Dysplastic coxarthrosis of the hip joint: classification, treatment

Dysplastic coxarthrosis is a degenerative process, a disease of a dystrophic nature. Sometimes provokes its congenital defect - the hip joint does not develop, as it should for a normal organism. This phenomenon is called "dysplasia".

What about what?

Dysplastic coxarthrosis of the hip joint is characterized by the fact that in the bones the articular extremities are deformed under the influence of incorrect development, the form becomes irregular, the acetabulum is an abnormal depth. The proximal part of the hip bone changes. Studies show an abnormal cervico-diaphysial angle.

More often the disease is fixed in women. The risk group is between 30 and 40 years of age, although some doctors estimate that it is up to 55. If the discongruence of the joint surfaces is fixed, the probability of pathology development almost doubles.

How often?

Statistics show that dysplastic coxarthrosis of the hip joint is a fairly common disease. Among others, classified as degenerative, dystrophic pathologies affecting this joint, coxarthrosis, according to some researchers, occurs in every fourth case. But other scientists say that it is diagnosed in 77% of patients. The most famous studies devoted to this issue were made in 2006 in Finland under the guidance of Antti Eskelinen, as well as in 1996 by Sergey V. Sergeev, in 2001 - by VI Ugnivenko.

European researchers estimate the prevalence of the disease among the adult population of Europe in 7-25%. The scientific events dedicated to this were held in 1965 and 1996. If you study the statistics on pathological disorders of the musculoskeletal system, it becomes clear that dysplasia is about 16.5% of cases known to science. Against the backdrop of such a high percentage, the question of how to treat dysplastic coxarthrosis of the hip joint becomes especially urgent. Up to 60% of all cases of sickness lose their working capacity over time, and 11.5% become disabled.

Dysplastic coxarthrosis: what happens?

Classification of subspecies of the disease is based on the signs:

• The joint changes anatomical relationships (how pronounced is the process?);
• Articular cartilage varies (how active is arthrosis?).

In modern medicine, the classification, called Crowe, is most often used. This is a system in which it is estimated how much the femur is displaced near the head. There are 4 subtypes of the disease.

Dysplastic coxarthrosis of the 1st degree is expressed by proximal displacement not more than half the height, which is about 10% relative to the pelvis. The second stage assumes displacement indicators of 50-75%, 10-15%, respectively. Dysplastic coxarthrosis of the third degree is a displacement of 75-100%, 15-20%. Finally, the fourth stage - when the displacement occurred more than the size of the head of the bone, which relative to the pelvis shows a position violation by 20 or more percent.

Hartofilakidis classification system

This theory assumes to evaluate how much the femur in the head region changes its position cranially. They also study the state of the acetabulum, suggest a true position and reveal the position of the head relative to it. This classification of dysplastic coxarthrosis distinguishes three degrees of development of pathology.

In the first type of disease, the dysplasia of the cavity is expressed in the fact that the entrance of the cavity is larger than the normal size, that is, a subluxation occurs. Dysplastic coxarthrosis of the 2nd degree in this terminology is diagnosed with a low dislocation, subluxation, high head displacement. Diagnosis allows you to determine neoarthrosis associated with the true cavity. The figure, formed with the organs, is similar to the figure "8" in the picture. The false cavity, the head of the bone interact. Finally, the third type of pathology is complete dislocation. The false, true cavities of the acetabulum are delineated and unrelated. The femur has a connection only with the false cavity.

If the Crowe technique is applicable when it is necessary to identify the effectiveness of a surgical procedure, Hartofilakidis is widely spread due to ease of use. It must be remembered that Crowe does not allow you to accurately take into account how much the cavities change due to dysplasia. Hence the problems of endoprosthetics of dysplastic coxarthrosis are born: insufficient information to form a clear plan creates difficulties in the implementation of surgical interventions.

However, Hartofilakidis also has some imperfections. Such a methodology does not provide an opportunity to monitor the position of the proximal department. Namely, these changes greatly affect the operation. To choose the logic of treatment, you need to apply different classifications: both those that reflect dysplasia, and those who evaluate osteoarthritis.

Osteoarthritis: how does it happen?

So, where does bilaterial dysplastic coxarthrosis come from? How do other subtypes of the disease develop? What is the joint undergoing?

The first thing that is subject to negative changes is the joint fluid. It thickens, turns into a viscous. The reasons for this can be very different, but the result is the same - the cartilage does not get the proper lubrication, because of what dries up. The surface of the cartilage is covered with small cracks, roughnesses. The fabric becomes thinner with time, which is provoked by strong friction during any movements. The joints are separated by an ever smaller and smaller distance. From under the cartilage, the surface of the bone becomes visible, which leads to an increasing pressure, and in the future - to deformation. Therefore, dysplastic coxarthrosis is also known as deforming.

What's next?

Unfortunately, degenerative processes are not limited to changes in the joint fluid. Over time, the supply of blood to tissues is disrupted, the metabolism becomes slower than normal, as blood circulates through the vessels with the necessary activity saturated with useful components, including oxygen.

Over time, bilateral dysplastic coxarthrosis causes the atrophy of the muscles of the affected limb. But the changes occur for a long time, gradually, so the patient often does not notice the progression of the disease. In some cases, the chronic illness is exacerbated, which is accompanied by severe pain in the joints. The period is called "reactive inflammation." Strongly expressed pain syndrome forces a person to visit a doctor, and only then they diagnose "dysplastic coxarthrosis" for the first time.

Causes of the disease

Dysplastic coxarthrosis may appear due to a variety of factors:

• Problems with blood circulation, resulting in inadequate nutrition of tissues and the accumulation of non-oxidized to the desired degree of metabolic products, which activates destructively affecting cartilage enzymes.
• Mechanical, provoking the load on the joint beyond measure. Such athletes, people suffering from excessive weight are susceptible. For the second, the problems of metabolism, lack of blood flow, which additionally affects the joints.
• Biochemical reactions, metabolic problems, hormonal.
• Injuries, fractures, dislocations, often provoking the disease at a young age.
• Pathology of the spine.
• Infectious, inflammatory processes affecting the joints.
• Aseptic necrosis.
• Congenital disorders.
• Passive lifestyle.
• Age changes.

Heredity, genetic predisposition to various arthrosis has a strong influence. Coxarthrosis can not be inherited, but it is the inheritance mechanisms that determine the specificity of cartilaginous tissue, metabolism. If the closest relatives suffer from arthrosis, the likelihood of getting sick in a person increases dramatically.

How to suspect?

Medicine identifies the following symptoms of the disease:

• Stiffness, movements are given "tight";
• pain syndrome;
• Atrophy of the thigh muscles;
• Shortening of the diseased limb;
• Slight lameness.

Most often to the doctor, patients are treated when the leg, joints begin to ache. This sign is the most characteristic and notable. It should be understood that the manifestations of pathology depend on the level to which it developed.

The stage of the disease directly determines the duration of the attacks of pain, their intensity and the area in which the sensations are localized. Treatment of dysplastic coxarthrosis of the hip joint shows good results only when it was started at an early stage of the development of the disorder. But this happens infrequently, since the tenderness of the joints is not strong, and people delay the trip to the doctor.

Not having addressed in time to the expert, patients lose time - the joint is destroyed day by day all is stronger. With time, mobility is lost, pain is aggravated, even the first steps are given with difficulty, painlessly it is possible only to not move. The person is limping, atrophy of the femoral muscles occurs. Of course, all these signs stimulate a trip to the clinic, but it is already too late.

Pain and atrophy

In pathology, the atrophy of the femoral muscles provokes an additional pain syndrome - it is localized where the tendons are attached. The knee pain is most painful, but the syndrome is weaker in the groin and in the thigh. This leads to an incorrect diagnosis. A common mistake is the definition of arthrosis of the knee joint, which leads to an incorrect choice of therapy.

Arthrosis is not the only cause of pain in the femoral, inguinal region. Perhaps this is an echo of the pain associated with the inflammatory processes in the tendon, so the spine can also manifest itself.

Dysplastic coxarthrosis: treatment. Where do we start?

Several different methodologies of approach to patients with this pathology were invented. Any variant has positive and weak points. But there is one general rule: self-medication is unacceptable. Even if you are convinced that you know exactly what are sick, how it can be cured, therapy is allowed only under the supervision of a doctor with a profile education. Otherwise, there is a possibility not only to not slow the degenerate processes, but only to exacerbate them. It should also be understood that the stage of the disease strongly influences the approaches to its treatment.

If the first or second stage is diagnosed, conservative therapy can be practiced. In this case, the treatment of dysplastic coxarthrosis is performed with the help of ointments, tablets and injectable preparations. When diagnosing the third stage, only one way is surgery. Endoprosthetics of the joint, produced with this diagnosis, involves replacement of the joint with an artificial article. The procedure is rather complicated, expensive, but effective. The implant is implanted in the pelvis and hip bones. The prosthesis is identical to the biological joint.

The first, the second stage: than we treat?

If it was possible to detect the disease earlier than the development of the third degree, one can achieve positive results with conservative therapy. Widely used non-steroidal anti-inflammatory drugs, the most effective in the reactive period. The main advantage of these drugs is the relief of the pain syndrome, caused by a strong effect on the inflammatory processes. Medications quickly remove inflammation and eliminate puffiness.

However, all have drawbacks. So, regular use of anti-inflammatory drugs reduces the body's ability to recover by natural mechanisms. In addition, most of the known drugs have a wide range of side effects, affecting the body as a whole and the individual organs and organ systems. The choice of medication should be entrusted to the doctor. Categorical it is not recommended to simultaneously use several drugs. If the prescribed medicine does not help to stop the pain, you can do a dose more or contact a doctor for a prescription for another medication.

What else will help?

Pretty well proven drugs that can expand the blood vessels. At the same time, the smooth muscle relaxes, the lumen of the vessels becomes larger. If coxarthrosis is diagnosed, such therapy shows good results fairly quickly.

On the one hand, with the correct use of medicines of this group under the supervision of a doctor, the result is good, it will not have to wait long. Also attracts a small list of contraindications. The joint is restored with time, since the best blood flow is provided, that is, the tissues are fed in the right amount. Vessel-diluting drugs have proven extremely effective against nighttime pain.

But there are weaknesses. Not all patients tolerate this group of drugs, and with individual intolerance of at least one component, therapy becomes inapplicable. Before the beginning it is necessary to consult with the doctor, to hand over analyzes. Starting the course of treatment, initially take no more than a pill per day - this dose is maintained for the first three days, controlling the body's performance. If everything is normal, you can switch to the recommended concentration of the doctor and the manufacturer.

Miorelaxates and chondroprotectors

Miorelaxates are medicines that help to relax the muscles. If coxarthrosis is diagnosed, such remedies are used very carefully, but they achieve elimination of spasms, stop the pain syndrome. The use of drugs helps to improve the flow of blood to the affected area. But possibly depressing effect on the nervous system, why the head is spinning, consciousness is inhibited and there is a feeling similar to the effect of alcohol.

Chondroprotectors are aimed at restoring cartilaginous tissue. They are considered one of the most useful for arthrosis, as they improve the structure of the cartilaginous tissue and direct useful, nutritional components to the cells. If such drugs are used regularly, the development of the disease stops. However, a quick positive effect when using chondroprotectors is not noticed: it is felt only in perspective. Even after the cessation of the treatment course, the tendencies to improve the state of the cartilage remain. However, it is impossible to practice the reception of these medicines during pregnancy, inflammatory processes in the joints. Individual intolerance of components is also possible.

Hormonal therapy

Finally, we can not fail to mention hormonal steroid medicines, which have become quite widespread in recent years. They are injected directly into the joint. The result often appears almost immediately after the beginning of treatment, the most pronounced it, if the inflammation struck the femoral tendons. But the effect is quite fast, and the course of therapy is accompanied by side effects.

Doctors recommend injecting no more than three injections into one joint. Between two injections it is necessary to maintain two weeks and more.