Coxarthrosis – is osteoarthritis of the hip joints. The essence of the arthritic disease is degenerative damage to the cartilage. Cartilage covers the joint surfaces of the bones forming the joint and acts as a shock absorber for stress on the joint. In osteoarthritis, the cartilage loses its elastic properties, becomes dry and fragile. Normal loads for a healthy person can lead, in a patient with osteoarthritis, to partial cartilage destruction, followed by reactive inflammation in the joint or surrounding tissues, which causes pain.

Coxarthrosis develops gradually. In the early stages, there is mild pain in the groin and thigh, as well as aching pain when walking. As the disease progresses, there is increasing limitation of hip joint mobility. Exacerbations can occur after heavy loads or improper movements. Other symptoms include limited mobility and stiffness of the hip joint: the patient has difficulty moving the leg sideways or pulling it toward the stomach. The affected joint may also creak when walking, and the affected leg may shorten, eventually leading to limping.

Depending on symptom severity, there are 3 stages of disease progression:

Grade I Coxarthrosis: Pain occurs periodically after heavy exertion and usually only in the hip joint. After rest, the pain disappears. Joint mobility is not limited. Small bony growths are observed on X-rays.

Grade II Coxarthrosis: Pain becomes more severe and may radiate to the knee and groin. Pain can occur even at rest. With prolonged physical activity (walking or running), limping begins. X-rays show visible bone growth.

Grade III Coxarthrosis: Pain is constant and may disturb even during sleep. There is a sharp limitation of all joint movements, and the patient is forced to use a cane.

Causes of Coxarthrosis

Coxarthrosis can be primary or secondary depending on etiology. Primary cartilage atrophy develops for unknown reasons (idiopathic). Secondary coxarthrosis is a complication of other diseases. This progressive pathology can be associated with metabolism, congenital disorders, trauma, and other conditions.

Possible causes include:

  • Disruption of hip joint formation during the prenatal period. This leads to tissue changes that increase stress on the cartilage. Congenital hip dysplasia is a common pathology.
  • Destruction (necrosis) of the femoral head of non-infectious origin, characteristic of Perthes disease, with first symptoms appearing in childhood or adolescence. Changes in the femoral head shape affect joint mobility.
  • Inflammation of hip joint tissues, most often due to infection. Some patients have autoimmune disorders where the body attacks healthy tissue.
  • Injuries and surgeries that affect bone surface shape and cartilage condition. Frequent fractures and dislocations can trigger osteoarthritis.
  • Idiopathic hip osteoarthritis often accompanies knee and spinal joint involvement and can manifest unilaterally or bilaterally.

Risk factors

Orthopedists consider not only direct causes but also predisposition factors, including lifestyle, primary musculoskeletal diseases, and heredity.

Possible risk factors:

  • Age and sex: most often diagnosed in women over 40.
  • Excess weight: increases pressure on the joint and adipose tissue produces proteins causing joint inflammation.
  • Occupational activities: sports or weightlifting; long-term trauma can cause degenerative changes.
  • Hereditary factors: genetic mutations can lead to abnormal joint development.
  • Hormonal disorders: endocrine system controls musculoskeletal development; pituitary, thyroid, and other disorders increase risk.
  • Sedentary lifestyle and poor diet: metabolic disorders reduce oxygen and nutrient supply to joint tissues, reducing their properties.
  • Impaired blood supply to joint tissues.

Considering risk factors is important for preventive measures.

Diagnosis

Diagnosis is performed by a trauma or orthopedic specialist. During consultation, the doctor will ask about complaints, review medical history, and identify risk factors. A general examination is done to detect changes in the pelvic area and lower limb. The orthopedic specialist evaluates range of motion, bone position, and muscle function. Instrumental and laboratory studies clarify the diagnosis.

Additional diagnostic methods:

  • Complete blood count: Typically shows no significant changes. Elevated leukocytes and ESR indicate an inflammatory process that caused joint changes.
  • Biochemical blood test: Used for differential diagnosis. In inflammatory joint diseases (arthritis), inflammatory markers increase significantly; in osteoarthritis, they remain unchanged.
  • X-ray: Primary method for diagnosing coxarthrosis. Shows bone deformities, joint shape changes, bone tissue compaction, and joint space width. Limitation: cannot evaluate soft tissues.
  • MRI: Uses magnetic waves to provide detailed images, detects early changes invisible on X-ray.
  • Ultrasound: Evaluates soft tissues and the amount of joint fluid.

These procedures are usually sufficient for diagnosis. If necessary, the patient may consult a rheumatologist, traumatologist, or other specialist. Accurate diagnosis is essential for effective therapy selection.

Treatment

Orthopedists choose treatment based on cause, cartilage destruction severity, patient age, and other factors. The main goal is to prevent further joint degeneration.

Conservative treatments:

  1. Pain relief medications: NSAIDs (e.g., celecoxib) or paracetamol. Liver and kidney function must be monitored. Topical analgesics (ointments, gels) reduce side effects.
  2. Cartilage metabolism enhancers (chondroprotectors):
    • Alflutop: 1 vial IM daily; total course – 25 vials, 2 courses/year, 6 months apart (not for organ cysts or tumors).
    • Structum (chondroitin sulfate): 3 tablets 2x/day for 3 weeks, then 2 tablets 2x/day for 3 weeks; 2–4 courses/year, 2–6 months apart.
    • Dona powder: Dissolve 1 dose in water, take on empty stomach once/day for 6 weeks; repeat in 2–6 months, 2–4 courses/year.
    • Condroxide ointment: Apply over joint 2–3 min, 2–3x/day for 2–3 weeks; can be combined with above drugs.
      These should be taken for several years (at least 3) to stop progression and partially restore cartilage.
  3. Topical corticosteroids: Reduce inflammation and pain. Examples: Movalis (Meloxicam) 1 tablet/day after meals, Diclofenac 0.025 g 1 tablet 3x/day, topical creams (Dolgit, Fastum gel), Dimexide compresses. Always under medical supervision.
  4. Joint injections: Hydrocortisone and other medications directly into the joint.
  5. PRP therapy: Injecting a concentrate of growth factors from patient’s blood to stimulate tissue regeneration.
  6. Hyaluronic acid injections: Acts as natural lubricant after inflammation is reduced, protects cartilage from friction and destruction.
  7. Physiotherapy: Heat therapy improves blood flow and speeds recovery.
  8. Complementary methods: Massage, daily exercises, and special diet. Avoid jumping, running, heavy lifting, long walks, stair climbing, and squatting. Beneficial exercises include lying or seated leg exercises, stationary cycling, skiing, swimming.

Surgical treatment is indicated if conservative methods fail or disease progresses rapidly.

  • Hip replacement (endoprosthesis): Complete joint replacement; prosthesis lasts up to 20 years. Success depends on obesity management and rehabilitation.
  • Arthroscopic debridement: Cleans joint of damaged tissue fragments and flushes cavity.
  • Periarticular osteotomy: Artificial fracture of femur fused at a different angle to reduce joint load; pain may return after 2–5 years.
  • Arthrodesis: Rigid fixation of bones in joint with metal braces and screws; preserves leg as support but immobilizes joint.

Prevention

Avoid excessive stress and injury risk to hip joints. Moderate, regular exercise strengthens the body and reduces injury risk.

After injuries, follow medical instructions carefully and take rehabilitation seriously, as post-traumatic coxarthrosis often develops due to improper recovery or lifestyle.

Complications

Without treatment, coxarthrosis progresses, potentially leading to disability. Fixation of femur in a permanent position may be required. Complications may include other musculoskeletal disorders due to poor posture and inability to walk or sit properly.

Timely medical consultation can prevent severe consequences and improve quality of life.