The ball (femoral head) rotates in the socket on a smooth layer of cartilage. Arthritis refers to the loss of this protective cartilage covering on the ends of the bones. It is usually progressive and results in painful aching, grinding and stiffness as the rough surfaces of the bones in the joint rub against each other. It is common in the weight bearing joints, such as the hip. The most common form is osteoarthritis which has a genetic component, but is also related to wear-and-tear. Some patients have an inflammatory condition which attacks the joints, such as rheumatoid arthritis. The symptoms can often be controlled with weight loss, NSAIDs, and activity modification. If pain persists or continues to limit activities, hip arthritis is treated by replacing the worn out surfaces with a total hip replacement.
This condition occurs when the blood supply to the end of the bone is disrupted causing a segment of the bone to die. While it often occurs without an identifiable cause, risk factors include a history of prednisone use, sickle cell disease, or alcohol abuse. When the involved area is in a joint, the overlying cartilage is not supported and the joint becomes painful. In some instances the bone is capable of healing, while in others, that area must be replaced surgically either with donor bone and cartilage or a joint replacement.
A bursa is a thin fluid-lined space that is situated over a bony prominence which allows the skin to move freely when the joint is flexed. Occasionally it can become inflamed for no particular reason or as a result of trauma or infection. This bursitis results in greatly increased fluid production often causing swelling, tenderness, and restricted joint motion. Patients with lateral hip (trochanteric) bursitis will have difficulty lying on the affected side or sitting for prolonged periods, such as when driving. This is best treated with physical therapy, NSAIDs, and occasional corticosteroid injections.
A fracture is a broken bone. These may occur at the top of the thigh bone (femur) where it meets the hip socket. As we age, we lose bone density causing our bones to become weaker and more brittle. Patients with low bone density (osteoporosis) are more likely to sustain fractures, such as hip fractures. A fall on the hip can cause pain and inability to weight bear. Surgical repair is needed to allow the patient to walk and regain some level of independence.
Normally, the ball (femoral head) and the socket (acetabulum) are perfectly matched to allow good stability and full range of motion. In patients with femoral-acetabular impingement (FAI), there is a mismatch causing the two sides of the joint to pinch against each other during normal activities. This can cause pain, stiffness and injury to the labrum and cartilage in the hip. This can often be addressed by removing the impinging bone spurs with either a minimally-invasive open or arthroscopic approach.
The edge of the socket (acetabulum) is lined with a thick rubbery cartilage seal, called the labrum. Just like the labrum in the shoulder, certain activities or injuries can result in a tear of this structure. Symptoms of a torn labrum include painful catching and popping deep in the front of the hip or groin which is often worse with rotation. This is one of the most common reasons for performing a hip arthroscopy. The surgeon either removes a torn piece or sews the labrum back down into position.
There are two types of snapping around the hip. External snapping is often visible and occurs when a tight fascial band (iliotibial or IT band) snaps over the outside of the hip bone. Internal snapping occurs deep in the hip and is therefore not visible but may cause an audible “pop”. It is caused by snapping of the iliopsoas over the front of the hip joint. They are both usually treated with physical therapy and NSAIDs if they are painful. Surgery is rarely needed except in severe or chronic cases.
Patients will often complain of pain over the front of the hip and pelvis when performing sporting moves or attempting to do a sit-up. It is often due to an injury to the lower abdominal wall. Rest and physical therapy are the initial treatments. Persistent cases are referred to a general surgeon for possible laparoscopic repair.