I. What is osteoarthritis of the hip joint?
Osteoarthritis is a chronic degenerative joint disease characterized by the degeneration and destruction of articular cartilage and osteophytes. The etiology and pathogenesis of osteoarthritis are still not completely clear. Osteoarthritis of the hip joint usually starts insidiously and progresses slowly, initially mainly manifesting as localized pain and stiffness in and around the joint, and as the disease progresses, joint deformation and dysfunction may occur, seriously affecting the patient’s mobility and quality of life.
The disease is usually seen after middle age, more in males than females, unilateral than bilateral, and the upper lateral aspect of the joint is more commonly involved, accounting for 60% of cases. There are primary and secondary osteoarthritis of the hip joint, and the clinical symptoms and signs of both are basically similar. Pain is a common symptom of the disease, starting with mild to moderate intermittent dull pain, which mostly occurs during activity, especially during weight-bearing, and is relieved after rest. The pain progresses slowly, and later it is also painful at rest, and is often accompanied by nocturnal awakening.
Another common symptom is a slow onset of limited hip motion. Patients often have difficulty walking, walking up stairs, and standing from a seated position; some patients have claudication. Another unique hip symptom is hip stiffness, which is of clinical differential diagnosis. Unlike other diseases that cause hip stiffness, its duration is short, usually not more than 15 minutes, and after a period of joint movement, the symptoms disappear, but excessive movement makes the joint area soreness and pain worse and movement limited, and then reduced after rest.
There is no specific laboratory test result. Blood count, sedimentation, C-reactive protein and anti-O are generally normal, rheumatoid factor and antinuclear antibody are negative. X-rays are not only the primary technique for diagnosing the disease, but also considered by some scholars as the gold standard for tracking changes in osteoarthritis.
Staging and diagnostic criteria of osteoarthritis of the hip joint.
(A) hip osteoarthritis can be clinically divided into 4 stages.
1, the early stage: hip joint discomfort after activity, with hip joint activity enhanced with joint pain, hip joint X-ray and CT examination without obvious cartilage damage performance.
2.Early stage: the hip joint pain is obvious after activity and relieved after rest. MRI can directly display the cartilage, which can show the cartilage damage of early osteoarthritis earlier.
3.Progressive stage: pain is obvious after hip joint activity, accompanied by partial loss of hip joint function and deformity. x-ray shows narrowing of hip joint space, cystic changes of periarticular bone, and sometimes intraarticular free body can be seen.
4.Late stage: Severe loss of hip function and deformity. x-ray shows that the hip joint gap is narrowed, periarticular bone hyperplasia is serious, and the femoral head is collapsed.
(B) Clinical diagnostic criteria are based on the 1995 American Rheumatism Association revised diagnostic criteria for osteoarthritis of the hip joint.
1.Hip pain for most of the time in the past 1 month;
2.Blood sedimentation ≤20 mm/ h;
3, X-ray shows the formation of osteoarthritis;
4.X-ray shows narrowing of the hip joint space;
If a+b+c or a+b+d or a+c+d is satisfied, hip osteoarthritis can be diagnosed.
Third, the treatment of hip osteoarthritis.
The aim of treatment is to reduce or eliminate pain, correct deformity, improve or restore joint function and improve the quality of life. Although the two types of hip osteoarthritis perform the same in the late stage, primary hip osteoarthritis is slow and light, and may remain asymptomatic for a long time; while secondary hip osteoarthritis continues to progress no matter what non-surgical treatment is used, so it is important to strictly distinguish between the two different types of hip osteoarthritis before treatment, in order to choose the treatment method. Therefore, a strict distinction between the two different types of hip osteoarthritis prior to treatment is an absolute guide to the choice of treatment. The principles of treatment are to consider individualized factors, to combine non-pharmacological treatment with pharmacological treatment, and to decisively adopt surgical treatment when necessary.
(I) Non-pharmacological treatment
1. Health education: Provide health education to patients with osteoarthritis of the hip joint, provide treatment and rehabilitation information, such as moderate activity, reduce unreasonable exercise, avoid storm walking and prolonged running, jumping and squatting. Patients should also be given psychological treatment. Pain is largely influenced by psychological factors, and some patients may be depressed for a long time, so patients should be made aware of the nature and prognosis of the disease and actively cooperate with other treatments on this basis.
2, weight reduction: obese people reduce weight, can partially improve the pain and function of the hip joint.
3.Exercise therapy: train the hip joint to flex and extend in the non-weight-bearing position to maintain the maximum mobility of the joint, and water exercise can relieve hip pain.
4.Physical therapy: It mainly increases local blood circulation and reduces inflammatory reaction. Hip pain can be relieved by heat therapy, ultrasound, acupuncture and other treatments.
(B) Drug treatment
If non-pharmacological treatment is ineffective, medication can be administered in a stepwise manner according to the joint pain.
There are three main types of medications for hip osteoarthritis:
1, symptom control drugs, including analgesics, non-steroidal anti-inflammatory drugs ( NSAIDs), glucocorticoids and sodium hyaluronate (through the use of hip joint cavity injection sodium hyaluronate treatment, in order to slow down the development of its disease course and improve clinical symptoms.
Its therapeutic effects are as follows.
Increasing the content of sodium hyaluronate in the synovial fluid to cover the surface of cartilage and synovial membrane, forming a barrier to repair cartilage lesions and prevent further destruction of the bone matrix;
Improving the physiological function of synovial fluid, reducing friction during joint movement through lubrication, and relieving joint pain;
Sodium vitrate covers the surface of articular cartilage and synovial tissue, forming a protective barrier against the invasion of bacteria, toxins and immune complexes;
By shielding the synovial membrane and subsynovial nociceptive receptors, it inhibits the excitability of sensory fibers in order to reduce nociceptive sensitivity, relieve joint pain and increase joint mobility.
2.Improve the condition of drugs ;
3.Chondroprotective drugs (including glucosamine, chondroitin sulfate, diacerein, etc.).
(C) Surgical treatment
For patients with severe osteoarthritis of the hip who have failed to receive conservative medical treatment and whose daily activities are significantly limited, surgery can be performed as needed.
Treatment objectives:
1.To reduce or eliminate hip pain;
2.Prevent or correct hip deformity;
3.Prevent further aggravation of hip joint damage;
4. To improve the function of the hip joint.
The choice of surgical method is generally based on the patient’s age, occupation, living habits and personal wishes. Surgical methods can be divided into two categories: one is the surgery to preserve the patient’s hip joint, such as arthroscopic flushing and free body removal, osteotomy, acetabular cyst scraping and bone grafting, osteotomy and closed-hole neurectomy, etc.; the other category is hip reconstruction surgery, such as hip fusion, hemi hip replacement and total hip replacement.
Fourth, the new progress of hip arthritis
Small acupuncture has the effect of Chinese medicine acupuncture to activate the meridians and remove stasis and paralysis, and at the same time has the effect of Western medicine percutaneous minimally invasive surgical treatment. In patients with hip osteoarthritis, early synovial inflammatory exudation, joint cavity effusion, increased intra-articular pressure, which causes joint pain and discomfort and dysfunction, at this time, the use of acupuncture can reduce the pressure inside and outside the hip joint, improve the blood circulation around the hip, which has a significant effect of reducing pressure and relieving pain; in the middle and late stages of soft tissue spasm around the hip, adhesions, scars, bone superfluous formation, joint space narrowing, the use of acupuncture to loosen it, can significantly improve joint The function of the joint can be improved. The combination of needle knife release and sodium vitreous acid joint injection for hip osteoarthritis can effectively improve the range of motion of the hip joint. Therefore, conservative hip preservation treatment for hip osteoarthritis is a treatment option, especially for patients who are not suitable for premature arthroplasty.