Hip pain: Common causes and treatments
The difference between chronic and acute pain
The hip is a large ‘ball-and-socket’ shaped joint, connecting the hip (or femur) bone to the pelvis. Injuries of the hip can come on slowly (chronic) or suddenly (acute) and require a range of treatments.
To find out more about the difference between chronic and acute pain along with the different treatment options we can offer read more here and get back to the life you love!
Many people at times suffer from pain on the outside of their hips. This problem is given many names, such as bursitis, or in medical jargon, greater trochanteric pain syndrome.
Commonly, this is due to irritation of the iliotibial band on the outside of the hip. The iliotibial band is a tight band that runs from the pelvis over the hip to the knee. The band is protected from the outside bone of the hip by a bursa. In patients who have a limp, either severe or very mild, the band can rub across the outside of the hip, causing inflammation of the bursa and pain on the outside of the hip. A common cause for limp is gluteal muscle weakness. The gluteal muscles may be weak from inactivity, tendinopathy or gluteal tendon tears.
Bursitis can be treated with simple analgesics, such as paracetamol or anti-inflammatories, or steroid can be injected into the bursa to settle the inflammation. Often these injections will give short to medium term relief from pain, but the pain will recur unless weakness in the gluteal muscles is addressed. Strengthening of the gluteal muscles with rehabilitation is the first line of treatment, but if this fails, tests such as ultrasound or MRI scan can look for gluteal tendon tears, which may be repairable with surgery.
In some patients with large gluteal tendon tears, surgery can be performed to improve pain and function.
Traditional methods of repairing the tendon back to the bone with sutures have had a high failure rate, due to weakness of the repair and the large forces which go across the tendons when the patient mobilises.
The gluteal tendon can also be repaired with a synthetic LARS augment. The LARS technique uses a synthetic ligament to strengthen the repair of the gluteal tendon back to the bone, allowing early mobilisation and weight bearing following the surgery, protected with crutches. Generally, patients will be on crutches for six weeks after this operation to allow time for the tendon to heal. Once the tendon has healed, extensive strengthening and rehabilitation is required to rebuild the strength in the gluteal muscles and improve walking and pain.
Osteoarthritis of the hip is a disease in which the smooth cartilage which covers both the ball and socket of the joint wears out.
This is often seen as we get older from everyday wear and tear, but can also happen in younger patients due to injury, genetic influences and in patients whose ball or socket is not perfectly round or when the ball impinges on the edge of the socket. If a patient develops hip osteoarthritis, it often affects both sides. As the osteoarthritis progresses, the cartilage can wear out all the way to the bone and cause bone spurs, cysts and even a shorter leg.
Patients often experience pain in the groin, buttock or down the leg into the knee. The hip can become stiffer, preventing daily activities such as putting on shoes and socks and can also cause a limp. Patients often report pain and stiffness, which is worse with the first few steps, and say that it takes a while to "warm the hip up". Osteoarthritis arthritis symptoms can come and go with some days and weeks being worse than others.
Total hip replacement is one of the safest and reliable operations performed, not just in orthopaedics but across all surgical subspecialties. Most total hip replacements are done for osteoarthritis of the hip, but it can also be done for rheumatoid arthritis, necrosis of the ball joint and fracture of the neck of the femur.
After making the approach to the hip joint, the surgeon makes a cut through the neck of the femur, removing the ball from the ball and socket joint. The surgeon will then remove the cartilage from the socket with a circular reamer. The new metal hip is then placed into the femur and into the acetabulum and the wound is closed.