Which doctor treats the hip joints

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Hip joint pain: causes, diagnosis and treatment

The hip joints are exposed to the greatest stress in the body. They arise from weight, walking, jumping, running, lifting and carrying heavy objects. Patients often suffer from pain in the hip joint. Orthopedists at Yusupov Hospital determine the cause using modern diagnostic equipment. Doctors determine the extent of the damage to the joint and can therefore make an accurate diagnosis and develop the best treatment tactics. Doctors at Yusupov Hospital offer comprehensive treatment of the diseases that caused hip pain. Patients are individually selected for effective drugs that act on the cause and mechanism of the pain syndrome. The rehabilitation clinic's specialists offer rehabilitation therapies using the latest physiotherapy treatments, therapeutic exercises and acupuncture. Special exercise equipment is available to reduce stress on the joint during exercise. Doctors from various specialties are involved in the treatment of hip pain: endocrinologists, rheumatologists, orthopedists, physiotherapists, chiropractors and acupuncturists. A multidisciplinary approach to the treatment of hip pain can quickly eliminate the pain syndrome. Patients with hip osteoarthritis often require care. This care is professionally carried out by Yusupov Hospital's specially trained staff.

causes

• Inflammation of the tendon (tendinitis);
• tear of the muscle;
• Iliotibial tunnel syndrome;
• Other localized changes in surrounding tissue;
• Systemic diseases (rheumatoid arthritis, polymyalgia).

1. Recording the symptoms, explaining the type of hip pain;
2. Obtaining information about the course of the disease, the occurrence of pain, the course of the pain syndrome, the domestic and professional factors that the patient considers responsible for the pain;
3. An external examination allows the doctor to detect any visible abnormalities. To understand the nature of the pain and the area in which it spreads, the doctor suggests that the patient perform various movements with the lower extremity in the hip joint. Abnormal posture of the hip joint may indicate the presence of abnormalities;
4. Palpation (tactile examination). The doctor can detect rheumatic and rheumatic nodules, localize the exact location of pain when moving the lower limbs, and determine the moisture and temperature of the skin in the hip joint area.

When the hip joint is inflamed, the number of white blood cells and the erythrocyte sedimentation rate are increased. The inflammatory nature of the disease is indicated by an increase in serum C-reactive protein.

Immunological blood tests show the presence of antinuclear antibodies in inflammatory rheumatic diseases. Serum uric acid concentration increases rapidly in arthritis patients. Lysosomal enzymes (acid proteinase, acid phosphatase, cathepsins, deoxyribonuclease) in serum and synovial fluid are altered in patients with rheumatism, psoriatic arthritis, rheumatism and ankylosing spondylitis. In severe forms of hip arthritis, significant abnormalities can be seen in the urine test.

• Chronic or acute pain in the hip joint at rest and during movement;
• difficulty moving lower limbs;
• Swelling and discoloration of the skin on the hip joints.

Where should I go if I have coxarthrosis?

If you do not know which doctor treats coxarthrosis, you should contact your family doctor.

The doctor will take a medical history, examine the affected joint and recommend a series of medical tests to diagnose the disease:

• X-ray of the limb: The X-ray shows deformation of the condyle, destruction of cartilage and narrowing of the joint stroma;
• MRI: detects coxarthrosis at an early stage and assesses the extent of damage to the surrounding tissue;
• Arthroscopy: The exact stage of coxarthrosis is determined using a device that is inserted into the affected joint;
• General blood test: Increased white blood cells and deposits are signs of inflammation.
• Hip puncture: performed to confirm the presence of infection in the synovial fluid and select further treatment.

Tests to be carried out after admission to hospital

Once the diagnosis is confirmed, the family doctor will refer the patient to an endocrinologist to check hormone levels, which is one of the most common causes of coxarthrosis. If abnormalities are detected, the patient is treated with hormone therapy.

Treatment of grade 1 and 2 hip arthrosis is carried out by a rheumatologist, who selects drugs depending on the severity of the patient's disease.

Groups of drugs that the doctor prescribes for coxarthrosis:

• Nonsteroidal anti-inflammatory drugs (diclofenac, ibuprofen, indomethacin) relieve pain, tissue swelling and inflammation;
• Cartilage protectants (Glucosamine, Unium, Arthra) regenerate cartilage and prevent further cartilage destruction;
• Vasodilators (Trental, Theonicol) improve microcirculation in the affected tissues;

Ointments and poultices are ineffective in treating hip osteoarthritis - they cannot penetrate the joint. Instead, physiotherapy is prescribed - heat therapy, electrical muscle stimulation, laser therapy and magnetic therapy. If necessary, massages and gymnastics are also carried out. The aim of treatment is to rebuild the damaged tissue.

Specialist care for coxarthrosis

Which doctor treats coxarthrosis if medical treatment is ineffective? If stage 3 coxarthrosis is diagnosed, the therapist refers the patient to other specialists: surgeons, neurologists and orthopedists. The help of these specialists is necessary when drug treatment is ineffective.

There are two types of operations that are performed at the doctor's discretion: organ preservation or endoprosthesis. In the first variant, the function of the joint is restored without removing it. With endoprosthesis, the diseased bone is replaced with a metal prosthesis.

The operation is intended to restore mobility to the limb, replacing the damaged parts with endoprostheses. After insertion, the prosthesis must 'take root' in the tissue and must then be finished.

Endoprosthetics is only a surgical technique for the treatment of coxarthrosis, other methods of restoring hip function are not excluded:

• Periarticular osteotomy: In this operation, the thigh bone is filed down in certain places and then put back together at a different angle. The aim of the procedure is to slow down the development of toxarthrosis.
• Arthroplasty: First, the adhesions that are the cause of the limited mobility of the joint head are removed. The joint surfaces are then reshaped and a brace is placed between them to prevent toxarthrosis from developing again.
• Intra-articular fluid transplantation: Hyaluronic acid is injected into the joint cavity, which is deposited in the damaged cartilage and has an antioxidant, anti-inflammatory effect.

In the postoperative period, control over the patient's condition is taken over by the surgeon through a rehabilitation specialist, whose goal is to restore joint function. This is achieved through exercises, breathing exercises and massage.

After the operation and a rehabilitation phase, the patient has to take it easy every day, is not allowed to move and is monitored by an orthopedist.

Symptoms of coxarthrosis

The severity of symptoms depends on the stage and duration of the disease and whether the patient receives treatment. Symptoms of coxarthrosis:

• Severe pain in the pelvis, hips, groin and knee;
• Instability of motor functions of the legs;
• Stiffness, crunching and stiffness in the joints of the lower limbs;
• Shortening of one or both legs;
• disturbance of the gait pattern;
• pain after exertion;
• Damage or thinning of the thigh muscles;
• difficulty moving lower limbs from side to side;
• pain at rest;
• Occasional swelling in the joint area;
• Need to use a walking stick.

In the initial phase of the disease, joint pain is mild and short-lived. They occur and worsen with exercise or other physical activities. As the disease progresses, the pain increases in intensity and persists even after long periods of rest.

Classification of coxarthrosis

Coxarthrosis is classified on several levels. First, a distinction is made between congenital and acquired forms of the disease.

Depending on the cause of its development, coxarthrosis can look like this

• Post-traumatic – occurs as a result of injury to the limbs;
• involuntary – develops after the age of fifty as a result of age-related changes;
• Post-infectious – develops as a result of infectious diseases;
• Dyshormonal – caused by hormonal imbalances in the body.

Doctors distinguish between four stages or degrees of coxarthrosis of the hip, each with different symptoms.

Grade 1 hip osteoarthritis often progresses without a clear clinical picture. Occasionally, mild pain occurs after physical activity, which quickly disappears with rest.

In grade 2 hip osteoarthritis, the pain is more pronounced and travels to the lower leg, knee and ankle. They do not subside immediately at rest.

In grade 3, it is painful for the patient to move the leg from side to side and swing it inward. The pain increases and often occurs at rest. In the third stage of coxarthrosis, the affected person has to adopt a forced posture and use a stick when walking because they experience severe pain.

In the fourth stage of the disease there is a significant loss of ability to work. The patient has pain in the groin, buttocks, hips, knees, hip joints and ankles. The leg gradually becomes flat-footed, shorter, and the muscles become thinner.

Each stage of coxarthrosis has characteristic symptoms on x-rays, so only a doctor can make the diagnosis after an examination.

Visiting a trauma surgeon: How does it work?

In reality everything is very simple and quick. When visiting an orthopedist or traumatologist, there are usually several steps to consider:

1. Examination of the patient, clarification of the details (collection of anamnesis), making a preliminary diagnosis based on the information received and examination of the patient;
2. Carrying out a number of additional diagnostic procedures:

• computed tomography (CT),
• MRI,
• ULTRASOUND,
• ultrasonic densitometry,
• x-rays,
• Blood tests
• and other tests to fully understand the causes and picture of the disease;

1. Decision-making (tactics) about effective treatment methods (conservative methods, radical methods – surgical intervention);
2. Advice on further recovery (rehabilitation).

Why should you contact an orthopedic trauma surgeon?

• Quick diagnosis of the cause of the disease,
• Choosing an effective treatment method,
• prescribes appropriate treatment
• and gives recommendations for the further rehabilitation process.

As practice shows, hip pain does not go away on its own, but gets worse day by day. In this situation, time plays against a person. If hip pain is delayed or ignored, the situation becomes worse and more serious negative consequences can occur. Therefore, it is extremely important to seek help from an orthopedist/traumatologist in a timely manner. After all, this specialist deals with this type of complaint on a daily basis and knows very well how to help a person cope with the condition. Remember: Only if doctor and patient work together can you achieve good treatment results and return to a fulfilling life without pain.

Arthritis in the hip

Arthritis or coxitis is a disease characterized by an inflammatory reaction in the tissues of the hip joint. The disease can be acute (main symptom), long-term (2 months to a year) or chronic, that is, lasting more than 12 months.

There is a classification of arthritic damage to the tissue structure of the hip joint:

• Infectious or septic arthritis is an inflammatory process that results from the penetration of a fungal, parasitic, infectious-allergic or viral pathogen into the synovial fluid;
• Reactive coxitis is an immunologic-inflammatory process that occurs during or after an infectious joint injury;
• Rheumatoid arthritis is an autoimmune disease caused by the formation and hypertrophy of granulation tissue in the synovial capsule, leading to the destruction of articular cartilage and subchondral bone;
• Psoriatic arthritis is a rare autoimmune hip joint arthritis disease caused by damage to joint tissue by psoriasis.

Symptoms, symptoms and treatment of hip bursitis

causes

The etiology of hip osteoarthritis is very different. A special group of diseases is formed by lesions of various origins that occur in childhood and adolescence. These are summarized under the term 'juvenile idiopathic arthritis' (JIA), where 'idiopathic' refers to an undetermined cause. These include true indeterminate arthritis as well as rheumatoid, psoriatic and other arthritis in children under 16 years of age. Hip osteoarthritis is very common at this age.

Another cause of hip osteoarthritis is a specific infection such as tuberculosis, gonorrhea, syphilis or brucellosis. Infectious hip osteoarthritis occurs most often in adults with gonorrhea and in children and adolescents with tuberculosis.

Nonspecific infections (mainly cocci) can also cause hip arthritis. The inflammatory process usually develops against the background of open trauma from wounds, operations and intra-articular manipulations. The process often becomes purulent and requires surgical treatment.

Coxitis occurs rarely in rheumatoid arthritis but is often one of the symptoms of ankylosing spondylitis, an autoimmune disease that affects the spine and large joints.

Hip arthritis is often caused by chronic intestinal diseases and certain other diseases of the internal organs. Reactive hip osteoarthritis is rare.

Read more about which joints are affected by reactive arthritis here.

Coxofemoral arthritis is very often hereditary - close relatives suffer from the same disease. The triggers for the onset of the disease are infections, colds, stress, heavy physical exertion and bad habits.

Symptoms of hip osteoarthritis

Hip osteoarthritis can be acute or chronic. The main signs of the disease are different. It's worth paying attention to these symptoms so you can see a doctor early.

First symptoms.

Symptoms of hip arthrosis in the acute course of the disease: high body temperature, chills, malaise, joint pain, inability to stand on one leg due to pain syndrome. The symptoms are characteristic, so the diagnosis is usually not in doubt.

The symptoms of chronic hip osteoarthritis are difficult to recognize. It begins imperceptibly with slight muscle soreness when moving and stiffness in the morning, which quickly subsides. Sometimes the pain occurs when the leg is in a certain position, such as B. when putting it up. Particular attention should be paid to such vague symptoms.

Clear symptoms

In acute hip osteoarthritis, this involves increasing joint pain and fever that lasts longer than 5 days. As a rule, this indicates the development of a purulent process.

More commonly, however, hip osteoarthritis develops gradually, with the obvious symptoms being a slow increase in stiffness and pain. If the patient begins to rest the leg, muscle atrophy develops, the diseased leg becomes thinner than the healthy one, and gait and posture are impaired. It is easier to bend your leg at the hip than to straighten it.

Dangerous Symptoms

If you notice these symptoms, you should see a doctor as soon as possible:

• Pain associated with high fever following trauma, surgery, or manipulation to the hip;
• Joint pain 1-4 weeks after infection;
• Hip pain accompanied by morning stiffness.

All doctors who treat hip pain 424

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Advice before visiting the orthopedist

An orthopedist deals with the diagnosis, prevention and treatment of congenital and acquired malformations of the musculoskeletal system, including the consequences of trauma. There are pediatric orthopedists and adult orthopedists. For children, preventative examinations by an orthopedist are recommended: at 1, 3 and 9 months of age and annually thereafter.

There are no special preparations for a visit to the orthopedist. You should shower hygienically and wear clothes that you can easily remove during the examination. It is very important that you bring any scans and CT scans you have previously taken with you.

Diagnosis of hip pain

Your doctor will tell you which diagnostics you need to undergo. They may be prescribed for you:

• MRI of the hip
• Magnetic resonance imaging of the hip
• X-ray of the joints
• MRI of the hip
• Computed tomography of the hip
• X-ray of the joints
• X-ray picture
• X-ray of the pelvic bones
• Bone scintigraphy of the skeleton.

Moscow orthopedists – reviews

Everything worked out fine. The doctor is competent and courteous. During my visit he explained everything to me, examined me thoroughly and sent me to the right place to solve my problem. I was happy with everything.

The doctor is very nice, friendly, responsible and courteous. I recommend him, you won't regret it.

The visit went well. The doctor explained everything to me competently and gave me a referral. I was given comprehensive advice on how to proceed. His attitude was respectful. He was a pleasant doctor.

A very good doctor. He looked at my MRI scan and gave me advice. He was the best trauma surgeon I have ever seen!

I would like to express my sincere gratitude to the orthopedist and traumatologist Smirnov Aleksey Vladimirovich for his high professionalism, competent treatment and sensitive approach to patients. Aleksey Vladimirovich builds excellent relationships with his patients, conducts thorough examinations, prescribes effective treatment and gives necessary and useful recommendations. I wish Aleksey Vladimirovich good health and continued success in his professional activities!

I got my back from Dr. Get Filippović treated. I am more than satisfied with the result. The doctor selected the right medications, gave me a series of injections and several physiotherapy sessions. I recommend him, he is a very competent and reliable specialist!

The doctor is excellent, very good, professional and very experienced. During the visit, Yuri Vasilyevich did everything necessary, determined the cause, told me much more than necessary. He found other problems, not just the ones I had. He solved all my problems. In the end everything was fine. The consultation lasted approximately 50 minutes. He explained his recommendations and treatment plan to me. I will go to him again.

A very good doctor, I liked him very much. He has good experience, you can see that. I've been to so many doctors and no one could tell me anything. But Gagik Mushegovich, after seeing the MRI, told me what I had. I came from far away, but the doctor helped me a lot.

Very good, on time. The doctor got to know me well, explained everything to me and performed all the procedures and tests I needed. He was a good professional. The clinic is not very expensive and is in a convenient location.

Inability to work due to coxarthrosis.

Coxarthrosis is a progressive disease that sooner or later leads to disability. Doctors at Yusupov Hospital are doing their best to stop the progression of the degenerative process and free patients from disabilities. With grade 2 hip arthrosis, no disability group is formed. In the vast majority of cases, disability occurs with grade 3 osteoarthritis when the affected person can only carry out their work with difficulty or no longer at all.

A severe course of coxarthrosis leads to permanent loss of ability to work. The medical committee for medical and social issues decides which disability group is determined for coxarthrosis. It depends on the severity of the disease and the patient's condition. In most cases, a second disability group is established. This means that the patient is able to care for themselves without outside help. This group includes people who are able to walk with a cane or on crutches. In group 2, those affected can do some work with the help of devices. To receive appropriate therapy, rehabilitation and recovery after coxarthrosis surgery, make an appointment with a rehabilitation specialist at Yusupov Hospital.

Differential diagnosis of hip pain

Pain in the hip joint when walking is the most common complaint that patients present to the doctor with. They can be localized around the joint or radiate into the buttocks, thighs or knee joints. Severe pain in the hip joint when walking leads to the patient having to use a cane. Limitations of movement and pain in the hip joint are noted, especially when turning the lower limbs in and out.

Aseptic necrosis of the femoral head is manifested by pain in the hip joint, gluteal region and groin. The disease is often associated with alcohol abuse and hormone therapy. The deformation of the femoral head is accompanied by limited mobility of the hip joint. In the early stages of the disease, range of motion may be normal.

Patients with hip bursitis experience pain in the front of the hip joint and a clicking sensation when the joint moves. The pain radiates to the hip and is accompanied by paresthesia (burning, tingling) due to compression of the femoral nerve. The patient feels pain in the hip joint when bending and straightening the leg. On deep palpation, the hip triangle (bounded by the inguinal ligament, the inner edge of the cauda equina muscle, and the outer edge of the adductor longus muscle) is painful.

Iliopsoas syndrome is manifested by pain on the outside of the hip joint, accompanied by a cracking sound when moving, and pain in the lateral (outer) part of the knee joint, which increases with movement.

Meralgia Rotha manifests itself as a burning pain in the front outer hip joint and in the hip, which increases when walking and when straightening the leg. Pain in the right or left hip joint occurs with dysplasia. Over time, the patient develops a characteristic 'duck gait'. He rolls from side to side as he walks. Only after determining the exact cause of hip pain do doctors at Yusupov Hospital develop a treatment plan for the patient. Serious cases of the disease in which the patient suffers from dull or acute pain in the hip joint are discussed at a meeting of the expert council with professors, associate professors and doctors of the highest category.

Treatment of hip pain

An important condition for the successful treatment of diseases that cause hip pain is the elimination of factors that cause structural changes in the soft tissues in the joint and articular cartilage. Yusupov Hospital rheumatologists prescribe nonsteroidal anti-inflammatory drugs (NSAIDs) for acute hip pain. Significant improvements in patient well-being can be achieved with topical treatments, that is, with ointments and gels containing nonsteroidal anti-inflammatory drugs. These are used to relieve hip joint pain in trauma, inflammatory soft tissue injuries (synovitis, tendinitis, epicondylitis).

If the treatment is not sufficiently effective, glucocorticoids are injected into the hip joint cavity. Since the joint space is narrowed and difficult to access in deforming coxarthrosis, the rheumatologists at Yusupov Hospital carry out the procedure under X-ray control. If the cause of the pain is inflammation of the muscles and tendons, corticosteroid hormones are injected into the periarticular tissue.

Chondroprotectors (glucosamine and chondroitin sulfate) improve cartilage and relieve pain in the hip joint. These medications are taken over several months. Muscle spasms involved in the movement of the hip joint are relieved by myorelaxing drugs (mydocalm, sirdalud).

Physiotherapeutic treatments for hip pain are of minor importance. They are less effective due to their deep anchoring in the joint, but physiotherapy treatment complements drug therapy. Severe pain in the hip joint is relieved by irradiation with medium-wave ultraviolet light. Inflammation was treated with infrared, low-intensity UHF laser, and high-intensity centimeter wave therapy. Once the inflammation has subsided, the intensity of the pain decreases. High-frequency magnetic therapy, shock wave therapy and ozone therapy stimulate tissue regeneration. When blood circulation and nutrition to the hip joint is impaired, acute pain occurs. Their intensity is relieved by ultrasound, various types of electrotherapy (electrical irradiation) and therapeutic baths.

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