Coxarthrosis (osteoarthritis of the hip or deforming hip arthrosis) is a degenerative-dystrophic disease characterized by the destruction of the cartilage covering the femoral head and the surface of the acetabulum.

ANATOMY

The hip joint is one of the large spherical joints of our body. It is the main supporting connection and carries a significant load during walking, running, and carrying weight.

The hip socket is formed by the pelvic bone and is called the acetabulum (acetabular cavity). It contains the femoral head, which is connected to the femur. Slightly below the femoral neck, there is a bony prominence called the greater trochanter. The muscles of the gluteal region attach to this femoral area. The hip joint capsule is reinforced with strong ligaments that connect it to the pelvis at one end and to the femur at the other.

The hip joint is covered by the gluteal muscles at the back and the anterior thigh muscles at the front. The femoral head located inside the acetabular cavity is covered with articular cartilage. Normal cartilage in the hip joint reaches a thickness of 6 mm. Articular cartilage has a very smooth surface, an off-white color, and a dense, elastic consistency. Due to the presence of articular cartilage, friction between the contacting joint surfaces is significantly reduced. The blood supply to the femoral head is provided by blood vessels. In case of a femoral neck fracture, blood circulation to the head may be disrupted, leading to avascular (aseptic) necrosis of the femoral head. Therefore, a hip fracture may be accompanied by a serious complication called aseptic necrosis. In addition, due to the disruption of local blood circulation, femoral neck fusion (healing) may not occur during fractures.

STAGES OF COXARTHROSIS

Stage I Coxarthrosis – pain affects the patient only after prolonged physical exertion, such as walking or running. Pain is usually localized in the hip joint, and less frequently in the knee and thigh. The movement of the painful leg and joint mobility are not restricted. The pain subsides after rest.

• Stage II Coxarthrosis – the pain intensifies, radiates to the groin area, and causes discomfort not only during exertion but also at rest. Additionally, after walking a long distance, the patient begins to limp. The joint becomes less mobile, and hip abduction is restricted. The abductor and extensor muscles weaken.

Stage III Coxarthrosis – pain is constantly present, even at night. Movements of the affected leg are severely restricted, and the muscles are atrophied. The patient is forced to use a cane when walking. At this stage, the pelvis shifts its position in space; if the affected leg shortens, the torso tilts toward the affected side, which increases the inflammatory load in this position.

 

CAUSES OF COXARTHROSIS

• Genetics: A number of hereditary diseases lead to coxarthrosis. Most often, it is associated with disorders in the connective tissue (ligaments, bones, and joints) or collagen damage.
• Age:
  • 30-35 years – the disease is very rare.
  • 40-45 years – affects 2-3% of the population.
  • 45-65 years – the risk of coxarthrosis increases to 30%.
  • After 65 years – the risk of disease increases to 70%.
• Causes and predisposing factors for the development of coxarthrosis:
  • Congenital joint dysplasia;
  • Congenital subluxation or dislocation of the femoral head;
  • Joint overloading in professional athletes;
  • Infectious joint diseases;
  • Hip injuries;
  • Circulatory disorders in the joint;
  • Spinal alignment disorders;
  • Hormonal imbalances in the body;
  • Rheumatoid arthritis;
  • Avascular necrosis of the femoral head;
  • Sedentary lifestyle.

SYMPTOMS OF COXARTHROSIS

The primary symptom of coxarthrosis is pain during both movement and rest. Pain is usually localized in the joint, knee, groin area, or thigh. The movements of the patient’s legs are restricted. The disease develops slowly. After some time, the thigh muscles atrophy. All of this leads to limping.

HOW IS COXARTHROSIS DIAGNOSED?

The main methods for diagnosing the disease include instrumental diagnostic methods, specifically hip X-rays. The patient’s complaints are analyzed, the joint is examined, and the mobility of the affected joint is assessed. An X-ray of the joints is the primary method for diagnosing coxarthrosis. In most cases, this method allows the doctor to determine not only the degree of damage but also its cause. Bone deformations, changes in joint shape, and bone density increases (osteosclerosis) are clearly visible on X-rays, and the width of the joint space can be measured. The disadvantage of this method is that it is impossible to visualize and evaluate the condition of the joint’s soft tissues.

TREATMENT OF COXARTHROSIS

At our Private EKOL Hospital, we strive to provide individualized, high-quality treatment using the best equipment and technology. Professor Dr. Erol YALNIZ, Professor of Orthopedics and Traumatology, guarantees you accurate diagnosis, patient education, and professional treatment of hip diseases and joint problems. The treatment of patients is performed with modern technologies specially designed for this purpose. In our hospital, coxarthrosis is treated surgically.

Surgical Treatment – ENDOPROSTHESIS

Joint arthroplasty (endoprosthesis) is the reconstruction of damaged joints using mobile artificial joint models composed of metal alloys and synthetic materials.

The main indications for hip replacement are:

• Coxarthrosis of various etiologies;
• Femoral neck and hip fractures;
• Joint damage;
• Rheumatoid hip lesions.

In our clinic, cementless endoprostheses are used; the cup of the endoprosthesis is secured using pelvic bone screws. The stem of the femoral component fits tightly into the specially prepared femoral medullary canal. The surfaces of this type of endoprosthesis that come into contact with bone have a porous appearance. Due to this structure, bone tissue can gradually grow into the surface layer of the endoprosthesis, which is an important additional factor for long-term fixation.

The procedure lasts from 1.5 to 2.5 hours. The surgeon performs the removal of the head and neck of the femur, and the components of the endoprosthesis are fixed in place. The acetabulum is prepared (reamed) and an artificial cup is inserted, and the stem of the endoprosthesis is placed into the pre-prepared femoral canal. After checking joint and limb function, the surgical wound is closed in layers.

Postoperative Period

After surgery, you will be transferred to the postoperative recovery ward. Your condition will be monitored by experienced medical staff. During the first day, vital signs (blood pressure, pulse, electrocardiogram, and blood oxygen saturation) are monitored. To quickly strengthen the muscles of the lower limb, it is very important to start performing exercises under the guidance of a rehabilitator from our clinic. The day after surgery, you can sit on the edge of the bed and stand up (under the supervision of medical staff). Physical activity increases daily. Your average hospital stay is 4 days.