In developing a joint preservation practice over the last 5 years, I see patients from 16 years old to well over 90 years old with hip pain. Though common, not all hip pain is arthritis.
When the pain persists despite taking an anti-inflammatory medication (i.e., Ibuprofen) for 3-4 weeks or doing formal physical therapy, evaluation with an orthopaedic surgeon should be sought. It can mean you’re dealing with a serious injury or condition. Find out more about the common causes of hip pain and methods to treat them.
Hip Arthritis
Hip arthritis is the most common diagnosis that comes to my clinic and is typically (but not always) in patients over 50 years old. Often these patients are “stiff” in the hip joint(s) and feel groin pain with activity which sometimes also occurs at night and interferes with sleep. This pain can also travel down the front of the leg to the knee.
An evaluation with a few simple x-ray views of the hip can diagnosis moderate to severe hip arthritis. When the pain is diminishing quality of life, hip replacement surgery has great patient satisfaction and can last for 25+ years if performed well. There are a variety of surgical techniques now that can have patients back to the gym, golfing, doing yoga and Pilates, tennis, etc. by 4-6 weeks after hip replacement surgery.
Before hip arthritis begins, often times a similar pain will occur in the groin that is sharp and feels like something gets caught, especially with pivoting activities. The hip is a ball-and-socket joint like the shoulder, and both of these joints have a soft tissue “gasket” that surrounds the socket called a labrum. Joint preservation surgeons think that pain from a labral tear is the first signal that something is wrong with the hip joint, and if it progresses for a few years, arthritis of the joint can then occur.
Hip Labral Tears, Dysplasia and Impingement
Though traumatic labral tears certainly do occur, different types of hip anatomy have a predilection toward labral tears, including hip dysplasia (a developmental under coverage of the femoral head by the pelvis) and femoroacetabular impingement also known as FAI (a prominence that forms on the neck of the femur abuts the labrum with deep flexion of the hip). Prior to the start of arthritis, labral tears can be repaired with hip arthroscopy. Here, a camera and a tool are inserted into the hip joint, and sutures are used to re-affix the labrum back onto the rim of the pelvis. The “bump” that forms on the femur in FAI can also be sculpted down with hip arthroscopy to improve motion and limit impingement of the femur onto the pelvis.
Other patients complain of hip pain that is more lateral, on the side of the hip joint instead of in the groin. The iliotibial band is a muscle and fascia that arises from the top of the pelvis and travels down to the lateral knee. This fascia can become tight and inflamed resulting in iliotibial band tendinitis.
Stretching, physical therapy, and acupuncture are great modalities to improve symptoms of tendinitis.
Another cause of lateral hip pain is from the gluteal or abductor muscles that insert on the bony prominence, the greater trochanter, of the hip. These muscles (gluteus medius and gluteus minimus) are the rotator cuff of the hip joint (just like you have a rotator cuff in your shoulder) and can also get a tendinopathy, but overt tears of these muscles occur as well. These patients have difficulty sleeping on the affected side due to pain, struggle going up stairs, and can also limp due to the pain.
If just a tendinopathy, physical therapy and a single anti-inflammatory injection at this spot can improve the pain and function of the hip. If no improvement is seen, formal evaluation with an orthopaedic hip specialist is warranted, and a MRI will likely diagnose the problem. For significant gluteal muscle tears that do not respond to physical therapy, an abductor/gluteal muscle repair surgery can be performed to reattach the torn portion of muscle to the bone in a similar way that we repair rotator cuff tears in the shoulder joint.
Lower Back Pain
Finally, pain that is felt in the low back, radiating into the buttock area is often caused by a low back issue. As a hip surgeon, my practice overlaps with neurosurgeons and orthopaedic spine surgeons. With a detailed physical examination and sometimes higher level imaging (MRI), the cause of this pain (herniated disc, lumbar spine degeneration, etc.) can be found.
Treating Hip Pain
If you have a hip problem that persists for over 4-6 weeks despite rest, anti-inflammatory medications, or physical therapy, evaluation from a specialized orthopaedic hip surgeon is recommended. Often, by diagnosing the problem, a nonoperative solution can be found. If surgery is needed, make sure you feel confident and comfortable with your surgeon and trust they will get you back to your active lifestyle and feeling great.
Dr. Jeffrey Petrie is a fellowship trained orthopaedic surgeon with extensive expertise in hip and knee replacement, including complex revision surgeries, and sees patients in Davenport. For more information or to make an appointment, click here.
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