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Why it comes and how to relieve hip pain

By Cristiano Antonino On Nov 3, 2022

Hip pain is a widespread problem because it affects one of the most heavily loaded joints in the body

Over time it can become disabling, affecting the patient’s ability to walk, climb stairs, play sports, and carry out daily activities.

Often the pain is caused by a degenerative disease, arthrosis, which in advanced stages can be solved by prosthetic surgery aimed primarily at safeguarding the patient’s quality of life.

Why does the hip hurt?

The most common cause of hip pain is osteoarthritis, a degenerative process that occurs by altering the joint’s ability to perform its main activity: rotating and moving in all planes of space.

Arthrosis, in fact, affects the articular cartilage of the hip, progressively wearing it down so much that it loses its ability to maintain full extension.

As a result, the subject will tend to flex the torso and bend the knees, adopting a forward-arching position.

Necrosis of the femoral head is also a primary cause of hip pain

This condition has no clear genesis, but if not properly treated, it can lead to:

loss of joint mobility
increased pain
subsequent need for surgery.

Hip pain in young adults can also be caused by what is known as femoro-acetabular conflict, a structural alteration of the femur and/or acetabulum that eventually damages the joint components of the joint.

Arthrosis: why it occurs and who is most at risk

Traumas such as fracture of the femur and pelvis, sports accidents and excessive levels of sports with a high impact on the joints (volleyball, basketball, skiing) are secondary causes of arthrosis, which cannot be predicted and can lead to an early onset of the disease, which would have occurred at a later age anyway.

In addition, there are other pathologies that accelerate the arthritic evolution, leading to an early onset of arthrosis at a younger age, such as hip dysplasia, Perthes’ disease and epiphysiolysis, which, however, are now diagnosed and treated early thanks to very accurate screening.

Those most at risk are adults and the elderly, since it is in this age group that the arthritic process physiologically begins to set in.

Hip pain as a symptom of arthrosis

The first symptom of arthrosis is hip pain, which occurs constantly when the patient walks, climbs stairs, moves the joint, but also in so-called ‘postural transitions’, when changing position, getting up from a chair, tying shoes.

The hip can also hurt when lying in bed: the supine position, in fact, although it does not place a load on the joint, can be uncomfortable during movements in sleep.

At the onset, arthrosis causes a fluctuating, occasional pain, which then becomes constant as the joint wears out and the hip, due to a physiological defence mechanism, tends to become rigid.

This is precisely the reason why in some cases the patient with hip arthrosis comes to the orthopaedist’s evaluation reporting pain in the knee, also extending to the front part of the thigh, or back pain.

Treating arthrosis: medication or surgery?

Arthrosis is a chronic developmental disease that progresses in 3 phases: initial, moderate and severe.

The starting point for the diagnosis is the orthopaedic examination, which allows the doctor to assess the individual case and prescribe instrumental examinations (X-ray, MRI) to find out the degree of severity of the pathology.

In the initial, moderate phase, the suggested therapy is conservative and involves medical treatment, physical therapy and infiltrations.

After the moderate phase, the indication for treatment becomes surgical. In the past, this indication was suggested as a last resort; nowadays, thanks to the use of advanced surgical techniques and prostheses with a longer life expectancy, the surgical indication is anticipated.

Hip prosthesis: how the operation is performed

Hip replacement surgery is referred to by many as the ‘surgery of the century’, is now considered routine, and has a very high success rate with a minimal complication rate.

During the operation, the surgeon replaces the joint with a titanium implant, inserted into the head of the femur, which aims to reconstruct the correct joint geometry so that the patient can feel the hip as naturally as possible.

The operation is performed under spinal anaesthesia, lasts less than 1 hour, and is carried out using the traditional technique or by means of a robot that allows the perfect execution of what the surgeon has programmed.

Post-operative

A few hours after surgery, the patient is already helped to get back on his feet and ambulate.

In the following days, he is assisted by the staff in carrying out daily activities so that the joint starts working properly again.

Once he has been re-educated to be minimally independent, he can be discharged, usually between the second and third day after surgery, with the aid of crutches.

What awaits me after surgery?

The rehabilitation process lasts on average 3 to 4 weeks, during which the patient learns to be autonomous in his movements with a view to resuming most of his daily activities.

After 2 to 4 weeks, the crutches can be removed, depending on the individual response to the surgery.

The lifespan of a correctly implanted hip replacement is 20/25 years.

Does hip replacement surgery have risks and complications?

The most frequent complications of hip replacement surgery are:

loosening of the implant, which occurs in cases where the prosthesis is implanted sub-optimally;
infections;
implant instability.

The material of the prosthesis, titanium, is generally well tolerated by patients and has no risk of postoperative complications.

Can the operation be performed on both hips?

When the arthrosis is bilateral, it is important for the surgeon to assess the degree of wear on both hips.

If the discrepancy of the defect is large, the operation is performed at 2 separate times, with the more damaged joint being given priority.

If, on the other hand, the hips have the same high degree of arthrosis, a simultaneous operation is possible, with a slightly longer recovery of function in the first week after the operation, but with an extraordinary final result that does not involve an increased risk of complications.

In the latter case, the patient will walk optimally, as the joints are immediately restored to symmetry after the operation.

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