The department of endoprosthetics and traumatology under the leadership of Prof. Dr. Eugen Winter offers a wide range of treatment options for dystrophic-degenerative joint diseases, in particular, for coxarthrosis. Prof. E. Winter and his team possess extensive experience as far as the surgical treatment of knee and hip joints is concerned.
Coxarthrosis (hip cartilage wear) is one of the most common diseases of the musculoskeletal system. It is a chronic disease, characterized by the lasting damage to the joint cartilage, and, therefore, by a considerable limitation of its mobility. To be able to choose an appropriate treatment method, it is essential to know the form and the stage of coxarthrosis, as well as what kind of symptoms the patient suffers from. Hip replacement surgery is often the only way to eliminate severe pain and swelling.
Coxarthrosis refers to a wear of the cartilage in the hip joint and thus a degenerative change of the cartilaginous tissue. Osteoarthritis develops from a mismatch between the load capacity of the articular cartilage and the actual load. Over time, cartilage and other parts of the joint (bone, joint mucosa, joint capsule) are damaged.
Unfortunately, medical science still cannot fully explain the cause of coxarthrosis. There are a number of factors that can provoke the disease, beginning with a sedentary lifestyle and up to various joint injuries and fractures. Almost all ages are prone to this disease. However, coxarthrosis is most often seen in patients over 40. During the initial stages of the disease, it is quite possible to use the so-called sparing treatment methods, i.e. conservative non-surgical treatment. Unfortunately, the majority of the patients tend to ignore the initial coxarthrosis symptoms, such as periodic, nagging pains in the joints, hips, groin and knees, and, therefore, let the disease become chronic without proper treatment measures.
The causes of coxarthrosis are systemic (primary) or acquired (secondary). Primary arthroses are more common, secondary arthrosis can be the result of accidents (eg axial misalignments in the sense of an O- or X-leg, direct cartilage injury), inflammation or even internal diseases (for example rheumatism).
Primary arthrosis is the most common joint disease in humans. Around 75 percent of all 50-year-olds and around 90 percent of those over 70 years old have corresponding joint changes. The joint wear most often affects the hip joint. The primary coxarthrosis usually develops in the second half of life, without the exact cause of the degradation of cartilage is known. After the age of 60, about every second adult is affected, especially women. But not every coxarthrosis needs to be treated, often the degenerative change is only minor and does not affect the quality of life.
At the beginning of the disease is a cartilage cell damage, resulting in the release of cartilage-degrading mechanisms. Inflammation irritates the articular mucosa and produces more joint fluid. It can form an articular effusion. The irritation of the mucous membranes causes pain. The muscles of the thigh and buttocks tense involuntarily, which limits the resilience and mobility of the hip joint. Typical pain in osteoarthritis is onset pain, fatigue pain, and stress pain. Rubbing noises in the joint can be added.
As the disease progresses, pain increasingly occurs even at rest. Joint blockages are another symptom. Later, it comes to shrinkage and scarring of the joint capsule, in extreme cases stiffens the hip joint.
Coxarthrosis is generally divided into three stages: Initially, coxarthrosis patients are suffering from periodic pains, mostly concentrated in their hips, and occurring during or after intense physical exertion. These unpleasant sensations disappear fairly quickly, and patients often ignore them, lacking the appropriate treatment.
During the second stage the pain intensifies and spreads out to the hip and groin areas, causing a feeling of pressure and burning. Now the coxarthrosis symptoms appear both after physical effort and in a state of rest. With prolonged exertion patients become more and more limited in their range of motion. This symptom might also be accompanied by lameness.
Finally, during the third coxarthrosis stage patients suffer from prolonged pains in the hip area. The movement of the affected joints is severely limited, so that patients often have to use walking aids, e.g. a cane, etc. Pain combined with the restriction of movement amplitude leads to a partial atrophy of the thigh, calves and buttocks muscles, which may in its turn cause limb shortening on the affected side.
Diagnostics of coxarthrosis is based on the description of existing symptoms, and usually involves X-rays, which help to determine the stage of coxarthrosis, and sometimes even allow specifying the cause of the disease. Treatment options depend on the stage of coxarthrosis. Coxarthrosis treatment is generally aimed at reducing pains, at avoiding possible inflammations in the affected hip as well as at maintaining the mobility of the joint after the treatment. Early detection and prompt treatment of coxarthrosis play an essential role as far as successful recovery is concerned. As an addition to therapeutic treatment, physicians usually recommend a combination of daily exercise and an individually designed physiotherapeutic course aimed at strengthening the muscles of the hip and pelvic areas.
Leading pain or limited mobility to the doctor, this also asks comorbidities and the individual lifestyle. When reporting hip discomfort, the doctor asks about the pain location in the groin and possible emanations in the thigh to knee directions. Distinctive pain is caused by regularly occurring stress-dependent hip symptoms (isolated or combined with night pain). The clinical examination includes an assessment of external joint shape, leg axis (X- or O-leg), leg length, gait pattern, and range of motion. The posture is assessed and also the overall statics. When examining the gait, the doctor pays attention to the presence of shortening, pain and muscle weakness (Trendelenburg and Duchenne signs).
In addition, functional and pain tests are made and skin and connective tissue are assessed. The doctor looks for redness and swelling, which may indicate a possible inflammation or mass. Circulation is assessed by groin and foot pulses to detect advanced vascular disease. An orienting neurological examination that identifies motor function and sensibility of the lower extremities serves to identify a possible neurological cause of hip pain. A pioneer in the diagnosis of hip osteoarthritis is the X-ray examination of the pelvis. The radiograph shows signs of advanced arthrosis. Sometimes the joint wear is also accidentally detected in the X-ray image, such as a fracture of the femoral neck.
In individual cases, special layer or memory examinations, such as magnetic resonance tomography, computed tomography or scintigraphy can make the diagnosis easier and more precise. Further information on the delineation of the cause can be obtained by examining the blood and synovial fluid.
There is currently no causal treatment of coxarthrosis. Non-surgical treatments aim to reduce pain and improve quality of life, mobility and walking performance. The progression of the disease, however, can be delayed at best. Non-surgical treatment involves the administration of medication. Painkillers and anti-inflammatory drugs may be administered in tablet form or injected locally into the joint. The latter must be done under sterile conditions to prevent infection. When taking anti-inflammatory drugs, the main side effect is the frequent occurrence of gastrointestinal complaints.
Physical applications and exercise therapy are further therapeutic measures. The patient learns physiotherapy exercises (gait training, mobilization, muscle strengthening, muscle stretching and coordination training). Thermal therapy, cold and water therapy and electrotherapy are individually adapted to his needs. In individual cases, the use of orthopedic aids may also make sense.
At the initial stage of coxarthrosis, specialists usually recommend conservative medication treatment, which is a combination of sedative, anti-rheumatic and anti-inflammatory drug-treatment. Physiotherapy is an additional treatment option, which is aimed at strengthening local muscle groups, stimulating metabolism and reducing pains and inflammation, which are as a rule associated with coxarthrosis. Homeopathic medicines, pulsed magnetic field therapy and Orthokin therapy (building of cartilage) belong to alternative treatment methods. In the latter case, for example, the patient's own immune proteins are used as a treatment against cartilage degradation, which is one of the consequences of coxarthrosis.
If the disease has already reached an advanced stage, the only possible treatment is surgery. For example, treatment by hip arthroscopy allows to eliminate the locally limited cartilage damage, associated with coxarthrosis, and to fill existing defects with a substitute material based on the body’s own cells. The newest treatment of light cartilage damage caused by coxarthrosis is the so-called tissue engineering. Here spheroids are used in order to grow and later transplant cartilage tissues. Partial or complete hip prosthetics is often recommended in the latter stages of the coxarthrosis. Treatment by means of an artificial joint implant eliminates the pain and restores the patient’s mobility. The latest generation of prostheses (McMinn prosthetics and Hip-TEP) ensures high stability and durability of the implant after the joint therapy.
If the patient wants to cure coxarthrosis, they must be aware of the fact that the treatment of this disease has no standard pattern. The patient must understand that the treatment is usually symptomatic and, therefore, individual. They should also bear in mind that the main task of coxarthrosis treatment is to reduce disorders of the musculoskeletal system and pain.
The Friedrichshafen clinic is one of the leading centers in Germany, providing a specialized coxarthrosis treatment. You can always rely on the high-quality medical treatment even in the most difficult cases. Experience and professionalism of Friedrichshafen specialists, modern medical technology and individual approach allow creating the best conditions for the recovery of the patient and a pleasant atmosphere during their stay. Don’t hesitate to contact us under the number +49 7541 97 82 751 or via email .
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