The musculoskeletal system is not only subject to dystrophic changes. Often, pain in large joints causes acute or chronic inflammatory processes. Hip problems are especially difficult to tolerate. Partly, the situation is aggravated by the fact that it is large and plays an irreplaceable role in human physical activity. However, unlike degenerative-dystrophic changes, inflammation of the hip joint is effectively treated. It is only important to know the features of TBS disease and consult a doctor in a timely manner.
Why is the hip joint inflamed?
There are 2 large etiological groups that cause the painful process – these are aseptic factors and microorganisms. In the first case, the mechanism of the formation of the disease is immunoallergic or traumatic, and in the second, purulent. The destruction and degeneration of the joint, which inevitably arise without adequate treatment, are purely secondary in nature, associated with the ongoing exposure to the etiological agent. As a result, coxitis occurs – an acute or chronic inflammation of the hip joint.
One of the causes of the disease is microorganisms that cause infectious inflammation in the joint cavity. These include:
- nonspecific microbial agents – streptococci, staphylococci, Escherichia, Klebsiella and others;
- tubercle bacillus – a specific curdled inflammatory necrosis occurs in the joint cavity;
- chlamydia, trichomonads – sexually transmitted infections;
- pale treponema – syphilitic coxitis;
- mix arthritis – mixed flora.
Microorganisms enter the joint cavity more often by the hematogenous route from a source located in another organ. Most often, coxitis is a secondary complication of genitourinary infections, skin diseases and the respiratory system. The lymphogenous pathway is much less likely – direct entry into the joint cavity after an open injury or medical intervention.
Immunoallergic (aseptic) etiological factors have a different genesis. All of them have only one common property: the cavity of the hip joint remains sterile. There are the following causes of aseptic inflammation of the hip joint:
gout – uric ac >
Reactive inflammation of the hip joint is also possible. But in this case, the state of the cavity can be both sterile (the process is only immune in nature) and bacterially seeded. A separate group is idiopathic coxitis: in extremely rare cases, the cause of the disease cannot be established.
Symptoms and Clinical Differences
Since the causes of the disease vary significantly, there are differences in the manifestations of the disease. But for all etiological factors, the following symptoms are characteristic:
- joint pain
- stiffness of movements in the morning;
- swelling of the affected area;
- reactive changes in the musculo-ligamentous apparatus;
- general reaction of the body.
However, the clinical diversity of manifestations is quite large. For purulent coxitis, the following symptoms are characteristic:
- acute onset;
- severe pain;
- sharp swelling;
- flushing of the skin over the hip joint;
- fever to febrile and hectic numbers;
- general serious condition of the patient.
Acute purulent coxitis threatens a person’s life: due to massive blood circulation in the area of the hip joint, microorganisms easily enter other organs, which leads to sepsis. Intoxication and severe pain are extremely difficult for patients, therefore, immediate treatment is necessary to successfully help a person and alleviate suffering.
With tuberculosis and other specific processes, intoxication is less pronounced. Edema and painful manifestations are smoothed, but the destruction of bone tissue occurs at a very fast pace, which leads to a sharp violation of the motor function of the joint. Temperature – often subfebrile, skin hyperemia is not observed, but a clear clinical picture is steadily increasing, leading to serious functional disorders.
Aseptic inflammation of the hip proceeds somewhat differently. This is always a chronic process with periods of exacerbation and remission. In gout, acute clinical manifestations are expressed only during the formation of crystals in the synovial cavity. In this case, the symptoms resemble purulent arthritis, but intoxication is less pronounced:
- sharp pains in the joint, often occurring at night;
- a clear connection with the consumption on the eve of alcohol or meat products rich in purines;
- severe swelling;
- complete impairment of joint function;
- the temperature is low-grade or normal.
Despite the severity of clinical symptoms, the patient’s condition remains at a satisfactory level. However, during remission, gouty masses form around the joint, which leads to immobilization and disfigurement of the affected joint.
Rheumatoid arthritis and other systemic diseases are chronic. During the period of exacerbation, there is a slight pain in the joint, but a significant stiffness of movements. The articulation function is seriously affected, which quickly leads to muscle atrophy and degenerative processes in the synovial cavity. Without therapeutic measures aimed at suppressing immune inflammation, ankylosis occurs, which will require endoprosthetics.
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With traumatic effects or as a result of systemic lesions, inflammation of the tendons of the hip joint occurs, the symptoms of which are somewhat different. For this pathology, the following manifestations are characteristic:
- pain radiating to the groin;
- the impossibility of abduction movements;
- painful and dense formations in the area of the hip joint, palpable under the skin;
- clear connection with trauma;
- weak and moderate nature of pain;
- lack of intoxication.
If the joint cavity is intact, and the lesion affects only the ligamentous apparatus, then the treatment started on time fully normalizes the function of the joint. However, tendon ruptures may require operational tactics. The process is always short-lived, although painful sensations in the inguinal region during abduction movements in the hip joint can persist persistently for a long time.
How to establish an accurate diagnosis
If the clinical symptoms develop rapidly, and the anamnestic information is not contradictory, it is not difficult to establish a diagnosis and start treatment for inflammation of the hip joint. However, a minimal examination is necessary to differentiate the etiological agents of coxitis. The diagnostic search includes the following studies:
- standard blood and urine tests;
- extended biochemistry with the inclusion of acute phase indicators, uric acid and systemic reactions;
- rheumatology panel;
- urinary tract examination for infection;
- radiography of the lungs;
- Diaskin test for suspected tuberculosis nature of the disease;
- radiography or tomography (CT or MRI) of the joint;
- diagnostic puncture with accumulation of exudate in the synovial cavity;
- if necessary – arthroscopy and therapeutic and diagnostic measures during a minimally invasive surgical procedure.
Performing all diagnostic tests for each patient is optional. As soon as the cause of the disease is established, all efforts must be directed to therapeutic measures that allow you to quickly help the patient. However, in difficult situations, when the etiology is difficult to establish, it is important to complete the entire diagnostic process, since only a precisely identified problem can be cured quickly.
The effectiveness of therapeutic measures depends on how accurately the etiological factor is established. General principles of treatment include the following activities:
- pain relief;
- struggle with the cause of the disease;
- improvement of blood circulation in the joint area;
- activation of movements;
- anti-relapse therapy.
The principles of treatment can be implemented through the following actions:
- use of medicines;
- Spa treatment;
- diet food;
- operational correction.
The tactics of therapeutic measures are usually conservative. The operation may be needed only in case of critical degenerative changes that cannot be influenced by other methods. The standard surgical tactic is endoprosthetics in the presence of clinical and radiological indications.
The use of medications for various types of inflammation is not the same. The table below discusses the main types of coxites and typical drugs for their therapy.
|Drug / Disease||Purulent Arthritis||System process||Gout||Tuberculosis and mixed arthritis|
|NSAIDs||Briefly, to relieve pain. 150 mg diclofenac used in knocking||Constantly. Typically, drugs with minimal exposure to the gastrointestinal tract are aceclofenac, nimesulide||For pain – in the most tolerated doses, the most effective is indomethacin – 200 mg per day||Use as needed in low doses, as the pain syndrome is not clearly expressed|
|Antibiotics||Always apply. Typically, a wide spectrum of action – cephalosporins, glycopeptides in high doses and combinations. The course of treatment is at least 10 days, and usually with a change of drug – up to 3 weeks||Not applicable||Not applicable||Usually prescribed, since mix arthritis is difficult to diagnose. Doses are high since microbial damage can never be completely ruled out.|
|Cytostatics||Banned||Used always, constantly, inside or in the muscle. Methotrexate and Leflunomide are popular||Rarely used, in the presence of clinical indications and recommendations of a rheumatologist||Usually not used|
|Hormones||Only a short course to combat intoxication, strictly intravenously||Constantly, to suppress immune inflammation. Usually prednisone inside||Not applicable||Not applicable|
|Other drugs||Immunostimulants, vitamins, detoxification||Chondroprotectors||Anti-gout medications (allopurinol). For pain relief – colchicine||Anti-TB drugs, chondroprotectors|
The treatment of the hip joint with the relief of inflammation is carried out according to an individual program under the supervision of a rheumatologist or traumatologist. With purulent coxitis, the basis of treatment is antibiotics, which are usually administered intravenously. If the process is aseptic in nature, then therapeutic measures are aimed at suppressing immune inflammation. In this case, the basis of treatment is hormones and cytostatics. With gout in the interictal period, uricosuric agents are shown to help remove excess uric acid from the body. With all etiological factors, chondroprotectors help, since they slow down the degeneration of the joint.
With coxitis of any etiology, physiotherapy is used. In acute situations, it helps to increase blood circulation, which facilitates the delivery of antibiotics to the site of damage. With chronic inflammation, physiotherapy removes painful manifestations. Commonly used are laser, diadynamic currents or UHF. Treatment can be supplemented with exercise therapy and sanatoriums according to the profile of “musculoskeletal system diseases”.
Conclusion and Forecast
With inflammation of the hip joint, it is important to solve two main problems – to remove the activity of the process and restore the function of the joint. The forecast will depend on the following factors:
- timeliness of seeking medical help;
- etiological nature of inflammation;
- diagnostic accuracy;
- high patient compliance;
- active and targeted comprehensive treatment.
It also depends on the patient himself how quickly he will recover. When the very first symptoms appear, you should immediately consult a doctor. It is important to complete the prescribed treatment, therefore, adherence to therapeutic measures has a decisive influence on the prognosis.
Acute coxitis in the absence of septic complications responds well to treatment. Against the background of massive antibiotic therapy, it is possible to level the influence of pathogenic flora, which allows for a complete clinical recovery. Chronic inflammation is more difficult to therapeutic measures. In such a situation, the prognosis will depend on the rate of increase of degenerative-dystrophic changes. If active inflammation can be stopped against the background of constant supportive intake of basic medicines, then joint function worsens slowly. This allows an optimistic look at the quality of life of such patients. In cases where the immuno-allergic process is steadily progressing, even against the background of combined use of basic drugs, the prognosis is uncertain. In this case, the problem is solved operatively using endoprosthetics.
Traumatic injuries of ligaments can be treated quite quickly, but in some individual situations, the help of a surgeon is also required. Specific inflammation lends itself well to treatment, but tuberculous coxitis is prone to recurrent course.
Shishkevich Vladimir, orthopedic and traumatologist, project editor-in-chief ExpertNews.
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