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Coxarthrosis: arthrosis in the hip joint
Hip arthrosis is one of the most common arthrosis, especially in older people, where damage to the cartilage tissue causes the hip joint to degenerate. Very different causes can be responsible for this so-called coxarthrosis. Part of prevention and treatment is to minimize beneficial factors such as being overweight and overworked. However, if the hip osteoarthritis is already very advanced and very painful for those affected, surgery and, if necessary, the insertion of an artificial hip joint may be advisable.
A brief overview
Osteoarthritis of the hip is a common disease in the elderly, but coxarthrosis can also occur and cause discomfort at a young age. In the following summary, first read the most important facts and learn more about this often complained suffering in the following article.
- definition: Osteoarthritis of the hip (also called coxarthrosis) first manifests itself through damage and wear and tear of the cartilage tissue. As the disease progresses, other structures of the hip joint are also damaged by the arthrosis.
- Symptoms: First of all, hip pain occurs, which can go hand in hand with restrictions on movement and stress and also affect the gait pattern in the advanced stage.
- causes: The causes have not yet been fully clarified and are the subject of current research. Many previous illnesses, injuries or overloading of the joints are assumed to be triggering factors, as are genetic predispositions. Complex relationships probably determine the development of coxarthrosis.
- diagnosis: Every orthopedic examination is supplemented by special radiological procedures to reliably determine arthrosis. X-rays are usually sufficient to be able to make a reliable diagnosis and to determine the severity.
- Prevention: Influenced risk factors can prevent or develop hip arthrosis. These include weight optimization, moderate exercise and stress as well as physiotherapy.
- treatment: If preventive measures and drug therapy for pain management are not sufficient, surgery and joint replacement with an endoprosthesis may be necessary.
- Naturopathic treatment: Various alternative measures can support the treatment of coxarthrosis, such as acupuncture, hydrotherapy or magnetic therapy.
Hip arthrosis is a degenerative disease of the hip joint. The term initially refers to signs of wear and damage to the cartilage tissue. In the advanced stage of the disease, pathological changes also occur in the joint capsule, the hip bones and other surrounding structures (muscles, connective tissue).
The so-called coxarthrosis (also coxarthrosis) is one of the most common arthrosis. In Germany, around five percent of the population over the age of sixty develop this joint disease.
Typical complaints are hip pain, which occurs particularly under stress. Most of the time the pain manifests itself especially after getting up and during the first movements as well as in the evening. In between, depending on the severity and stress situation, there can also be symptom-free periods or phases with only minor complaints. In general, the symptoms increase continuously over the course of the disease, which can also lead to a relapsing worsening.
If the person suffers from permanent (severe) pain in the hip or even complaints during periods of rest (for example at night), the arthrosis is already at a late stage.
What exactly causes the pain is not clear. Not only the actual degenerated structures in the hip joint come into question, but also pain-causing sequelae such as muscle hardening. Accordingly, low back pain, back pain or groin pain can also occur.
If the arthrosis is already advanced, there may also be restricted movement in the hip joint, which may change the gait pattern.
Coxarthrosis can have very different causes. In some cases, however, there are still ambiguities in the development of the disease. The general division between the primary and secondary forms of osteoarthritis still largely remains. Often, however, it is not clear whether an inferior quality of the cartilage tissue is primarily responsible for the disease or whether there are secondary causes due to various congenital or acquired diseases as well as (joint) injuries.
However, other concepts now assume that an extremely complex disease process with many as yet unknown factors leads to the harmful developments on the hip joint. It is believed that the disease-causing circumstances are offset by various repair mechanisms that can compensate for any damage that has occurred. Ultimately, an existing imbalance between damage and its compensation justifies the development of arthrosis in the hip joint. The actual stress or existing degeneration then exceeds the individual's ability to repair and endure.
If no clear causes or triggers for the occurrence of osteoarthritis can be found, one often speaks of a primary (idiopathic) osteoarthritis of the hip. This is usually bilateral and occurs particularly often from the age of over fifty. It is believed that natural aging processes lead to abrasion-related complaints on the joint (cartilage), which can at best be associated with an (innate) malnutrition of the cartilage or a less compensatable quality of the cartilage.
Cartilage tissue does not have its own blood vessels. Nutrition takes place through the fluid between the cells (intercellular fluid). If the composition of the fluid is not optimal, for example due to a poor metabolic state in the organism, a low absorption of nutrients or a disturbed inflow, this can have an impact on the quality of the cartilage.
Joint damage and underlying diseases that also occur in childhood are often considered causes, especially in hip arthrosis that occurs well before the age of fifty and often one-sided. The following symptoms are associated with secondary coxarthrosis:
- Trauma (acetabular fracture) after serious accidents (post-traumatic hip arthrosis),
- Congenital or acquired malformations of the hip such as hip dysplasia, hip dislocation or acetabular deformity,
- Hip diseases (in children and adolescents) such as femoral head necrosis (Perthes disease) or femoral head solution (epiphysolysis capitis femoris),
- Obesity (cause of accelerated joint wear),
- Metabolic diseases,
- Circulatory disorders,
- inflammatory or rheumatic diseases of the hip joint,
- Bone infections (hematogenous osteomyelitis, septic arthritis).
Furthermore, the beneficial factors include excessive stress, for example due to competitive sports or other strong physical exertion, as well as an extreme lack of exercise in return.
Those with a hip problem will in most cases seek medical advice in an orthopedic practice. An anamnesis and clinical examinations then take place here, which focus primarily on the pain symptoms and on restrictions in mobility and resilience.
Since, in addition to osteoarthritis, many other diseases and injuries to the hip or also in the areas of the lumbar spine and groin can cause similar symptoms, an X-ray diagnosis is essential. Special recording techniques enable the typical radiological signs to be displayed well. To ensure security, not only images of the thigh and hip are taken, but also of the entire pelvis and other adjacent bone structures.
The existing severity can be determined using the x-ray images using various classification systems. The most common use is the Kellgren and Lawrence score, which differs from grade 0 (no signs of osteoarthritis) to grade 4 (severe arthritis).
If there is a discrepancy between the clinical and radiological findings, further examinations and other imaging diagnostic procedures are used.
In order to prevent new hip arthrosis, changeable risk factors need to be reduced and at best switched off. This includes, among other things, early treatment of congenital or acquired malformations of the hip or other triggering diseases, as well as the avoidance of overloads (e.g. due to overweight or harmful work and leisure activities).
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If you already have osteoarthritis, certain precautions should be taken to counteract worsening. This includes optimizing or reducing body weight and regular, moderate physical activity. In some cases, it may make sense to perform joint-preserving surgery.
If the hip arthrosis is already advanced, the main focus is on preventing consequential damage.
In order to alleviate existing complaints and to maintain joint function in the long term, conservative treatment methods are available before an operation should be considered. Here, individual advice on everyday behavior, physical exertion and movement, and weight loss is of great importance. A change in diet and light sports (e.g. cycling, walking, swimming or water aerobics) have a very positive effect. It is not uncommon for specific exercise units (physiotherapy) to be involved.
In addition, various analgesic and anti-inflammatory drugs are used. The use of special hip orthoses for lesser degrees of severity is not uniformly recommended, but is also a possible treatment option.
Physical therapies (heat and cold applications, ultrasound and electrotherapy) can also help to alleviate the symptoms.
If these measures are not sufficient, an operation can make sense. Determining the right time for a surgical procedure is not always easy. A few months should always be devoted to the conservative approach, but one should not wait until the final stage of the disease.
Various surgical methods are used, in which either the joint is corrected or completely removed and replaced with an endoprosthesis. Another possibility is the stiffening of the joints. Endoprosthetic hip replacement (artificial hip joint) is one of the most successful treatment methods for advanced arthrosis and offers those affected good chances of significantly improving their quality of life.
In addition to the classic, conventional medical therapy options, there are also other options for treating arthrosis, although the effectiveness of the individual methods and means has not been proven.
Acupuncture and hydrotherapy or balneotherapy can have a beneficial effect on the healing process. Pulsating magnetic field therapy can also have a positive effect on osteoarthritis complaints.
The use of nutritional supplements for cartilage regeneration is discussed rather controversially. The therapeutic effectiveness of glucosamine and chondroitin is considered to be very questionable. For some years now, these cartilage building agents have not been allowed to be advertised as such. The intra-articular injections of hyaluronic acid are viewed similarly critically.
If you are interested in self-help for osteoarthritis, the guide published by Dr. Andrea Flemmer recommended. This reading sometimes provides comprehensive information on the possibilities of phytotherapy, such as applications of the devil's claw and nettle.
Current state of research
The widespread disease arthrosis is the subject of current research, especially with regard to the causes and treatment options. A research group recently discovered several specific genetic changes in the genome that pose a higher risk of developing osteoarthritis. The results of the study published in Nature Genetics also provide insights into new treatment options in the treatment of arthrosis. (tf, cs)
Author and source information
This text corresponds to the specifications of the medical literature, medical guidelines and current studies and has been checked by medical doctors.
Dr. rer. nat. Corinna Schultheis
- Tachmazidou, Ioanna / Hatzikotoulas, Konstantinos Hatzikotoulas / Southam, Lorraine / u.a .: Identification of new therapeutic targets for osteoarthritis through genome-wide analyzes of UK Biobank data, nature genetics, 2019, nature.com
- Amboss GmbH: Coxarthrosis and gonarthrosis (accessed June 25, 2019), amboss.com
- German Society for Orthopedics and Orthopedic Surgery (DGOOC); Professional association of doctors for orthopedics (BVO): S3 guideline orthopedics: Koxarthorse, July 2011, leitliniensekretariat.de
- Rüther, Wolfgang / Lohmann, Christoph H .: Orthopedics and trauma surgery, Urban & Fischer Verlag / Elsevier GmbH, 20th edition, 2014
- National Health Service UK: Hip replacement (available on June 25, 2019), nhs.uk
- Deutsche Arthrose-Hilfe e.V .: What is arthrosis? (Accessed June 25, 2019), arthrose.de
- Institute for Quality and Efficiency in Health Care (IQWiG): Arthrosis (accessed June 25, 2019), gesundheitsinformation.de
ICD codes for this disease: M16ICD codes are internationally valid encodings for medical diagnoses. You can find yourself e.g. in doctor's letters or on disability certificates.