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Hip Pain

Hip pain, hip symptoms and hip disorders are more common than realised, likely due to the difficulty with diagnosing them accurately. Several body areas can refer pain in the hip area and cause leg pain, including the lumbar spine, the sacroiliac joints, pelvic structures, buttock syndromes and the hip joint itself. Lower back pain may have as part of its picture pain in the hip, sometimes as the main symptom.

Hip pain problems can be classified according to the age group they occur in, and whether they include joint stiffness with or without pain, or normal joint motion with hip pain. Pain can include buttock pain, hip pain, thigh pain, lateral hip pain, bursitis pain and groin pain.

As hip pain can be referred as far as the knee the initial diagnosis can be knee pain with osteoarthritis of the knee, and a knee replacement may be planned. Careful examination and history should discover that hip arthritis is the cause of the knee pain.

There is a good emedicine page on hip pain here, and more information about hip pain in About.com:Orthopedics.

Age-related classification of hip disorders:

Newborn babies

  • Developmental Dysplasia of the Hip (DDH), formerly called Congenital Dislocation of the Hip (CDH)

Young children approx 4-12 years

  • Perthes’ disease (Legg-Calve-Perthes disease) occurs when the upper growth plate of the thigh bone (femur), just below the ball of the hip, loses its blood supply. The bone of the ball then dies and can regain its blood supply over time.

It is not a common syndrome, with about one in 1200 children under 15 years in the US affected. It is a self-limiting condition but the results can vary from a normal hip to significant osteoarthritis.

  • Tuberculosis

  • Transient (short-lived) arthritis. This is a common cause of hip pain and limping in young children and the cause is not known. It tends to settle on its own and leave no lasting problems, although it can recur.

Transient arthritis presents as similar to septic arthritis (a serious infection) so the diagnosis needs to be made accurately. If transient arthritis is the diagnosis, the treatment is rest, anti-inflammatory drugs and time.

Older children, approx 12-17 years

  • Slipped capital femoral epiphysis (SCFE), also called slipped upper femoral epiphysis (SUFE)

  • Osteochondritis dissecans

Adults

  • Osteoarthritis (OA), the most common degenerative joint condition. Arthritis pain is extremely common throughout the world and most people over 50 years of age have at least one joint with arthritis pain. This is the commonest joint disease for which people have hip replacement or hip resurfacing to achieve hip pain relief. There are many types of hip replacement to treat hip pain with a range of hip replacement costs.

  • Broken hip. Fractured neck of femur is common in older people with osteoporosis and a broken hip is serious occurrence in the elderly, requiring hip surgery for fixation or hip replacement.

  • Rheumatoid arthritis (RA), an inflammatory arthritis, more common in women.

  • Ankylosing spondylitis (AS), an inflammatory arthritis more common in men.

  • Bursitis, an inflammation of the small lubricating sacs which the body has in areas where structures pass across each other and cause friction. Hip bursitis can occur with too much distance road work and be a cause of hip pain running.

  • Loose bodies in the joint



It can be difficult to visualise what the operation is for and what is done when the hip is replaced with a metal and plastic insert. Watching a hip replacement video can be useful to understand what is going on and enable a patient to participate in a more informed way in, for example, the hip replacement exercises and rehabilitation.



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