Hip osteoarthritis. Clinical and social aspects of disease. Analytical review of the literature. Part I

V.O. Fischenko, V.I. Kirichenko, S.Yu. Yaremin, O.Yu. Branitsky, O.D. Karpinskaya


Among the many forms of articular pathology, the most common is osteoarthritis (OA), which affects every fifth human. According to population surveys, the frequency and prevalence of OA increase 2 to 10 times in the age from 30 to 65 years. Osteoarthritis is manifested in most people over the age of 65 years and virtually in every person after 75–80 years. The paper considers the clinical and social aspects of hip OA during long-term course of the disease. Development of methods for conservative and surgical treatment of coxarthrosis is considered in the historical aspect. Through the consideration of the features of the anatomical structure of the lower limbs, the concepts of the causes of hip joint diseases, the main difficulties that arise during endoprosthetics and the causes of unfavorable outcomes of arthroplasty are described. It is known that coxarthrosis can be divided into rapidly progressive (aseptic necrosis of the femoral head, femoral neck fracture, posttraumatic coxarthrosis) and slowly progressive (dysplastic and idiopathic coxarthrosis). Often, the cause of coxarthrosis is congenital hyperplasia of the hip joint or its ends. The facts of the progression of the joint destruction process are known, but most doctors continue to adhere to expectant management that leads to an increase in the number of severe forms of the disease in advanced stages. Severe coxarthrosis is clinically accompanied by significant pain syndrome. This forces a person to spare the diseased limb, to shorten the time of support on her, with time it leads to pathological walking. In the absence of adequate medical care in the preoperative period, the patient develops contractions (muscle spasms), which leads to reflex pelvic distortion, curvature of the spine and increased walking asymmetry. Patients have worsened biomechanical parameters of the hip joint, which manifests itself in the asymmetry of weight loads on the foot, acceleration of oscillations of the general center of gravity of the body, reduced length of steps, disturbances of walking rhythmicity, etc. In further development of the disease, patients are forced to use additional support — canes, crutches. Lameness is not just a bad habit, but an adaptive response of the body. The endoprosthetic surgery is aimed at relieving pain and restoring the range of movements by rebuilding or reconstructing the dysfunctional joint. However, after surgery, many people have an antalgic gait, or an adapted walking pattern to avoid postoperative pain, and although the normalization of walking should occur 6 months — 1 year after the operation, many patients still have pathological walking. This peculiarity of walking is not suitable for the full functioning of endoprostheses and can significantly reduce their life and quality of patient’s life. Correctly conducted pre- and postoperative rehabilitation in patients with coxarthrosis is a guarantee of a good result of endoprosthetics. In the case of insufficiently active rehabilitation, the patient’s adaptation after the surgery is slow and may turn out to be incomplete. The authors of many papers stress the importance of an individual approach to rehabilitation, in which a physiotherapist, a doctor of physical therapy, and a psychotherapist take part. In recent years, a number of works on the rehabilitation after the lower limb joint replacements appeared abroad, in which the authors insist not only on the functional necessity of periodic rehabilitation, but also emphasize the significant economic efficiency of such activities.


osteoarthritis; hip joint; endoprosthetics; review


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