Risk factors for the development of pathological processes in the structures of the hip joint

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Risk factors for the development of pathological processes in the structures of the hip joint

D.A. Nasirli

Azerbaijan Medical University, Baku, Azerbaijan

Risk factors for the development of pathological processes in the structures of the hip joint

The study included 160 patients with coxarthrosis of the III-IV radiological stages aimed at a total hip replacement for the period 2015-2018. Several variants of the course of the disease were identified, taking into account the age factor (group I), the post-traumatic factor (group II), the metabolic factor (group III) and the polyethological nature of the process (group IV). The number of patients in each group was 40 people. Upon admission to the hospital, all patients underwent a comprehensive examination using instrumental, physical, clinical, functional and laboratory research methods. The presence of excess body weight was determined based on BMI. In the presence of an age-related risk factor, coxarthrosis manifested much later than with the development of joint pathology of post-traumatic, metabolic and poly etiological genesis. Of the somatic diseases, arterial hypertension was most often found in patients with coxarthrosis, chronic heart failure, diabetes mellitus and varicose veins of the lower extremities were somewhat less common. When analyzing the incidence of diseases of the genitourinary system, chronic pyelonephritis was diagnosed in most cases. Hyperglycemia of 17.5 %and 37.5 %, respectively, were often diagnosed in these two groups, and the fasting glucose level was 5.3±0.06 mmol/l. It should be noted that there were no disorders in the functional state of the thyroid gland in patients of the second group.

Key words: corsarthrosis, prevalence, age, etiology, risk factors

Д.А. Насірлі

ФАКТОРИ РИЗИКУ РОЗВИТКУ ПАТОЛОГІЧНИХ ПРОЦЕСІВ У СТРУКТУРАХ ТАЗОСТЕГНОВОГО СУГЛОБУ

До дослідження було включено 160 пацієнтів із коксартрозом III-IV рентгенологічних стадій, спрямованих на тотальне ендопротезування кульшового суглоба за період 2015-2018 років. Було виділено кілька варіантів перебігу захворювання з урахуванням вікового фактора (І група), посттравматичного фактора (ІІ група), метаболічного фактора (ІІІ група) та поліетиологічного характеру процесу (IV група). Кількість пацієнтів у кожній групі становила 40 осіб. Всім хворим під час вступу до стаціонару проводили комплексне обстеження із застосуванням інструментальних, фізикальних, клініко-функціональних та лабораторних методів дослідження. Наявність надлишкової маси тіла визначалося на підставі індексу ІМТ. За наявності вікового фактора ризику коксартроз маніфестував значно пізніше, ніж при розвитку суглобової патології посттравматичного, метаболічного та поліетіологічного генезу. З соматичних захворювань найчастіше у пацієнтів з коксартрозом виявлялися артеріальна гіпертонія, дещо рідше - хронічна серцева недостатність, цукровий діабет та варикозне розширення вен нижніх кінцівок. При аналізі частоти захворювання сечостатевої системи, в більшості випадків діагностувався хронічний пієлонефрит. У хворих з віковим та посттравматичним типом суглобової хвороби нерідко діагностувалася гіперглікемія 17,5% та 37,5%, відповідно, а рівень глюкози натще склав 5,3±0,06 ммоль/л. coxarthrosis arthroplasty radiological

Ключові слова: корсартроз, поширеність, вік, етіологія, фактори ризику

Diseases of the musculoskeletal system that have a negative impact on the health indicators of the population, an increase in their prevalence, an increase in the level of disability and disability over the past decade in almost all age and gender groups, as well as significant losses in socio-economic and psychological spheres, all this indicates the relevance of this problem for practical and scientific medicine. Analyzing world statistics, it can be argued that more than half of the world's population represent risk groups for diseases of the musculoskeletal system, in particular joint diseases with a clear tendency to increase epidemiological indicators [8]. The reason for the lack of sometimes due attention from public health specialists to this issue can be considered insufficient data on the prevalence of the pathology under study in each population in most countries of the world and the lack of comparable data obtained in different regions on the degree of influence of diseases of the musculoskeletal system on the main indicators of the quality of life of patients [10]. At the same time, the implementation of regular examinations makes it possible to identify the incidence of the disease among various groups and strata of the population and to determine the etiopathogenetic role of various exo- and endogenous risk factors in the occurrence and development of pathology [2, 7]. Thus, the conducted epidemiological population studies provided reliable information and determined significant fluctuations and excellent indicators of morbidity in different countries of the world [4, 9, 14]. This, in our opinion, can be explained by the presence of many different genetic and environmental factors in each region. When assessing the prevalence of severe forms of pathology of the musculoskeletal system, it was found that hip arthrosis occupies one of the first places in the structure of pathology of large joints. It is also important to note here an increase in the frequency of disability depending on age and gender indicators, that is, the degree of disability increased with age [13]. Coxarthrosis occupies a leading place in the general structure of joint diseases in terms of incidence and terms of disability. In its occurrence, various causes are important, among which one can note a congenital violation of the normal anatomical shape, inflammatory diseases of the joint, dysplasia, post-traumatic factor represented by intra-articular fractures, dislocations, excessive loads with overload of the joint areas, as a result of which the cartilage loses hydrophilicity, becomes fibrous and loses its functional properties, that is, degeneration of cartilage, subchondral bone occurs [5, 11]. When studying the causes of the occurrence and development of the pathology understudy, an opinion was formed about the multifactorial etiology. Some scientists have grouped causal factors and singled out as a number of the most important risk factors that determine the nosological characteristics of the disease, metabolic disorders, hereditary diseases of bones and joints, old age, overweight, professional activity, joint injury and systemic diseases [2, 12].

The purpose of the study was a clinical assessment of the influence of risk factors on the manifestations of coxarthrosis.

Materials and methods. The work was carried out on the basis of the AMU Surgical Clinic, Baku. The study included 160 patients with coxarthrosis of the III-IV radiological stages (according to Kellgren and Lawrence, 1957), aimed at a total hip replacement for the period 2015-2018. The classification criteria of R.D. Althman et al. were used to make the diagnosis. (1991). The study was carried out in strict accordance with the bioethical norms recommended by the International Committee on Bioethics (UNESCO). Indications for total endoprosthetics were: poorly relieved joint pain, stiffness and significant restriction of motor activity, radiologically - III-IV stages of coxarthrosis. Criteria for inclusion of patients in the study: the presence of coxarthrosis and voluntary written informed consent to participate in the study.

When studying the most common risk factors for the development of coxarthrosis, we identified several variants of the course of the disease, taking into account the age factor (group I), post-traumatic factor (group II), metabolic factor (group III) and the polyethological nature of the process (group IV). The number of patients in each group was 40 people. There were more female representatives in the study groups than men. Upon admission to the hospital, all patients underwent a comprehensive examination using instrumental, physical, clinical, functional and laboratory research methods.

The presence of excess body weight was determined on the basis of BMI in accordance with the recommendations of the World Health Organization (WHO) by the ratio of the patient's body weight (kg) to the square of his height (m). At the same time, an index equal to 16 or less kg/m2 was interpreted as a pronounced body weight deficit; 16-18.5 kg/m2 - insufficient body weight; 18.5-24.9 kg/m2 - norm; 2530 kg/m2 - overweight, 30-35 kg/m2 - obesity of the first degree, 35-40 kg/m2 - obesity of the second degree, 40 or more kg /m2 - obesity of the third degree.

Statistical data processing was carried out using the Statistica 7.0 application software package and the Excel 2013 standard statistical analysis package. Statistical methods included the estimation of the arithmetic mean (M), the standard error of the mean (± m). Fisher's exact criterion was used to select the most informative features. The critical level of reliability of the null statistical hypothesis (about the absence of significant differences or factor influences) was assumed to be 0.05 (p<0.05).

Results of the study and their discussion. When analyzing the main complaints of patients with coxarthrosis, the most characteristic clinical manifestations are more often revealed, in particular, the presence of pain, limited movement and a decrease in the main indicators of quality of life. The main criteria for the inclusion of patients in this study are presented in table 1.

Table 1

Criteria for inclusion of patients in groups

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