OSTEOARTHROSIS OF THE HIP JOINT

Definition
Osteoarthrosis is a degenerative joint disease that occurs as a result of mechanical overload of the joint [1]. With osteoarthritis of the hip joint (coxarthrosis), articular cartilage is affected, and also changes occur in the subchondral bone, synovial membrane, ligaments and capsule of the joint [2]. Degenerative-dystrophic changes lead to a narrowing of the joint space, which can manifest itself with various symptoms [2].
EPIDEMIOLOGY AND ETHIOLOGY

PREVALENCE
Coxarthrosis is one of the 15 most common causes of disability [3]. Hip osteoarthritis (TBS) is detected in 10% of people over the age of 65, while 50% of these cases are symptomatic [4]. Studies show that the risk of developing osteoarthritis of the hip joint in people who live to be 85 years old is 25% [1].
PRIMARY OSTEOARTHROSIS
Most often, the cause of the lesion is associated with a change in the articular cartilage, but also the pathological process can be caused by femoro-acetobular impingement [6]. Cartilage is affected more often in the acetabulum than in the head: 72.2% and 16.7%, respectively. The anteroposterior surface of the acetabulum suffers mainly.
SECONDARY OSTEOARTHROSIS
Various anatomical features predispose to the appearance of secondary osteoarthrosis, which can be either congenital or acquired [6], [8].
RISK FACTORS
previous hip injury (mainly leads to unilateral coxarthrosis);
primary arthritis (for example, rheumatoid arthritis, ankylosing spondylitis);
structural features of the joints;
genetic predisposition;
congenital and acquired diseases of the hip joint (for example, congenital dislocation of the hip, Perthe disease, displaced upper femoral pineal gland, hip dysplasia);
subchondral bone defects;
obesity (most often leads to bilateral coxarthrosis);
occupation and physical activity at work, causing excessive stress on the hip joints;
elderly age;
gender (female> male);
sport (engaging in high-intensity sports at a young age, which can cause joint injury or wear of articular cartilage);
menopause;
metabolic diseases and acromegaly;
passive lifestyle;
femoro-acetobular impingement;
ethnicity - 80-90% less common among the population of Asia than among the population of the Caucasus in the United States;
diet - low levels of vitamins D, C and K.

SYMPTOMS
Pain:

gradually increasing;
amplified: during physical activity, with improper load distribution, with too long a load on the TBS, in cold weather;
decreases after prolonged movement;
localization of pain more often in the groin / thigh, radiating to the buttocks or knee;
in the terminal stage: constant pain, night pain.

Stiffness:

in the terminal stage of osteoarthrosis, morning stiffness is not more than an hour, usually decreases after movement;
Limited range of motion - leads to joint contractures and muscle atrophy;

Crepitus during movement;

Gait disorders - antalgic gait, gait of Trendelenburg;

Shortened legs;

Local inflammation.

[10], [11], [12], [13].
DIFFERENTIAL DIAGNOSIS
1. Contusion of muscles;
2. Stretching of the muscles - the gluteus maximus muscle;
3. Athletic pubalgia (sports hernia);
4. Piriformis syndrome;
5. Hamstring syndrome;
6. Inflammatory diseases;
7. Clicking hip syndrome;
8. Bursitis of the hip joint;
9. Arthritis;
10. Septic arthritis TBS;
11. Avascular necrosis (aseptic necrosis);
12. Tear lip rupture;
13. Hip fractures;
14. Dislocations of TBS;
15. Tumors;
16. Chondral defect;
17. Ligament damage;
18. Sciatica;
19. Neuropathy (especially of the obturator and lateral cutaneous nerve of the thigh);
20. Damage to the joint capsule;
21. Stretching of the inguinal ligament.
DIAGNOSTICS
The diagnosis of coxarthrosis should be made on the basis of anamnesis, objective examination and clinical diagnostic studies. The American Rheumatology College in the diagnosis of TBS osteoarthrosis recommends the use of the following criteria: [1], [15].

Class A clinical criteria
hip pain;
TBS rotation angle <15 °;
erythrocyte sedimentation rate (ESR) ≤45 mm / h OR flexion in the hip joint ≤115 °, if ESR is normal.

Clinical Criteria B
hip pain;
pain that occurs when the thigh rotates inward;
morning stiffness ≤1 hour;
age> 50 years.

Clinical plus radiological criteria
hip pain;
two of the following criteria:
ESR <20 mm / h;
osteophytes on the head of the femur or acetabulum on the radiograph;
narrowing of the joint space on the radiograph.

Sutlive et al published a list of criteria for the detection of coxarthrosis in patients with unilateral pain in the field of TBS. If 3 out of 5 criteria are present, the likelihood of osteoarthritis is 68%. If 4-5 criteria out of 5 are present, the probability increases to 91%. The criteria are positive when, when performing tests, the patient experiences pain or movement restriction [16]. Five criteria of Satliv:
bending;
rotation inward;
Scour test: rotation in and out during abduction and adduction of the hip;
Patrick or FABER test: flexion, abduction and outward rotation of the thigh;
hip flexion test [17].