2023-06-14 18:45:53
Definition: what is osteoarthritis of the hip or coxarthrosis?
L’hip osteoarthritis also called coxarthrosis corresponds to a progressive degeneration of the cartilage of the hip jointjoint located between the thigh bone (femur) and the pelvis.
The disease begins with a breakdown of the cartilage and then progresses to all the other structures of the joint, resulting in inflammation of the synovial membrane (which lines the inside of the joint) as well as remodeling of the subchondral bone. (located under the cartilage).
Hip osteoarthritis can cause pain and loss of mobility. It evolves according to:
- of the chronic phases in which motor impairment and pain are mild to moderate.
- of the acute phases during which the patient may present with a significant motor handicap, intense pain and a significant deterioration in the quality of life.
Over time, the disease can get worse leading to a major loss of mobility. Sometimes the evolution is very slow and the patient will not experience any significant handicap.
Age is the main risk factor for the development of osteoarthritis. Only 3% of the population under 45 is affected, 65% is affected following 65 and 80% is affected over 80. For its part, osteoarthritis of the hip would affect 10% of people aged 65 to 75 years. It is therefore “commonplace” among seniors and the elderly.
Doctor David Levine, sports doctor in Fontainebleau: We are not all equal in the face of coxarthrosis. There are risk factors such as family history, overweight or hip pathologies. Some of us will hardly experience coxarthrosis during our lifetime, while others will live a real ordeal.
Causes: what causes coxarthrosis?
Osteoarthritis corresponds to a degradation of articular cartilage partly of physiological origin, linked to advancing in age. Indeed, osteoarthritis of the hip is more common following 60 years. Nevertheless, the aging normal is not the only explanation for the development of osteoarthritis. Other risk factors expose to the disease such as:
- frequent carrying of heavy loads ;
- excessive or poorly adapted practice of certain sports ;
- overweight and obesity ;
- sex: women are more affected than men;
- the menopause;
- a family history of osteoarthritis.
Sometimes hip osteoarthritis is the result of disease or trauma, we are talking regarding secondary hip osteoarthritis. Among the factors of secondary coxarthrosis, we find in particular:
- metabolic disease (goutte, chondrocalcinose…) ;
- chronic inflammatory disease (ankylosing spondylitis, rheumatoid arthritis);
- bone or ligament damage to the coxofemoral joint (osteonecrosis of the head of the femur, fracture of the end of the femur or the hip, etc.);
- an anatomical abnormality of the hip or leg joint (congenital dislocation of the hip, anomaly of the femoral neck or the roof of the acetabulum, unequal length or deviation of the axis of the lower limbs, etc.).
Osteoarthritis: progressive degradation of the entire joint
Osteoarthritis is a degenerative disease. Initially, alone cartilage is affected. The latter becomes friable and loses small fragments (like grains of sand) in the joint cavity.
Afterwards, l’os sous-chrondral (located under the cartilage) reacts producing an excess of bone tissue in the form of a collar around the joint: the osteophytes (or “parrot beaks” in common parlance).
The membrane synoviale lining the joint becomes inflamed, causing the joint pain and stiffness characteristic of osteoarthritis.
An accumulation of fluid in the joint cavity is also possible. We then speak ofsynovial effusion.
What are the symptoms of coxarthrosis (osteoarthritis of the hip)?
The main symptom of osteoarthritis of the hip (coxarthrosis) is chronic pain of varying intensity in the fold of the groin. The pain may radiate to the back, side or front of the thigh and more rarely project to the knee. “Many patients consult for a thigh or knee problem when in reality they are diagnosed with hip osteoarthritis,” says Dr. David Levine.
Be careful, it happens that osteoarthritis does not cause any pain (even though it is visible on x-rays). In this case, no treatment is necessary.
Beginning coxarthrosis
In the case of early coxarthrosis, the pain is calmed by rest and increases as soon as the person starts moving. The pain does not wake the patient at night The pain usually occurs first thing in the morning when getting up, the patient requiring a short time of “morning stretching“. THE rotational movements are the most difficult to perform.
Advanced forms of coxarthrosis (moderate to advanced)
At a more advanced stage, walking can be compromised with sometimes a tendency to lameness. “Over time, certain daily activities may require assistance, such as putting on shoes, getting out of the car (abduction movement)to climb the stairs, to pick up an object on the ground…”, according to the practitioner. limitation of autonomy is such that some patients experience the disease as a real handicap.
Complications: when coxarthrosis leads to disability
When the symptoms become severe, some parties suffer from a real motor disability. A patient with advanced hip osteoarthritis can sometimes even consult Wheelchair, so embarrassed is he. In these cases, patients can request the disabled worker status at the departmental house for disabled people (MDPH) on which they depend. As such, patients can benefit from job adaptation, a redeployment bonus and training specific to their new activity. If the job cannot be kept, the patient benefits from job search assistance.
How is the diagnosis of osteoarthritis of the hip (coxarthrosis) established?
The diagnosis of hip osteoarthritis first requires a doctor clinical examination. A x-ray of both hips confirms the diagnosis. Coxarthrosis can be unilateral (on one hip) or bilateral (on both hips). Imaging makes it possible to specify whether coxarthrosis is primary or secondary to another disease or anomaly (such as an anatomical malformation of the hip, for example).
Doctor David Levine, sports doctor in Fontainebleau: these are so-called “transparent” x-rays: the cartilage is invisible there corresponding to spaces. In case of coxarthrosis, these spaces are reduced to localized places. Only these imaging examinations allow confirmation of the diagnosis.
Treatments: How to treat osteoarthritis of the hip?
In case of coxarthrosis, the first advice generally given is to losing weight in case of overweight in order to spare the joints. In addition, a healthy lifestyle with daily physical activity (apart from periods of painful flare-ups) is also recommended. Pain relief (through medical treatments) as well as rehabilitation through physiotherapy are central to the treatment. Sometimes surgery may be necessary.
Medical treatments for coxarthrosis
Once the diagnosis is confirmed, painkillers may be prescribed to relieve pain during acute flare-ups. THE paracetamol is used in first intention.” If the latter proves to be ineffective, nonsteroidal anti-inflammatory drugs can be prescribed. They’re very effective,” said sports physician David Levine.
Applications of nonsteroidal anti-inflammatory gels or creams are sometimes offered.
It is best to seek medical advice before taking any medication. Self-medication is not recommended. Respect the prescribed doses (or in the absence of a prescription, the dosage). If in doubt, ask your pharmacist for advice.
THE corticosteroid injections can also act once morest pain. “It is also possible to do viscosupplementation with injections of hyaluronic acid into the joint or PRP which are effective”, according to the expert.
The rehabilitation with a physiotherapist preserves joint mobility and musculature.
The wearing a knee brace (in case of associated knee osteoarthritis) or of soles can be proposed in order to relieve the hip.
Surgical operation sometimes necessary
A corrective surgery (osteotomy or installation of a stop) can be proposed in case of bone or joint malformation at the origin of hip osteoarthritis.
In case of severe hip osteoarthritis, a total hip prosthesisis most often considered. “Today, it is possible to make custom-made 3D prostheses. This solution makes it possible to completely overcome hip osteoarthritis”, according to Doctor David Levine.
After surgery, anticoagulant therapy is prescribed for regarding 6 weeks. It is associated with the wearing of compression stockings. Physiotherapy promotes recovery.
Coxarthrosis and hip pain (coxopathy): which sports?
In case of hip osteoarthritis, it is essential to maintain physical activity. The ideal is to promote “carried” sports, with little impact, which allow muscle strengthening while preserving the joints. We generally recommend: swimming, cycling, pilates, aquagym, yoga or even tai-chi-chuan.
Doctor David Levine: you need to have a less intense training load in terms of impact on the ground, but still maintain a minimum impact because it stimulates bone remodeling. Typically if a patient runs every day, he can continue running once or twice a week and replace the other sessions with low impact activities (swimming, cycling…).
Prolonged static standing and carrying heavy loads should be avoided.
Sufficient recovery time should be allowed between training sessions.
Is walking good for hip osteoarthritis?
Walking is a gentle activity that can be practiced even in the case of coxarthrosis. Nevertheless, it is better to avoid long walks in case of painful flare-ups. It may be recommended to use a cane on the side opposite the diseased hip.
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