Collateral circulation in the hip joint. Collaterals of the hip joint

Arthrosis is a degenerative-dystrophic process that affects joint tissue. Simply put, it is the slow destruction of a joint, leading to loss of function. Any joint can undergo arthritic changes. But among all the joints, the hip joint suffers most often. This is where arthrosis of the hip joint develops. This disease is also called coxarthrosis.

Causes and pathogenesis

Before finding out what the causes (etiology) are and what is the sequence of negative changes (pathogenesis) with arthrosis of the hip joint, we should briefly dwell on some features of the anatomy and physiology of this joint. The hip joint is formed by two bones - the ischium (its acetabulum) and the femur (its head).

The configuration of the hip joint is close to spherical. The head of the femur, like a billiard ball, is located in the pocket of the acetabulum. To facilitate friction, the articular surfaces are covered with cartilage. A continuation of the cartilaginous surface of the acetabulum is the cartilaginous lip, designed to increase the area of ​​contact between the acetabulum and the head of the femur. All these structures are surrounded by a joint capsule and are additionally strengthened by ligaments, femoral and gluteal muscles.

The hip joint is the largest. Here hip movements are carried out in all three planes. The prerequisites for ensuring all these movements are:

• Normal tone of nearby muscles;
• Integrity of joint structures;
• Their complete blood supply;
• Elasticity of articular cartilage;
• Optimal volume and composition of intra-articular fluid.

In the absence of these conditions, dystrophic changes that are irreversible are formed in the articular cartilage. At the initial stage, the nutrition of the articular cartilage deteriorates, which leads to its thinning. Due to further trophic disorders, the subchondral (located under the cartilage) bone undergoes negative changes. Pathological cavities (cysts) form inside the head of the femur, and bone growths (osteophytes) form on its surface. As a result, congruence (anatomical correspondence) of the articular surfaces is lost, which cannot but lead to motor disorders.

The causes of arthrosis of the hip joint are diverse, and among them:

• Congenital anomalies – dysplasia. Hip dysplasia in children can be a consequence of genetic abnormalities or occur during childbirth (congenital hip dislocation). In these conditions, the anatomical axis of the joint changes, and articular surfaces that have not yet formed are affected.
• Elderly age. It is not for nothing that the age of most patients suffering from hip arthrosis exceeds 40 years. As we age, restoration processes in various tissues slow down. And this cannot but affect the articular hip cartilage, which experiences the maximum load.
• Overweight. The greater the body weight, the greater the static load on the joint, and the faster the articular cartilage wears out.
• Accompanying illnesses. Diabetes mellitus, thyroid diseases, atherosclerosis and other metabolic disorders are accompanied by insufficient blood supply to the hip joints. A deficiency of oxygen and nutrients forms in the joint structures, instead of which waste products accumulate.
• Physical exercise. Systematic hard work and sports can also lead to wear and tear of the cartilaginous articular surfaces.
• Sedentary lifestyle. On the one hand, it is often accompanied by obesity. On the other hand, it leads to a decrease in the tone of the muscles that stabilize the hip joint.
• Injuries. Here, mechanical damage to the articular structures is combined with a decrease in the tone of nearby muscles.
• Coxarthritis. Inflammation of the hip joint (infectious, rheumatic or any other) is accompanied by a change in the quality of the joint fluid and a disturbance in the nutrition of the articular cartilage. In addition, the inflammatory process can lead to direct damage - aseptic necrosis (non-infectious death) of the femoral head.
• Damage to other parts of the musculoskeletal system. Lateral curvature of the spine (scoliosis), flat feet, diseases and injuries of the knee joint - all this increases the load on the hip joint and leads to arthrosis.

In some cases, despite comprehensive clinical and laboratory studies, it is not possible to establish the cause of arthrosis. Then they talk about idiopathic arthrosis of the hip joint.

Symptoms

The main signs of arthrosis of the hip joint are as follows:

• Pain. It is the main complaint of patients suffering from this disease. At an early stage of the disease, pain is mild or may be absent altogether. As degenerative changes in the hip joint progress, pain literally “drives” the patient to the doctor.
• Decreased range of motion. Partly due to pain, but mainly due to disruption of the congruence of articular structures due to the appearance of osteophytes, thinning of the articular cartilage and destruction of the femoral head. At first, motor disturbances are accompanied by mild lameness, and at a later stage the patient is practically unable to move at all.
• Impaired muscle tone. Decreased muscle tone is not only the cause, but also the consequence of hip arthrosis. Subsequently leads to irreversible atrophic changes in the muscles of the thigh and buttocks.
• Scoliosis. Also the cause and effect of hip arthrosis. With unilateral hip arthrosis, the patient spares the affected joint. At the same time, the load on the healthy limb increases. This misalignment eventually leads to a lateral curvature of the spine.
• Shortening of the limb. With an advanced process, the lower limb on the side of arthrosis is shortened. Among the reasons are joint destruction, muscle atrophy and forced positioning of the patient.

All these external changes are formed against the background of corresponding structural disturbances. In the affected joint, in addition to the above-mentioned osteophytes and cysts, thickening of the articular capsule, narrowing of the joint space, and thinning of the cartilaginous lip of the acetabulum are noted. All these structural disorders lead to a displacement of the functional axis of the hip joint. When articular structures are destroyed, the neck-diaphyseal angle between the femoral neck and the vertical axis of the femur changes. These disorders are easily detected by radiography and computed tomography of the hip joint.

Degrees of arthrosis

All these changes are not equally expressed and may depend on the duration of arthrosis of the hip joint. In this regard, there are three degrees of arthrosis of the hip joint:

1. Arthrosis 1st degree. The pain is mild, occurs during physical activity and completely stops with rest. There are no restrictions on movements or decrease in muscle tone yet. X-rays show a narrowing of the joint space.
2. Arthrosis 2 degrees. The pain occurs even at rest, intensifies with physical activity and may be accompanied by lameness. It does not go away on its own, it can only be relieved with analgesics. Limitation of range of motion and decreased muscle tone. Structural changes in the form of thinning of the articular cartilage, the appearance of osteophytes and cysts of the femoral head, and its displacement relative to the glenoid cavity.
3. Arthrosis 3 degrees. The pain is constant, bothers me even at night. Practically not relieved by analgesics. Severe muscle atrophy, movements in the hip joint are reduced or completely absent. The limb is shortened. As a result, the patient is forced to walk with a cane. Osteophytes on the acetabulum are clearly visible. Lack of cartilage on the head of the femur, its partial or complete destruction.

The transition of hip arthrosis from one degree to another occurs gradually, over several years.

Treatment

Treatment for arthrosis of the hip joint depends on its degree. In order to relieve pain and relieve associated inflammation, anti-inflammatory drugs (Diclofenac, Indomethacin, Voltaren) are prescribed in the form of locally applied ointments, lotions and compresses. To improve the nutrition of cartilage tissue, chondroprotectors are used - Chondroitin complex, Chondroxide. And Trental and Pentoxifylline administered intravenously by drip improve local blood supply, and at the same time the delivery of oxygen to the tissues of the hip joint.

Physical procedures (UHF, magnetic therapy, inductothermy) enhance the effect of medications. And physical therapy strengthens the pelvic and femoral muscles, and to some extent helps to stabilize the hip joint. A set of exercises is developed by a physical therapy specialist individually for each patient. In any case, the exercises performed should be smooth, without sudden movements or pain. For such patients, exercise in a swimming pool is recommended.

All these measures are justified only with coxarthrosis of 1-2 degrees. Grade 3 comes with the destruction of osteochondral structures. Simply put, there is nothing left to treat and restore. The only way out is endoprosthetics, an operation to replace a worn-out joint with a synthetic endoprosthesis.

The diet for coxarthrosis should be aimed at correcting weight and removing toxins from the body. In this regard, it is undesirable to consume flour and pasta, potatoes and other foods that lead to obesity. You should also limit table salt, strong tea, coffee and alcohol. Although, in fairness, it is worth noting that the diet for hip arthrosis is not strict and is advisory in nature. A nutritious diet for such patients should be low in calories and include vegetables, fruits and lean meats.

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Arthritis of the hip joint in children: symptoms and treatment of the disease.

Diseases of a rheumatological nature in children are not so rare. And if previously juvenile rheumatoid arthritis was in first place in the structure, now there is a continuing trend towards an increase in the number of reactive arthritis (RA). The most common inflammation of large joints is the knee, hip, and ankle. Arthritis of the hip joint in children is called coxitis. Preschoolers account for about sixty percent of cases and about forty percent occur in adolescence.

Structural features

The hip joint (HJ) is a spherical joint and has increased blood supply and innervation. It is the largest in the human body. Until the age of six, the formation of the head of the femur and articular surfaces occurs, and an increase in ossification and growth of the neck occurs during adolescence. At earlier stages, the acetabulum is flattened, and the head is soft, cartilaginous and elliptical in shape. It is held in place by ligaments, which in children are more elastic and tend to stretch.
That is why dysplasia, dislocations and injuries of the hip joint are so common in children. In addition, the immune system is still imperfect and does not always cope with the infectious agent that has entered the body.

Etiology

The group of arthropathy associated with the hip joint is extensive, so there are many reasons for the occurrence of hip arthritis.

The development of coxitis can be provoked by:

• hypothermia;
• vaccinations;
• use of certain medications;
• excessive physical activity (sports).

Classification

Arthritis of the hip joint is divided into two large groups, based on the causes:

• Infectious nature: reactive, rheumatic, tuberculous, etc.
• Non-infectious: juvenile rheumatoid arthritis, psoriatic, ankylosing spondylitis, etc.

Infectious arthritis, in turn, is sometimes conventionally divided into septic (purulent), which develops when the pathogen enters the joint directly, and aseptic (reactive), which occurs after an infection of another localization. But nowadays, with the improvement of diagnostic methods, such a division is controversial, since with reactive arthritis it is possible to detect a pathogen in the synovial fluid.

According to duration, they are classified as acute, subacute, chronic and recurrent. By degree of activity:

1. Remission
2. Low
3. Average
4. High

When classifying arthritis, it is customary to talk about the degree of dysfunction: the first is preserved, the second is impaired, the third is completely lost.

Clinical manifestations

Since arthritis of the hip joint in children can be caused by different pathogens and have different etiologies, the symptoms accompanying each form are different. The onset of the disease can be acute and begin with general intoxication, hyperthermia (with septic arthritis), or it can be gradual, unnoticeable. Common to all types is the presence of inflammation, accompanied by edema, swelling, pain, impaired blood supply, and the inability to step on the leg. The baby becomes capricious, cries, refuses usual games, and spares a limb. Since the most common form is reactive arthritis of the hip joint in children, all symptoms appear some time after a viral or bacterial infection, most often urogenital or intestinal.

Septic hip arthritis is very dangerous - a disease that develops rapidly, acutely, with high fever, severe pain, significant hyperemia and increased temperature in the affected area. Due to good blood supply and insufficient protective function of the immune system in children, the bloodstream can transfer the pathogen and its toxins throughout the body, which can lead to a serious condition - sepsis.
Arthritis of the hip joint in tuberculosis in children is characterized by a special course of the disease. This is a fairly common complication of the pulmonary form of the disease. It occurs chronically. It starts gradually, gradually. Characterized by slight low-grade fever, irritability, sweating, and weakness. Joint pain, lameness appears, muscle atrophy increases, pale edema, and the formation of fistulas with cheesy contents is possible.

In addition to the main characteristic signs, arthritis of the hip joint can be accompanied by both general symptoms of intoxication (weakness, drowsiness, weight loss) and various extra-articular symptoms: damage to the skin, mucous membranes of the eyes, kidneys, and the cardiovascular system.

Treatment

The assistance provided depends on the form of arthritis, its course and concomitant pathology. Therapy should be comprehensive, aimed both at the cause, elimination of symptoms, and at preventing complications and restoring function. There are conservative (medicinal) treatment and surgical.
For drug therapy the following is used:

• Etiotropic treatment: elimination of the pathogen, allergen, etc.
• Pathogenetic: destruction of the mechanisms of pathological reactions.
• Symptomatic: elimination of manifestations and improvement of general condition.

The first group of drugs includes antibiotics, antiseptics, antiviral and antituberculosis drugs.

In the case of septic coxitis, the drugs of choice are penicillin antibiotics and cephalosporins (ceftriaxone, cefuroxime), prescribed intravenously. A culture of the synovial fluid is required to determine the pathogen and its sensitivity. Based on the results of this analysis, therapy is adjusted. A combination of intravenous and joint administration is effective.

In case of tuberculosis, treatment is carried out with specific drugs (ftivazide, isoniazid). It is most effective in the early period. When treating reactive arthritis of the hip joint with antibiotics, the type of pathogen is also taken into account, since the choice of drugs in children is limited. Fluoroquinolones (Tsiprolet), tetracyclines and macrolides (azithromycin) used in adults have a wide range of contraindications in childhood.

If hip arthritis is caused by an autoimmune or metabolic disorder, then therapy is carried out with pathogenetic drugs that can slow down or stop the process - cytostics or immunosuppressants.

Symptomatic medications include medications that can relieve pain and reduce inflammation and swelling. This is a group of non-steroidal anti-inflammatory drugs (NSAIDs). Due to their irritating effect on the mucous membrane of the gastrointestinal tract, the list of these drugs used in childhood, especially in preschoolers, is very limited. Nemisulide in the form of a suspension, nurofen, and ibuclin are used. They reduce fever, relieve swelling, affecting general symptoms of intoxication, and improve well-being. In cases of their low effectiveness, combination with hormonal drugs (dexamethasone, prednisolone) is permissible.

In the acute period, the load on the affected joint is reduced: bed rest, immobilization with a plaster cast, splinting, etc. The expansion of physical activity is carried out gradually. Long-term immobilization with plaster is indicated for tuberculous coxitis.

After the acute manifestations are relieved, physiotherapy, massage, physical therapy, and vitamin therapy are prescribed. Spa treatment is indicated.

In some cases, if conservative therapy is ineffective, surgical intervention is resorted to. Small forms: opening and drainage of the hip joint, administration of drugs internally.

When the deformation is significant, ankylosis and contractures form, and reconstructive surgery is performed to restore mobility. In case of tuberculous arthritis, foci of destruction in the bones are surgically removed and the hip joint is resected.

Prevention

The prognosis depends on the type of disease. As a rule, most arthritis with timely treatment achieves complete recovery or stable long-term remission.

There are no special methods to permanently prevent the development of arthritis. However, one should not neglect a healthy lifestyle, personal hygiene, regular exercise, and proper nutrition. Include vitamin and mineral complexes rich in calcium and vitamin D in your child’s diet. To avoid infectious infection, you should consult a doctor in a timely manner, sanitize foci of chronic infection, do not suffer viral diseases “on your feet” and be attentive to the health of your children.

Bilateral coxarthrosis leads to deformation of the surface of the joint and bones. There is a risk of development not only in 1 joint, but also in 2 joints at once. In this case, the disease will be bilateral in nature. The disease is typical for people over 40 years of age, although the development of the disease cannot be ruled out earlier.

The symptoms of this disease can be divided into several groups. The division is based on the degrees of the disease, since the signs of coxarthrosis in each case have some differences. During stage 1 of the disease, minor pain occurs in the pelvic area. They may appear after physical activity, standing for a long time or while walking. By the end of the day, the discomfort subsides, which provides slight relief to the patient. Pain in the knee or hip area may occur, but this phenomenon occurs in rare cases.

If any of these symptoms occur, you should immediately seek help from a specialist. This will allow you to deal with the problem in a timely manner, quickly eliminate it and prevent the development of complications and the transition of the disease to the next stage of development.

At grade 2, the pain intensifies. They can occur not only in the pelvic area, but also in the hips, knees, and groin. Unpleasant pain occurs even with simple movements and light load. This is observed even during sleep, when muscle tension does not disappear. This causes poor sleep quality. As a result, the patient experiences slight changes in gait, lameness appears, and some movements are limited.

The 3rd degree is characterized by very severe pain, which radically changes the patient: his gait, position in lying, standing and sitting positions, and much more. The unpleasant sensations persist constantly and intensify when walking or doing other activities. The joint no longer works; muscle dystrophy occurs in the thigh and buttocks. This complicates the patient’s basic actions; it is even difficult for him to stand without assistance. There is no need to talk about walking in such conditions.

During this stage, there is a constant contraction and tension of the leg muscles, which creates a feeling of shortening of the legs. Treatment in conditions of the 3rd degree is difficult. A large number of medications used may not help the patient, then they resort to using the surgical method.

In addition to the presented degrees, primary and secondary coxarthrosis of the hip joint are distinguished. In case 1, the cause of the development of the disease may not be clear, which indicates the presence of other processes that could lead to the disease. The second case implies that the development of coxarthrosis of the hip joint is based on a certain disease.

The bilateral type of arthrosis develops due to an existing disease in one joint. Due to certain conditions, the disease can spread to another joint. Various reasons can lead to this, ranging from lifestyle to impaired metabolism. Modern scientists, in the course of laboratory studies, have come to the conclusion that arthrosis of the hip joint is not inherited, but a predisposition to metabolic disorders can be genetically transmitted, which leads to the occurrence of this disease.

Often the disease appears when there is a heavy load on the joints. Therefore, athletes and overweight people are in the 1st position at risk. This should also include people who have a very active daily routine and who need to perform heavy loads.

But you shouldn’t assume that lack of exercise will protect you from this disease. A sedentary and sedentary lifestyle also causes the disease. At risk are patients who have osteoporosis, arthritis, diabetes, or underdeveloped joints. In addition to the age group over 40 years, the disease also appears in young people. In their case, the cause of the development of coxarthrosis is associated with a congenital type of hip dislocation, the presence of injuries or bruises.

A person’s emotional state plays a significant role, so stressful situations and frequently developing depression can contribute to the onset of the disease. This is explained by the fact that during prolonged stressful conditions, corticosteroid hormones are produced, which have a negative effect on the production of hyaluric acid. The last component is responsible for lubricating the joints, so in the absence of lubrication, the cartilage begins to dry out, and the structure of the joint changes. In addition, stress disrupts the blood supply to tissues, and bilateral coxarthrosis appears.

The method of treating the disease depends on the specific stage that has developed in the patient.

It should be pointed out that it is possible to completely eliminate the disease in the presence of the 1st stage of arthrosis; in other cases, the process is irreversible, which can only be stopped and prevent the situation from worsening.

At stage 1, treatment is not difficult if you contact a specialist. Your doctor may prescribe an at-home type of hip treatment. Anti-inflammatory and vasodilator drugs, analgesics and other medications are used. Gymnastics and physical therapy can be used as additional measures.

When doing gymnastics and physical education, it is important to exclude sudden movements; axial loads are completely excluded from the program. Classes must be held regularly and without absences. Before class, you need to stretch the joint a little and give it a massage.

Stage 2 is characterized by more complex treatment. The previously mentioned analgesics and anti-inflammatory drugs are used, but electrophoresis, ultrasound, laser and magnetic therapy are beginning to be used. Don't forget about massage and therapeutic exercise. The patient must undergo a maintenance course, which is performed every 6 months.

At the 3rd stage, prosthetics and surgery can be a way out of the situation. If a bilateral type of arthrosis develops, the patient automatically becomes disabled. A contraindication to surgical intervention may be the presence of problems with the heart and blood vessels; age and the drugs used for treatment are taken into account. If the patient is experiencing severe pain, then intra-articular blockades are used. And, although such actions will not lead to the patient’s recovery, it is possible to ensure that the patient remains unhindered in a lying or sitting position.

The anatomy of the human hip joint (HJ) is interesting because of its significant modification throughout evolution, which can be seen when compared with non-upright mammals. Maintaining body weight in an upright position required special mechanics of this joint, which cast a shadow on the structure of the joint.

The hip joint is the connecting link between the torso and lower limbs. It is a strong and spherical joint. Its structure is aimed at maintaining stability and performing a large number of movements in it.

Important! The hip joint is the second most mobile in the human body.

Bone anatomy - what connects and how

The head of the femur has the shape of a sphere located on the “pedicle” - its neck. Its entire surface is covered with articular cartilage, thickening in areas of increased exposure to body weight on the lower limb. The exception is the place of attachment of the own ligament of the femoral head, namely its fovea (fovea for the ligament of the femoral head).

The acetabulum (English, acetabulum), in turn, the second main component of the joint, is a hemisphere covered over most of its length with cartilage tissue. This reduces the friction of the head on the pelvic bone.

In the photo - intra-articular surfaces - head and cavity (fossa)

The depression is a consequence of the connection of the three bones of the pelvis - the ilium, the ischium and the pubis. It consists of a semilunar-shaped rim, protruding slightly upward, covered with cartilage, and being the articular part of the joint, as well as the surface of the acetabulum, which has the same shape.

Attached to the rim is the acetabular labrum, which in appearance resembles a lip, which is how it got its name. Through it, the surface area of ​​a given cavity increases by approximately 10%. The part of the acetabulum that does not participate in the formation of the joint is called the fossa, and is made entirely of the ischium.

Due to the presence of a complete connection between the femoral head and the pelvic bones, the structure of the hip joint allows it to remain one of the most stable joints. The congruence of the articular surfaces is most complete at a position of flexion at the joint at 90°, abduction of the lower limb at 5° and external rotation at 10°. It is in this position that the axis of the pelvis coincides with the axis of the head of the femur and forms a straight line.

Joint capsule and its ligaments

The stability of the hip joint is further strengthened by covering the entire length of the joint with two layers of capsule - a loose outer fibrous layer and an inner synovial membrane.

The hip ligaments are compacted parts of the fibrous layer of the capsule, which are spirally stretched between the pelvic bones and the thigh, thereby strengthening this connection.

The structure of the human hip joint, especially its ligamentous apparatus, determines the complete insertion of the head into the acetabulum during its extension by rewinding the spiral ligaments that tighten the fibrous capsule; problems in this place can occur. Thus, the congruence of the joint during its extension is produced through passive movements of its articular surfaces.

The tense ligaments of the fibrous capsule limit excessive extension, which is why the full vertical position is 10-20° short, however, it is this slight difference in angle that increases the stability of this joint.

The structure of the hip joint includes three internal ligaments:

1. Iliofemoral ligament. It is located in front and slightly upward, stretching between the lower anterior iliac spine and the intertrochanteric line of the femur distally.
   It is believed that this ligament is the strongest in the body. Its job is to limit hyperextension of the hip joint in a standing position.
2. Pubofemoral ligament(English, pubofemoral ligament). It extends from the obturator ridge, going down and laterally to connect with the fibrous capsule. Intertwined with the medial part of the iliofemoral ligament, it is also involved in limiting excessive extension of the joint, but to a greater extent prevents hip hyperabduction (too much abduction).
3. Ischiofemoral ligament. Localized on the posterior surface of the joint. It is the weakest of all three ligaments. It spirals around the neck of the femur, attaching to the base of the greater trochanter.

A major role in gait is played by the hip joint, the structure of which is supported precisely by the above-described ligaments and muscle frame, which ensure its structural integrity. Their work is interconnected, where the disadvantage of some elements is offset by the advantage of others. More details about this can be found in the video in this article.

Thus, the work of the ligamentous and muscular apparatus is balanced. The medial hip flexors, located in front, are weaker than the medial rotators, but their function is strengthened by the anterior internal ligaments of the thigh (pubofemoral and iliofemoral), which are much stronger and denser than the posterior ligament of the joint.

The only ligament that performs almost no function in relation to strengthening the joint is the ligament of the femoral head. Its weak fibers are directed from the fossa located in the center of the femoral head to the acetabular notch. Its work consists largely of creating protection for the vessel (artery of the head of the femur) stretching between its fibers.

The fatty tissue that fills the fossa of the acetabulum, together with the ligament, is covered with a synovial membrane. This adipose tissue compensates for the lack of congruence of the articular surfaces by changing its shape during movements.

Movements in the joint

This:

• flexion and extension;
• abduction and adduction;
• medial and lateral rotation;
• rotation.

All of the movements described above are extremely important, as they ensure such daily human activity as getting out of bed, holding the body in an upright position, sitting, if you have problems with performing these simple actions, please read.

The anatomy of the hip joint is rich in muscles that allow the above-described functions of the hip joint to be realized.

These include:

• iliopsoas muscle - the strongest flexor of the lower limb;
• the adductor magnus muscle is its synergist;
• simultaneous flexion and adduction of the limb is ensured by the piriformis and gracilis muscles;
• The gluteus minimus and medius muscles serve simultaneously as abductors and medial rotators;
• The gluteus maximus plays the role of the main extensor, participating in the transition of the body from a bent position in the hip joint to an extended one (standing up).

Blood supply

The head and neck of the femur are supplied by branches of the medial and lateral circumflex artery, the deep femoral artery, and the own artery of the femoral head. In adulthood, the medial circumflex femoral artery is considered the most important source of blood supply to the femoral head and proximal neck.

Attention! In old age, the blood supply to the head and proximal neck of the femur is reduced, which causes a high incidence of trauma to this area and difficulty in healing fractures, which is why complete or partial replacement of the joint is often required to restore its mobility.

Among other things, recovery from a hip fracture is long and requires the patience and desire of the patient, but more importantly, the full implementation of all the techniques suggested by the instructions developed by the rehabilitation doctor. The lesson plan is developed individually and requires the efforts of the patient.

Important! Only a doctor can diagnose problems in the hip joint and prescribe appropriate treatment. If symptoms appear that indicate a violation of full movements in this joint, contact an orthopedic traumatologist.

The hip joint is the largest joint in the human musculoskeletal system, connecting the lower limbs to the body. Takes an active part in movement and maintaining balance with a vertical position of the body. Despite its strength, the hip joint is one of the most vulnerable parts of the human skeleton, as it experiences stress every day when walking, running and doing physical exercise.

Anatomy of the human hip joint

The hip joint is a large spherical joint with several axes of rotation, formed by the articular surface of the head of the femur and the acetabulum of the iliac bone of the pelvis. The structure of the hip joints in women and men is not fundamentally different.

In fact, the hip joint consists of a neck and head, covered with cartilage tissue, the femoral bone, the acetabulum and the acetabular lip that deepens it, located inside the capsule. The joint capsule of the hip joint is a hollow formation that limits its internal cavity. The walls of the capsule consist of three layers:

• external – dense fibrous tissue;
• middle – connective tissue fibers;
• internal – synovial membrane.

The synovial membrane lining the joint capsule from the inside produces a serous secretion that serves to lubricate the articular surfaces during movement, reducing their friction against each other.

Articular ligaments

The ligamentous apparatus of the hip joint provides rotation, supination, and mobility of the lower extremities in the longitudinal and transverse directions; it is formed by several structures:

• The iliofemoral ligament is the largest and strongest of all, holding and ensuring mobility of the hip joint. It originates near the anterior inferior spine of the pelvic bone, and then diverges in a fan-shaped manner, attaching in bundles to the femur along the intertrochanteric line. Included in the group of muscles and ligaments responsible for balance and keeping the body in an upright position. Another function of the ligament is to inhibit hip extension.
• Ischiofemoral - one end is attached to the ischium; passing inside the trochanteric fossa, the other end is woven into the articular capsule. Inhibits the adducting movements of the hip.
• Pubofemoral - originates on the anterior surface of the pubic bone and is woven into the articular capsule. Responsible for inhibiting hip movements performed in a direction transverse to the axis of the body.
• Circular ligament - located inside the joint capsule, originates from the anterior edge of the ilium and loops around the head of the femur.
• Femoral head ligament – ​​located inside the joint capsule, protecting the blood vessels of the femoral head.

Muscles of the hip joint

The hip joint has several axes of rotation:

• frontal (transverse),
• sagittal (antero-posterior),
• longitudinal (vertical).

Movements of the joint along the frontal axis provide flexion and extension movements of the hip. The muscles responsible for hip flexion are:

• straight,
• comb,
• iliopsoas,
• tailoring,
• wide.

Hip extension is provided by antagonist muscles:

• two-headed,
• semitendinosus,
• semimembranous,
• gluteus maximus.

The adducting and abducting movements of the hip are performed along the sagittal axis. The following are responsible for hip abduction:

• pear-shaped,
• twin,
• obturator internus muscle.

The casting is carried out:

• adductor magnus,
• comb,
• thin,
• adductor brevis and longus muscles.

The longitudinal axis of rotation is necessary for hip rotation, as well as for pronation and supination of the joint. These functions are carried out:

• square,
• gluteus maximus,
• iliopsoas,
• pear-shaped,
• twin,
• tailoring,
• obturator externus and obturator internus muscles.

Blood supply of hip joint

The blood supply to the hip joint is provided;

• ascending branch of the lateral femoral artery,
• round ligament artery
• acetabular branch of the obturator artery,
• branches of the inferior and superior gluteal arteries,
• deep branch of the medial femoral artery,
• branches of the external iliac artery,
• branches of the inferior hypogastric artery.

The importance of these arteries for providing blood supply to the hip joint varies. The main supply is provided by the deep branch of the medial femoral artery. The outflow of blood from the joint and surrounding tissues is provided by the branches of the femoral, hypogastric and iliac veins.

Innervation and lymphatic drainage of the hip joint

The innervation of the hip joint is carried out through the branches of the femoral, obturator, sciatic, inferior gluteal, and genital nerve trunks.

Periarticular neurovascular formations and nerve roots of the periosteum also take part in the innervation.

The lymphatic drainage of the joint passes through deep lymphatic vessels leading to the pelvic lymph nodes and internal sinuses.

Functions of the hip joint

One of the main functions of the hip joint is the connection of the lower limbs with the body. In addition, the joint plays an important role in ensuring their movement, performing the following functions:

• supports,
• bending,
• extension,
• rotations,
• pronation,
• supination,
• leads,
• adduction of legs.

Possible causes of pain in the hip joint

Daily stress, injuries, age-related changes, inflammatory and infectious processes in the tissues of the joint and its surroundings can cause pain.

Injuries

Injuries are one of the most common causes of hip pain. The severity of symptoms is directly related to the severity of the injuries received.

The mildest injury to a joint is a bruise caused by a blow or falling on its side. Symptoms of a bruise are pain in the hip area, swelling and redness, temporary lameness.

A more severe injury to the hip joint is a dislocation, which can be the result of a strong blow, for example, in a traffic accident, a fall from a height, a sharp jerk, or excessive movement. Symptoms of a dislocation are:

• sharp pain that gets worse when you try to move your leg or lean on it;
• swelling and redness of tissue in the area of ​​the damaged joint;
• formation of an extensive hematoma in the thigh area;
• visually discernible deformities, protrusion on the thigh at the site of ligament separation;
• forced rotational position of the limb;
• loss of functionality of the affected leg.

The most severe injury is considered to be a fracture of the femoral neck. In young and middle-aged people, such injuries are relatively rare and occur as a result of severe blows received in a car accident or fall from a height. The vast majority of hip fractures occur in older people.

The bone tissue of older people loses its strength as a result of hormonal and age-related changes that accelerate the process of calcium leaching. A fracture can occur with minor physical impact or even spontaneously, in the absence of any external causes.

Symptoms of a femoral neck fracture:

• pain in the groin area;
• loss of function of the injured limb, inability to lean on it;
• forced rotational position of the leg outward;
• shortening of the injured limb relative to the healthy one, visually discernible in the supine position;
• “stuck heel” syndrome - the inability to lift a leg straightened at the knee from a supine position;
• swelling and redness of tissues.

Inflammatory and degenerative diseases

One of the most common causes of pain in the hip joint is inflammatory processes in the tissues.

Arthritis- inflammation of joint tissue caused by autoimmune reactions, chronic injuries, bacterial or viral infections. The disease can affect either one or both joints, manifesting itself as pain that intensifies after exercise and with prolonged exposure to a stationary position, limited mobility, swelling, redness of the tissues, and a local increase in temperature.

Arthrosis hip joint, or coxarthrosis, is a chronic, steadily progressing disease accompanied by degenerative changes in tissues. The causes of development can be injuries, genetic predisposition, endocrine disorders. In the early stages, pain in the joint area is the only symptom; as the disease progresses, it leads to dysfunction of the joint and, ultimately, to its complete destruction.

Bursitis– an inflammatory process that develops in the synovial cavity of the trochanteric bursa of the joint. The causes of development may be chronic injuries, as well as complications of inflammatory diseases of the joint. A characteristic symptom of the pathology is pain in the subgluteal region and on the back of the thigh, which intensifies when running or walking.

Tendinitis– inflammation of the ligaments that stabilize the joint. The cause of the development of the disease in most cases is inadequately high loads and regular microtraumas of the connective tissue. As a result of the formation of microtears in the fibers, scars are formed, and when pathogenic microorganisms enter them, an inflammatory process develops.

Systemic connective tissue diseases

Systemic connective tissue diseases mostly develop as a result of pathological autoimmune reactions or genetic disorders; in this case, several joints are involved in the pathological process.

Gout- pathological accumulation of uric acid salts in organs and tissues, causing inflammation of the joints and the formation of tophi - specific lumps in the area of ​​the affected joints.

Ankylosing spondylitis, or ankylosing spondylitis, is a genetically determined disease, in the early stages manifested by pain and a decrease in the range of motion, and in the later stages leading to ankylosis - complete loss of mobility - of the affected joints.

Epiphysiolysis– a disease whose development mechanisms are based on endocrine disorders, presumably of a hereditary nature. The main symptom of the pathology is displacement and slippage of the femoral head from the acetabulum, accompanied by forced outward rotation of the limb, changes in gait, lameness and chronic pain in the hip joint.

Diagnostics

Treatment of diseases of the hip joint is impossible without making an accurate diagnosis, since there are many reasons for the development of pain and impaired mobility, and each pathology requires its own tactics and choice of treatment methods. At the initial stage of diagnosis, the specialist conducts an examination and collects an anamnesis, and also prescribes a number of instrumental and laboratory tests to clarify the clinical picture:

• X-rays can reveal the integrity of bone structures and the presence of foci of tissue changes;
• ultrasound examination detects changes in soft and cartilaginous tissues;
• MRI and CT help to obtain the most accurate picture of the affected area for layer-by-layer study;
• arthroscopy and examination of effusion - pathological fluid accumulating in the synovial capsule.

Prevention of diseases and injuries of the hip joint

Injuries and diseases of the hip joint are the most common orthopedic pathologies that can be encountered by both professional athletes and people who are as far away from sports as possible. Compliance with a number of preventive measures will help minimize the risk of complications.

Osteoarthritis of the hip joint, the largest joint in the human body, is a long-term chronic disease. Due to the enormous load placed on the femur and ilium, this important joint in many people becomes unusable and gradually collapses. The interaction of two rubbing surfaces occurs due to the small size of the joint space, which makes them vulnerable to many factors and excessive load.

• Joint structure
• Changes in the joint with coxarthrosis
• Characteristic signs of second degree coxarthrosis
• Treatment of moderate coxarthrosis
• Methods for treating coxarthrosis
  • The use of non-steroidal drugs against inflammation
  • Treatment with chondroprotectors
  • Muscle relaxants in the treatment of coxarthrosis
  • Application of ointments and creams
  • Use of intra-articular injections
• Drinking regime for destructive coxarthrosis of the second degree

Joint structure

In order to have a clear idea of ​​how to treat grade 2 coxarthrosis of the hip joint, you should study the structure of the joint. The hip joint consists of the ilium of the pelvis, which contains the acetabulum and the head on the femur. The convex part fits into the depression and forms a kind of hinge, allowing you to perform various movements of the leg with a large amplitude. Outside, the joint is surrounded by an articular capsule and strengthened by muscles and ligaments.

Along the inner plane of the hip joint capsule is the synovial membrane, which produces fluid for lubrication and smooth movement in the joint. In the plane of the joint space there is cartilaginous hyaline tissue, which is both elastic and pliable in consistency. Cartilage helps bones move smoothly against each other and provides shock absorption when running and walking, preventing bone breakdown.

For the proper functioning of the hip joint, blood supply to tissues, metabolism and the degree of absorption of substances play an important role. With age or due to changes in the body, cartilage gradually ceases to hold water, dries out, and a network of cracks appears on the surface. These manifestations are considered the first signs of arthrosis; the cartilage lining loses its elasticity and becomes fragile.

Changes in the joint with coxarthrosis

Further progress of the disease leads to deformation of the cartilage body, its abrasion and destruction; exfoliated particles of cartilage fall into the gap between the bones and cause various inflammatory processes that are not of bacterial origin. Bone tissue grows along the edges of the cavity, inside and outside, with which the body tries to compensate for the missing lining. Such growths, which exacerbate inflammation and cause pain, are called osteophytes. Inflammation spreads to the bone, causing necrosis of the surrounding area.

The advanced stage of arthrosis is characterized by necrosis not only of bone endings, but also of nearby soft muscles, nerves, blood vessels, and ligaments around the hip joint. The final outcome of the disease, the treatment of which was ignored, is the destruction of the joint and, as a consequence, complete immobility.

Characteristic signs of second degree coxarthrosis

Coxarthrosis is a progressive disease, and it is completely impossible to cure it. The main indicators of the transition of arthrosis of the hip joint to the second degree are:

• pain symptoms are expressed more clearly, they are felt not only in the joint, but also radiate to the buttocks, groin, knee;
• lameness appears when walking or running for a long time;
• if you try to move your hip to the side, the amplitude of rotation becomes limited;
• X-rays show that the joint space has narrowed to half normal;
• there are massive growths on the edges of the acetabulum;
• the head of the femur increases, its deformation, characteristic protrusions and uneven edges are visible;
• the muscles on the side of the affected hip joint dry out and the proportions of the two hips appear unequal.

Treatment of moderate coxarthrosis

It is not possible to completely cure the disease of hip arthrosis at the second stage. In addition to cartilage damage, bone tissue deformation begins and the disease progresses. It is almost impossible to restore damaged bones to their original state. Treatment at this stage is aimed at improving the joint as a whole, enhancing the nutrition of the cartilage, increasing the blood supply to nearby tissues and widening the interosseous gap.

It will no longer be possible to return a wounded joint to its original state, nor will it be possible to make ideal rotation of the head in the acetabulum, but a timely course of treatment will help make the patient feel much better. This is achieved by reducing piercing pain and increasing joint mobility and its amplitude when rotating the hip. If the operation cannot be completely avoided, then there is a real possibility of postponing it indefinitely. This becomes possible only if the patient is determined to undergo comprehensive treatment.

Methods for treating coxarthrosis

The use of non-steroidal drugs against inflammation

The main drugs from this group: piroxicam, diclofenac, indomethacin, butadione, ketoprofen, movalis, arcoxia, nimulid, zeolebrex and derivatives of these drugs. Non-hormonal, that is, non-steroidal medications actively act to relieve pain in the damaged hip joint, thigh, groove, and gluteal region. Any visit to a doctor begins with the appointment of NVPS.

This is justified by the fact that some procedures, for example, gymnastics, massage, joint traction, require removal from pain. Therefore, with the help of non-steroidal drugs, pain is removed, and then proceed to the prescribed procedures. It should be remembered that non-steroids only remove inflammation and pain symptoms, but they have nothing to do with curing coxarthrosis.

After finishing taking the medications, the pain returns. Temporary relief is still dangerous because during treatment with non-steroidal drugs the disease continues to develop. Recent scientific research confirms the fact that long-term use of non-steroidal drugs affects the formation of proteglicans (molecules responsible for retaining fluid in cartilage tissue).

This suggests that if the patient takes the pills for more than a year, the pain and inflammatory symptoms will disappear, but non-steroidal drugs, to some extent, contribute to the destruction of cartilage. Long-term use is fraught with other side effects that affect overall health.

Treatment with chondroprotectors

Modern varieties of the group include:

• chondroitin sulfate;
• glucosamine

These drugs are substances that deliver nutrition to the pads and restore the damaged structure. These medications are considered to be the most effective in the treatment of coxarthrosis. Unlike non-steroidal drugs, they not only eliminate the symptoms of the disease, but also help restore the cartilage of the hip joint, increase the production of fluid to lubricate surfaces and normalize its performance.

The multifaceted effect on the joint during coxarthrosis makes them indispensable for treating the disease in the initial stage. These medications are well suited for curing second-degree coxarthrosis. But if the disease progresses to the third degree, then chondroprotectors do not produce the required effect if the cartilage tissue is completely destroyed.

In the first two stages of coxarthrosis, the drug acts slowly, sometimes it takes several courses to get the desired result, although advertising claims an immediate cure. To complete the period of initial application, it sometimes takes from six months to one and a half years.

Of all the drugs used in the treatment of deforming coxarthrosis, chondroprotectors are the most useful specifically for treating the disease, and not just for relieving the main symptoms. Medicines have almost no side effects or contraindications. To get maximum results, the drug is taken in courses for a long time; regularity of use plays an important role. It is absolutely pointless to take the medicine in single doses, from time to time.

Muscle relaxants in the treatment of coxarthrosis

These medications are used to reduce muscle spasms. Arthrosis is most often treated with drugs:

• sirdalud;
• mydocalm.

They are prescribed to relieve pain and reduce spasm of smooth muscles. They can improve blood circulation in neighboring tissues. The use of muscle relaxants requires caution, since sometimes the body’s reaction to preserving the joint is a spasm. If it is removed without protecting the joint from excessive stress, this will lead to accelerated destruction. Muscle relaxants are prescribed in combination with chondroprotectors and a joint traction procedure.

Application of ointments and creams

Often, advertising promotes these drugs as a miraculous remedy for getting rid of coxarthrosis of the hip joint. But in fact, doctors are forced to admit that these medications are used as a distraction; not a single case of curing arthrosis has been identified. But the use of ointments and creams gives a warming effect, which has a very good effect on the sore joint.

The irritating effect of the ointment gevkamen, menovazin, finalgon, espol leads to the production of analgesic substances in the body, due to which pain is relieved to a small extent. Warming the periarticular tissues leads to an increase in blood circulation in them and, accordingly, nutrition of the cartilage.

Use of intra-articular injections

Such injections into the joint have been used quite often recently, as this is an effective method. But the only limitation to the use of intra-articular injections is the doctor’s experience. According to statistics, about 30% of specialists miss and miss the joint space where the cartilage is located. This is further complicated by the fact that with coxarthrosis, the size of the opening of the slit is reduced by approximately half, which makes it difficult to administer the medicine.

Some doctors inject the drug not into the gap between the femur and ilium, but into the periarticular space. This way there is less risk of damaging nerve and vascular trunks. Such injections are designed to eliminate the developing exacerbation of pain. Therefore, there is little point in prescribing corticosteroid injections of diprosan, hydrocortisone, kenalog and flosterone if there is mild pain in the joint with second-degree coxarthrosis.

Much more benefit will come from the introduction of chondroprotectors into the periarticular space: chondrolone, alflutop. These medications are prescribed in courses of 7–15 injections per year, 3 courses each. Like all chondroprotectors, these drugs are used to restore cartilage tissue and improve metabolic processes in the periarticular muscles. Unlike corticosteroids, chondroprotectors treat the disease, but do not eliminate the visible symptoms of the disease. In addition, they act slowly, and it makes sense to introduce them into the interosseous gap, and not into the periarticular space.

Hyaluronic acid is used as intra-articular injections, which helps the joints work as a lubricant. The following names are used:

• ostenal;
• fermatron;
• Duralan;
• synvisc;
• hyastat.

To treat coxarthrosis, these medications are injected into the hip joint itself. Injections have an irreplaceable effect, but injections require increased control and a lot of experience. Many doctors prefer to give intra-articular injections only under the control of an X-ray machine or tomograph.

Drinking regime for destructive coxarthrosis of the second degree

It is known that with arthrosis of the hip joint, the cartilage loses moisture and dries out. Therefore, people suffering from coxarthrosis should drink more fluids. At the same time, attention is paid to the body’s predisposition to the manifestation of swelling in the lower or other parts of the body. But often the appearance of edema is the result of poor functioning of the kidneys, liver or blood vessels.

When increasing your fluid intake, you need to take care to remove water from the body as quickly as possible, for example, drink diuretics or use herbal remedies. You should drink only water, plain, not carbonated, you can boil it. You cannot increase the amount of moisture in the body through increased consumption of coffee, juices or strong tea. These drinks will not be able to circulate freely inside the body, like water, penetrate into the vessels and be removed outside the body.

In conclusion, it should be noted that at the first signs of discomfort in the joints, you should immediately undergo examination by a specialist, in which case the disease may stop and not develop further. The second stage, which was described in the article, is already a serious disease and requires more serious treatment.

Exercises for the hip joints

The largest and most complex joint in the human body is the hip. It consists of the head of the femur, connected to the pelvis by articular cartilage, numerous ligaments and muscle tissue. Shock absorption of the hip joint is provided by the presence of synovial fluid in the cartilage tissue. In inflammatory processes, as well as as a result of injury, the functionality of the joint may be impaired, which, along with drug therapy, can be dealt with by special exercises for the hip joint.

Conditions for performing gymnastics

The main focus of all therapeutic exercises is the correct distribution of loads on the hip joint, as well as the ability to eliminate pain symptoms not only in the joint, but also in the connective tissues.

When performing exercises, you must adhere to certain conditions:

• all movements should be done quite actively, but there should be no unpleasant or painful sensations;
• daily gymnastics increases elasticity and blood supply to the joint;
• for arthrosis and arthritis of the hip joint, the patient should take the most comfortable position to reduce the load on the joint;
• Correct nasal breathing plays an important role when performing gymnastics. After each exercise, take a deep breath and exhale, which allows you to relieve tension;
• movements should be smooth and unhurried, since sudden jerks can lead to microtrauma to the joint. With moderate exercise, a certain movement of blood is created, progressively washes the surface of the joint, nourishes it with the necessary elements while simultaneously removing toxins from the body.

Important! Even with a correctly performed set of exercises, the first improvement may not occur earlier than 2 weeks, which requires patience and a certain psychological attitude on the part of the patient.

General exercises

Gymnastics increases the stability of the hip joint while relaxing the surrounding muscles.

Common exercises include:

• The patient lies on his back and bends his knees, pressing his feet firmly to the floor. Then the knees are brought together and spread apart with a gradual acceleration of the pace and complication of the movements (the legs alternately rise and swing to the left and right);
• lying on your back, legs alternately rise and fall (5 times for each limb). Then the legs are bent at the knee and pulled up (alternately) with the help of the arms to the chest;
• in a sitting position, the patient bends over as much as possible, trying to touch his toes with his hands, and then returns to the starting position;
• the patient needs to stand up and lean his hands on the wall, after which the left leg is raised and moved to the side and back (5–7 times), then a similar exercise is performed with the right leg.

It is important to ensure that physical exercise is not accompanied by discomfort and pain. If this happens, you should stop exercising and consult a doctor.

For osteoarthritis

When affected by deforming osteoarthritis, gymnastics includes the following set of exercises:

• lying on your back, the straight leg rises with a delay of 5 seconds and slowly lowers. This action is then performed with the second leg;
• both legs are bent at the knee, after which the left and then the right leg are raised alternately. The purpose of this exercise for the hip joints is to stabilize muscle functionality and blood supply;
• Having bent your legs at the knee joint, you should spread them slightly, resting your feet on the gymnastic wall, after which the palms of your hands are also placed on the floor, and then the pelvis is slowly raised to the maximum height possible for the patient and lowered to its original position (3–5 times);
• lying on your side, one leg bends at the knee and the other straightens. Next, the leg that is on top is slowly raised to 45 degrees, held in this position for a few seconds and lowered. This exercise is then performed on the other side;
• in a sitting position, the patient takes the ends of the towel in both hands, forming a kind of loop, and leans forward, trying to throw it over his toes. For osteoarthritis, performing this exercise is aimed only at the leg muscles, excluding tension in other parts.

For osteoporosis

With this disease, there is a decrease in bone tissue density with disruption of metabolic processes. The main reasons for the development of the disease are nutritional disorders, the patient’s age and bad habits.

A characteristic difference between osteoporosis and other pathologies of the musculoskeletal system is bone fragility, which significantly complicates treatment, including concomitant diseases. Complex therapy, in addition to drug treatment, includes dosed exercises to accelerate the recovery of bone and muscle tissue.

For osteoporosis, the gymnastics complex is aimed at developing muscles and maintaining bone thickness:

• in a standing position, the patient steps several times over a jump rope located on the floor in the form of a straight line;
• lying on your stomach, put your hands behind your head, and lift your legs slightly up (at least 3 times);
• the patient stands, holding onto the wall, squats 3–4 times, first on the right and then on the left leg;
• sitting on a flat surface, a person holds a ball (no more than 18 cm in diameter) between his knees, which he squeezes with his knees and releases for 5 minutes.

In advanced cases, therapeutic exercises are performed only under the supervision of a doctor. The effectiveness of exercises is much higher at the initial stage of the disease.

For arthritis

The main reason for the development of arthritis is an inflammatory process that can develop latently (slowly) or, conversely, rapidly. Treatment of arthritis with the help of special exercises, first of all, allows you to relieve pain symptoms and includes:

• in a horizontal position, both legs are bent at the knee joints and very slowly pulled towards the chest, and then slowly return to their original position;
• the patient sits on a low chair, then slowly rises to his feet and smoothly sits down again;
• in a lying position, the pelvis is raised and several rotations are performed;
• lying on your back, legs are raised and crossed, forming “scissors”;
• lying on your side, the leg bent at the knee is placed on a small bolster or pillow, and then the leg is raised parallel to the surface and lowered onto the cushion;
• To develop and warm up your joints, walking calmly in place for 10 minutes is useful.

The total number of approaches when performing gymnastics should not exceed 5 times. In addition, with arthritis, any exercises with strength load, aerobics and jumping are excluded.

For arthrosis

Arthrosis is characterized by deformations and destruction of cartilage tissue, accompanied by pain in the hip joint. In this case, the most gentle physical training complex is selected.

The main goal of gymnastics is to improve blood circulation in the joint. Physical education classes are aimed at maintaining joint mobility and are performed without sudden and vigorous movements:

• in a horizontal position, the patient performs the “bicycle” exercise;
• legs alternately rise and slowly fall;
• lying on your back, extended legs turn inward with your toes and then your heels;
• holding onto the back of the chair, the patient makes smooth swings to the sides, first with the right and then with the left leg.

For severe forms

In the case when a person is diagnosed with a complicated form of arthrosis, gymnastics is performed in a special mode. To strengthen muscle tissue and the hip joint, the following complex is recommended:

• You need to place a small elevation (chair, brick, etc.) near a stable support and stand on it with one foot. The other remains in a free state and swings with a small amplitude, which should be increased as pain symptoms are relieved. Then the legs change;
• sitting on a chair, the patient spreads his knees shoulder-width apart, and then brings them together, holding in this position for 5 seconds, and then relaxing his legs;
• lying on his back and placing a low pillow under his lower back, the patient stretches his legs, spreads them apart and connects them again. Then the same exercise is repeated, but with slight turns of the feet (inward and outward).

At the initial stage, the total duration of the exercises should not exceed 10 minutes, but within 1 month it is recommended to increase the duration to 25 minutes. The presence of pain is an indication for canceling classes with subsequent medical coordination of exercise.

For dysplasia

Gymnastics and massage for congenital dysplasia in children are included in the general complex of therapy and rehabilitation measures aimed at avoiding surgery. The massage is performed by a specialist, while parents can perform gymnastics on their own, which is a definite advantage.

First, parents should calm the baby down and stroke him so that all muscle tissue relaxes as much as possible. Then the child is placed on his back, the legs are slightly bent and straightened at the hip joint, without applying any physical force. Next, the legs are bent at the knees and spread to the sides, forming a “frog” pose. This position is fixed for 10 seconds and returns to its original position. Such techniques are aimed at muscular development of the hip joint.

Having placed the child on his back, one of the baby’s legs is bent at the knee and hip, after which the adult fixes the hip with one hand, and holds the knee with the other and performs circular rotations, first to the left and then to the right. If the baby becomes restless while performing the exercise, you should reduce the impact or stop the gymnastics altogether.

Important! It is necessary to calculate the efforts on the part of an adult. Pressure and jerking when performing gymnastics are completely eliminated.

The complex starts with 3–5 minutes and is gradually increased to 15–20 (daily). For greater effectiveness, it is recommended to combine gymnastics with massage.

Contraindications to exercise therapy classes

Despite the fact that gymnastics prescribed for diseases of the hip joint is one of the effective ways to combat various pathologies, there are a number of contraindications to its implementation.

• arterial hypertension;
• blood diseases;
• hernias and acute period of the disease;
• severe disturbances in the functioning of the cardiovascular system;
• infectious diseases accompanied by increased body temperature;
• exacerbation of chronic diseases.

You should know that gymnastics for the hip joint is one of the therapeutic methods, so before starting the exercises, it is recommended to consult a doctor. If necessary, he will prescribe a number of diagnostic measures, select a special complex of exercise therapy and monitor the correctness of its implementation. Self-medication can provoke various complications, which in the future can lead to disability of the patient.

In the process of evolution, the hip joint in humans becomes the main supporting element of the skeleton, combining both strength and mobility. The transition to walking on two limbs required the body to gradually rearrange the bones and soft tissues of articulation. Adaptation to new loads occurred gradually, but inevitably, so modern man acquired a joint with a unique structure.

First of all, the changes affected soft tissues - ligaments and muscles, which previously provided the necessary strength and mobility to the legs. The need for stable support made the muscles and tendons extremely strong and resistant to stretching. At the same time, they have not lost any flexibility, allowing you to perform almost the full range of movements in the hip joint. This feature ensured human survival in nature, giving him an advantage over natural enemies.

Changes in the structure of soft tissues over time ensured a complete restructuring of the bones, which made it possible to stably hold the human torso in an upright position. Despite such transformations, the hip joint has practically not lost its mobility. The largest joint in the skeleton is second only to the shoulder joint in terms of range of motion, providing almost complete rotation of the leg. Although previously there was much in common between these two joints, evolution ensured their different purposes for humans.

Bones

The fewer active elements a mechanism has, the more reliable it is. The anatomy of the hip joint is designed according to this principle, which provides a strong and flexible support for the entire human skeleton. The special structure of the bones that form the joint allows it to perform movements in all axes:

• During normal walking, thousands of subtle flexions and extensions are performed every day to raise and lower the leg. Also, such movements are necessary for a person for everyday activities - they soften any jumps and falls, and allow you to quickly pick up a necessary object from the floor. The largest muscle groups in the human body are responsible for their implementation - the anterior and posterior thigh muscles.
• Unlike the shoulder joint, the structure of the hip joint does not allow for full abduction and adduction. Therefore, these movements play a supporting role, allowing a person to suddenly move to the side when running. For example, they allow you to change direction to dodge objects moving towards you.
• Internal and external rotation of the leg also plays a supporting role in providing people with freedom to perform activities or play. It allows the legs to be positioned at a comfortable level for any occasion to allow people to climb and grip various ledges and surfaces.

The listed range of movements is created by only two anatomical formations - these are the largest bones in the human skeleton.

Pelvic

The fixed part of the joint is formed by the pelvic bones, which form the acetabulum in the area of ​​the outer surface. It is a deep round bowl, the center of which is directed obliquely and upward. This feature provides reliable support for the torso, since the center of gravity in this position is distributed evenly over the entire upper part of the pelvic bones.

This part of the joint is securely hidden under the thickness of soft tissue, so its structure can only be studied with the help of books or special diagnostic methods. Its following features deserve attention:

1. The acetabulum is formed simultaneously by three pelvic bones - the pubis, the ischium and the ilium. It is surprising that their bone sutures divide the anatomical formation into equal thirds.
2. Despite its diverse composition, the articular cavity is a very strong and integral formation. It is least stable in childhood, when its main part is formed from cartilage tissue.
3. The edge of the socket is represented by a thickened bone ridge (unlike the shoulder joint), and covers the head of the femur along the entire circumference. This allows you to create reliable support for the leg, preventing the development of injuries.
4. The upper half of the glenoid fossa is much more massive than the lower half, which is due to its supporting function. The largest pelvic bone, the ilium, forms the arch of the acetabulum, which bears the entire load of body weight.
5. In the center of the formation there is a special hole in which a ligament is attached, leading to a similar depression on the head of the femur. This tendon not only provides additional strengthening of the joint, but also contains in its thickness the vessels necessary for the blood supply.

The “health” of the joint completely depends on the condition of the acetabulum, since many diseases of the hip joint begin with its damage.

Femoral

The movable part of the joint is formed by the head and neck of the femur, as well as the greater and lesser trochanters - bony protrusions that are the site of muscle attachment. They are also quite densely surrounded by soft tissues, so they are inaccessible for direct examination - palpation. Externally, one can only evaluate the structure of the greater trochanter, which is defined as a dense protrusion on the lateral surface of the upper third of the thigh.

The anatomy of the largest bone in the human skeleton is interesting, despite the small number of external formations. Therefore, within the framework of the hip joint, we can only describe the features of its upper part:

1. The head has a regular rounded shape, which fully corresponds to the internal structure of the acetabulum. And for a complete match, it is completely covered with dense cartilage, hiding any roughness. If the device did not have such precision, then with every movement a person would feel slight jolts and crunches associated with the friction of uneven surfaces.
2. In the center of the head there is a hole from which a strong ligament emerges - together with a similar depression on the acetabulum, it forms additional support.
3. The neck does not exit the head at a right angle - this would create an excessive load on all elements of the joint. An angle of about 130 degrees is obtuse - it provides an almost vertical transmission of gravity to the limbs. In this case, mobility in the joint is not lost at all, which could be lost with the vertical position of the bones.
4. The trochanters are the anatomical completion of the joint - the joint capsule is attached to their base. They also fix the tendons of almost all the muscles that carry out movements in the joint.

In the moving part of the joint, the weakest point is the femoral neck; fractures are often observed as a result of various injuries.

Internal organization

To fully match the articular surfaces, there are anatomical devices - capsule and cartilage. They provide softening of movements, making them more accurate and invisible to the body:

• The shell, the capsule, is a source of synovial fluid, which provides natural lubrication of the articular surfaces. It also has special folds that, when stretched, do not interfere with movements in different directions.
• The cartilage in the hip joint also has its own characteristics: it covers the head completely, but the acetabulum is only shaped like a horseshoe, open downwards. This is due to the function of the articulation - its lower part practically does not participate in support, therefore it is devoid of a dense cartilaginous plate.

The normal supporting and motor function of the joint depends entirely not only on the internal elements, but also on the surrounding soft tissues. Good muscle and ligament tone ensures good blood supply to the joint, supplying it with all the necessary substances.

Ligaments

The tendons surrounding the hip joint on all sides form its soft corset. There are three main groups of ligaments that provide support for bone elements:

• The strongest tendons in the body surround the entire circumference of the joint, covering not only the socket with the head, but also the neck of the femur. A powerful ligament extends from each pelvic bone, after which they are directed to the trochanters of the femur. Their strength is such that they can withstand stress of about 600 kg.
• A powerful band strengthens the joint from the inside, ensuring a continuous connection between the femoral head and the acetabulum. The ligament was created by nature with a small margin of length, which in no way limits the range of movements in the joint.
• Ligaments also include a circular zone around the joint space, which is formed by a soft plate of connective tissue. Despite its apparent unreliability, this ligament plays the role of a shock absorber, softening any shocks during movements.

It was the change in the structure of the ligaments that ensured during evolution the complete restructuring of the bones that formed the hip joint.

Muscles

The remaining elements of the connection have only supporting qualities, and only muscles allow you to create mobility in it. The following muscle groups are involved in the implementation of this function:

• In the hip, all the muscles are involved in any movement of the hip joint - even normal standing. Both everyday and special human activities – sports, professional – depend on their joint work.
• The muscles of the pelvis and lower back also play a supporting role in some movements, also further strengthening the joint from the outside. Their role is most noticeable in flexion or internal rotation of the hip.
• The gluteal muscles play a huge role not only in movement, but also in external protection of the joint. Short and powerful muscles serve as a real “cushion” that protects the joint from external impacts. They also create hip abduction and flexion.

Good development of the muscles surrounding the hip joint ensures the correct position of the bone formations during movements.

Blood supply

The hip joint receives nutrition from several sources, allowing blood vessels to be brought to the joint cavity from the inside and outside. This structure of the circulatory system ensures an uninterrupted supply of nutrients and oxygen to all elements of the joint:

1. All external elements of the joint receive blood from the arteries that go around the femur. Their branches go in the opposite direction - from bottom to top, which is due to the location of their source - the deep arteries of the thigh. Therefore, the blood supply affects only the superficial parts of the joint - the capsule, ligaments, and surrounding muscles.
2. Also, some of the blood comes from the lower and superior gluteal arteries, which approach the hip joint from above.

The largest joint in the human body, the hip joint, is part of the so-called lower limb girdle. It must bear a huge load, ensuring physical activity, a person’s ability to work, and the ability to perform various types of activities. Without its health and full functionality, a person is severely limited in life, and becoming disabled due to a disease of a given joint can significantly reduce self-esteem and social adaptation in society.

Joint anatomy means its structure. All joints consist of two or more bones, covered with cartilage and enclosed in a kind of bag. A cavity is formed filled with fluid necessary for free movement of the articular surfaces. On the outside, this bag is braided with ligaments and tendons, which are attached at one end, for example, to the bone of a limb, and at the other to a muscle. An extensive system of blood vessels and nerve fibers ensures the delivery of oxygen to joint tissues, removal of metabolic products, communication with brain centers and coordination of movements.

Bones and cartilage

The anatomy of the hip joint differs from other limb joints in that it involves the pelvic bone. More precisely, its acetabulum, curved in a special way and completely repeating the contours of the spherical head of the femur. They are completely congruent, that is, they match in size and shape.

Bones and cartilage of the joint

The joint is of the spherical type and is called nut-shaped, since the femoral head is covered by the acetabulum by two-thirds. The shape of the hip joint determines its multi-axiality, the possibility of movements in different planes. In the frontal plane, a person can flex and straighten the hip, in the vertical plane - pronate and supinate it (external and internal rotation of the hip), in the sagittal plane - abduct and adduct. It is also important that movements in the joint can be rotational.

The surfaces of the femoral head and socket are covered with hyaline cartilage. This is a smooth and durable substance; the functionality of the joint largely depends on its condition. The hip articular cartilage experiences constant dynamic load. Under the influence of mechanical force, it should compress and expand, remaining elastic and smooth. This is possible due to its structure, containing more than 50% collagen, especially in the upper layers. The rest is occupied by water and chondrocytes, the actual cartilage cells that ensure its restoration when damaged.

Ligaments, tendons and muscles

The hip joint is surrounded and protected by a synovial bursa, or capsule. This formation consists of strong connective tissue, elastic and elastic. In its upper part, the bag covers the acetabulum in a semicircle, and with its lower edge it is attached to the thigh below the neck, which is part of the joint. The inner surface of the bursa is covered with a layer of synovial cells, which produce fluid that fills the joint cavity. The normal functioning of the joint largely depends on the properties of synovial fluid, its quantity and viscosity.

Joint ligaments

The joint capsule contains several ligaments that perform not only a strengthening function. The intraarticular ligament of the femoral head provides adduction and pronation. Extra-articular ligaments create a fibrous layer of the capsule on the outside. In addition, the iliofemoral ligament prevents excessive extension and falling backwards.

The ischiofemoral and pubofemoral ligaments provide rotation and abduction. The ligaments of the “circular zone” additionally strengthen the femoral neck. The strength of the ligamentous apparatus is necessary for statics and safe movement; it explains the small number of hip dislocations, in comparison with dislocations in the shoulder joint.

Muscles of the joint

The muscles surrounding the hip joint provide all the variety of movements in it. The psoas major muscle flexes the hip and tilts the torso forward while the leg is fixed. The obturator internus, piriformis, and gemellus muscles externally rotate the hip. The gluteus maximus muscle consists of several bundles of fibers that perform different functions. They extend and rotate, adduct and abduct the hip, and participate in knee extension.

Muscles of the joint

The gluteus medius and minimus muscles abduct the thigh and rotate it inward and outward. The tensor fascia lata is involved in hip flexion. Its location allows this muscle to be used during hip surgery as a “bridge” for nutrition. The quadratus and obturator externus muscles are involved in external rotation. The layer of muscles surrounding the joint also provides static torso and full range of motion.

Blood supply and innervation

To supply the joint with oxygen and energy, there is a whole network of blood vessels, represented by arteries and their branches. The vessels pass through the muscles, penetrate the ligaments and fascia and enter the bone substance of the pelvic and femur bones. From there, in the form of a system of capillaries, they penetrate into the joint cavity, nourishing the intra-articular ligament, cartilage and synovial membrane.

Arteries of the joint

The main role in the blood supply to the joint is played by the medial and lateral femoral circumflex arteries. Less significant are the round ligament artery, the iliac and gluteal arteries. The outflow of blood with the products of joint metabolism occurs through veins running parallel to the arteries. Collecting together, they flow into the iliac, femoral and hypogastric veins.

Veins of the joint

Nerve fibers weave around the joint outside and inside, ending in the articular cavity with receptors that respond to unwanted changes. These include pain, signaling injury or inflammation. The main innervation of the joint occurs due to large nerve conductors: femoral, obturator, sciatic, gluteal. Without them, normal functioning of the muscular and vascular apparatus and full tissue metabolism are impossible.

Nerves of the joint

All of its components are involved in the functioning of the hip joint. Each element performs its important function.