Hip

Oakland Regional Hospital Orthopaedic Surgeons that can improve your lifestyle:
 
Jerome V. Ciullo, M.D.
Mark J. Milia, M.D.
Nilesh Patel, M.D.
 
Common Hip Conditions and Treatments:
 
Symptoms 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 which has been referred from the hip.

  • 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 inflame, causing fluid accumulation.
  • 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. Pelvic fractures may have pain similar to a hip fracture but the leg appears normal.
  • Sciatica pain: Pain from sciatica tends to start in the 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. 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 or impinges on the way the femoral head can glide in the acetabulum, or if there is a cartilage or labrum tear, the pain may be associated with a "catch," or a feeling like there is something impeding hip movement.
  • 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.
Hip Fracture
Falls are the most common reason that elderly people break a hip. The fracture is due to a combination of two effects of aging, osteoporosis (thinning of bones) and a loss of balance. These two risk factors often precipitate many falls. Occasionally, the bone may spontaneously break due to osteoporosis and become the cause of the fall.

When health-care practitioners talk about a hip fracture, they really mean a fracture of the proximal or upper part of the femur. The precise location of the fracture is important, because it guides the decision of the orthopedic surgeon as to which type of operation is needed to repair the injury.

Aside from a fall, any trauma can potentially cause a hip fracture. Depending upon the mechanism of injury, the femur may not break; rather, a portion of the pelvis (often the pubic ramus) may be fractured. The initial pain may be in the hip area, but examination and X-rays may reveal a different source of the injury. Trauma can also cause a hip dislocation in which the femoral head loses its relationship with the acetabulum. This is almost always associated with an acetabular (pelvic bone) fracture; however, in patients with hip replacements, the artificial hip may dislocate spontaneously

Contusions (Bruises)
Contusions (bruises), sprains, and strains may occur as a result of trauma, and even though there is no broken bone, these injuries can still be very painful. Sprains are due to ligament injuries, while strains occur because of damage to muscles and tendons. Because of the amount of force required to walk or jump, the hip joint is required to support many times the weight of the body. The muscles, bursas, and ligaments are designed to shield the joint from these forces. When these structures are inflamed, the hip cannot function and pain will occur.
 
Overuse Injuries
Hip pain may also arise from overuse injuries in which muscles, tendons, and ligaments can become inflamed. These injuries may be due to routine daily activities that may cause undue stress on the hip joint or because of one specific strenuous event. Overuse may also cause gradual wearing away of the cartilage in the hip joint, causing arthritis.

Other structures should be mentioned as a cause of hip pain because they become inflamed. The iliotibial band stretches from the crest of the pelvis down the outside part of the thigh to the knee. This band of tissue may become inflamed and cause hip pain, knee pain, or both. This is a type of overuse injury that has a gradual onset associated with tightness of the muscle groups that surround the knee and hip. Piriformis syndrome, in which the piriformis muscle irritates the sciatic nerve in the buttock, can also cause significant posterior hip pain.

Bursa Inflammation (Hip Bursitis)
The trochanteric bursa is a sac on the outside part of the hip that serves to protect muscles and tendons as they cross the greater trochanter (a bony prominence on the femur). Trochanteric bursitis describes the inflammation of this bursa. The bursa may become inflamed for a variety of reasons, often due to minor trauma or overuse.
 
Nontraumatic Hip Pain
Hip pain may be caused by a variety of illnesses. Anything that causes systemic inflammation in the body may also affect the hip joint. The synovium is a lining tissue that covers those parts of the hip joint not covered by cartilage. Synovitis, or inflammation of this lining tissue, causes fluid to leak into the joint, resulting in swelling and pain.
 
Arthritis
Osteoarthritis is the most common cause of hip pain in those over the age of 50; however, other types of arthritis can be present.
 
Avascular necrosis
Avascular necrosis of the femoral head may occur in people who have taken corticosteroid medications like prednisone for a prolonged period of time. In this condition, the femoral head loses its blood supply, becomes weakened, and causes hip pain.
 
Fibromyalgia
Fibromyalgia is a systemic pain syndrome associated with pain and stiffness that can cause significant discomfort throughout the body and may present as hip pain. There may be associated sleep disorders, muscle cramps and spasms, tenderness of a variety of muscle groups in the whole body, and fatigue.

 

When is Total Joint Replacement necessary? 
An arthritic or damaged joint is removed and replaced with an artificial joint, called a prosthesis.
 
The goal is to relieve the pain in the joint caused by the damage done to the cartilage. The pain may be so severe, a person will avoid using the joint, weakening the muscles around the joint and making it even more difficult to move the joint. A physical examination, and possibly some laboratory tests and X-rays, will show the extent of damage to the joint. Total joint replacement will be considered if other treatment options will not relieve the pain and disability.
 
For further information about total joint replacement, please visit  A.A.O.S