19. Degenerative joint diseases /coxarthrosis and gonarthrosis/

Coxarthrosis (deforming arthrosis of hip)

Definition

• Coxarthrosis is a disorder of the physiological balance between the strength of the articular cartilage and articular bone, and between the pressures exerted on the joint
• 80% of people over 40 are affected!

Etiology

• There are many causes of coxarthrosis:
• Congenital dysplasia of the hip
• Congenital abnormalities in the development
• Coxa vara
• Protrusio acetabuli
• Past inflammatory diseases such as rheumatoid arthritis
• Disorders of blood circulation (aseptic necrosis of the head)
• Perthes disease

Pathogenesis

• There is a discrepancy between the loading of the joint and the ability of the cartilage to withstand these loads

Pathology

• Shine of cartilage lost, becomes darker, turbid and thinner + underlying spongiosa flattened, sclerous, deformed
• Proliferative changes- hyperemia, growth of bone tissue (osteophytes)
• Reactive synovitis, joint capsule thickened

Symptoms

• Pain:
• The pain has a typical location on the anterior surface of the joint - in the area of the groin crease!
• Appears when joint is loaded and in the morning
• Diminishes at rest!
• Any movement in the joint can sometimes trigger and intensify the pain
• Irradiates towards medial area of thigh and adductors!
• Limitation of movement in the joint
• Contractures at the hip joint
• Lameness due to difficulty in gait

Diagnosis

• History
• Physical exam
• X-ray:
• Narrowing of the joint slit
• Osteosclerosis
• Thickening of the subchondral bone in "the overloaded area"
• Appearance of degenerative cysts located symmetrically (kissing cysts)

Treatment

• Depends on the individual
• In the early stages of the disease, conservative treatment is preferred
• Rest and anesthesia of joint
• Thermal procedures, massage, rehabilitation
• Medications- NSAIDs, chondroprotectors, food additives, hyaluronic acid (injected)
• Surgery:
• Varisating intertrochanter osteotomy
• Various osteotomies of the pelvis
• Varus or valgus osteotomy