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Hip Pain …Treatment Options

Dr. Raju Vaishya

Hip pain can make it hard to walk, go up and down stairs, squat, or sleep on the side that hurts. A clicking or snapping feeling or sound around your hip joint (snapping hip) may bother you or cause you to worry.

Hip problems may develop from overuse, bone changes with age, tumors, infection, changes in the blood supply, or a problem that was present from birth (congenital). Oddly enough, a person who has a hip problem often feels pain in the knee or thigh instead of the hip.

How Hip works

It is the largest ball-and-socket joint in the body. The thighbone (femur) fits tightly into a cup-shaped socket (acetabulum) in the pelvis. The hip joint is tighter and more stable than the shoulder joint but it does not move as freely. The hip joint is held together by muscles in the buttock, groin, and spine; tendons; ligaments; and a joint capsule. Several fluid-filled sacs (bursae) cushion and lubricate the hip joint and let the tendons and muscles glide and move smoothly. The largest nerve in the body (sciatic nerve) passes through the pelvis into the leg.

Causes of Hip Pain

While many causes of hip pain can arise from the joint itself, there are numerous structures surrounding the hip that can also be the source of pain.

Trauma is often the cause of hip pain, but any source of inflammation may cause pain in the hip area. Pain is one of the symptoms of inflammation, along with swelling, warmth, and redness; together these are signals and symptoms that a problem may exist.

Pain may arise from structures that are within the hip joint or from structures surrounding the hip.

The hip joint is a potential space, meaning that there is a minimal amount of fluid inside it to allow the femoral head to glide in the socket of the acetabulum. Any illness or injury that causes inflammation will cause this space to fill with fluid or blood, stretching the hip capsule lining and resulting in pain.

The femoral head and the acetabulum are lined with articular cartilage that allows the bones to move within the joint with less friction. Also, the socket area of the acetabulum is covered with tough cartilage called the labrum. Just like any other joint cartilage, these areas can wear away or tear and become the source of pain.

There are thick bands of tissue that surround the hip joint, forming a capsule. These help maintain the hip joint stability, especially with movement.

Movement at the hip joint is possible because of the muscles that surround the hip and their tendons that attach across the hip joint, allowing the leg to move in different directions. Aside from controlling movement, these muscles act together to maintain joint stability. There are large bursas (fluid-filled sacs) that surround areas of the hip and allow the muscles and tendons to glide more easily over bony prominences. Any of these structures can become inflamed.

Pain can be referred from other structures outside the hip joint, meaning that while the hip hurts, the problem may potentially originate elsewhere. Inflammation of the sciatic nerve as it arises from the spinal cord in the back can cause hip pain, especially if the L1 or L2 nerve roots are involved. Other types of nerve inflammation may manifest as hip pain, including pain arising in the lateral femoral cutaneous nerve of the thigh, which is often inflamed in pregnancy. Pain from an inguinal or femoral hernia may also cause pain that is felt in the hip.

Hip pain is a nonspecific complaint that requires the health-care professional to find the underlying cause from the many potential injuries or illnesses. The approach to the diagnosis of hip pain requires an open mind because the source of trauma or the cause of illness may not be readily apparent.

Symptoms and Signs of  Hip Pain

Hip pain is often difficult to describe, and patients may complain that the hip just hurts. The location, description, intensity of pain, what makes it better, and what makes it worse depend upon what structure is involved and the exact cause of the inflammation and injury.

Pain from the hip joint may be felt anteriorly (in front of the hip) as groin pain, laterally over the greater trochanter, or posteriorly in the buttock. Sometimes the patient may complain of knee pain that has been referred from the hip. This is especially true in children.

Trauma to the hip: With a fall, direct blow, twist, or stretch, the pain is felt almost immediately.

Overuse injury: The onset of pain may be delayed by minutes or hours as inflamed muscles surrounding the hip joint go into spasm or joint surfaces become inflamed, causing fluid accumulation. Overuse injuries may also cause cartilage, labrum, or capsule damage, resulting in inflammation, pain, and limping.

Pain: Most often, pain is felt in the front of the hip, but the joint is three-dimensional. Pain may be also felt along the outside part of the hip or even in the buttock area.

Limp: Limping is the body’s way of compensating for pain by trying to minimize the amount of weight the hip has to support while walking. Limping is never normal. Limping produces abnormal stresses on other joints, including the back, knees, and ankles, and if the limp persists, these areas may also become inflamed and cause further symptoms.

Fracture: With a hip fracture, there is an acute onset of constant pain after the injury that usually is made worse with almost any movement. The muscles that attach to the hip cause the fracture to displace, or move, and the leg may appear shortened and rotated outward. If no displacement occurs, the leg may appear normal but there is pain with any range of motion of the hip joint. Pelvic fractures may have pain similar to a hip fracture, but the leg appears normal.

Sciatica pain: Pain from the sciatic nerve tends to start in the lower back and radiate to the buttocks and to the front or side of the hip. It may be described in different ways because of nerve inflammation. Some typical descriptive terms used for the pain of sciatica include sharp, stabbing, or burning. The pain of sciatica may be made worse with straightening the knee, which stretches the sciatic nerve and may make it difficult to stand from a sitting position, or walk with a full stride. There may be associated numbness and tingling in the leg or foot. Physical examination may be able to map out which nerve root from the spine is involved.

Loss of bowel and bladder function associated with the pain may signal a neurosurgical emergency and the presence of cauda equina syndrome. If not recognized and treated with immediate surgery, there is risk for permanent damage to the spinal cord.

Arthritis: If arthritis narrows the hip joint and impinges the femoral head’s gliding motion within the acetabulum or if there is a tear in cartilage or labrum, the patient may describe a click, catch, or feeling that range of motion is somehow impeded. Usually, there is pain almost immediately that does not get better as activity continues.

Pain from arthritis tends to be worse after a period of inactivity and gets better as the joint “warms up” with use. But as activity increases, the pain will return.

Bone cancer: Cancer that arises primarily in bone or is metastatic, having spread from another site in the body, can cause intense, constant pain. It is often not related to activity and not made better with rest. Its location and radiation (where the pain spreads) may depend upon the location of the cancer within the hip or pelvis and what neighboring structures are involved or irritated.

Treatment for Hip Pain

The treatment of hip pain depends upon the diagnosis and any underlying illness that may be present.

Aside from medications, therapy will be directed to maintain the strength and range of motion of the hip. As with any illness or injury, the goal is to return the patient to their normal level of function. A team approach involving the health-care professional, physical therapist, or chiropractic-care provider may be considered.

Surgery for Hip Pain

Hip fractures commonly require surgery to fix the fracture. The type of surgery depends upon the location of the fracture within the hip joint. The underlying health of the patient needs to be assessed, and the risks of general anesthesia need to be considered. Surgery often occurs soon after the injury, if the patient’s condition allows, to allow quicker return of activity. Patients who are immobilized and lie in bed for prolonged periods of time are at risk for developing blood clots in their legs (deep vein thrombosis) and breakdown of their skin, or bedsores.

Hip replacement

Hip replacement is perhaps the most common joint replacement surgery. It is considered in patients with progressive arthritis that affects the patient’s ability to do daily activities. Hip resurfacing is an alternative to hip replacement. The choice of procedure is a joint decision made by the orthopedic surgeon and patient to be able to return the patient to the level of activity that they would like to achieve.

Total Hip Replacement

The end portion of the thighbone affected by arthritis is replaced with a metal head that can be cemented with special glue to the stem of the thighbone (or) can be uncemented (in younger patients). The socket is replaced with a metallic cup and high density plastic is used as an insert into it. The socket is usually left uncemented (screws are used to connect to the thighbone). The Total Hip Replacement procedure enables restoration of the natural gliding motion of the joint.

Proxima Hip Replacement

The Proxima Hip Replacement is also ideal for young patients. In this minimally-invasive procedure, the part of thighbone at the point where it begins is shaped and replaced by a metal head. This sits in a metal cup that is fitted into the socket.

Bilateral and Revision Hip Replacements are also done at Apollo Hospitals, India. Some hip surgeries can also be performed using minimally-invasive techniques.

Hip arthroscopy has become more widely available to evaluate and treat hip joint damage, including labrum and cartilage tears, loose bodieswithin the joint, and early arthritis. 

Is a surgeon of international repute, is best known for his swift surgical skills in the field of Orthopedic & Joint Replacement. He has been working at Indraprastha Apollo Hospitals, New Delhi as a Professor and Senior consultant. He is the founder president of Arthritis Care Foundation.  Apart from his distinguished clinical work in the field of arthroscopic and joint replace¬ment surgery, he is well known for his academic contributions. He has more than 150 published articles in various International and national peer-reviewed medical journals and has been regularly invited to give lectures, chairing sessions,etc. in Orthopaedic conferences around the world. He has been awarded for the best paper publication on nu¬merous occasions by Delhi Orthopedic Association and Apollo Hospitals. His work was recognized in the Limca book of records in 2012, 2013 & 2015 for do¬ing bilateral Total Knee Replacement in 93 years old gentleman, bilateral Total Knee Replacement in the oldest couple in a single sitting, ACL reconstruction on oldest man.

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