Osteoarthritis of the Hip Joint: A Case of Successful Comprehensive Treatment
Introduction:
A 52-year-old man presented to the clinic with complaints of pain in the groin area, right and left hip joints, and restricted movement in them.
Complaints:
The patient noted that the pain originated deep in the groin area, both on the right and left sides, radiating to the knee joints. Typically, it worsened in the morning when getting out of bed and walking, but then became easier after several dozen steps. At night, he occasionally experienced pain when turning from back to side. The patient also complained of difficulty in zipping up shoes and putting them on.
The pain often intensified after brief rest, as well as in the evening after prolonged standing or walking or carrying heavy loads. Taking pain relievers temporarily alleviated the symptoms. The patient also noted that he had gained 5 kg in weight over the past 3 months, which exacerbated the symptoms.
History:
The patient first began to experience pain in the hip joints about 3 years ago after a sudden weight gain of about 7 kg and exposure to cold (while fishing in the morning). However, the symptoms were not as pronounced and either resolved on their own or after taking pain relievers for several days.
The patient’s grandfather suffered from osteoarthritis of the knee joints, for which he underwent joint replacement surgery.
Examination:
Moderate hypotrophy (reduction in volume) of the thigh muscles was observed during examination. The area of the hip joints was not deformed. The skin over the joints was unchanged, and local temperature was normal. Movements in the right and left hip joints were moderately restricted, with passive movements, especially inward rotation of the leg, causing moderate pain. No sensory disturbances were detected.
X-rays of the right and left hip joints revealed signs of osteoarthritis (coxarthrosis) of grade 2.
Routine blood tests, syphilis, HIV, hepatitis B and C tests came back normal.
Diagnosis:
Bilateral coxarthrosis grade 2.
Treatment:
The patient was prescribed a course of therapeutic exercises for 3 weeks, followed by preventive morning gymnastics.
A course of intra-articular injections of plasma enriched with platelets (PRP) was administered at intervals of 7-10 days. During this treatment, about 15 ml of the patient’s own blood was taken, followed by centrifugation, during which erythrocytes were separated and the concentration of platelets in 1 ml of blood was increased by more than 2 times. It is this concentration that allows achieving a therapeutic effect.
The patient was also provided with custom orthopedic insoles, and consultation with an endocrinologist/dietitian was recommended to lose 5 kg in weight.
By the second day of intra-articular injection, the patient noted a decrease in pain. After 3 weeks, it no longer bothered him in the mornings, but there was still some discomfort after heavy physical exertion.
After 4 weeks, the patient reported that the pain had subsided, and mobility of the hip joints had returned. The man was satisfied with the treatment. A follow-up examination with an orthopedist was scheduled for 12 months.
Conclusion:
This clinical case confirms the high efficacy of a comprehensive approach to treating patients with osteoarthritis of the hip joints, which includes making orthopedic insoles and therapeutic exercises for the joints and muscles. Intra-articular injection of plasma enriched with platelets plays a significant role in reducing inflammation in the joint and promoting its functional restoration.