Coxarthrosis
It is the localization of degenerative rheumatism in the hip joint.
It’s a common condition and is the most disabling of arthritis.
Etiology
Primary Coxarthrosis
Secondary Coxarthrosis (55% of cases)
TREATMENT
Specific drug treatment may involve several groups of drugs that can be administered systemically or topically. The use of anti-inflammatory and pain-relieving drugs should be used with great discretion in patients with coxarthrosis.
Systemic therapy:
common analgesics such as acetaminophen are initially used for pain control
opioid analgesics, tramadol may be used for short periods of time for very severe joint pain, that could not be controlled by other means
pathogenic medication – the so-called structure-modifying drugs (glucosaminophosphate, chondroitinsulphate, diacerin, piasledin) are theoretically the ideal medication in arthrosis, the only one able to prevent joint destruction and restore the structure of cartilage. For the time being, they are considered only as nutritional supplements.
Intra-articular therapy: joint infiltrations with cortisone preparations must be performed under fluoroscopic guidance and with great discernment due to the danger of aseptic necrosis of the femoral head
Topical therapy:
Capsaicin taken in cream form inhibits the release of substance P from nerve endings and may relieve joint pain
Methyl salicylates
PHYSICAL-KINETIC TREATMENT
Physical-kinetic treatment must be individualized for each patient and constantly adapted to the stage of the disease.
Objectives:
Elimination or improvement of pain;
Prevention, elimination or improvement of inflammation;
Maintenance or improvement of joint stability and mobility;
Maintenance or improvement of muscle strength and endurance;
Improvement of quality of life
Patient and family education
ELECTROTHERAPY
Electrotherapy for its pain-relieving, anti-inflammatory, vascularization and local tissue trophicity improving effect:
- galvanic current either in the form of simple galvanization or ion galvanization
- low frequency currents: CDD, TENS, C Trabert
- medium frequency currents
- laser
- short-wave pulsed athermic, microwave
- ultrasunet
- slides
THERMOTHERAPY
- Local thermotherapy to control pain and increase soft tissue compliance in order to establish a physiotherapy program
- paraffin packs, electric pillow applied 1-3 times a day
- in case of a local inflammatory reaction apply cold compresses with magnesium sulfate 60g/l; local ice massage repeated several times during the day;
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MASAJ
For its analgesic, myorelaxant/tonic (depending on the maneuvers used), vascularization improvement and local tissue biotrophic effect:
the patient’s positioning is particularly important because each position allows a better approach to the different structures to be massaged
massage maneuvers address all structures: skin, subcutaneous cellular tissue, fasciae, tendons and muscles
the massage session ends with manual traction performed in the axis of the lower limb; traction and traction and traction are performed in correlation with the respiratory rhythm (favors circulation and local troficity)
KINESIOTHERAPY
It is made according to the clinical-anatomo-functional stage of the disease.
There are 3 different stages:
Initial stage (SI)- pain in orthostatism and during prolonged walking, local musculo-articular “fatigue”, reduction of the maximum (“de lux”) hip amplitudes.
Advanced stage (SE) – pain at rest, joint stiffness in the area of current use amplitudes, vicious attitudes that can be corrected passively or even actively.
Final stage (FS) – intense pain, marked limitation of mobility to the point of ankylosis, irreducible vicious attitudes.
Hip function is assessed on the basis of muscle and joint tests as well as global tests.
The kinesiotherapeutic program has 4 main objectives:
decrease pain;
increase hip stability;
increase hip mobility;
increase coordination and balance while walking.
Examples of exercises:
1.Example of passive mobilization for the extension movement
General rule: during forced extension of the coxofemoral joint the knee remains extended.
The patient in supine position, with the opposite lower limb flexed maximally (knee with thigh on the chest); strong tilting of the pelvis itself extends the affected joint and eventually the assistant emphasizes the extension. In autopassive mobilization, the patient holds the knee of the opposite limb to the chest with the hands, the affected limb lying on an inclined plane.
2. Example of exercise for hamstring toning
Patient in supine position, with flexed coxofemoral joint, knee almost extended (knee position is important – the knee should not be fully extended, but only as far as the hamstrings are in action); the patient extends the thigh, the physiotherapist checks at the heel.
3. Sample exercise for toning the quadriceps muscle.
The patient is seated, with the lower limbs hanging at the edge of the bed; knee extension is performed with a weight hanging at the ankle.
4. Example of an exercise for toning the triceps suralis muscle.
Patient supine, with the lower limb extended and ankle in dorsal flexion; the physiotherapist grasps the heel on its posterior aspect and resists the patient’s attempts to extend the leg. As there is no resistance on the toes or forefoot, only the sural triceps will come into activity.
5. Sample exercise for toning the gluteus medius.
The patient in contralateral decubitus, with the opposite lower limb flexed and the affected limb with the knee flexed; the patient performs abduction while the physiotherapist provides resistance on the lateral aspect of the knee.
Occupational therapy will take into account the avoidance of orthostatism; exercises on ergometric bicycle through normal pedaling and back pedaling; exercises on a board with wheels;
Hydrokinetotherapy – advantage of weight relief, mild sedative effect, myorelaxant: postural for flexum – TFNP contraction-relaxation, passive, active mobilizations, re-education of stability, balance and coordination;
Complementary methods: cane, Canadian crutches
The kinetic exercise program established for the recovery of coxarthrosis is much more complex and involves the establishment and monitoring of certain steps depending on the evolution and pathology of the disease.It must also be carried out under the supervision of a specialist to avoid possible complications and for the recovery to be complete.
Long-term management (including adaptation to the home environment, initiation of an outpatient or home rehabilitation program, in-resort treatment, etc.)
It is particularly important to educate the patient to follow the secondary prophylaxis rules that make up the “orthopedic hygiene” of the hip:
Maintaining a normal body weight
Avoid orthostatism and prolonged walking
Avoiding walking on uneven ground, going up/down stairs
Walking with cane support that is placed on the ground on the same line with the affected leg; for SI and SE as for most cases of FS – in the opposite hand; in severe cases of FS with severe pain and dysfunctionality – in the homolateral hand;
Avoiding limping through voluntary gait control
At least twice a day – postural rest in bed with the coxofemurals extended
Cycling will be preferred
Wear shoes with soft heels
Correction of unevenness of the lower limbs (from 2 cm upwards)
A special hip gymnastics program consisting of mobilization and muscle toning exercises will be performed at least twice a day
Sports: swimming, cycling, skiing, horse riding
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