What causes hip pain?

Common sources of hip pain that rarely require surgery:

Trochanteric Bursitis – Throughout the body, small sacs, sometimes filled with a little fluid, called bursae act as cushions between bones, tendons and muscles. Several bursae are located around the outer area of the hip near the portion of the thighbone (femur) called the greater trochanter. The greater trochanter is a broad, flat area of bone that anchors several large muscles. An inflammation of one of the trochanteric bursa is a common cause of hip pain.

Labral Tear -The labrum is the cartilage that lines the socket (acetabulum) in which the ball of the hipbone (femur) sits. This cartilage provides cushioning for the joint. It also helps keep the ball in the socket. A tear in the labral cartilage can result from injury or degeneration, such as from osteoarthritis.

Iliopsoas Bursitis – The iliopsoas bursa is a saclike cavity between the iliopsoas tendon and the lesser trochanter of the femur. This bursa is the largest and most important bursa about the hip. Iliopsoas bursitis, or an irritation and inflammation of the iliopsoas bursa, occurs primarily in gymnasts, dancers and track athletes and is caused by repetitive hip flexion.

If conservative treatment, such as lifestyle and activity modification, physical therapy and/or medications, such as non-steroidal anti-inflammatory drugs (NSAIDs) or nutritional supplements, (Chondroitin/Glucosamine) to reduce pain and inflammation does not provide relieve from these common sources of hip pain, your physician may recommend an injection of a corticosteroid preparation, which is usually successful in relieving symptoms. Surgery is rarely required.

The most common cause of chronic hip pain and disability is arthritis.

Arthritis of the hip is a disease which wears away the cartilage between the femoral head and the acetabulum, the two bones will scrape against each other, raw bone on raw bone. When this happens, the joint becomes pitted, eroded and uneven.

The result is pain, stiffness and instability. In some cases, motion of the leg may be greatly restricted.

Osteoarthritis

Osteoarthritis, which is the most common form of arthritis in the US; is degenerative and, although it most often occurs in patients over the age of 50, it can occur at any age, especially if the joint is in some way damaged.

Osteoarthritis is usually confined to the large weight-bearing joints of the lower extremities, including the hips and knees, but may affect the spine and upper extremity joints, too. Patients with osteoarthritis often develop large bone spurts, or osteophytes, around the joint, further limiting motion.

Osteoarthritis of the hip is a condition commonly referred to as “wear and tear” arthritis. Although the degenerative process may accelerate in persons with a previous hip injury, many cases of osteoarthritis occur when the hip simply wears out. Some experts believe there may be a genetic predisposition in people who develop osteoarthritis of the hip. Abnormalities of the hip due to previous fractures or childhood disorders may also lead to a degenerative hip. Osteoarthritis of the hip is the most common cause for total hip replacement surgery.

Symptoms

The first and most common symptom of osteoarthritis is pain in the hip or groin area during weight bearing activities such as walking. People with hip pain usually compensate by limping, or reducing the force on the arthritic hip. As a result of the cartilage degeneration, the hip loses its flexibility and strength, and may result in the formation of bone spurs. As the condition worsens, the pain may be present all the time, even during non weight-bearing activities.

Treatment

Before considering total hip replacement surgery, your doctor and you may try various non-surgical therapies. An appropriate weight reduction program may be beneficial in decreasing force across the hip joint. However, weight reduction can be difficult for people with hip arthritis since the arthritis pain precludes them from increasing their activity and burning calories.

An exercise program may be instituted to improve the strength and flexibility of the hip and the other lower extremity joints. Lifestyle and activity modification may be undertaken in an attempt to minimize the activities that are associated with hip pain.

Finally, various medications such as non-steroidal anti-inflammatory drugs (NSAIDs) and/or nutritional supplements (Chondroitin/Glucosamine) to reduce pain and inflammation associated with the disease may be considered.

Assistive devices like a cane or a crutch can help to reduce the force transmitted through the hip joint during walking and thereby may help to decrease hip arthritis pain. If non-surgical treatment is unsuccessful, you and your surgeon may decide that a total hip replacement is the best available treatment option.

Rheumatoid Arthritis

Unlike osteoarthritis which is a “wear and tear” phenomenon, rheumatoid arthritis is a chronic inflammatory disease that results in joint pain, stiffness and swelling. The disease process leads to severe, and at times rapid, deterioration of multiple joints, resulting in severe pain and loss of function.

Causes

Although the exact cause of rheumatoid arthritis is unknown, some experts believe that a virus or bacteria may trigger the disease in people having a genetic predisposition to rheumatoid arthritis. Many doctors think rheumatoid arthritis is an autoimmune disease in which the synovial tissue of the joint is attacked by one’s own immune system. The onset of rheumatoid arthritis occurs most frequently in middle age and is more common among women.

Symptoms

The primary symptoms of rheumatoid arthritis are similar to osteoarthritis and include pain, swelling and the loss of motion. In addition, other symptoms may include loss of appetite, fever, energy loss, anemia, and rheumatoid nodules (lumps of tissue under the skin). People suffering with rheumatoid arthritis commonly have periods of exacerbation or “flare ups” where multiple joints may be painful and stiff.

Treatment

Treatment of rheumatoid arthritis may involve medications such as NSAIDs, aspirin and analgesics. Corticosteroids, such as prednisone may be prescribed, and are effective in decreasing the inflammation associated with rheumatoid arthritis. Side effects can occur with the use of corticosteroids, and close monitoring by a physician is essential.

Researchers have made progress in the treatment of rheumatoid arthritis and newer prescription drugs are now available. If non-surgical measures fail, you and your surgeon may decide that total hip replacement is the best treatment option to relieve your pain and help you return to an improved functional level.

Click here for information on treatment options for hip arthritis

Link to the American Academy of Orthopaedic Surgeons