The human hip joint is a complex ball and socket formed to enable standing and walking. The hip joint is a prime example of a congruous joint. The concave acetabulum and the convex femoral head are symmetrical, and the joint space is equal at all points, with slight gap to permitting adequate lubrication.
This symmetry allows for axial rotation and simplifies the joint's muscle action. The femoral head articulates within the horseshoe-shaped acetabulum, coated almost all with cartilage. The centre, however, is cartilage-free.
It is deepened by a cartilage-covered ring of fibrocartilage called the labrum. The femur head fits into the acetabulum and is firmly held by a thick capsule, divided into thick layers forming the iliofemoral, pubofemoral and ischiofemoral ligaments.
What causes hip pain?
As hip pain is a common problem with multiple causes, an accurate diagnosis is crucial for appropriate treatment.
Arthritis
Arthritis, characterised by a progressive wearing away of the joint, is among the most frequent causes of hip pain. Hip arthritis usually affects patients over the age of 50 and is common in overweight people.
Trochanteric bursitis
Trochanteric bursitis is a highly common problem causing inflammation of the bursa outside the hip joint.
Tendonitis
Tendonitis is inflammation in any of the tendons surrounding the hip. Iliotibial band (IT band) tendonitis is the most frequently encountered type.
Osteonecrosis
Restricted and inadequate blood flow to the bone will cause cellular death and its collapse. One of the most common places of occurrence is in the hip joint.
Lumbar Pain
Many back and spinal problems can cause symptoms around the buttocks and hip, most commonly herniated discs and sciatica.
Snapping Hip Syndrome
This hip disorder constitutes three distinct problems. The first involves the IT band snapping over the thigh. The second occurs when the deep hip flexor snaps over the front of the hip. The third involves tearing of the cartilage, or labrum, around the hip socket, causing a snapping sensation.
Muscle Strains
Straining of hip and pelvic muscles can cause pain and spasms, most commonly in the groin and of the hamstring.
Hip Fracture
Hip fractures, most common in elderly patients with osteoporosis, requires surgery to either replace the broken portions or repair them with metal plates and screws.
Hip Stress Fracture
Most common in athletes participating in high-impact sports, such as long distance runners, hip stress fractures are usually preventable by limiting such activities.
Childhood Hip Problems
Developmental Dysplasia
The hips may not properly develop if dislocated or out of position in infancy. Though not usually painful in childhood, early arthritis and problems with walking may arise.
Legg-Calve-Perthes Disease
Also called Perthes disease, this disease is similar to osteonecrosis (see above) but occurs during childhood. Severe cases can lead to permanent hip damage and early arthritis.
When do you need to call your doctor about your hip pain?
If you are unsure of the cause of your symptoms, or if you do not know the specific treatment recommendations for your condition, you should seek medical attention. Treatment of hip pain must be directed at the specific cause of your problem. You should see your doctor when:
You are unable to walk comfortably on the affected side
You have an injury that causes deformity around the joint
Your hip pain occurs at night or while you are resting
You have hip pain that persists beyond a few days
You are unable to bend the hip
There is swelling of the hip or the thigh area
There are signs of an infection, including fever, redness, warmth
You experience any other unusual symptoms
Treatment Options
Treatment depends on the cause of the problem. Therefore, it is important that you understand the cause of your symptoms before embarking on a treatment programme. If you are unsure of your diagnosis, or the severity of your condition, you should seek medical advice before beginning any treatment plan.
Not all of the treatment options listed are appropriate for every condition.
Rest
The first treatment for most conditions that cause hip pain is to rest the joint, and allow the acute inflammation to subside. Often this is the only step needed to relieve hip pain. If the symptoms are severe, crutches or a cane may be helpful as well.
Ice and Heat Application
Ice packs and heat pads are among the most commonly used treatments for inflammation. Ice packs are mostly used for acute injuries to help minimise swelling while heat pads are used for chronic conditions to help relax and loosen tissues, and to stimulate blood flow to the area.
Stretching
Stretching the muscles and tendons that surround the joint can help with some causes of hip pain. A good routine should be established.
Physiotherapy
Physiotherapy is an important aspect of treatment for almost all orthopaedic conditions. Physiotherapists use different modalities to increase strength, regain mobility, and help return patients to their pre-injury level of activity.
Anti-Inflammatory Medication
Nonsteroidal anti-inflammatory medications, commonly referred to as NSAIDs, are some of the most frequently prescribed medications, especially for patients with hip pain caused by problems such as arthritis, bursitis, and tendonitis.
Total Hip Replacement
Hip replacement surgery may be considered when arthritis limits your everyday activities such as walking and bending, when pain continues while resting, or stiffness in your hip limits your ability to move or lift your leg. Hip replacement may be recommended only after careful diagnosis of your joint problem. It is time to consider surgery if you have little pain relief from anti-inflammatory drugs or if other treatments, such as physical therapy, do not relieve hip pain.
Hip replacement surgery involves replacing the femur (head of the thighbone) and the acetabulum (hip socket). Typically, the artificial ball with its stem is made of a strong metal or ceramic, and the artificial socket is made of polyethylene (a durable, wear-resistant plastic) or metal backed with a plastic liner. The artificial joint may be cemented in position or held securely in the bone without cement. The ball and insert are designed to glide together to replicate the hip joint.
Success Rate
For the vast majority of patients, joint replacement can be successful in providing relief from pain and improved mobility for many years. According to the American Academy of Orthopaedic Surgeons, hip replacement procedures have been found to result in significant restoration of function and reduction of pain in over 90% of patients.
Benefits of Hip Replacement Surgery
Hip Replacement surgery helps more than 200,000 Americans each year to relieve their hip pain, and get back to enjoying normal, everyday activities. Most patients need to stay in hospital for only 4 to 5 days.
Hip Resurfacing
In this innovative process, the end of the thigh bone (femur) is capped with a metal covering – a strong cobalt chromium metal – much like the capping of a tooth. This fits neatly into a metal cup that sits in the hip socket. The head swivels within the cup, gliding together to replicate the hip joint. The surfaces that rub against each other are both made from highly polished metal. This type of hip device is called a metal-on-metal hip resurfacing device.
The first benefit of hip resurfacing is that its bone conserving – This means that more of your healthy bone is kept intact. The damaged area is simply resurfaced, not fully removed.
In addition, there is more natural motion and less chance of dislocation than total hip replacement1 – As large amounts of bone are not removed, the surgeon can resurface the hip closer to the size and shape of your natural hip. In fact, your resurfaced femur is similar to the size of your natural bone so you get a better fit inside your hip socket. This may result in greater stability and the potential for an increased range of motion – so you can return to the gym or dancing, or whatever activity you loved.
You are better prepared for a later treatment - hip resurfacing removes less of your own bone, which may be important should you ever require a total hip replacement in the future.
Hip Resurfacing may be appropriate for younger, more active patients, patients with good bone quality, osteoarthritis and rheumatoid arthritis.
Hip Resurfacing is not recommended for patients with the following conditions
Active or suspected infection in or about the hip joint
Poor bone quality which your surgeon feels could not support the implant
Multiple cysts
Any known allergy to metal (e.g., jewelry)
Extreme overweight (overload on device that would lead to failure)
Skeletal immaturity
Women in child-bearing years
Weak immune system due to disease or certain medications (e.g., corticosteroids)
Kidney failure
Watch this video to learn about treatment, recovery and prevention tips for hip fracture:
