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Coxarthrosis: Causes, Symptoms & Treatment

Coxarthrosis is a degenerative disease of the hip joint in which the articular cartilage gradually breaks down, causing pain, stiffness, and reduced mobility.

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Things worth knowing about "Coxarthrosis"

Coxarthrosis is a degenerative disease of the hip joint in which the articular cartilage gradually breaks down, causing pain, stiffness, and reduced mobility.

What is Coxarthrosis?

Coxarthrosis (also known as hip osteoarthritis) is a degenerative joint disease affecting the hip joint. It is characterized by the progressive breakdown of articular cartilage, the smooth tissue that cushions the ends of the bones in a joint. Over time, the underlying bone, joint capsule, and surrounding muscles may also be affected. Coxarthrosis is one of the most common causes of chronic hip pain, particularly in older adults.

Causes

Coxarthrosis is classified as either primary or secondary:

Primary Coxarthrosis

In the primary form, no single identifiable cause is found. It typically results from a combination of genetic predisposition, age-related wear and tear, and prolonged mechanical stress on the joint.

Secondary Coxarthrosis

The secondary form develops as a consequence of other conditions or factors, including:

Hip dysplasia (congenital malformation of the hip joint)
Perthes disease (avascular necrosis of the femoral head in childhood)
Femoral neck fracture
Rheumatoid arthritis or other inflammatory joint diseases
Obesity and excess body weight
Repetitive overloading of the joint, e.g., due to competitive sports or heavy physical labor

Symptoms

The symptoms of coxarthrosis typically develop gradually and worsen over time:

Pain in the hip, groin, thigh, or knee, especially during activity or after periods of rest (start-up pain)
Joint stiffness, particularly in the morning or after prolonged sitting
Reduced range of motion, for example when bending, rotating, or abducting the leg
Limping or altered gait pattern
Audible joint sounds such as creaking or clicking
In advanced stages, resting pain and pain at night

Diagnosis

The diagnosis of coxarthrosis is usually made through a combination of clinical assessment and imaging:

Medical history: Assessment of symptoms, risk factors, and previous conditions
Physical examination: Evaluation of range of motion, pain localization, and gait
X-ray: The gold standard for identifying joint space narrowing, bone changes, and osteophyte formation (bone spurs)
MRI (Magnetic Resonance Imaging): Used when more detailed assessment of cartilage and soft tissue is needed
Blood tests: To rule out inflammatory causes such as rheumatoid arthritis

Treatment

Treatment of coxarthrosis aims to relieve pain, preserve mobility, and improve quality of life. It encompasses both conservative and surgical approaches:

Conservative Treatment

Physiotherapy: Strengthening of the hip-surrounding muscles and improving range of motion
Pain medication: Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or diclofenac for short-term pain relief
Weight management: Reducing body weight to decrease stress on the joint
Heat and cold therapy: To relieve stiffness and reduce pain
Assistive devices: Walking canes, orthopedic insoles, or adapted footwear
Intra-articular injections: Corticosteroids or hyaluronic acid may be used for temporary pain relief

Surgical Treatment

When symptoms are severe and conservative measures are insufficient, surgery may be required:

Total hip replacement (THR): Replacement of the entire hip joint with an artificial implant – the most effective procedure for advanced coxarthrosis
Osteotomy: Corrective surgery to realign the joint and redistribute load, primarily considered in younger patients

Prognosis and Outlook

Coxarthrosis is a chronic progressive condition that cannot be cured. However, early treatment and lifestyle modifications can slow disease progression and significantly improve quality of life. When a total hip replacement is performed at the appropriate time, the prognosis for pain relief and restored mobility is generally very good.

References

Altman R et al. – The American College of Rheumatology criteria for the classification and reporting of osteoarthritis of the hip. Arthritis Rheum. 1991;34(5):505-514.
National Institute for Health and Care Excellence (NICE): Osteoarthritis: care and management. Clinical guideline CG177 (2014, updated 2022). Available at: www.nice.org.uk
World Health Organization (WHO): Musculoskeletal conditions. Available at: www.who.int/news-room/fact-sheets/detail/musculoskeletal-conditions

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