Virtual Medical Centre

Hip pain

• What is Hip pain?
• Who gets Hip pain?
• Predisposing Factors
• Progression
• Probable Outcomes
• How is Hip pain Diagnosed?
• How is Hip pain treated?
• Hip pain References
• Drugs/Products Associated with Hip pain

What is Hip pain?

The hip is the part of the body anatomically referred to as the 'hip joint' is where the upper part of the femur (the thigh bone) attaches to the pelvis (acetabulum).

Image courtesy of Dr Iván Saenz (Virtual Medical Vision)

When patients complain of hip pain, they most commonly actually refer to the buttock or lower back. Hip problems, on the other hand, usually cause pain in the thigh region, groin, or even knee due to the innervation of the hip.

Who gets Hip pain?

Hip pain is very common and can resuly from numerous different causes. Hip pain tends to occur commonly in certain age groups - the young (from 0 to 15 years) and older population (>45 years of age).

Predisposing Factors

The most common causes of hip pain in adults are:

• Osteoarthritis of the hip especially if you are older than 50.
• Lower back problems (e.g. vertebral dysfunction)
• Fracture of the femoral neck
• Traumatic muscular strains and bursitis or tendinitis (inflammation of the bursa and tendons respectively. Bursae are fluid filled sacs that reduce friction and improve movements at joints)
• Polymyalgia rheumatica (an inflammatory condition that tends to cause symmetrical back and hip pain)
• Other inflammatory conditions - e.g. rheumatoid arthritis, ankylosing spondylitis.
• Serious infections - septic arthritis, osteomyelitis.
• Malignancy- The hip and pelvis are common sites for secondary bony deposits. The pain is likely to be severe, unremitting and constant and be associated with weight loss

In children, the common conditions are:

• Congenital dislocation of the hip (0-4 years, 1/800 infants).
• Transient synovitis (4-8 years) transient inflammation of the hip joint lining - usually due to minor trauma or virus.
• Perthes' disease: (4-8 years) necrosis (tissue destruction) of the femoral head due to lack of blood supply.
• Slipped capital femoral epiphysis (SCFE),: 10-15 years. The femoral head 'slips' with respect to the femoral neck. Tends to occur in adolescent boys.
• Septic arthritis is rare but should be considered in ill children who are unable to walk.

Progression

Largely depends on the condition. Importantly, in older adults:

• Osteoarthritis is a chronic condition that causes pain and stiffness most days, usually worse after activity.
• Acute infections such as septic arthritis (joint infection) or osteomyelitis (bone infection) need urgent diagnosis because they can cause joint destruction as well overwhelming sepsis if not treated.
• A condition such as polymyalgia rheumatica also requires early diagnosis since it is treatable with corticosteroids and is commonly associated with temporal arteritis - which can be serious.

In children:

• Transient synovitis remits on its own after 7 days.
• The other conditions such as congenital dislocation, SCFE, and Perthes' require urgent diagnosis for appropriate treatment, otherwise can result in permanent disability and lead to osteoarthritis.