Bilateral Coxarthrosis

Generality

Bilateral coxarthrosis is osteoarthritis in both hip joints.

Typical of advanced age, bilateral coxarthrosis can be an idiopathic condition - that is, that arises without recognizable causes - or a secondary condition, that is supported by a very specific factor; the causative factors of secondary bilateral coxarthrosis include diseases such as congenital dysplasia of the hip, trauma to the hip, obesity, diseases of the cartilage, etc.

The typical symptoms of bilateral coxarthrosis consist mainly in: pain in the hips exacerbated by physical activity, stiffness in the hips, lameness and limited joint mobility by the hips.

The therapy of bilateral coxarthrosis varies in relation to the severity of the symptomatology present: for a bilateral symptomatic bilateral coxarthrosis, a conservative treatment may suffice; for severely symptomatic bilateral coxarthrosis, however, surgical therapy is required.

Brief anatomical recall of the hip

Equal anatomical element, the articulation of the hip (or more simply hip ) includes a skeletal scaffold, to the support and mobility of which various ligaments and a series of muscles contribute.

The bony constituents of the hip are the femur (thigh bone) and the iliac bone (one of the bones of the pelvis). The femur contributes with its proximal region, precisely with the so-called femoral head and the underlying neck of the femur ; the iliac bone, instead, participates with a portion similar to a cavity, called acetabulum .

The hip is among the largest joints in the human body and belongs to the articular family of the so-called enartrosis . Extremely mobile, arthrosis are joints resulting from the housing of a convex bone portion in a concave bone portion; moreover, they are provided with synovial fluid and layers of cartilage (" articular cartilage "), whose purpose is, for both, to reduce interosseous frictions and impact shocks (if absurdly they were devoid of such elements, the convex bone portion and the concave bone portion would rub against each other so as to deteriorate each other).

The hip is fundamental for the motor skills of the human being; thanks to her, in fact, an individual can take up a standing position, walk, run, jump, etc.

What is bilateral coxarthrosis?

Bilateral coxarthrosis is a chronic inflammatory disease, which affects both hip joints and is characterized by progressive and inexorable degeneration of articular cartilage; the latter, as mentioned, serves to protect the bony portions constituting the hip from rubbing and subsequent deterioration (think of the articular cartilage as a protective pad).

Meaning of coxarthrosis

In medicine, coxarthrosis is synonymous with osteoarthritis of the hip .

Very famous pathology, arthrosis or osteoarthritis is the most common type of arthritis in humans.

To distinguish it from the other degenerative inflammatory processes, which can affect the joints, is the progressive deterioration of the articular cartilage.

Epidemiology

According to statistics, bilateral coxarthrosis is a disease whose onset tends to increase in parallel with age; in other words, it is associated with aging.

This is not surprising, given that osteoarthritis is a phenomenon typical of old age.

Unilateral coxarthrosis

Coxarthrosis can also affect only one of the two hip joints. In these circumstances, the most appropriate medical term for defining the present inflammatory condition is unilateral coxarthrosis .

Note: sometimes, the term coxarthrosis is used as a synonym for unilateral coxarthrosis and this can create confusion.

However, the bilaterality of coxarthrosis is always specified.

Causes

From a physiopathological point of view, the cause of bilateral coxarthrosis lies in the degenerative process discussed in the previous chapter and which specifically concerns the articular cartilage of the hip. This degenerative process, in fact, involves the thinning of the articular cartilage and the subsequent anomalous rubbing of the bone portions constituting the hip.

Forms of bilateral coxarthrosis

Based on the triggering causes, bilateral coxarthrosis can be distinguished in two forms: idiopathic bilateral coxarthrosis and secondary bilateral coxarthrosis.

IDIOPATIC BILATERAL COXARTROSIS

In medicine, the term idiopathic, associated with a pathological condition, indicates that the latter has arisen for unrecognizable reasons (in general, it is said "for unknown causes").

Therefore, idiopathic bilateral coxarthrosis is that form of bilateral coxarthrosis in which the causal factors are unknown and unrecognizable.

Epidemiology of idiopathic coxarthrosis

48% of cases of mono- and bi-lateral coxarthrosis are of an idiopathic nature.

SECONDARY BILATERAL COXARTROSIS

In the medical field, the secondary term, combined with a pathology, indicates that the onset of the latter is due to a very precise and recognizable cause.

Thus, secondary bilateral coxarthrosis is the form of bilateral coxarthrosis whose origin is a specific pathological condition.

Among the diseases that can potentially cause bilateral coxarthrosis, include:

Congenital dysplasia of the hip;
Congenital hypoplasia of the acetabulum;
Acquired hip dislocation;
Congenital diseases of cartilage;
The strong bilateral traumas to the pelvis, culminating in the fracture of the two iliac bones or of the acetabulum;
Hip deformities known as coxa vara and coxa valga; these deformities can be congenital or acquired;
Bilateral osteonecrosis affecting the acetabulum of the femur;
Obesity.

Epidemiology of secondary coxarthrosis

52% of cases of mono- and bi-lateral coxarthrosis are secondary.

Risk factors

The list of risk factors of bilateral coxarthrosis is long and includes: advanced age, belonging to the female sex, a past history of bilateral injuries to the hip joint, a sedentary lifestyle, the overweight / obesity binomial, the diabetes, the presence of other forms of arthritis (eg: rheumatoid arthritis or gout), cigarette smoking, hypothyroidism, hemophilia, osteoporosis and an unhealthy diet.

Symptoms and complications

The typical symptoms of bilateral coxarthrosis are:

Pain at the level where the two hip joints are located in the human body. This pain becomes more intense with physical activity, especially if the latter is vigorous;
Pain in the immediate vicinity of the hip joints (eg: groin, anterior part of the thigh);
Sense of rigidity on the sides. This sensation is more pronounced when awakening from nocturnal sleep (in other words, when one gets up from the bed) and after long periods spent in a sitting position;
Limitation in the movements of both hips. Often, this limitation is linked to the pain that creates the movement of the hips;
Lameness;
Swelling at the joints of the hips;
Noises, similar to crunches, coming from inside the hips. Generally, it is the movement of the hips that causes the emission of these noises.

Symptomatic stages of bilateral coxarthrosis

Based on what was established by the doctors, bilateral coxarthrosis (NB: on a par with the unilateral one) can be divided into three symptomatological stages, identified simply with the terms "first stage", "second stage" and "third stage".

First stage: represents the initial and less severe stage of bilateral coxarthrosis.
In this phase of the disease, the patients suffer from periodic pains in the hips, triggered, more often than not, by a moderate / high intensity physical activity.
At the first stage, bilateral coxarthrosis is a somewhat devious condition; with rest, in fact, the painful sensation caused by it tends to disappear quite quickly and almost completely, and this leads those directly interested to neglect the symptomatology of which they were recently victims, with obvious repercussions on a possible early diagnosis of problems joint.
Second stage: it is the intermediate stage of bilateral coxarthrosis.
In this phase of the illness, pain takes on new connotations: first of all, it becomes more intense; secondly, it involves a wider anatomical area, including the inguinal area and the anterior part of the thigh; thirdly, it can sometimes be associated with an unusual sense of pressure or burning; finally, it can appear not only after physical exertion, but also at rest.
The intensity of the pain characterizing the second stage of bilateral coxarthrosis is such that patients find it very difficult to perform certain movements with the lower limbs; in other words, the pain produced by bilateral coxarthrosis in the second stage affects the joint mobility of the hips.
Third stage: represents the final stage, as well as the most serious of bilateral coxarthrosis.
In this phase of the disease, the pain becomes very intense, takes on a chronic character and affects an extended anatomical area.
Patients with bilateral coxarthrosis in the third stage struggle so much to move their hips, due to pain and stiffness, which find even difficult physical activities difficult, such as walking, climbing or using a bicycle.

Complications

In its most advanced stage (third stage), bilateral coxarthrosis can drastically affect the quality of life of patients; in fact, the intense pain that characterizes the third symptomatic stage of the disease can force physical inactivity such as to cause, on a physical level, the progressive atrophy of the leg muscles and, on a psychological level, a depressive and remarkable state of discomfort (the patient realizes that he must depend on others even on the occasion of the simplest physical activities and this demoralizes him).

When should I go to the doctor?

The presence in those who are at risk of bilateral coxarthrosis of suspected pains in the hip joints, especially after a physical activity, is an excellent reason to contact your doctor, in order to investigate the situation.

It is important to inform readers that the identification of a bilateral coxarthrosis at an early stage (first stage) can have several positive implications: among all, a less invasive treatment and a lower tendency for the patient to develop complications.

Diagnosis

As a rule, the diagnostic pathway that leads to the identification of bilateral coxarthrosis begins with the physical examination and the medical history . Therefore, also based on what emerged from these two tests mentioned above, it can continue with a series of diagnostic imaging tests (including X-rays at the hip, magnetic resonance of the hip and ultrasound of the hip), blood analysis and an arthroscopy for diagnostic purposes.

Physical examination and medical history

During the physical examination and the anamnesis, the doctor takes note of the symptomatology exhibited by the patient and, through a critical study of the latter, tries to understand the possible reasons.

Although they require assessment, physical examination and anamnesis are essential to understand whether the symptoms present depend or not on an affection of the hips.

Diagnostic imaging tests

Although with different technologies and physical principles, the diagnostic imaging tests show in a rather detailed manner the various articular components of the hips (acetabulum, femoral head, ligaments, articular cartilage, synovial fluid, etc.); this allows the doctor to study the health of these joints, ascertaining, in the case of bilateral coxarthrosis, the presence of a degeneration of the articular cartilage.

Diagnostic arthroscopy

Arthroscopy for diagnostic purposes is a minimally invasive surgical procedure, exploited by doctors when previous diagnostic tests have provided meager useful information and doubts remain to be clarified on the precise causes of the symptoms in progress.

From a purely practical point of view, arthroscopy for diagnostic purposes consists in observing the painful joint from the inside, by means of a technological instrument equipped with a video camera, light source and connection cable to a monitor (on which the aforementioned camera reproduces what "observes"); the instrument in question is known as an arthroscope .

Therapy

The therapy of bilateral coxarthrosis depends mainly on the symptomatological stage of the affection to the present hips. In fact, in the presence of a bilateral coxarthrosis at the first stage (mild symptoms, pain only after intense physical activity, etc.), the choice of doctors usually falls on a conservative (or non-surgical) type of treatment ; on the contrary, in the presence of a coxarthrosis at a medium-advanced stage (severe pain at rest, chronic pain, severe motor deficits, etc.), the most popular option for doctors is a surgical treatment.

Conservative therapy

Before proceeding with the description of the conservative therapy of bilateral coxarthrosis, it is necessary to point out that this treatment represents only a remedy against the symptomatology and not against the degeneration of the articular cartilage; in other words, it limits the symptoms (providing relief to the patient), but does not stop the inexorable progressive deterioration to which the articular cartilage is subjected, as a consequence of arthrosis.

Possible conservative remedies for bilateral coxarthrosis include:

So-called non-steroidal anti-inflammatory drugs (NSAIDs). The most prescribed NSAID in these circumstances is ibuprofen;
Painkillers, to reduce the painful sensation triggered by intense physical activity;
The suspension of all those activities that favor the appearance of pain . There are alternative activities, whose execution does not involve annoyance, malaise, etc .;
Physiotherapy, for strengthening and lengthening the muscles of the lower limbs;
Injections of hyaluronic acid .

Conservative therapy

Surgical treatment of bilateral coxarthrosis includes two different procedures:

the intervention in arthroscopy for the remodeling of the articular cartilage;
hip replacement surgery .

Arthroscopic surgery for the remodeling of articular cartilage is a minimally invasive surgical procedure, which doctors use when bilateral coxarthrosis is in the intermediate stage and does not respond in any way to conservative treatment.

The hip replacement procedure, on the other hand, is a very invasive and delicate surgical procedure, which doctors perform only in the presence of very serious bilateral coxarthrosis that does not correspond to any of the previous treatments mentioned above (including arthroscopy).

Prognosis

Like all forms of osteoarthritis, bilateral coxarthrosis is a chronic disease, with a tendency to continuous deterioration. Therefore, it is destined to always have a negative prognosis or, at least, not a positive one.

It is good, however, to point out that, today, thanks to the continuous progress of medicine, patients with bilateral coxarthrosis can count on effective treatments, capable of significantly improving their quality of life, despite the presence of a chronic disease.

Prevention

The only feasible prevention against bilateral coxarthrosis is that towards secondary forms and consists in the elimination of modifiable risk factors (eg: obesity, smoking, sedentary lifestyle, diabetes, etc.).