Have Hip Pain?
The hip joints are the large weight-bearing junctions of where your leg (femur) and pelvis come together. Just as with any other mobile joint, the hips can become a source of pain. The pain can be caused by injury, wear and tear over time or other disease processes. The following are the more common conditions that can cause the hip joint to become a source of pain.
One of the most common sources of hip pain that we treat is osteoarthritis. This is a degenerative condition of the bones and cartilage. The cartilage is the cushioning of the hip. When this becomes worn down, it can cause inflammation, swelling, pain, dysfunction and can eventually lead to deformity if severe. There are many reasons that arthritis of the hip can form, including injury, aging, and other disease processes. The condition can often be diagnosed by x-ray, but sometimes an MRI is necessary. Once we establish that arthritis is the diagnosis, there are several options that can be offered, including anti-inflammatory medications, activity modification, steroid injections and surgical intervention. This entails making one incision over the lateral portion of the joint and replacing the diseased joint space with a joint prosthesis. This requires a 2-3 night stay in the hospital and several weeks of physical therapy to help regain function.
Avascular Necrosis (AVN)
The femoral head, which is the femur’s part of the hip joint, can loose its supply of blood, causing it to collapse and become deformed in some cases. This condition is called avascular necrosis. This can be caused from trauma, steroid use, vascular disease, chemotherapy, radiation, medication or a variety of other diseases. We often can not identify the cause of the loss of blood supply in many individuals’ cases. When the femoral head collapses, the joint can not work properly, causing pain, inflammation, deformity and dysfunction. To look for AVN, we often employ the use of x-rays and sometimes an MRI. If caught early, a small operation called a core decompression can be tried where, as an outpatient, a tunnel is made into the bone to try to reestablish blood flow. Unfortunately, in some cases, AVN is not discovered until the later stages. At this point, a total joint replacement may be necessary. As stated before, this requires hospitalization and physical therapy to regain function.
Unfortunately, traumas (including falls and car accidents) can occur, causing the hip to fracture. There are several areas of the femur or pelvis that can fracture and cause pain in the joint. If the fracture is in the pelvis, we can often treat this with pain medication and time for the fracture to heal as the patient returns to normal function. Unfortunately, when the femur breaks, surgery is often a necessity. Surgery may be as simple as placing a plate or rod and screws into the femur to hold the fracture together as it heals or may actually entail replacing part of or the entire hip joint. X-rays, MRI and CT scans are used to determine the type of fracture and the best treatment. It often takes at least 6 weeks for the bone to heal with therapy being employed during that time to allow the patient to return back to normal function.
Painful Joint Prosthetics
Even though in most cases joint replacement is a successful long-term treatment for pain, it is still possible for an issue to arise. Issues that can cause a prosthesis to become painful include infection, loosening, wear and tear, damage to the components, fracturing around the prosthesis and improper fit. When a patient has a joint prosthesis in place, several tests are necessary to determine the cause of the problem. These tests include blood work, x-ray, bone scan and needle sampling of the joint fluid to check for infection. Also, the original report of the operation is often necessary to determine the prosthetics used in the replacement. If one of the above problems is present, often surgery is necessary to correct the base issue. This may mean replacing a part of or the whole prosthesis. If infection is present, this may also require antibiotic medication to help fight off the infection. Additional prosthetics may be required if a fracture is present. After surgery, the patient will also have to participate in a physical therapy regimen to help regain normal function.
Other Causes of Hip Pain
This information, while extensive, is not an all inclusive list of all issues that can cause hip pain. It is simply a guide to give you an idea of some more common hip problems. If you have pain in your hip, it is best to seek medical attention to properly diagnose your issue. This will include a comprehensive review of history and examination as well as appropriate imaging studies to help us determine the diagnosis and best treatment options in your case.