disease, take antiresorptive drugs - bisphosphonates and products containing vitamin D and calcium.To relieve pain and inflammation, medications from the NSAID group and corticosteroids are used.If infectious complications are present, a course of antimicrobial therapy is performed.
There is no specific treatment for pseudogout; during exacerbations, anti-inflammatory drugs are prescribed.The accumulation of large amounts of fluid within a joint is an indication for intra-articular aspiration, during which the fluid is pumped out and corticosteroid drugs are administered.
Chondromatosis of the hip requires mandatory surgical intervention, the volume of which depends on the size of the lesion.If the cartilaginous bodies are few in number, they are removed by partial synovectomy (removal of the synovial membrane) or minimally invasive arthroscopy (through three punctures).Surgical treatment of progressive enchondromatosis can only be radical and is performed using open arthrotomy or complete (total) synovectomy.
Treatment of acute infectious arthritis includes the forced use of a cast in the hip area, the administration of drugs of different classes (NSAIDs, antibiotics, steroids).When a purulent process occurs, a series of medical punctures are performed to disinfect the joint.
The only treatment for juvenile epiphyseolysis is surgery.During surgery, a closed reduction of the bone is performed using skeletal traction.Pins and grafts are then used to secure the combined portions of bone.
Absolutely all hip pathologies are serious conditions that require mandatory medical supervision.Any injury that occurs after a fall or impact and is accompanied by severe pain, limited movement, and structural changes in the joint requires emergency medical care.If there is no trauma, but the joints are frequently experiencing varying degrees of pain, you need to make an appointment with a therapist or rheumatologist and get checked out.