Hip Joint Pain
Your hip is a very stable and strong joint. It’s known as a ball-and-socket joint. This is because the top of the thigh bone is shaped like a ball. This ‘ball’ sits inside a hollow socket in your pelvis. Ball-and-socket joints give the most movement of all the different types of joints in the body. The hip joint is held together by a covering of muscles which are secured to the bones by strong cords called tendons. These muscles and tendons form a capsule around the joint and support its movements. They help move the joint, supporting your leg and upper body movement. Inside the capsule is the synovium, which lubricates the joint with synovial fluid and keeps the cartilage healthy. The cartilage sits between the bones of your hip joint to stop them rubbing together and reduces any impact when you walk or move your hip.
Hip pain is the general term for pain felt in or around the hip joint. It isn’t always felt in the hip itself but may instead be felt in the groin or thigh.
What symptoms and signs may be associated with hip pain?
Symptoms vary in intensity from mild to severe. Hip pain can be a cause of disability.
What causes hip pain?
There are many causes of hip joint pain. Some hip pain is temporary, while other hip pain can be long-standing or chronic.
Inflamed tendons
The most common cause of acute hip pain is inflamed tendons, or tendonitis. This is often due to too much exercise. This condition can be very painful, but it usually heals within a few days.
Arthritis
The most common cause of long-term hip pain is arthritis. Arthritis can cause pain, stiff and tender joints, and difficulty walking. There are various types of arthritis:
Osteoarthritis (OA) can be the result of age-related wearing down of the cartilage that surrounds the joints.
Trauma to a joint, like a fracture, may cause traumatic arthritis like osteoarthritis.
Infectious arthritis is due to an infection in the joint causing the destruction of cartilage.
Rheumatoid arthritis (RA) is due to the body’s immune system launching an attack on the joints. This type of arthritis may eventually destroy joint cartilage and bones.
Osteoarthritis is much more common than rheumatoid arthritis.
Trochanteric bursitis
Another possible cause of hip pain is trochanteric bursitis. This condition occurs when the bursa, which is a liquid-filled sac near the hip joint, becomes inflamed.
A number of factors can cause trochanteric bursitis, including hip injury, overuse of the joints or posture problems.
Other conditions such as RA can also cause hip pain. This condition is much more common in women than in men.
Hip fractures
Hip fractures are common in older adults and in those who have osteoporosis, which is a weakening of the bones due to age or other factors.Hip fractures cause very sudden, severe hip pain, and they require immediate medical attention. There are complications that can arise from a fractured hip, such as a blood clot in the leg. A hip fracture usually requires surgery to be corrected. You’ll most likely need to have physical therapy to recover.
Less common causes
There are other, less common conditions that can cause hip pain. These include snapping hip syndrome and osteonecrosis, or avascular necrosis.
Snapping hip syndrome
Snapping hip syndrome, which most commonly occurs in dancers or athletes, is characterized by a snapping sound or feeling in the hip. This snapping may occur when you’re walking or getting up out of a chair, for example. The condition is usually painless, but can cause pain in some cases. Snapping hip with pain is usually a sign of cartilage tear or fragments of material in the hip.
Osteonecrosis
Osteonecrosis, or avascular necrosis, is a rare and painful condition that can affect any joint in the body in young-to-middle-aged adults. It occurs in the hip when the blood supply to the ball at the end of the thigh bone is lost. This causes the bone to die and the ball to collapse, which results in arthritis.
In this condition, the cartilage is normal initially but will eventually collapse as it progresses. Eventually, bones may break or crumple.
It’s often referred to as idiopathic, which means that it doesn’t have any clear cause. However, it’s linked with the following:
Diagnosis
If your hip pain hasn’t improved after two weeks you should see your doctor. It’s a good idea to make some notes about your condition before you go, so you can be sure to discuss everything that’s bothering you. Your doctor will ask about your pain and what movements make it feel worse. They’ll ask how your symptoms started, how they affect your daily activities and whether you’re in pain at night.
Pain when you bend your hip going up or down the stairs or when you put on your socks is often a sign of a hip problem. They’ll examine your hip to find out how well it moves, and this will usually give them enough information to plan your treatment. But you may need other tests to diagnose some conditions.
What tests are there?
X-rays are often the best way of finding out what’s wrong with your hip as they show the condition of the bones. They may also show problems in your pelvis which could explain your pain. They’re not as useful for looking at the soft tissues around the joint.
A CT (computerised tomography) scan can often be very helpful to work out if the hip joint has an unusual shape. CT scans use x-rays to show sections or ‘slices’ of the hip, which a computer then puts together to form a 3D image of the hip.
There are conditions where the socket of the hip can be very shallow, and a CT scan can show this.
MRI (magnetic resonance imaging) scans use radio waves to build a picture to show what’s happening to the soft tissue, such as the muscles and tendons, inside your hip. They’re particularly helpful for diagnosing the painful condition avascular necrosis, which reduces the flow of blood to the ends of bone, causing them to collapse (See Specific hip conditions section for more information).
If your doctor thinks your pain is caused by an infection or rheumatoid arthritis, blood tests can often help.
If your hip pain doesn’t improve with simple medications such as paracetamol and ibuprofen, and a mixture of rest and gentle exercises, you should see your doctor for further advice. They may recommend the following treatments:
Drugs
Non-steroidal anti-inflammatory drugs (NSAIDs)
Your doctor may prescribe stronger NSAIDs, such as diclofenac, naproxen, or a higher dose of ibuprofen, to help ease your pain. Like all drugs, NSAIDs can sometimes have side-effects. If you’re taking prescription NSAIDs your doctor will take precautions to reduce the risk of these – for example, by prescribing the lowest effective dose for the shortest time.
Bisphosphonates Bisphosphonates are used to treat Paget’s disease of the bone and osteoporosis. Drugs like Alendronate, Risedronate, Ibandronate, and Zoledronic acid can strengthen bones weakened by osteoporosis, preventing pain and further damage. They work by slowing bone loss, which reduces the risk of hip fractures.
Counterirritants Creams and ointments containing capsaicin, the substance that makes peppers spicy, can reduce pain in the joint area.
Disease-modifying anti-rheumatics (DMARDs) Drugs like Trexall and Plaquenil are used often to treat RA. They stop or slow the immune system from attacking the joints.
Biologic response modifiers Drugs like Enbrel and Remicade can also stop or slow immune response.
Corticosteroids Drugs like prednisone and cortisone can reduce inflammation and suppress the immune system. They are taken orally or injected into the painful joint.
Physiotherapy
A physiotherapist may be able to help get your hip moving by showing you gentle range of movement exercises and activities, specific to your condition.
They are trained specialist who can show you how to help reduce your hip pain and how to improve the way your hip works in future by using a variety of strengthening and stretching exercise, massage and other therapeutic techniques.
They’ll work with you to help get your hip moving properly again. Their approach will depend on whether your problem is short-term or a long-standing condition. Almost everyone will benefit from physiotherapy, and they can recommend things such as:
Hydrotherapy
Hydrotherapy is a form of physical rehabilitation that can encourage movement and uses temperature and pressure to encourage blood flow throughout the body. This can reduce pain in the hips.
Occupational therapy
If you think your work or certain activities might be the main cause of your pain, it’s worth discussing this with an occupational therapist.
An occupational therapist is a specialist trained to help you regain your independence by showing you how to change the way you do things. They can also advise you on how equipment or adaptations could reduce the strain on your hip at home, work, or while you’re driving.
They’ll be able to give you advice on how to change your movements to help prevent pain continuing or returning. If your place of work has an occupational health department, they may also be able to help.
Steroid injections
If your pain has been caused by bursitis or inflammation in or around your hip, steroid injections can help.
A They’re often given with a local anaesthetic which numbs the area to reduce the pain of the injection. They are usually very helpful in treating conditions affecting the trochanteric area on the outside of the hip.
Sometimes they’re also effective for treating iliopsoas tendonitis – though the injection will need to be given by a radiologist using ultrasound, because the iliopsoas tendon is so deep.
A radiologist is a doctor who specialises in imaging techniques – like x-rays, MRI and ultrasound imaging – and forms a diagnosis from the results. They can use ultrasound to pinpoint the place that a steroid injection would be most effective.
A snapping iliopsoas tendon can also be treated with steroid injections with the guidance of a type of x-ray, called video fluoroscopy, to make sure it’s given in the right place. Ultrasound-guided injections are also becoming more popular.
Surgery
Not everybody with hip pain will need surgery. Hip fractures however, almost always need surgery to stabilise the bone and hold it in place. Replacement of the ball of the hip may also be necessary.
It’s common for older people to experience hip fractures, which can take a long time to fully recover from. People can often be in hospital for a couple of weeks or more to get over the fall and subsequent operation, and many often need extra help at home after discharge.
Hip replacement surgery
If your hip pain is caused by arthritis and other treatments haven’t helped, your doctor may talk to you about hip replacement surgery. The modern techniques used in a hip replacement make the surgery very safe and people usually have extremely good outcomes after it.
More than 90% of people who have a hip replacement find their pain is greatly reduced.
A modern artificial hip should last at least 15 years.
Usually, you’ll only need to stay in hospital for a few days after surgery. Physiotherapists will help get your hip moving again by showing you simple exercises and ways to do daily activities.
If you’re being considered for hip replacement surgery, it’s important you’re in good health and try to keep your weight down.
Your general health will probably be assessed during a hospital appointment before, and your surgeon will also talk to you about the operation. You may also meet the physiotherapists and occupational therapists who’ll be involved in your treatment after surgery.
Revision surgery
If your hip replacement becomes loose, infected or otherwise fails, it can be corrected with further surgery. Modern revision surgery techniques are developing quickly, and most failed hip replacements can be dealt with.
You’ll be in hospital longer than your first hip replacement, and it might take longer to recover.
Acetabular labrum surgery
Surgery to reshape the hip can improve your ability to move the joint and reduce your pain and stiffness. In some cases, this procedure is performed using keyhole surgery as a hospital day case or you may stay a night in hospital.
You’ll need between one and two months off work. We don’t currently know whether this operation can stop arthritis developing in your hip.
In some cases, hip pain is nothing more than a short-term annoyance, while in other cases it can be a sign of a serious health problem. If you have mild to moderate hip pain, you might want to try an at-home treatment.
Basic treatments for all types of hip pain include:
If you know what’s causing your hip pain and the cause is not severe, there are things you can do at home to reduce your pain.
References
https://www.versusarthritis.org/about-arthritis/conditions/hip-pain/
https://www.healthline.com/health/hip-pain#less-common-causes
