Hip Pain: Causes, Symptoms, Diagnosis, Complications, and Treatment
Hip pain can be a fairly common finding, which can result from a variety of causes. It can occur as a result of trauma or chronic injury, such as fractures, which are very common among the elderly, especially among those who suffer from osteoporosis (bone loss)
Or again, a contracture, a traumatic dislocation or osteoarthritis can also cause pain in the groin and necrosis of the femoral head.
If the pain comes on quickly, it could be due to a viral or bacterial infection or inflammatory arthritis.
Most commonly, hip pain is caused by ongoing osteoarthritis
In Italy, currently, about 96,000 hip prostheses are implanted each years as it is a well-coded intervention with a high percentage of success performed when arthrosis reaches an advanced stage.
Hip pain is very common because it affects one of the most stressed joints in our body
When we are on the move, in fact, it is the hip that bears most of the mechanical load, which is why obese subjects and the elderly are the most exposed (the former due to excessive load, the latter due to cartilage wear). .
The pain can only affect the left or right hip, but in some cases it is felt on both.
Symptoms
A hip problem can manifest as pain in the front starting in the groin and spreading up the leg to the knee, posterior to the buttock, or lateral to the greater trochanter of the femur.
Usually the pain is perceived as more intense in the morning as soon as you get out of bed or after a period of rest, for example after sitting for a while on an armchair or sofa.
With the passing of time during the day, walking or carrying out simple activities, the pain may improve but may be accompanied by a reduction in the ability to move at the level of the hip joint.
In some cases, hip pain can be felt all the way up the thigh to the knee, even though the problem is actually in the hip.
Causes of hip pain
The cartilages that allow the joints to move easily can wear out over time but also thin out if too much load weighs on them (as happens for overweight or obese subjects), or because they simply weaken over the years.
In case of hip pain, the most common cause is osteoarthritis, a chronic degenerative disease characterized by the progressive destruction and loss of articular cartilage.
In fact, it causes a progressive thinning of the cartilage layer, until the bone is exposed and, due to the friction caused by the movement, it thickens, producing osteophytes (sharp growths).
Over time, the muscles contract and the patient develops the deformities typical of the advanced stage of this disease.
However, the origin of pain in the hips could also lie in an aseptic avascular necrosis of which it is the first symptom (dull or stabbing pain in the groin or buttocks area) or in a femoroacetabular conflict more typical in young sportsmen.
In fact, in young people, hip pains are usually attributable to physical activity without effective and preventive training or to exasperated activity that creates decompensation for the peri-articular tissues such as tendons or ligaments.
Lateral hip pain can also be caused by bursitis, tendonitis, and inflammation of the soft tissues that surround and articulate the femoral head and acetabulum.
Other possible causes of hip pain include congenital dysplasia, disc disease with sciatica, osteonecrosis (or avascular necrosis), rheumatoid arthritis, fibromyalgia, and bone tumors involving the proximal femur or acetabulum.
When the problem occurs at birth, we speak of congenital dysplasia of the hip, a deformity of the joint that begins during intrauterine life.
In practice, the joint is loose, so that, with a slight pressure from the pediatrician, the head of the femur comes out and comes back from the acetabulum.
If this is not diagnosed immediately and is not treated, the pathology degenerates until a permanent dislocation of the hip occurs, which degenerates into coxarthrosis.
Diagnosis
If the hip pain is persistent and acute, and the patient is unable to move freely, it is very important to book an appointment with an orthopedic surgeon as soon as possible who collects information on the patient’s state of health through the medical history.
First of all, the specialist considers the range of pathologies that are more typical contextualized to the specific age of the patient to orient himself in the diagnosis.
Indeed, menopausal subjects suffer from arthritis, young people experience peri-articular pain due to poorly managed physical activity, while the elderly may have arthritic or osteoporosis problems which predispose them to more serious problems such as femoral neck fractures.
A physical examination follows, during which the doctor examines the hip, assessing pain, range of motion, and muscle strength.
To understand the nature of the pain in the hips, he could therefore suggest carrying out diagnostic tests such as an X-ray of the pelvis and possibly, on the recommendation of the specialist, an MRI.
Complications
The complications of hip osteoarthritis can usually arise as a consequence of pains that are symptomatic of a more advanced stage of the disease: chronic pain and reduced hip movement capacity, in fact, negatively affect the patient’s quality of life, who complains of continuous discomfort and has problems walking even for short distances.
The forced sedentary lifestyle for those who feel these pains causes progressive atrophy of the muscles of the entire lower limb (especially the calves).
However, hip pain can also be felt after the prosthesis: it is the most frequent complication in the early post-operative stages, but it is not a permanent condition.
Often a greater permanence of pain is caused by other problems such as obesity, postural alterations or a sedentary life.
The complications that can arise following the application of the prosthesis can consist of a slowdown in the functional recovery of the patient and the impossibility or alterations of walking.
Operations and therapies for osteoarthritis of the hip
In the case of hip osteoarthritis, the most common pain-related pathology, the treatment depends on the stage in which the person who perceives this pain is located.
In the initial stages of an arthrosis of this type we usually proceed with a pain-relieving and anti-inflammatory medical therapy, which also involves the application of products that nourish the cartilage or other products that use hyaluronic acid, then rest and kinesitherapy (therapy movement) associated with physical therapies for analgesic purposes.
As the disease progresses, intra-articular infiltrative therapy is used, therefore the use of a cane is suggested to facilitate walking.
Taking anti-inflammatory drugs can always help reduce the perceived pain, just as it is certainly advisable to maintain a moderate body weight so as not to burden the joint and make movements even more tiring.
If the patient does not respond to previous treatments and the problem persists, arthroplasty surgery should be performed.
As with cases of aseptic vascular necrosis, the only solution to stop the pain is prosthetic surgery.
For particular conditions, such as outcomes of microtraumas for certain sports or outcomes of fractures, prostheses can also be used in younger subjects (30-40-50 years).
Today, in fact, thanks to the new orthopedic surgery techniques tested by teams from all over the world and to the evolution in the field of prostheses and materials, doctors tend to offer arthroplasty to younger people too, especially when the pain of the hip is associated with functional deficits.
If the hip pain is attributable to arthritis, which remains an inflammation, the treatment is anti-inflammatory and involves the application of cortisone products, NSAIDs and painkillers.
In the case of a dysplastic hip in an infant, it can usually be corrected with a splint, restoring its normal shape.
In adults, on the other hand, the treatment depends on the stage of the disease, because if the arthrosis is at an early stage, corrective surgery can be used.
On the other hand, when the arthrosis is in an advanced stage, the patient has a severe limp, or there is a full-blown arthrosis with a serious radiographic picture, it is necessary to resort to a hip prosthesis.
Prevent hip pain
Apart from age-related causes, which cannot be prevented in any way, there are situations in which hip pain can be prevented by adopting the right lifestyle and the right measures.
This is the case for athletes, or even for younger subjects: it is important to start sports activities by preparing gradually, without immediately aiming for excessive efforts, because the tissues are not prepared for immediate efforts.
You can’t improvise runners and expect not to feel pain. In short, it always takes preparation.
If the subject prepares himself adequately, with the right warm-up and a gradual increase in physical activity, the musculoskeletal structures react well, otherwise there is a risk of tendon or muscle ruptures due to stress.
To keep the hip agile and flexible, sports activities that allow the hip joint to perform circular movements in the axis with limited stresses are recommended.
Even when there are hip problems of mild or intermediate intensity, it is possible to practice sports such as swimming, water gymnastics, cycling, Nordic walking or walks on level ground without problems.
Nutrition is also a factor on which anyone can intervene to prevent pain in the hips and therefore possible complications: a diet that is too rich, for example, in animal proteins, could attack the cartilage, accelerating its degeneration.
Furthermore, obesity represents an important problem because the excessive weight of the individual affects the health of the joints, with serious consequences on the cartilage.
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