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Introduction:

If you have sustained an injury or developed a sudden serious problem with your hip, please initially see your GP or the accident and emergency department depending on the urgency of the problem.

If you have developed a significant non-urgent problem with your hip, you should initially see your GP.

The following are some of the non-urgent conditions for which your GP may refer you to an orthopaedic surgeon for further assessment or intervention.

If you are concerned about any symptoms you are experiencing or have suffered an injury you should seek a review by a medical professional in the first instance. The following information is intended to supplement what you may be told by your Doctor or Nurse and cannot be used on its own to reach any kind of diagnosis.

Osteoarthritis (wear and tear)

Symptoms:

Gradual onset of progressive pain felt in the groin and round the side of the hip from middle age onwards but most commonly in the 70s.  Pain is worse with activity and is accompanied by stiffness. if pain becomes very severe, it can disturb sleep.  Walking and other such activities become increasingly difficult and it is only possible to walk short distances before pain forces one to have to stop and rest. Stiffness can make it difficult to reach down to the feet.

It is imperative that an accurate diagnosis is initially reached and for this reason you should always seek a medical review if you are concerned. Having done so the treatment options will vary depending on the nature of the cause of your hip pain.

The condition:

Osteoarthritis is the most common form of degenerative wear and tear type of arthritis of the hip. Osteoarthritis means that the cartilage that normally covers the surfaces of the bones in the joint degenerates and is worn away. The underlying bone is exposed and with hip movement, bare bone rubs against bare bone. This is painful and restricts normal hip function. The hip can carry on functioning surprisingly well even with diminishing cartilage cover and losing cartilage from the joint is actually a natural process with ageing.  The rate of loss varies between individuals and in some people if cartilage is lost earlier on in life whilst still active, symptoms and in particular pain may be more noticeable. The condition usually only progresses very slowly over many years but occasionally rapid deterioration is experienced.

Similar symptoms are noted with rheumatoid arthritis and other types of inflammatory arthritis – these conditions cause pain in the joint initially but can also cause wear and tear type of damage to the joint eventually resulting in more severe pain. Surgical treatment options are similar to severe cases of osteoarthritis.

Treatment options:

If hip pain is secondary to plain osteoarthritis without any worrying features, the options are as follows:

  • If you are overweight, losing weight should help greatly. The less weight is put through the hip the less it will hurt.
  • Simple painkillers including some more powerful ones which can be prescribed by your GP.
  • Appropriate modifications to activities if only certain non-essential activities result in pain and help from walking sticks or some adaptations to the house.
  • Consideration of surgery to have a hip replacement.

Hip replacement surgery:

As a brief guide, a hip replacement may be worthwhile in the following situations:

  • Pain is sufficient to disturb sleep
  • Pain prohibits walking far enough to be able to attend to essential everyday needs
  • Taking all the painkillers that one can safely take is not sufficient
  • Stiffness in the hip prevents one from moving comfortably and prevents being able to reach the feet

The Oxford Hip Score can help to quantify the severity of the condition. For further information see section on hip replacement (click here).

Hip impingement (a cause of hip or groin pain in younger adults)

This condition causes hip pain mostly in the groin in young adults through to middle age especially with long periods of sitting down, driving  or sports and exercise. There can be several causes including groin strain but also ‘Hip Impingement’ (also known as “Femoro-Acetabular Impingement”) which can be diagnosed and treated in many instances.

Most cases are due to soft tissue problems (involving ligaments and muscles) and may resolve of their own accord over a few months or respond to physiotherapy.  However, a small number of cases may be due to a condition known as ‘Hip Impingement’ (also known as ‘Femoro-Acetabular Impingement’) in which the ball and socket of the joint exhibit a slight miss-match in the curvature of the ball and that of the socket resulting in impingement or catching of the edge of one side of the joint against the other.

In a large number of people this shape of hip is normal and never causes any problems but in some people by middle age, the cartilage of the joint has been scratched by the process and it starts to hurt. The diagnosis is reasonably difficult to make and may not necessarily be picked up on plain x-rays which are routinely carried out and reported back to GPs.

If you are troubled by such symptoms, an Orthopaedic Surgeon with an interest in this condition, such as Mr Sehat, may be able to advise.

There is surgery available which can help with many cases.