Sometimes the disease is also observed at an earlier and later age - up to 18 - 19 years, very rarely in adults. In most cases, one side is affected.

Pathological changes in the femoral head represent primary aseptic subchondral epiphyseal necrosis.

Osteochondrosis of the femur begins with necrosis of the spongy bone tissue of the epiphysis, which softens in the dead area and is crushed and compressed under the pressure of the wall of the acetabulum.

The accumulated dead, crushed cystic mass slowly dissolves. At the same time, the regeneration process is underway. The processes of the periosteum of the metaphysis and untouched cartilaginous tissue grow into the shapeless dead bone mass and divide it into separate areas, which on an x-ray image appear as “sequiestropodum shadows”.

The absorbed dead bone mass is gradually replaced by living bone tissue. At the final stage of the process, changes characteristic of deforming arthrosis occur in the joint. The head and neck of the femur change shape. The shape of the acetabulum also changes somewhat. The head is flattened and looks like a mushroom cap.

Changes in the head are sometimes limited to an increase in its volume. The neck thickens and shortens, the angle between the neck and the femoral diaphysis decreases, and plow vara often develops. There are no changes in tissues characteristic of the inflammatory process. The described process lasts 4 years and ends with the restoration of the stiff tissue and, if we do not count the remaining deformation, with a cure. In adults, the disease takes longer and is more severe and often ends in disfiguring arthrosis.

Epiphyseal necrosis of the femoral head usually affects children who are otherwise healthy. Clinically, the disease in the initial stage manifests itself as slight pain in the hip joint, sometimes pain in the hip or knee.

The pain intensifies during the day after walking and then subsides. Often the pain stops for a certain period of time and then appears again. Sometimes there is lameness. Passive movements are little painful. Flexion and extension are free, while abduction and partly rotation of the hip is limited, which is typical for this disease.

A push to the heel or greater trochanter causes no pain in the hip joint or very little pain. In the last stage of the disease, the limb may become somewhat shortened. There is no or very slight muscle atrophy. Treidelenburg's symptom is positive, but expressed to varying degrees. After the end of the pathological process, the patient recovers, sometimes symptoms associated with deformation of the head and neck, i.e. symptoms of coxa vara, remain.

Recognizing osteochondrosis of the femur in the initial period is difficult; later, changes in the femoral head, visible on an x-ray, facilitate the diagnosis. An X-ray image gives a very characteristic picture, especially in the stages of resorption and regeneration.

The head is flattened, its outline is irregular, sometimes small fragments of bone are visible. The joint space is widened. Epiphyseal necrosis of the femoral head differs from tuberculous coxitis by insignificant pain, mild course, the ability to continue walking, no limitation of flexion and extension, normal temperature, absence of muscle atrophy, cold abscesses and fistulas. An x-ray resolves doubts.

Treatment

Due to the tendency of the disease to heal itself, conservative measures are limited. Their goal is to minimize the resulting deformation of the joint. Prolonged walking and standing are prohibited; muscle massage, walking on crutches, and physiotherapeutic procedures are recommended.

If acute pain occurs, the patient is put to bed or the limb is immobilized. Surgery is contraindicated.

Working capacity during illness is limited.

Osteochondrosis is a dystrophic damage to the cartilage tissue of the joints with its subsequent destruction. The disease can appear anywhere, but most often affects those areas where the greatest load is observed. This area near the thigh is the hip joint. Dystrophic damage to this zone occurs in 7% of citizens. Osteochondrosis of the hip joint is a dangerous disease that often leads to disability.

Reasons for the development of the disease

The hip joint consists of the head of the femur and the acetabulum of the pelvis. The joint is covered on top by an articular capsule consisting of cartilage and connective tissue. The joint cavity is filled with synovial fluid. The head and acetabulum are covered with cartilage tissue. It is this that is destroyed during osteochondrosis, and the process is also accompanied by a decrease in the amount of synovial fluid.

In this case, bone growths appear on the head, which only complicate the patient’s situation. The negative effect of the pathology affects not only the affected area, but also the ligaments, muscles and the adjacent hip joint, since the entire load is transferred to it. The disease can lead to fusion of the bones of the joint and its immobility - ankylosis.

There are two immediate causes of osteochondrosis:

1. Injury. This can be a one-time severe injury or regular microtraumas. The latter occurs in athletes or people whose position of the femoral head is disturbed, due to which the load is distributed unevenly and the cartilage is constantly injured.
2. Metabolic disease. In most cases, this manifests itself in a decrease in the regenerative ability of cartilage tissue and synovial fluid. This pathology develops with age. At the same time, calcium is washed out of the bones. However, metabolic disorders can also arise for other reasons.

Osteochondrosis destroys cartilage tissue and can lead to disability

The following factors can lead to these situations:

• deficiency or impaired absorption of calcium and phosphorus;
• vitamin D deficiency;
• hereditary pathologies affecting the metabolism of hyaluronic acid;
• sedentary lifestyle;
• infection of the hip joint;
• joint injuries: dislocations and subluxations;
• infectious and genetic blood diseases;
• somatic pathologies;
• obesity.

Stages and characteristic symptoms of hip osteochondrosis

There are several stages of disease development, during which the clinical picture becomes more vivid and severe.

First stage

At the beginning of the disease, the patient does not feel much discomfort. After physical activity, long walks or work, joint pain is observed, which can be sharp or dull, aching or sharp. Sometimes the pain radiates slightly to the leg. All this can be combined with numbness or body aches. Sometimes when moving, a crunching sound is heard in the joint.

After rest, the pain subsides. It is already possible to diagnose the pathology, but patients rarely see a doctor. At this stage, the amount of collagen fibers and proteoglycan in the cartilage tissue decreases, but no changes are detected on x-rays.

Second stage

The cartilage becomes thinner, loses elasticity and strength, and ceases to fully perform its functions. Bone growths appear on the edges of the head of the femur, which, when rubbed, cause acute pain. The pain syndrome interferes with the patient's physical activity and any other movements in the joint.

The interarticular fluid decreases in volume, becomes thick, and loses its lubricating function. The pain begins to radiate to the groin area. The crunching sound is clearly audible and appears much more often. An x-ray can reveal a decrease in the lumen of the joint by 2-3 times. Local blood supply deteriorates, causing the disease to progress more rapidly.

Third stage

Terrible pain appears even with minimal movement. The cartilage on the head of the femur and in the acetabulum completely disappears along with the synovial fluid, causing the joint to lose mobility. The patient experiences pain even at rest. The joint capsule shrinks, loses its volume and gradually atrophies.

The x-ray shows the complete disappearance of the articular cavity, as well as flattening and deformation of the femoral head. Atrophy also affects surrounding muscles. The leg becomes noticeably shorter. Restoring cartilage tissue is no longer possible.

Diagnosis of osteochondrosis

First of all, you need to distinguish osteochondrosis from arthritis, which has very similar symptoms:

1. With osteochondrosis, pain occurs during passive movement of the limb: when the doctor moves the patient’s leg, but he himself does not strain the muscles. With arthritis, pain appears only with active movement.
2. With osteochondrosis, pain increases during the period of human activity - the longer the patient moves, the more damage occurs in the joint. With arthritis, the discomfort after walking decreases, because the pain syndrome is caused by stagnation of blood, which resolves with movement.
3. With osteochondrosis, changes in the joint are very noticeable: size, shape, angle of movement. X-rays show degenerative processes and a decrease in the size of the articular cavity.

Treatment methods for hip osteochondrosis

Therapy for successful rehabilitation must pursue several goals:

• eliminate pain;
• accelerate the regeneration of cartilage and interarticular fluid;
• restore blood supply to the sore spot;
• reduce the load on the joint;
• increase the distance between the femoral head and the acetabulum;
• strengthen the muscles and ligaments of the joint;
• restore mobility.

All treatment methods are divided into surgical and conservative.

Conservative treatment

Used only at stages 1 and 2 of the disease. Conservative treatment methods include:

• Symptomatic drug therapy. Non-steroidal anti-inflammatory drugs are used to relieve pain: Diclofenac, Piroxicam, Ketorolac. However, since they impair the synthesis of proteoglycans in cartilage and have many contraindications, it is better to use selective anti-inflammatory drugs (Movalis).
• Specific drug therapy. First of all, the patient is prescribed chondroprotectors (glucosamine and chondroitin sulfate), which will accelerate the restoration of cartilage tissue. The first drug will enhance the functioning of chondrocytes and the production of proteoglycan. The second remedy will increase the creation of collagen fibers and also improve the binding of moisture by proteoglycan. In addition, intra-articular injections of hyaluronic acid are used - raw materials for cartilage and interarticular fluid.
• Massage. Its task is to stretch the joint and strengthen the muscles and ligaments, which reduces pressure on the affected area. Thanks to this, the cartilage will quickly restore its functioning. Massage is contraindicated for infectious diseases and inflammation in the joint.
• Physiotherapy. Ultrasound, electrophoresis, heating, magnetic and laser therapy and other treatment methods are used. Their task is to improve blood circulation, thereby accelerating tissue regeneration. Physiotherapy is often contraindicated for inflammation.
• Exercise therapy. The exercises are designed to increase mobility and blood circulation in the joint. Gymnastics is prescribed by a qualified specialist.

All folk remedies that have proven at least some effectiveness have long become part of traditional medicine.

Surgery

Such a radical method of treatment is used at stages 2 and 3 of osteochondrosis. During surgery, the doctor actually amputates the leg. The joint is disconnected from the pelvis, after which the femoral head and joint bed are cut out. Instead, the surgeon installs a titanium prosthesis with a bed made of durable plastic. The product is attached to the bones with pins.

The difficulty of the operation lies in the extensive trauma that the surgeon inflicts when disconnecting the leg. Blood clots formed as a result of such intervention can cause a heart attack, stroke, or pulmonary embolism. But even with successful engraftment, the prosthesis will also become loose over time, which is why it will need to be replaced.

Currently, osteochondrosis occupies one of the leading places among diseases of the musculoskeletal system, with an annual increase in incidence. The disease affects cartilage and bone tissue - the cartilage becomes thinner, and growths (osteophytes) appear on the bones. All this provokes the development of the inflammatory process, and, as a result, pain.

Osteochondrosis of the hip joint is characterized by destruction of cartilage tissue, pathological changes in periarticular structures and a decrease in the volume of synovial fluid. In the later stages, partial or complete immobility may develop, which will almost inevitably lead to loss of ability to work.

Anatomy

The hip joint is formed by the head of the femur and the pelvic bone, which contains the so-called acetabulum. This depression in the ilium is framed by the acetabular lip - cartilaginous tissue. The articulating surfaces are also covered with cartilage, the end of the femur is located inside the acetabulum.

Attached to the edges of the acetabulum and femur is an articular capsule containing synovial fluid, which is necessary for the free sliding and shock absorption of bone elements. Cartilage tissue has the ability to change size depending on the load - when walking or carrying heavy loads.

The higher the load on the joint, the more synovial fluid is produced, forming a protective layer. Thanks to blood circulation, nutrients are supplied to the joint; when blood flow is disrupted, congestion and nutritional deficiency occur. Loss of fluid due to age-related changes also negatively affects the condition of cartilage.

The destruction of cartilage tissue is expressed in changes in its structure, thinning and cracking. Bone growths form, provoking inflammation, and the shock-absorbing function gradually and steadily decreases. This process is called osteochondrosis of the hip joint.

Causes

Doctors are divided on the causes of the disease: some believe that first the cartilage is destroyed and inflamed, creating the ground for the formation of osteophytes. In thinned and damaged cartilage, cracks appear in which inflammation occurs and regeneration is activated. The response of inflamed tissues is the formation of marginal growths - osteophytes.

Another part of the medical community is convinced that it is the appearance of osteophytes that is primary, and only then does the inflammatory process begin. As a result of stagnation, salts from the synovial fluid precipitate, which provokes the growth of osteophytes.

The following are considered risk factors that contribute to the appearance of congestion and the development of osteochondrosis of the hip joint:

• high physical activity;
• metabolic disorders;
• excess weight, physical inactivity;
• hip injuries;
• hereditary predisposition;
• past infections.

Wearing high-heeled shoes can also lead to the development of chondrosis, since this shifts the center of gravity of the body and changes posture. The muscles of the pelvic area are in constant tension, and free blood circulation becomes difficult. Most often, the disease appears as a result of a combination of several causes.

Symptoms

The disease develops in 3 stages, each of which is characterized by certain symptoms. Symptoms of osteochondrosis of the hip joint increase gradually; in the early stages they may appear only from time to time.

First, pain occurs during periods of physical activity or immediately after it. The pain may be accompanied by numbness in the leg and a crunching sound when moving. You should pay special attention to the crunching sound, as it indicates the onset of a pathological process.

The intensity of pain in the first stage is moderate, the range of motion is preserved in full. The pain can be aching, pulling, sometimes sudden and short-term, involving the entire limb.

With the onset of the second stage, the situation changes for the worse, and pain worries the patient almost constantly. The leg in the hip area hurts even during rest and at night. In addition, freedom of movement is impaired: it is difficult to turn the leg, and the process of walking causes significant inconvenience. Crunching in the joint occurs more and more often.

At the third stage, the transformation of cartilaginous tissue into bone tissue is completed, which is expressed by a significant, sometimes complete restriction of mobility. Due to pain and difficulty moving, the leg muscles weaken and atrophy, and a visual shortening of the affected limb is observed.

The third and final stage of osteochondrosis of the hip joint can only be treated surgically, since it is no longer possible to restore the joint.

Diagnostics

As a rule, patients consult a doctor only in the later stages, when the pain prevents them from moving normally and does not leave them alone even at night. Diagnosis of osteochondrosis begins with an examination and is confirmed by clinical studies.

X-rays are quite informative; depending on the stage, they show:

• Stage 1 – narrowing of the joint space, the presence of single small osteophytes;
• Stage 2 – the dimensions of the joint space are much smaller than normal, the head of the femur is deformed, multiple osteophytes have a characteristic fringe appearance (beak-shaped bone growths);
• Stage 3 – cartilage tissue is destroyed and replaced by bone structure. Sometimes isolated elements of remaining cartilage are observed between the connected bones. Inflammation is severe, manifested by swelling, redness and pain. When you turn your leg to the side, the pain intensifies sharply, and at rest it is aching in nature. Due to the difference in the length of the limbs, the gait changes greatly, independent movement is difficult.

Treatment

Treatment of osteochondrosis of the hip joint is complex and includes the following areas:

• relief of pain and inflammation;
• restoration and strengthening of cartilage tissue;
• normalization of blood circulation in the damaged area;
• reducing the load on the hip joint, gentle work schedule;
• restoration of motor activity;
• strengthening the ligamentous apparatus and muscles located next to the joint.

Drug therapy begins with pain relief and inflammation relief with analgesics or nonsteroidal anti-inflammatory drugs. In case of severe disease and severe pain, injection blockades with Novocaine are performed, as well as intra-articular injections with Kenalog, Dexazone.

To activate the restoration processes in cartilage, chondroprotectors are prescribed - Teraflex, Aflutop, Osteoartisi. Muscle relaxants are used to relax muscles: for example, Sirdalud, Mydocalm, Cyclobenzaprine.

Since pain causes muscle spasms and constriction of blood vessels, vasodilator drugs are used - Trental, Xanthinol, Pentoxifylline, etc.

Patients who suffer from osteochondrosis often experience depression from constant pain. Therefore, the doctor may prescribe sedatives or antidepressants. In addition to the main therapy are vitamin complexes, which are taken in a monthly course.

B vitamins can be prescribed in the form of tablets or injections. The most popular remedies are Neuromultivit, Milgamma, Neurobion.

After acute symptoms are relieved, the patient is referred for physiotherapy; for osteochondrosis, the following techniques are used:

• magnetic and laser therapy;
• electro- and phonophoresis;
• heat therapy.

An effective method in the fight against osteochondrosis is therapeutic exercises, which help restore mobility in the joint, normalize blood circulation and strengthen the muscular-ligamentous apparatus. Exercises are selected individually for each patient by a physical therapy doctor.

It should be taken into account that during treatment it is necessary to follow some rules - it is strictly not recommended to lift weights, squat, jump or walk too fast. To relieve stress on the joint when walking, it is better to use a cane.

Operation

Surgical intervention is necessary only in advanced cases, when it is no longer possible to cope with the disease using conservative methods. In this case, endoprosthetics is performed - replacing a joint with an artificial prosthesis.

The hip joint endoprosthesis can be ceramic, polymer or metal. These are inert materials that do not react with surrounding tissues and take root well. The prosthesis is an analogue of a natural joint and consists of the acetabulum, the head of the femur, a polyethylene liner that simulates cartilage, and a rod that is fixed in the femur.

Joint replacement surgery lasts about 3 hours, followed by a rehabilitation period. If successful, negative symptoms are eliminated and motor ability is normalized.

Postoperative complications are possible if the prosthesis is incorrectly selected or if the rehabilitation period is shortened.

It is necessary to treat osteochondrosis of the hip joint as early as possible, when its manifestations are limited only to discomfort and minor pain. If you consult a doctor in a timely manner and make proper lifestyle adjustments, you have every chance of living a long and fulfilling life.

Hip pain is a problem that occurs in completely different groups of the population. Not only older people, as is commonly believed, face such complications. Age is just one of the possible factors that can affect the deterioration of the joint. Yes, over the years the number of people suffering from this disease increases, and wear and tear of the joint over time is the most common reason for visiting a doctor.

An important factor is the condition of the patient’s muscles (especially in the hip area), ligaments, as well as the amount of excess weight. People with poor physical shape, as well as a lot of extra pounds, are much more likely to develop abnormalities. In youth, women are more likely to experience joint pain, but over time, the preponderance goes to the male half. Diseases in children are not excluded: both congenital pathologies and those that developed after birth are not uncommon - the consequences of dislocations, birth and other injuries.

Why does joint pain occur?

The pelvic bone and lower back hurt for various reasons. Pain can accumulate on the right or left, and also spread throughout the entire area and beyond. They can be roughly divided into four main categories:

1. Pathological changes and processes occurring directly in the joint itself, as well as in the muscles and ligaments located near it. This group includes any injuries, inflammations, degenerative changes, etc.
2. A violation of the anatomical structure of the joint, when the head of the femur is displaced from its normal position in the acetabulum. This can happen with all kinds of dislocations and subluxations (congenital or traumatic), with contractures of the spinal and femoral muscles, and chronic disorders of the physiological motor pattern.
3. Disturbances occurring in other body systems can also cause pain in the hip area and joint. These are, for example, inflammation of the pubic or sacroiliac joint, muscle disorders in the buttocks, abnormalities in neurology (compression and pinched nerves, radiculitis, neuritis). Often the cause of pain is completely unrelated diseases, such as influenza, tonsillitis or pyelonephritis, complications in the abdominal cavity, lumbar region, or genitals.
4. Psychological or stress pain. They appear due to severe anxiety and in the overwhelming majority are not a sign of the onset of the disease; they pass quickly.

The first and second categories are based on changes occurring directly in the organ itself, and the third and fourth talk about painful sensations not associated with damage to the hip bone.

The table below shows the most common diseases:

Pathology	Description	Associated symptoms
Arthritis	The general name for joint diseases, independent or secondary (for example, as a manifestation of rheumatism), due to infection, metabolic disorders, injuries, etc.	Limited inward movement of the legs, swelling in the hip joint, changes in its appearance
	A degenerative disorder that affects all age groups (usually after 40 years), reducing the elasticity of cartilage	Inflammation, surface deformation, bone spurs, lameness due to decreased muscle activity
Juvenile epiphysiolysis	Displacement or separation of the epiphysis, hidden or acute, resulting from an imbalance of growth hormones and sex hormones. A rather rare disease, most often typical for girls 11-12 years old, boys 13-14 years old	Displacement of the hip (Hofmeister's symptom), gait disturbance (claudication), stretch marks (striae), decreased mobility in the hip joint inward, increased outward
	Possible development due to injury or in the absence of obvious external factors; a common disease among athletes, especially female runners. Inflammation of the joint capsule	Pain in the area of ​​adjacent muscles, a slight increase in temperature, and decreased mobility may occur.
Tendinitis	Dystrophy, inflammation of the tendon, which can spread to the muscles. Most often it appears at the site of attachment of the tendon to the bone. Reasons: non-physiological loads, age-related changes in the hip joint	Decreased joint mobility, redness and increased temperature over the affected area, increased pain when pressing, sometimes the appearance of a crunching sound
Legg-Calvé-Perthes disease	Disruption of the normal blood supply to the head of the femur, nutrition of the cartilage. Most often occurs in boys 3-14 years old	Change in gait, limping

As it becomes clear from the table, many diseases are similar in symptoms. And it is possible that the pain only radiates into the joint from the surrounding tissues, and the true cause of the pathology is located in another area or system of the body. But there are also cases when pain in the hip joint is projected onto the knee joint. Therefore, you should take the diagnosis as seriously as possible: each ailment requires special, specific treatment, exercise regimen, and rehabilitation.

What to do before visiting the doctor

The basis for making a correct diagnosis is most often high-tech methods of studying joint functions (ultrasound, x-ray, etc.). Self-diagnosis is a very unreliable method that can lead to the development of more serious complications, including disability. Despite this, it is possible to hypothesize the cause of pain and other symptoms and evaluate the functioning of the limb and the affected area at home.

Pathology	Feel
Arthritis	Pain when leaning on a limb, when trying to rise on tiptoes
Coxarthrosis (osteoarthrosis of the hip joint)	Stiffness, starting and morning pain, initially disappearing after rest, and subsequently without relief
Juvenile epiphysiolysis	At first it is asymptomatic, then pain appears in the knee and hip joints
Bursitis (trochanteric, iliopectineal, sciatic)	Pain in the groin, thigh, buttocks, worsening when putting weight on the leg, when lying on the injured side
Tendinitis	At first - a dull pain after long physical work or training, later it becomes constant
Legg-Calvé-Perthes disease	Most often, the pain begins in the hip joint, then in the knee

To determine possible violations, carry out several tests, simple manipulations (do not overdo it!), and the result obtained can be compared with the table above. Perhaps this will help the specialist make a diagnosis, but he will also conduct all the necessary tests on site.

First, you should calm down and relax in order to eliminate the influence of psychological factors on the reliability of the test. Next, we monitor the body’s reaction to various actions, examining the functionality in the joint of the hip region and the sacroiliac joint. Keep track of which side there is discomfort (discomfort can appear only on the right or left, or can spread over a fairly large area).

1. If the pathology is a fracture or dislocation, then the mobility of the legs will be minimal, the pain will be constant and acute, intensifying even with minimal strain on the limb.
2. Assess your sensations immediately after waking up: are they unpleasant when you are in a relaxed horizontal position or do they only manifest themselves when you try to get up? Where is the main painful area (lower back, hip, foot)?
3. Lie on one side and the other. Do both hips feel the same, is there any pain?
4. Sit down and get up from your chair several times. How do muscles, joints, and lower back react to tension at the beginning of the load, at the end, where are the problems?
5. Check the mobility of each joint in the limb: describe a circle with your knee, foot, lift it forward, backward, to the side. Which position is the most unpleasant, how much can you perform each movement?
6. Step on your full foot, stand on each leg and try to rise on your tiptoes.
7. Do squats and bends in different directions. Is there any stiffness?
8. Ask your loved ones to carefully examine your gait: is there any limping, asymmetry when walking, or leaning to one side?
9. Consistently apply pressure with your hands over the entire surface - from the pelvic area to the toes, explore the spine. Pay attention to where there is discomfort and where there are noticeable deformations.
10. Look carefully and meticulously at yourself in the mirror. Check whether symmetry is maintained on the right and left, and whether there are any abnormal irregularities, depressions, bumps, or redness anywhere. Assess the correct position of the legs (if there is any inversion).

At each check, pay attention to any clicks, creaks and crunches that occur during movement, both in the hip area and in all parts of the legs.

Where to go with a problem

The results of your self-examination, as well as additional tests, can be reliably assessed by your doctor. Specialists to contact:

• traumatologist;
• rheumatologist;
• neurologist;
• physiotherapist.

You will be prescribed studies (ultrasound, X-ray, MRI), which will allow you to accurately judge the nature of the disease, its location, the degree of complication and damage to the hip tissue, and also prescribe the only correct treatment option.

Deviations from the norm in the hip system can lead to completely different consequences. In order not to bring your body to a critical condition, even to the point of disability, do not delay contacting a specialist, and even if there is a slight suspicion of a fracture, urgently call a doctor at home. Timely treatment will help control the disease, alleviate symptoms and consequences.

Take care of yourself at any age and be healthy!

Sources:

1. Berglezov M. A., Ugnivenko V. I., Nadgeriev V. M. Prevention and treatment of dysplastic coxarthrosis in an outpatient setting. Disease and damage to the hip joint. – materials of the scientific and practical conference, Ryazan, 2000
2. Pain in the hip joint. Sereda A.P.
3. Pain in the hip joint. Nasedkina A.K.
4. Orthopedic diagnostics. Marx V. O. - “Science and Technology”, 2002.
5. Human anatomy: textbook in 3 volumes. Sapin M. R., Bilich G. L. - M.: GEOTAR-Media, 2007. - T.1. - 608 p.
6. Traumatology and orthopedics. Guide for doctors. Shaposhnikov Yu. G. (ed.) t3, 1997

Aseptic necrosis of the femoral head

A disease called aseptic necrosis of the femoral head is quite common. Women get it several times less often than men. It is typical that 2/3 of patients are young people 20-45 years old. This is a rapidly progressing disease.

In the absence of proper treatment, it can lead to dysfunction of the joint and, ultimately, loss of ability to work.

This is why it is important not to miss the first symptoms of the disease.

The main causes of the disease

The femoral head is a closed compartment that is sensitive to circulatory disturbances that alter the architecture of the bone.

The head is supplied with blood through three small arteries. When one of them stops (disturbs) the blood supply, necrosis (ischemia, necrosis) occurs in the area of ​​the head that the damaged artery supplied.

The essence of asthenic necrosis is a violation of microcirculation and further necrosis of the bone tissue zone in the head of the femur. As a result, the integrity of the cartilage covering this area is disrupted, and secondary deforming arthrosis develops.

Vascular causes

Common reasons for the artery to stop supplying blood to the head of the femur:

• compression or twisting of an artery due to injury,
• its blockage with a small blood clot,
• venous stasis,
• prolonged vasospasm,
• increased blood viscosity,
• impaired venous outflow.

Vascular disorders increase intraosseous pressure, leading to mechanical destruction of bone tissue.

About mechanical theory

The vascular theory of causes is complemented by the “mechanical” theory. According to it, the head of the femur experiences “overwork.”

Impulses about this are sent to the cerebral cortex.

Return signals lead to vasospasm or blood stagnation, disruption of metabolic processes, and accumulation of decay substances in the bones.

As a result, the physicochemical and structural properties of the bone change, which is gradually destroyed with difficulty in local blood circulation.

Metabolic disorders and pathological conditions

Among them, the leading causes of the disease are:

• prolonged use of alcoholic beverages;
• long-term use of corticosteroids in large doses; patients with arthritis or bronchial asthma take corticosteroid hormones (metipred, prednisolone, etc.) for a long time;
• chronic pancreatitis;
• large doses of radiation exposure;
• decompression sickness;
• osteomyelitis;
• sickle cell anemia and other diseases,
• injuries (hip bruise, hip dislocation, hip fracture, etc.).

One of the causes of the disease is a congenital defect in the form of hip dislocation (hip dysplasia).

Symptoms and diagnosis of the disease

Stages of aseptic necrosis of the head of the hip joint with distinctive symptoms:

1. Initial. Pain serves as the starting clinical manifestation. It grows to a maximum and becomes unbearable within the first two or three days. Usually appears in the groin, less often in the thigh, knee joint, and lower back. The joint retains its full mobility.
2. The second is an impression fracture. The patient has constant severe pain in the joint even at rest. Over a period of several days to six months, vascular disorders develop. Atrophy of the thigh muscles is possible. The sore leg seems to decrease in volume. Movements are limited. There is a slight limp in the gait.
3. The third is secondary arthrosis. Over 6-8 months, the bone beams are destroyed and the head of the femur is deformed. There is severe pain in the joint. Movements are limited in three directions. When walking, there is initial pain, moderate lameness, and a desire for support.
4. Fourth. When the disease lasts more than 8 months, complete destruction of the head occurs. Constant pain in the joints of the hip and knee, in the lower back. Movements are severely limited. Atrophy of the muscles of the buttocks and thighs is pronounced. The affected leg becomes shorter; in the more severe version, it lengthens.

Diagnostic methods

Widely used methods for diagnosing the disease include:

1. MRI. The early stage is detected by magnetic resonance or computed tomography. This diagnostic method almost 100% detects the disease when x-rays “do not see” it. Therefore, during the first weeks of the disease, diagnosis using MRI is a priority.
2. Radiography. Aseptic necrosis becomes noticeable on an x-ray only at stages 2-3 of the disease. When the disease has been “experienced” for more than a year, its signs appear very clearly in the photographs. At this stage, a tomogram is not needed.
3. Radioisotope scanning. This method shows unequal absorption of the radioactive drug by pathological and normal bone tissue. The administered dose of the drug serves as a “tag” for the abnormal zone in the bone. The result is a two-dimensional image showing the affected areas of the bone.

Treatment and pain relief using conservative methods

Drug therapy

The main groups of medications used to treat the disease include:

• Anti-inflammatory non-steroidal drugs, for example, diclofenac, indomethacin, piroxicam, butadione, etc. They help reduce pain in the hip and groin. This group of medications does not cure the disease. But due to the analgesic effect, reflex muscle spasm during pain is prevented. These medications are especially effective in the first six months of the disease.
• Vasodilator drugs, for example, Trental, Teonicor. They eliminate stagnation in blood circulation. As a result, arterial blood flow is activated and spasms of small vessels are relieved. Vascular night pain in the affected joint is reduced. Effective in the first 6-8 months of the disease.
• Bone tissue restorers. Products containing vitamin D (calcium D3 forte, oxidevit, natecal D3, etc.) help stimulate the recovery process. These drugs promote the accumulation of calcium in the head of the affected femoral bone.
• Calcitonins effectively stimulate bone formation and eliminate bone pain. These include miacalcin, sibacalcin, alostin, etc.
• Chondroprotectors (chondroitin sulfate and glucosamine) provide nutrition to cartilage tissue and restore the structure of damaged cartilage. The treatment is effective over a period of 8 months.

Therapeutic gymnastics and massage

One of the most important methods of treating necrosis of the femoral head is therapeutic exercises. Without it, it is impossible to overcome the progressive deterioration of blood circulation in the area of ​​the femoral head and the increasing atrophy of the thigh muscles.

It is necessary to choose exercises to strengthen the muscles and ligaments of the sore leg. Moreover, there should be no pressure on the head of the femoral bone without active flexion-extension of the legs.

An example of a static exercise is a small straight leg raise in a supine position. The leg is supported by weight. Fatigue will appear, although the joints do not work. The set of exercises should be carefully considered with your doctor.

Therapeutic massage is used as an additional treatment method. But if you do it competently, without harsh pressure, it will bring real benefits. By massaging the thigh muscles and back, blood circulation improves.

Orthopedic rules

In their opinion, this threatens:

• progressive muscle hypertrophy,
• formation of persistent pain syndrome,
• violation of motor stereotypes.

To ease the course and shorten the duration of the disease, you need:

• walking up to 20 min. at an average pace,
• walking up the steps,
• swimming,
• exercises on an exercise bike,
• using a cane in the first weeks and during long walks,
• fight against excess body weight.

It is necessary to exclude inertial loads on the joint in the form of lifting heavy objects, jumping, and running.

Surgical treatment of the disease

Surgical intervention is resorted to when conservative measures are unsuccessful.

Femoral head decompression

The surgical method of decompression consists of drilling a canal into the area of ​​the femoral head with no blood flow. The drill passes along the greater trochanter and the neck of the femur.

Goals of decompression:

• increased blood supply to this area due to the growth of new vessels in the formed channel (puncture),
• decrease in intraosseous pressure in the femoral head.

By reducing blood pressure, pain is reduced in 70% of patients.

Fibula autograft transplantation

Unlike decompression, a fragment of the fibula located on a vascular pedicle is transplanted into the drilled cavity. Such a transplant from one’s own body improves blood flow and strengthens the femoral neck.

Hip replacement

It consists of completely replacing the damaged hip joint with an artificial one. A titanium pin (or zirconium) with an artificial head at the edge of the joint is inserted into the formed cavity of the femur bone and fixed.

At the same time, the second articulating part of the joint is operated on, inserting a concave bed to rotate the new head in it. Correctly performed surgery eliminates pain and restores joint mobility.

In another part of the patients, the condition stabilizes, which does not lead them to surgical measures.

Video: What systemic diseases can provoke the development of GBC necrosis

Juvenile osteochondrosis is a disease in which degenerative phenomena are observed in the intervertebral discs of adolescents. Boys aged 11 to 18 years are most often affected. Many people think of it as elderly people, but in fact this disease also occurs in children during periods of rapid growth. Scientists have not fully elucidated the causes of damage to cartilage tissue and changes in the discs between the vertebrae, but most believe that it is all due to a sharp jump in skeletal development.

In the article we will look at how to recognize juvenile osteochondrosis at an early stage by symptoms, how to identify it and how to treat it. We also advise parents to take special care when their child is growing up, since it is best to prevent a disease than to treat it.

Factors predisposing to the disease

Juvenile has several identified factors of occurrence. Degeneration of the vertebral body can be of a hereditary nature, in which an anomaly in the formation of intervertebral discs is detected. The spine is often curved due to the inability of the muscle corset to hold the back skeleton in the correct position. This indicates that the child is not physically developed enough, has incorrect posture, spends a long time at the computer or desk, carries a heavy briefcase in his hand or a bag on one shoulder, and does not play sports.

Deformation of the discs between the vertebrae can also be associated with excessive physical exertion; this is often associated with poor nutrition and, as a consequence, overweight of the young man. The pathological process can also begin due to injury.

It is very difficult for parents to recognize the onset of juvenile osteochondrosis, since often at first little attention is paid to the child’s complaints of pain in the back or lower back. Only with the appearance of kyphosis or other curvature of the spine do adults take their child to the doctor. Let us carefully consider the symptoms of the disease, by what signs the disease can be recognized in order to begin treatment on time.

Symptoms

Juvenile osteochondrosis can occur in any part of the spine. In this case, the symptoms will vary slightly. Let's consider what signs can be used to determine degeneration of the intervertebral discs of the cervical spine:

• Severe headaches turning into migraines.
• Dizziness and semi-fainting.
• The listed symptoms are accompanied by nausea and even vomiting.

Disease of the thoracic spine causes:

• Pain in the chest, which is often mistaken for pain in the heart or lungs.
• Difficulty breathing.

Youthful osteochondrosis of the lumbar spine is accompanied by lumbodynia, that is, sharp pain in the lower back that a person experiences when lifting weights, coughing and even sneezing. There is also cervicalgia, that is, pain radiating to the neck.

Discomfort is experienced more often after physical activity. You need to pay attention to the child’s complaints and not ignore the presence of the first symptoms. Parents often associate painful sensations with other diseases and self-medicate, which in this case can lead to pathological processes in the cartilage tissue and curvature of the spine - scoliosis or kyphosis.

Development of the disease

Spinal disease occurs in several stages, each of which has its own characteristics.

1. Hidden stage. The child does not particularly complain about his health; his back may ache after lifting heavy objects or physical stress. A slight stoop is visually visible. You can check for the presence of pathology using a simple method - ask the young man to lean forward and touch his feet with his palms. If a child cannot do this, this is the first sign of osteochondrosis in adolescence.
2. Early stage. It is characterized by an even greater curvature of the spine, while the nerve endings are pinched, which causes already noticeable pain in the lumbar region and between the shoulder blades, which is periodic. Such symptoms can be noticed between the ages of 15 and 20 years.
3. If treatment is not started in time, then at a later stage the appearance of intervertebral hernias is observed, calcium deposits appear in the ligaments, and the cartilaginous elements of the joints are affected. Visually, in most cases you can see the formation of a hump on the back, and occasionally scoliosis.

Diagnosis of the disease

If early signs appear, you should immediately consult a specialist. First of all, the doctor conducts a survey of the patient to collect information for anamnesis. The following questions are clarified:

• Do close relatives have similar problems?
• Has the patient had any viral or bacterial infections?
• Were there any injuries or bruises to the spine?
• How does the child eat?
• What are his physical activities?

The doctor then performs a visual examination of the back and chest. At the second stage of the examination, the following diagnostics are used:

• Radiography. This makes it possible to identify areas of damage to discs and vertebrae, the degree of curvature of the spine, in contrast to the norm. If the x-ray does not clearly show the causes of back pain, the doctor may refer you for additional examinations.
• MRI or electroneuromyography.
• CT scan.

To detect the presence of an inflammatory process, you will have to undergo general blood and urine tests.

Juvenile osteochondrosis of the femoral head

Another unpleasant pathology, which is caused by a violation of the blood supply, causing bone tissue to die. Osteonecrosis affects the head of the femur, causing a child aged 2 to 15 years to experience pain in the knee and hip joint when walking, which can result in complete immobilization of the limb. Often leg pain and lameness occur after physical exertion; the child cannot explain the cause of the pain. The diagnosis can be confirmed only after a radioisotope scan of the femur.

How to treat the disease?

At the initial stage, the disease is treated with conservative methods - massages, physiotherapy, exercise therapy or manual therapy, and may be prescribed wearing a special corset.

In severe and advanced cases, surgery may be necessary. The need for surgery is determined by the attending physician after consultation with a surgeon in the case when there is sufficiently severe pain that does not disappear even with the help of medications, if the curvature of the spine is more than 75 degrees, when the disease impairs blood circulation and heart problems arise.

When treating osteochondrosis of the femoral head, the joints can be fixed with splints to avoid compression fracture of the head or its deformation.

Prevention

In order to prevent such a disease, it is necessary to pay great attention to the proper nutrition of a teenager; it should contain useful substances, minerals and other trace elements. In autumn and spring, it is advisable to support the body with additional vitamins.

Avoid excess weight, it puts a lot of pressure on the spine, gradually deforming it.

Let the child spend more time in active movement, take a break between lessons, send the student to fitness or any sports section. Maintain proper posture while sitting at a desk and consult a doctor promptly at the first signs of illness or back pain.

Code of juvenile osteochondrosis according to ICD-10 - M42.0

The World Health Organization has come up with a universal classification of all diseases, where each has its own serial number and code, consisting of several numbers and letters.

It is called ICD-10, which stands for International Classification of Diseases. #10 indicates the 10th revision.

Knowing the disease code, a doctor in any country will understand what exactly you are sick with. For example, the ICD code for juvenile osteochondrosis is M42.0, where M42 means osteochondrosis, and 0 means the patient’s age is from 11 to 20 years.

Now you know that if the doctor put code M42.0 on the medical card, it means that your child has been diagnosed with osteochondrosis and urgently needs treatment. After all, it threatens not only external deformity, but internal organs are displaced, breathing and blood circulation are disrupted, and heart problems appear.

In the article, we examined in detail the causes of occurrence, the main symptoms, treatment methods and preventive actions for juvenile osteochondrosis; in the ICD, this pathology has code M42.0. Take care of your children and consult a doctor in time for help.

Osteochondrosis is a degenerative-dystrophic process that affects the joints. This process refers to changes in bone and cartilage tissue that lead to dysfunction of the joint. These include microcirculation disorders, a decrease in the amount of fluid in the cartilage, changes in its biochemical composition, and deformation leading to a deterioration in shock-absorbing properties and movements in the joint.

Terminology problems

The word “osteochondrosis” contains the bases of the Greek words “bone” and “cartilage”, as well as the suffix “-oz”, denoting a pathological process. The term “osteochondrosis” is most often used in relation to spinal problems.

In relation to dystrophic conditions of the joints, the term “osteoarthrosis” is often used (“arthrosis” - joint from Greek). Therefore, the name “osteochondrosis of the hip joint” is acceptable in meaning, but is much less common than “osteoarthrosis of the hip joint.” In most cases, these two terms are used interchangeably.

Reasons for the development of the disease

Osteochondrosis of the hip joint, or, as they still say not entirely correctly, osteochondrosis of the hip, is common. The reasons for its development are not fully understood. Each of the theories that has been put forward to explain the causes of dystrophic changes in the femoral neck cannot give a complete picture, but describes a separate aspect.

It is believed that mechanical overload, endocrine and immunological factors play a role in the development of the disease.

Clinical picture

The main symptoms of the disease are pain, impaired hip mobility, and muscle atrophy. Depending on the severity of these symptoms, three degrees of degenerative-dystrophic process in the hip joint are distinguished.

In grade 1, pain occurs only after physical activity and goes away with rest. There is no restriction of movement in the hip.

The 2nd degree is placed when the pain begins to be felt even at rest. In addition to the joint itself, pain can affect the groin and femoral area. With osteochondrosis of the 2nd degree, there is a restriction in the mobility of the leg, and it is already difficult for a person to rotate the hip.

3rd degree – phase of advanced manifestations of the disease. The pain is constant, the ability to move is seriously impaired. When walking, a person must lean on something. Muscle atrophy begins. Due to muscle weakness, the pelvic bone tilts towards the affected side, which leads to the appearance of the “short leg” symptom.

The main means of diagnosing osteochondrosis of the hip joint are a medical examination and x-ray examination. The patient's characteristic complaints and appearance (changes in posture, gait, limited hip mobility, muscle atrophy, other symptoms) allow a presumptive diagnosis to be made.

The diagnosis is clarified using x-ray methods.

The 1st degree of the disease is characterized by the appearance of minor bone growths inside the joint capsule. The 2nd degree is characterized by an increase in bone growths, the contour of the femoral head becomes uneven, and the joint space moderately narrows. With the 3rd degree of growth, the bones inside the joint capsule are sharply expressed, the joint space is significantly narrowed.

How is the treatment carried out?

Conservative (non-surgical) treatment is possible for osteochondrosis of the hip joint of the 1st and 2nd degree. The 3rd degree of severity of pathological changes requires surgical intervention.

For grades 1 and 2, the following methods are used:

• prescription of non-steroidal anti-inflammatory drugs - diclofenac, celecoxib and other drugs;
• the use of drugs that reduce muscle spasms (tolperisone, tizanidine);
• treatment with drugs that restore the structure of cartilage (chondroprotectors) - chondroitin sulfate, glucosamine;
• intra-articular injections of steroids - powerful anti-inflammatory drugs of a hormonal nature;
• Massage and physical therapy play a great role in the treatment of this disease.

Osteochondrosis of the hip joint is a potentially disabling disease. Therefore, even at the first episodes of pain, an examination by a specialist is mandatory. Timely treatment can protect against further progression of the symptoms of the disease.