Brief overview
- Treatment: Symptomatic, conservative with painkillers, movement therapies and others; surgical joint preservation or in some cases joint prosthesis.
- Symptoms:Pain in the hip, especially with weight bearing, increasing immobility of the hip joint, bending is difficult; limping to rest is typical
- Causes and risk factors: Age-related wear and tear, overuse and improper use due to sports or occupation; unexplained factors; secondary osteoarthritis due to previous injury or disease
- Diagnosis: Medical history, physical examination, X-ray examination, magnetic resonance imaging and computer tomography
- Prognosis: Osteoarthritis is not curable; conservative therapy and surgery alleviate pain and maintain joint mobility.
- Prevention: Avoid over- and incorrect stress in sports and at work; use work techniques that are easy on the joints; heal and cure injuries and diseases of the joints and extremities properly.
What is coxarthrosis?
In coxarthrosis (coxarthrosis, hip osteoarthritis), the hip joint wears out. It is made up of two parts:
- Hip joint socket (formed by the pelvic bone).
- @ hip joint head (formed by the femur bone)
Coxarthrosis is a common condition whose risk increases with age. However, young people with certain pre-existing conditions may also develop coxarthrosis.
How can coxarthrosis be treated?
Doctors recommend some general measures for coxarthrosis, just as for other forms of arthrosis. These include taking pressure off the affected joint. Doctors therefore advise overweight patients to lose weight. Then less body weight weighs on the hip joint. Walking aids such as canes or crutches support the hip joint.
It is also important to move the hip joint regularly without putting too much strain on it. Sports such as swimming are particularly suitable for this. Physiotherapy, physical measures (such as ultrasound, electrotherapy or hydrotherapy, heat and cold applications) and medication also help to reduce the symptoms of coxarthrosis.
Conflicting or insufficient scientific data exist on alternative treatment approaches (such as herbal remedies) and injections into the joint (with “cortisone” or hyaluronic acid), among others. Regardless, they may help in individual cases, often as a supplement to conventional therapy. It is best to consult your doctor for advice.
You can read more about general and conservative measures for coxarthrosis and other forms of osteoarthritis in the article Osteoarthritis.
Sometimes the symptoms of coxarthrosis cannot be improved with the above measures. Then it may make sense to insert an artificial hip joint. In this case, the doctor replaces the femoral head, the acetabulum or both bone parts with a prosthesis.
There are different hip prostheses, which are constructed, shaped and fastened differently. Which prosthesis is most suitable in an individual case depends on various factors. For example, the age of the patient, the bone structure, the stage of the disease and any allergies to certain prosthesis materials all play a role.
Anchorage
In younger people, the doctor prefers to use cementless prostheses. In older patients, however, he often cements the artificial hip joint.
Cementless prostheses have the advantage that they are easier to replace. This is particularly important for younger people. After all, an artificial hip joint does not last indefinitely and must then be replaced.
In order to anchor the prosthesis, a strong bone structure is also necessary, which is usually the case with younger people. Older patients, on the other hand, often suffer from osteoporosis. For them, a prosthesis can therefore often only be fixed with cement.
Materials
Hip prostheses are made of different materials. This makes them durable and resilient in different ways.
A small sliding disc between the femoral head and the acetabulum is usually made of polyethylene plastic or ceramic. The other prosthesis parts are made of different metals (such as titanium, chromium, cobalt) or ceramics.
The combination of materials is called a wear couple. The sliding metal-polyethylene pairing is very common. In this case, the metal joint head slides in the polyethylene-lined cup. Polyethylene is very soft and wears out quickly if the patient moves a lot.
Alternatively, it is possible for the patient to choose a metal-on-metal bearing couple. The disadvantage of this is that metal gets into the body more easily. It is therefore not suitable for patients with metal allergies. In addition, clicking noises are possible when the patient moves.
A ceramic glide pair does not cause metal allergies and is rarely worn out. However, it breaks more quickly. It is therefore only useful in some cases.
Aftercare
As a rule, hip surgery is followed by rehabilitation. There, the patient specifically trains his muscles. In addition, he learns how to load and move the hip joint correctly This depends, among other things, on the selected operation.
Complications
The installation of a hip prosthesis may entail complications:
- Immediately after the operation, a blood clot may easily form. In some cases, this clot blocks a vessel (thrombosis, embolism). However, this can usually be prevented with appropriate blood-thinning medication.
- In some coxarthrosis patients, a nerve is injured during the operation. This changes the sensation in the leg in some cases.
- Often, the legs are no longer the same length after surgery. Therefore, many patients with osteoarthritis of the hip have to wear shoes with balancing soles after surgery.
- In some operated coxarthrosis patients, the hip joint ossifies. It can then only be moved to a limited extent.
- In some patients, the artificial joint replacement loosens and must be replaced.
- In some cases, the femoral head slips out of the socket. Doctors refer to this as dislocation. It is also possible for the bone around the prosthesis to break (periprosthetic fracture).
- So hip surgery for coxarthrosis carries some risks and requires good education and advice from the doctor.
Joint-preserving operations
During a joint endoscopy (arthroscopy), for example, the doctor removes detached joint particles. In this way, other joint structures can also be examined and treated if necessary. Joint-preserving interventions are usually no longer suitable for advanced coxarthrosis.
Symptoms
People affected by coxarthrosis often have pain in the hip and are more immobile. They often notice this when they tie their shoes or put on stockings.
So-called unloading limping or sparing limping is particularly typical of osteoarthritis in the hip joint. Patients limp in order to put less strain on the damaged joint. In addition, they often turn the affected hip joint outward so that the tip of the foot also points outward. Many sufferers also experience pain when pressing on their groin or on the outer ankle of the thigh.
For more about possible symptoms of coxarthrosis (and other forms of osteoarthritis), see the article Osteoarthritis Symptoms.
Causes and risk factors
Various diseases possibly harm the hip and promote coxarthrosis. These include fractures of the hip joint bones, joint inflammation and metabolic diseases.
In many cases, a specific cause cannot be determined, but age-related wear and tear as well as overloading and incorrect loading of the joint are considered to be the main causes. Coxarthrosis is considered the most common form of joint wear in humans.
Examinations and diagnosis
If coxarthrosis is suspected, the physician first asks about the patient’s medical history. To do this, he talks in detail with the patient and asks, for example, the following questions:
- How many meters do you walk without pain?
- Is it possible for you to bend down to the floor?
- Do you have problems climbing stairs?
- Do you have difficulty putting on stockings or shoes?
- Do you have pain when sitting or lying down?
- Do you have or have you had any pre-existing conditions or injuries in the hip area?
This is followed by a physical examination. The doctor examines the patient’s gait pattern and checks the mobility in the hip joint. Imaging tests such as X-rays show signs of wear and tear in the hip joint in cases of coxarthrosis.
You can read more about how coxarthrosis or other forms of osteoarthritis are diagnosed in the article Osteoarthritis.
Prognosis and course of the disease
Like all osteoarthritis, coxarthrosis is usually not curable. However, in many cases, conservative therapy and especially exercise can relieve the pain and keep the hip mobile.
Under certain circumstances and depending on the activity, coxarthrosis affects the ability to work. Whether and how coxarthrosis affects a possible occupational disability or even severe disability depends on the individual case, the activity and the severity of the symptoms. Depending on the occupational activity, recognition as an occupational disease is also possible if the arthrosis can be specifically traced back to certain occupational stresses on the joints, for example.
The first contact person, also for the determination of an inability to work, is usually the family doctor or the orthopedist.
After an operation, a period of rest and rehabilitation is often necessary, which can last several weeks or even months, depending on the case.
Prevention
In general, it is helpful to avoid overloading and incorrect loading or one-sided loading of the joints in order to prevent arthrosis. For example, certain carrying or working techniques as well as technical aids that relieve the joints are useful.
Regular, well-balanced exercise, especially sports, also has many preventive effects. Swimming in particular is a suitable sport even for those already affected by coxarthrosis.
In order to prevent secondary coxarthrosis as a result of an injury or illness, it is important to heal and cure it properly. Rehab measures may be helpful in this regard.
