Arthrosis of the hip joint - coxarthrosis

If you feel in the morning stiffness or pain in the joints, it takes you longer to limber up or the pain follows you even in a peaceful regime, and the doctor told you that you have arthrosis, and you search for an alternative treatment then the surgical treatment proposed by your doctor? In the following words we will try to explain you this topic and offer you a solution.

HIP JOINT

Hip joint is basically very simple joint, which connects two bones - pelvis and the thigh bone. This big joint enables movement in the legs, walking and at the same time it secures ideal distribution of the pressure. The hip joints at the same time are under pressure of the whole trunk (body weight) and dynamic pressure of the muscles. The sum of these pressures on the joint cartilage can evenly distribute the pressure under optimal conditions, so that the cartilage itself wouldn’t be damaged. Unfortunately, in some cases the pressures are sometimes too strong, and excessively burdened cartilage is gradually wearing out. Arthrosis usually affects one leg, however, given to the restricted mobility and higher demands on the second leg, the arthrosis can with time develop on both legs.

ARTHROSIS

Arthrosis is a degenerative illness of the joints, which results usually from long-term burdening. Therefore this disease affects usually big joints, such as hip, knees, ankles, joints that “carry” us the whole life. Though this disease does not leave out the shoulder joints as well as smaller joints of the hand. Arthrosis is the most common joint illness, in a higher age it appears by up to 80% of population. Arthrosis is non-inflammatory diseases, however inflammation - arthritis is often accompanying it as a secondary complication.

Causes of arthrosis can be several:

  • Anatomical - unequal leg length, hypermobility…
  • Traumatic - disproportionate physical pressure, joint dislocation, intra-articular fractures…
  • Metabolic - diabetes, gout, disorders of the metabolic steroids,
  • Inflammatory - rheumatoid arthritis,

Higher bodily weight can also stand behind various problems.

WHAT HAPPENS IN THE HIPS DURING ARTHROSIS

Higher demands on the joint cause its wearing off, that applies especially to the cartilages on the ends of the bones. The space between the bones filled with cartilage and synovial fluid is getting smaller, and after some time it can even completely disappear. Losing the cartilage is irreversible process. The influence of the increased pressure and loss of the protective cartilage sheath can form osteophytes on the ends of the bones - small spurs, which irritate even more the rough surface of the bone. Arthrosis affects also soft structures around the joints. Ligaments which are closely surrounding the hip joint, cannot anymore fulfill their stabilizing function, and it can even lead to deflection from the axis of the joint.

DIAGNOSIS

Among the imaging methods which can reveal arthrosis, is especially X-ray imaging method. The image can reveal visible space between the bones, which is under normal conditions filled with cartilage, even possible osteophytes (spurs on the bones). It is therefore possible to judge the degree of the disability. Not always do the findings on the X-ray image represent subjective problems.

Subjective symptoms

The first symptom is pain, which can be projected into the area of the groins and spread across the inner side of the thigh all the way to the knee. Restricting the mobility, instability, starting pain and later even pain during a peaceful regime during night, those are further symptoms of the hip joint arthrosis. People with this illness suffer especially from pain, which usually fades away when you relax. It is caused by higher intra-articular pressure while standing or walking. If the arthrosis is complicated by inflammation, the overloaded joint is warmer, it can be also red. Increased tension and attachment of the ligaments, joint capsules and muscles. Restricted joint range of mobility can also result in another pain. Affected joint is usually unstable, it leads then to restricted walking.

Objective symptoms

Objectively we see changes in the position of the pelvis during the examination, as well as disorder of the spine statics and incorrect walking stereotype. During examination we often meet with unequal leg length, which can be another cause, but also a result of the joint arthrosis. Significant restriction of the passive movement in the joint, especially inner rotation. Arthrosis is accompanied also by muscle tension especially from the inner side of the thighs, on the other hand the outer muscles are weakened. During examination we also meet with the so called creaking in the joint.

THERAPY

Pharmacological and operative treatment

The symptoms can be treated only pharmacologically, so doctors may prescribe you painkillers or non-steroid antirheumatics (anti-inflammatory drugs). It is ideal to supplement the treatment with chondroprotective compounds which are slowly and gradually releasing the compounds and it has long lasting effect. They slow down the degradation of the cartilage, because the cartilages do not restore after the birth. The most ideal products should contain glucosamine sulfate, chondroitin sulfate, hyaluronic acid etc…

Surgical approach contains less invasive methods, such as arthroscopy, during which the doctor cures the surface of the joints, and removes the osteophytes (spurs on the bones), or directly replacement of the whole joint.

It doesn’t matter for which variant you decide, but keep in mind that people suffering from obesity should start to decrease their weight before the treatment. It will lower the pressure which would be otherwise involved on the joint.

PHYSIOTHERAPY

Choosing the ideal physiotherapeutic approach depends on the stage of the illness. In acute conditions, peaceful regime is recommended. That is supplemented with release of the soft tissues, which are often reflexively contracted. By the hip joint it is usually in the area of the front side of the thigh (flexors of the leg). Outer thigh muscles are usually reflexively dampened, which can result in instability of the whole joint. Therefore is it ideal to exercise these muscle groups (isometrically - activating muscles without moving the leg) and relaxing the overloaded muscles. Isometrically you can exercise buttocks muscles, thighs and abdomen. Very effective and relieving is the gentle manual traction (stretching) of the hip joint.

It is important to continue to exercise even after the problems subside, but it is unnecessary to burden the joint and avoiding other positions which only cause pain. Very popular and effective is an exercise with the use of unstable surfaces, such as balance disc, BOSU, Posturomed and sensory motor skills exercise. Thanks to these techniques, not only the affected area but the whole body receives back its stability and certainty during walking and sport. Among ideal sport activities is swimming, where the pressure on the joints is significantly reduced, but also nordic walking and other activities are ideal. During the physical activity it is ideal to avoid hitting the ground too hard, as well as avoiding impacts and swinging moves. Very ideal option is to use the functional tape (special band applied on the skin), which directly affects the specific muscles. Whether the tape is used for a specific stimulation or just for relaxation, the area will be stabilized and the movement and exercising more effective. Functional tape will last you one week from application on the skin.

Stretching the front side thigh Stretching quads Stretching lumbar sacral musle

FOCUSED SHOCK WAVE THERAPY

If the arthrosis is accompanied with swelling, it is ideal to start with the focused shock wave therapy, which can aim on the swelling and get rid of quickly it by starting the natural repairing process, usually after the first application. It is also optional to use radial shock wave therapy on the muscles or muscle groups which are in higher tension. Shockwave can relax such muscles and its effect is long lasting, but the treatment has to be started immediately in the first stages of the illness. Application is then repeated according to the need 1-3x, in the interval of 7-10 days.



Author: Mgr. Iva Bílková, FYZIOklinika fyzioterapie Ltd, Prague, Czech Republic
Source: KOLÁŘ, P. et al., Rehabilitace v klinické praxi, Praha: Galén, 2012. ISBN: 978-80-7262-657-1; Clinical experience in diagnosing and therapy with focused shock wave.

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