What is osteoarthritis of the hip joint?
Osteoarthritis of the hip joint is one of the common orthopedic disorders. It is characterized by degeneration of the articular cartilage and the formation of new bone under the cartilage and around the joint. In addition to osteoarthritis, the disease is also called hypertrophic arthritis, proliferative arthritis, age-related arthritis, degenerative arthritis, osteoarthrosis, and so on. However, osteoarthritis of the hip joint is still the most common.
What are the conditions that lead to osteoarthritis of the hip?
Osteoarthritis of the hip joint can be divided into two types: primary and secondary.
Primary osteoarthritis is a physiological degeneration of the articular cartilage and is most often seen in the elderly. It is mainly related to the following factors.
① Aging: increasing age is the most risk factor, and its prevalence increases with age.
② Overuse of the hip joint: it is related to occupation, and the prevalence is high in those who repeatedly use the hip joint for a long time. The articular cartilage is very sensitive to repeated impact loading and is damaged. Excessive loading can also cause microfractures of the subchondral trabeculae, and the reconstructed trabeculae are poorly tolerant to impact forces and degeneration is accelerated.
③Obesity: obesity increases joint load, while obesity causes changes in posture, gait and motor vigor, which affects joint biomechanics.
④ Genetic factors: The prevalence of hip osteoarthropathy varies among races and populations.
Secondary is hip arthropathy that occurs due to damage to the cartilage of the hip joint from various causes. The common pathogenic factors are as follows.
① Congenital developmental abnormalities: such as acetabular dysplasia and congenital hip dislocation.
(2) Acquired unevenness of the articular surface: such as flat hip and slipped epiphysis of the femoral head.
③Trauma: poor alignment of fractures within the hip joint, resulting in uneven joint surfaces; fractures of adjacent joints with poor alignment, all of which can be secondary to hip osteoarthropathy, also known as traumatic arthritis.
④Joint diseases that damage joint cartilage: such as neuroarthritis, joint infection, etc.
⑤ Long-term use of glucocorticoids and heavy alcohol consumption cause femoral head necrosis, which can lead to hip arthropathy at a later stage.
Clinical manifestations.
1, hip joint pain It starts mildly, sometimes feeling sore and swollen after cold, exertion or minor trauma. With the development of the disease, the pain gradually increases. The pain starts when the joint starts to move, decreases after a little activity, and increases when weight-bearing and more activities. The pain can be located in the groin and radiates to the thigh or the medial aspect of the front of the knee, or it can be located in the hip and around the greater trochanter of the femur and radiates to the posterior lateral aspect of the thigh. The joint pain may remain constant for a long time and mostly worsens slowly. In the late stage, when the joint degeneration is serious, the pain is aggravated by the bone superfluous stimulating the hypertrophic inflammatory synovial membrane, and the pain is also felt when lying down and turning over.
2, hip stiffness After a period of inactivity, temporary hip stiffness can occur. When changing from one posture to another, it is inconvenient to move and there is soreness and pain. It is most obvious when you get up in the morning or when you stand up after sitting for a long time, and the joint becomes flexible after a little activity.
3.Limited movement of hip joint Fibrosis of joint capsule, bone redundancy and uneven joint surface can reduce the range of hip joint movement, and a rough friction sound can be emitted when moving.
4.Hip deformity Wear of articular cartilage, marginal osteophytes and joint capsule contracture can lead to hip deformity.
What tests are needed for hip osteoarthritis?
1, the routine choice of X-ray film examination: x-ray performance of primary hip osteoarthrosis early because of only the degenerative changes of cartilage, there can be no obvious x-ray changes. In the later stage, due to the loss of articular cartilage, the joint space becomes narrow and irregular, the femoral head becomes flat, the joint surface is not smooth, the femoral neck becomes thick and short, the outer upper edge of the acetabulum and the bottom bone superfluous formation is obvious, which can cover most of the femoral head. Subchondral cancellous osteonecrosis, resorption of necrotic trabeculae, and capsular changes of varying sizes with dense sclerosis of bone in the top of the acetabulum and the femoral head are seen. Sometimes the joint surface free body can be seen, and the hip joint subluxation can occur in the late stage.
2, CT scan: conventional CT scan is cross-sectional, which is difficult to show the whole picture of the hip joint, but it can show the cystic change of bone, sclerosis, thinning of articular cartilage surface, etc.. If necessary, 3D reconstruction can clearly show the situation of subchondral bone and joint surface, so it is of great significance.
3.MRI: It is mainly used for differential diagnosis.
What are the diagnostic criteria for osteoarthritis of the hip joint?
Serial number
Condition
1.Recurrent hip pain in the past 1 month
2.Blood sedimentation rate ≤ 20 mm /1 h
3.X-ray film shows bone superfluous formation and acetabular rim hyperplasia
4.X-ray film shows narrowing of hip joint space
If 1+2+3 or 1+3+4 of the diagnostic criteria are met, osteoarthritis of the hip joint can be diagnosed.
What are the treatment methods?
1, general treatment should be appropriate rest, avoid overexertion, weight bearing, cold and moisture; avoid long periods of inactivity, regular joint activities, such as moderate walking. When the symptoms are heavy, complete rest should be taken. Obese people should reduce their weight appropriately. A cane can be used on the healthy side to reduce the weight of the affected joint. To avoid joint flexion contracture, patients can lie prone 2 to 3 times a day and do not sit on low stools and sofas. External rotation, internal rotation, abduction and adduction exercises can avoid joint capsule contracture, and lower limb traction can relieve joint soft tissue contracture.
2.Physiotherapy Acute physiotherapy can relieve pain and swelling and improve joint function; chronic physiotherapy can enhance local blood circulation and improve joint function. Acupuncture and tui-na also have certain effects.
3.Medication Non-hormonal anti-inflammatory painkillers, such as Fenbid, Fotarim, etc., are available, and traditional Chinese medicine can also be used. If there are limited pressure points, local injection can be used, commonly used drugs are prednisolone acetate and procaine, once a week, 3 times for a course of treatment.
4.Surgical treatment includes joint cleanup, various deformity orthopedic osteotomy, femoral head acetabularplasty with vascular bundle implantation, joint fusion and artificial joint replacement. With the development of artificial hip joint prosthesis, total hip joint replacement is more and more widely used in clinical practice, which can save patients from pain and improve joint function. Its indications are.
①Patients with severe pain who have failed to respond to various treatments.
②Patients with functional impairment affecting daily life. The artificial joint has a certain lifespan limit, and the patient’s age for surgery is generally required to be over 60 years old, but with the development of prosthetic materials and surgical techniques, the age limit has been reduced.
How to prevent osteoarthritis of the hip joint
First, it should be understood that not everyone over the age of 40 will get osteoarthritis of the hip joint. Pay attention to proper rest and weight loss, and consistently participate in proper physical exercise to maintain the coordination of nerves and muscles, which can prevent atrophy of muscles, tendons and ligaments. Correct various incorrect postures in life and work to reduce the damage caused by repetitive impact of activities on the joints.
Second, mobility support, mainly to reduce the weight-bearing of the affected hip joint. Cane, crutches, etc. can be used.
Third, self-behavior therapy, reduce unreasonable exercise, moderate activity. Arthritis prevention should also avoid poor posture. Avoid prolonged running, jumping, squatting. Weight loss, aerobic exercise (such as swimming, cycling, etc.). Joint function training, muscle strength training, special attention should be paid to the training of abductor muscle groups, etc.
Life guidance for patients
As the old saying goes, “If you have a disease, you have to take care of it in three parts”, which includes the correct lifestyle. The correct “nurturing” can improve and preserve the function of the affected joints and reduce the occurrence of disability.
Psychological adjustment
Patients with depressive and pessimistic personalities tend to feel more severe pain and have significantly more pain per day; on the contrary, an outgoing and cheerful personality can reduce joint pain. Therefore, in addition to actively cooperating with physicians, arthritis patients should overcome negative psychological factors, remain optimistic and cheerful, and build confidence in overcoming the disease.
Diet and nutrition
Patients with osteoarthritis should take in as many nutrients and trace elements as possible, including protein, calcium, phosphorus, vitamin C, vitamin D and so on. Strive for a balanced diet, do not be partial, drink more calcium-rich milk, and supplement with beneficial foods or supplements that may relieve joint symptoms, such as fish oil, royal jelly, apple cider vinegar, garlic, honey, etc. People who take glucocorticoids for a long time should not consume too much food with high sugar content. Prohibit smoking and limit alcohol.
Joint Exercise
The purpose of joint exercise is to improve joint function, enhance muscle strength, maintain joint stability, improve daily activity and endurance, and improve cardiovascular function, bone density and mental status. Exercise should be gradual and not overly fatiguing. The intensity of exercise should be moderate, with acute arthritis patients having joint pain just after exercise, and chronic arthritis patients having pain lasting less than 2 hours after exercise. Strenuous over-exercise should be avoided, such as prolonged running, jumping, squatting, kneeling, kicking, etc., as this may aggravate joint symptoms. Strive to maximize the range of motion of each joint, and pull the joint slowly and gently to prevent the soft tissue around the joint from breaking.
Other
Patients with arthritis should wear comfortable and lightweight clothing that is easy to put on and take off. Patients who are sensitive to the climate should pay attention to cold and moisture protection during seasonal changes and avoid wind and rain. Long-sleeved pajamas and long pants are recommended in summer, and bamboo mats and beds are not recommended. In winter, light and warm clothes should be worn. Increase the time of daylight activities, sunbathing helps to absorb calcium and increase bone mass.