Coxarthrosis: definition, symptoms, cause and treatment

By Cristiano Antonino On Apr 7, 2023

Coxarthrosis is the medical term to indicate that particular type of arthrosis that affects the hip district, leading to a lesion and possible consequent inflammation of the joint or a specific part of it

Coxarthrosis is a chronic and progressive pathology, from which there is no cure

Hip osteoarthritis is widespread worldwide. Although typical of elderly subjects, it is less and less rare that it already suffers from it at a young age, especially if the patient has been subjected to intense and repeated efforts over time.

Generally, the first symptoms of coxarthrosis appear between the ages of 50 and 60, especially affecting the female population, because they have less resistant cartilage and are more subject to hormonal changes.

The hip is to date the joint most commonly affected by the rheumatic disease of osteoarthritis, probably because it is also the most used in the entire body.

Suffice it to say that most of the daily activities that our body is able to do pass through this anatomical area, which is therefore constantly subjected to strain.

Coxarthrosis, what is it?

Coxarthrosis is a particular type of osteoarthritis in which the target of the pathology is the cartilage that covers the femoral head, which lays the foundations for a deterioration process that affects the entire coxo-femoral area.

As already mentioned, the hip is the most important joint in the body, the one that is most subjected to loads and microtraumas.

It joins the lower limb to the trunk, connecting the femur to the acetabulum, i.e. the iliac bone of the pelvis.

Good hip health is essential for maintaining an upright position and for correct movement of the lower limbs.

As for the whole body, the hip cartilage has a bearing function that allows the sliding of the bones close to each other without generating friction and rubbing during movement.

When this resource is injured, the friction increases and a more or less intense inflammatory state of the surrounding tissues can result (subchondral bone – i.e. the one located directly under the articular cartilage -, but also tendons, ligaments and muscles).

In the more advanced stages of coxarthrosis, the bones can become deformed due to the presence of osteophytes, the typical bone growths in the shape of a bird’s beak that are generated as an attempt by the joint to repair the area.

When the joints are subjected to excessive trauma or effort, in fact, the body, in an attempt to repair the damaged tissues, stimulates the production of chondrocytes (cartilaginous cells) and osteocytes containing particular enzymes.

When the balance is altered, these enzyme products damage the cartilaginous and joint surface, making it rough and inflamed.

Hip osteoarthritis is the main cause of crunching, pain and difficulty walking in the groin area

It is advisable, even if you are faced with mild symptoms and pain, to notify your doctor: diagnosing coxarthrosis in time means trying to slow down the degenerative process and avoiding as much as possible the use of surgery with a prosthesis implant.

Types of coxarthrosis and stages of severity

Medicine has to date identified various classifications of coxarthrosis identified on the basis of the severity of the disease, the previous pathologies from which it may have arisen, or the extension of the anatomical area involved.

Primary coxarthrosis is typical of advanced age and physiological aging of the joints.

After these are subjected to loads for many years, it is easy for osteoarthritis to appear without a specific cause.

When a precise and defined triggering cause is not identified, we can also speak of idiopathic coxarthrosis.

Secondary coxarthrosis, on the other hand, occurs when hip arthrosis is the consequence of other bone or joint pathologies, such as joint dysplasia, previous fractures, inflammatory or septic arthritis/osteomyelitis.

If coxarthrosis affects only one hip, it is defined as unilateral. It becomes bilateral when the cartilage breaks down on both sides of the body.

A further classification of the types of coxarthrosis takes into consideration the severity of the symptoms.

You suffer from coxarthrosis in the first stage, the least severe and debilitating, when you have sporadic pain in the hip.

In most cases, it appears after excessive physical exertion, such as intense sporting activity.

Coxarthrosis at this stage is of little concern to patients because, with rest of the joint, the pain disappears quickly and almost completely, causing the symptoms to be completely neglected.

A second stage hip osteoarthritis is an intermediate level. The symptoms are more intense and present not only after an effort, but also at rest.

The pain is often not only traced back to the hip but to the entire groin area and the front of the thigh.

It can be accompanied by a burning sensation and a sense of pressure.

The patient may begin to experience difficulty in carrying out some activities.

Reaching the third stage means having coxarthrosis with chronic and intense pain.

The joint movements become increasingly reduced and the patient finds it difficult to carry out even simple daily activities, with the risk of progressively reaching muscle atrophy.

In these cases, the musculature shrinks and stiffens because it is not adequately moved.

Coxarthrosis, risk factors and causes

Below we present a list of all those risk factors recognized to date that can facilitate the development of coxarthrosis, whether mild or severe:

Overweight or obesity: a body weight that is too high compared to the lift and resistance of your joints acts as a real continuous overload on them and on the cartilage.
Sedentary life without physical exercise: as with all joints, the coxo-femoral joint also needs its natural lubricant which comes directly from sporting activity. A life spent on the sofa only stiffens the bones and other tissues which, in the long run, are compromised.
Heredity and genetics: if you are the child of parents who suffer from coxarthrosis or other types of arthrosis and joint pathologies, then you have a better chance of developing it in the future.
Age: as a natural consequence of the physiological aging of the individual and of all his organs, systems and vital apparatuses, bone and cartilaginous tissue also weaken with age.

This is why most people with coxarthrosis are over the age of 70.

The presence of other joint diseases such as hip dysplasia, femoroacetabular impingement, rheumatoid arthritis and gout are risk factors for the development of secondary coxarthrosis.

Joint and/or bone infections at the hip complex.

The same applies to traumas and fractures suffered or to surgical interventions already carried out on this joint.

As already defined, even in these cases we will speak of secondary arthrosis.

There is rarely only one cause of coxarthrosis: more and more often it is given by a combination of various risk factors combined with a bad lifestyle.

Coxarthrosis: associated symptoms

The typical symptoms of coxarthrosis are different and of variable intensity depending on the stage of severity in which the disease occurs.

It is essential, for the purposes of early diagnosis and subsequent minimally invasive conservative interventions, not to underestimate the symptoms as soon as they appear, even if they are mild and sporadically present.

Not treating this type of arthrosis immediately can become a serious problem for walking and future well-being.

Ache. Talking about osteoarthritis means talking about pain in the bones and joints.

The pain is mainly due to bone rubbing.

Feeling pain in movements that require the use of hips and pelvis is probably the first symptom that a coxarthrosis is in progress.

Often the discomfort can extend to the groin area, including the thighs, sacrum and buttocks.

The characteristic pain in the hip is called coxalgia.

Pain, tingling and soreness after being still for a long time (e.g. when you wake up in the morning).

It happens because the hip muscle, called ileo-psoas, becomes stiff and inflexible and needs time before regaining its physiological mobility.

This situation generally improves after a few minutes of movement, until it becomes imperceptible.

Pain at night. This is especially felt if the hip joint has been strained for a long time during the day, causing ongoing inflammation.

A contracted iliopsoas can also lead to pain in the knees and back.

In fact, this muscle, with its shape very similar to two braces, connects the trunk to the lower limbs and governs the mobility and flexibility of the surrounding bones and joints.

For this reason, when it is too contracted, it stiffens the whole coxo-femoral area.

Difficulty walking is a typical symptom of coxarthrosis in an already advanced stage.

Similarly, the resulting reduced joint mobility is very disabling because, by affecting the hip, it also greatly affects the performance of normal daily activities, leading those affected to a constant sense of physical and psychological discomfort.

How coxarthrosis is diagnosed

If you have obvious symptoms of coxarthrosis or suspect that they may be caused, you should promptly notify your doctor.

It should be remembered that an early diagnosis of the pathology can cause the various pharmacological therapies present today to slow down the evolution of the pathology, making the pain disappear and improving joint function.

Catching the disease in time also means trying to avoid an unfortunately invasive surgery, for partial or total hip replacement.

The road to diagnosis passes through an objective examination first by your own doctor, then by an orthopedic or rheumatologist specialist.

During the specialist visit, the patient’s clinical history is reviewed and his symptoms are studied.

Where the doctor hypothesizes coxarthrosis, he can carry out an active and passive movement test of the hip in order to identify which movements bring pain and which do not.

Similarly, the crepitus test observes the presence of any crunches present during movement, while the observation of walking helps to see if the patient walks correctly and maintains an adequate upright posture.

To allow for a correct differential diagnosis and to investigate the extent of the damage more thoroughly, the specialist may decide to request some diagnostic imaging techniques, in order to have a more complete view of the pathology, in order to better plan the possible methods of intervention.

Therefore, a hip X-ray as well as an MRI or an ultrasound become useful to see how the joint is and evaluate the extent of cartilage wear.

Arthroscopy, performed by an orthopedic specialist, is slightly more invasive (a small tube equipped with a camera is inserted near the hip to be observed), it also helps to evaluate the health of the connective tissues that affect the entire joint, such as ligaments, tendons and muscles.

It may happen that, using the same arthroscopic technique, the doctor inserts a particular tube in the side for the aspiration of the joint fluid.

Extracted directly from the joints and taken to the laboratory to be analyzed, arthrocentesis with examination of the synovial fluid is the procedure that most of all provides a complete and detailed picture of the state of health of the hip.

Coxarthrosis: treatments and prevention

As with all other types of osteoarthritis, to date there is no cure that is totally conclusive for hip osteoarthritis.

In fact, the pathology remains chronic, even if the therapies capable of slowing down its progression and reducing its negative effects such as pain and poor mobility are increasing.

The pharmacological treatments existing today are based on pain therapy

In cases of mild or intermediate coxarthrosis, the doctor can administer analgesics (paracetamol) or non-steroidal pain-relieving drugs (NSAIDs, such as ibuprofen) to be taken orally or parenterally, although lately there are many patients who use them in the form of creams and lotions to be applied directly to the affected joint.

These are therapies that relieve pain but do not resolve the pathology and do not restore worn cartilage.

Conservative therapy can also include corticosteroid drugs whose anti-inflammatory power is high but, being based on cortisone, they have many side effects.

It is a therapy to be considered as a last resort, when other medicines do not relieve the pain and when the doctor is certain that there is an important inflammatory process underway.

Modern infiltrations based on hyaluronic acid act temporarily restoring the cartilage, decreasing pain and restoring some mobility.

In fact, hyaluronic acid acts as a lubricant, decreasing the friction between the bones but, as with drugs, it is often a temporary remedy.

The patient is advised to perform several cycles of infiltrations during his life.

If the coxarthrosis is severe and negatively affects the individual’s walking, the only possible way is surgery.

There are currently two types of surgery

Resurfacing: the surfaces of the acetabulum and femoral head are replaced with metal shell prostheses. It is used when the damage is serious but not extensive, in fact it does not require the total change of the joint.
Arthroplasty: here the replacement is total, the whole acetabulum and the femoral head are transferred and replaced with titanium prostheses. The approach is invasive and to be used only in the most severe cases. Furthermore, the prostheses have a limited duration of about 20 years, for this reason the intervention in young people tends to be postponed, in order to avoid other surgeries in the future.

Properly performed exercise can be an excellent weapon in relieving symptoms.

Muscle reinforcement, stretching and posture correction make it possible to reduce the load on the hips, relaxing the joint more and making it less painful.

The result will be a state of well-being for the whole organism.

If you have coxarthrosis it is good to keep moving, but avoid running, jogging, tennis and all those activities that excessively strain the hip joint, lower limbs and ileo-psoas muscles.

It is advisable to prefer swimming and cycling which are full-bodied but low-impact activities.

If the arthrosis is mild, the use of crutches is recommended to walk better.

In addition to constant movement, preventing coxarthrosis means maintaining a normal body weight, following a healthy diet, rich in vitamins, omega 3 and mineral salts.

Although to date there is no real prevention against rheumatic diseases, maintaining a healthy lifestyle, performing physical activity and maintaining a good diet, is the first fundamental step for the health of your bones and the whole body.

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