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University Orthopaedics, Hand

and Reconstructive Microsurgery Cluster

Hip Conditions

 

 

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The human hip joint is a complex ball and socket joint and is well constructed for its intended use- standing and walking. The hip joint is an outstanding example of a congruous joint. Both the concave acetabulum and the convex femoral head are symmetrical and the joint space is equal at all points with slight deviation to permit adequate lubrication.

 

This symmetry allows for rotation about a fixed axis and simplifies the muscle action on the joint. The femoral head articulates within the acetabulum, which is horseshoe shaped and coated with cartilage around most of its periphery. The centre is free of cartilage.

 

It is deepened by a cartilage-covered ring of fibro cartilage termed the labrum. The head of the femur fits into the acetabulum, where it is held firmly by a thick capsule, which is divided into thickened layers forming the iliofemoral, pubofemoral, and ischiofemoral ligaments.

What causes hip pain?

Hip pain is common problem and there are many causes of hip pain. It is important to make an accurate diagnosis of the cause of your symptoms so that appropriate treatment can be directed at the underlying problem.

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Common Causes of Hip Pain

Arthritis
Arthritis, characterised by progressive wearing away of the cartilage of the joint, is among the most frequent causes of hip pain. While hip arthritis usually affects patients over the 50 years of age, it is also common in people who are overweight.  

Trochanteric bursitis is an extremely common problem that causes inflammation of the bursa over the outside of the hip joint.

Tendonitis
Tendonitis is the inflammation of the tendons and can occur in any of the tendons that surround the hip joint. The most frequently encountered tendonitis around the hip is iliotibial band (IT band) tendonitis.

Osteonecrosis
This is a condition that occurs when blood flow to an area of bone is restricted. If an inadequate amount of blood flow reaches the bone, the cells will die and the bone may collapse. One of the most common places for osteonecrosis to occur is in the hip joint.

Lumbar Pain
Many back and spine problems can cause symptoms around the buttocks and hip. The most common problems that refer pain to the hip region are herniated discs and sciatica.

Snapping Hip Syndrome

Snapping hip syndrome is a word used to describe three distinct hip problems. The first is when the IT band snaps over the outside of the thigh. The second occurs when the deep hip flexor snaps over the front of the hip joint. Finally, tears of the cartilage, or labrum, around the hip socket can cause a snapping sensation.

Muscle Strains
Strains of the muscles around the hip and pelvis can cause pain and spasm. The most common strains are groin pulls and hamstring strains.

Hip Fracture
Hip fractures are most common in elderly patients with osteoporosis. Treatment of broken hips requires surgery to either replace the broken portion or repair it with a metal plate and screws.

Hip Stress Fracture
Stress fractures of the hip are most common in athletes who participate in high-impact sports, such as long distance runners. Treatment usually is successful by avoiding the impact activities.

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Childhood Hip Problems

Developmental Dysplasia

When the hips are dislocated or out of position in infancy, the joint may not develop properly. While this is not usually painful as a child, it will lead to early arthritis and problems with walking.

 

Legg-Calve-Perthes Disease

Also called Perthes disease, this is a problem similar to osteonecrosis (see above) but happens during childhood. If severe, it can lead to permanent damage to this hip joint and early arthritis.

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When do you need to call your doctor about your hip pain?

If you are unsure of the cause of your symptoms, or if you do not know the specific treatment recommendations for your condition, you should seek medical attention. Treatment of hip pain must be directed at the specific cause of your problem. You should see your doctor when:

 

  • You are unable to walk comfortably on the affected side
  • You have an injury that causes deformity around the joint
  • Your hip pain occurs at night or while you are resting
  • You have hip pain that persists beyond a few days
  • You are unable to bend the hip
  • There is swelling of the hip or the thigh area
  • There are signs of an infection, including fever, redness, warmth
  • You experience any other unusual symptoms

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Treatment Options

The treatment depends entirely on the cause of the problem. Therefore, it is important that you understand the cause of your symptoms before embarking on a treatment programme. If you are unsure of your diagnosis, or the severity of your condition, you should seek medical advice before beginning any treatment plan.
 
Not all of the treatment options listed are appropriate for every condition.

Rest
The first treatment for most conditions that cause hip pain is to rest the joint, and allow the acute inflammation to subside. Often this is the only step needed to relieve hip pain. If the symptoms are severe, crutches or a cane may be helpful as well.
 
Ice and Heat Application
Ice packs and heat pads are among the most commonly used treatments for inflammation.  Ice packs are mostly used for acute injuries to help minimise swelling while heat pads are used for chronic conditions to help relax and loosen tissues, and to stimulate blood flow to the area.

Stretching
Stretching the muscles and tendons that surround the joint can help with some causes of hip pain. A good routine should be established.

Physiotherapy
Physiotherapy is an important aspect of treatment for almost all orthopaedic conditions. Physiotherapists use different modalities to increase strength, regain mobility, and help return patients to their pre-injury level of activity.

Anti-Inflammatory Medication
Nonsteroidal anti-inflammatory medications, commonly referred to as NSAIDs, are some of the most frequently prescribed medications, especially for patients with hip pain caused by problems such as arthritis, bursitis, and tendonitis.

Total Hip Replacement
Hip replacement surgery may be considered when arthritis limits your everyday activities such as walking and bending, when pain continues while resting, or stiffness in your hip limits your ability to move or lift your leg. Hip replacement may be recommended only after careful diagnosis of your joint problem. It is time to consider surgery if you have little pain relief from anti-inflammatory drugs or if other treatments, such as physical therapy, do not relieve hip pain.

Hip replacement surgery involves replacing the femur (head of the thighbone) and the acetabulum (hip socket). Typically, the artificial ball with its stem is made of a strong metal or ceramic, and the artificial socket is made of polyethylene (a durable, wear-resistant plastic) or metal backed with a plastic liner. The artificial joint may be cemented in position or held securely in the bone without cement. The ball and insert are designed to glide together to replicate the hip joint.

Success Rate

For the vast majority of patients, joint replacement can be successful in providing relief from pain and improved mobility for many years. According to the American Academy of Orthopaedic Surgeons, hip replacement procedures have been found to result in significant restoration of function and reduction of pain in over 90% of patients.

Benefits of Hip Replacement Surgery

Hip Replacement surgery helps more than 200,000 Americans each year to relieve their hip pain, and get back to enjoying normal, everyday activities. Most patients need to stay in hospital for only 4 to 5 days.

Hip Resurfacing

In this innovative process, the end of the thigh bone (femur) is capped with a metal covering – a strong cobalt chromium metal – much like the capping of a tooth. This fits neatly into a metal cup that sits in the hip socket. The head swivels within the cup, gliding together to replicate the hip joint. The surfaces that rub against each other are both made from highly polished metal. This type of hip device is called a metal-on-metal hip resurfacing device.

The first benefit of hip resurfacing is that its bone conserving – This means that more of your healthy bone is kept intact. The damaged area is simply resurfaced, not fully removed.

In addition, there is more natural motion and less chance of dislocation than total hip replacement1 – As large amounts of bone are not removed, the surgeon can resurface the hip closer to the size and shape of your natural hip. In fact, your resurfaced femur is similar to the size of your natural bone so you get a better fit inside your hip socket. This may result in greater stability and the potential for an increased range of motion – so you can return to the gym or dancing, or whatever activity you loved.

You are better prepared for a later treatment - hip resurfacing removes less of your own bone, which may be important should you ever require a total hip replacement in the future.

Hip Resurfacing may be appropriate for younger, more active patients, patients with good bone quality, osteoarthritis and rheumatoid arthritis.

Hip Resurfacing is not recommended for patients with the following conditions
•    Active or suspected infection in or about the hip joint
•    Poor bone quality which your surgeon feels could not support the implant
•    Multiple cysts
•    Any known allergy to metal (e.g., jewelry)
•    Extreme overweight (overload on device that would lead to failure)
•    Skeletal immaturity
•    Women in child-bearing years
•    Weak immune system due to disease or certain medications (e.g., corticosteroids)

•    Kidney failure.

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