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HIP

The hip is a ball-and-socket type joint. The thigh bone (femur) has a ball-shaped knob on the end that fits into a socket formed in the hip bone. The hip joint is a major weight-bearing joint, supporting a stress load of up to five times your body weight when you are walking. It takes a good deal of force to seriously damage the hip. This is because the hip is surrounded by the large muscles of the thighs and the fact the the femur itself is the largest bone in the body.

ORTHOPAEDIC SERVICES FOR THE HIP

STRAIN

Whereas a sprain is an injury involving a stretched or torn ligament, when your muscle fibers are overused or torn through repetitive or overly strenuous activity, the resulting injury is called a strain.

Commonly, the approach to relieving muscle strain in the hip is known by its acronym, RICE.

REST – Consider using crutches to avoid putting weight on your hip.
ICE – Gently apply ice to the area to help decrease swelling.
COMPRESSION – Compression shorts or an elastic (ACE™) bandage may help.
ELEVATION – Raise and rest the hip area.

Your doctor may also recommend anti-inflammatories or acetominophen, if not contraindicated, to reduce swelling and ease pain.

Orthopedic doctor examining a patient's hip

BURSITIS

Throughout the body, your joints are cushioned by small fluid-filled sacs called bursae. Healthy bursae help create a smooth gliding between bone and muscle, but when they become inflammed, moving your hip joint becomes painful.

The rounded outer edge of your femur is called the greater trochanter. The greater trochanter has a particularly large bursa to enable your hip to move. Inflammation of this large bursa, or bursitis, is often brought on through repetitive movement, such as running, cycling, or even standing.

Bursitis can also be the result of an injury, arthritis, and bone spurs that irritate the bursae with inflammation. It is also frequently a consequence of an awkward gait, especially if one of your legs is shorter than the other.

Many people with hip bursitis can experience relief with simple lifestyle changes, including avoiding the activities that worsen symptoms, temporarily using a walking cane or crutches, or the use of anti-inflammatory medicines.

Injection of a steroid medicine may also alleviate your bursitis. This simple and effective treatment can be done in your doctor’s office.

OSTEOARTHRITIS

Like other joints that bear your weight, your hips may be at risk for “wear and tear” arthritis (osteoarthritis). This happens when the cartilage on the ends of your bones wears thin.

If you do not get treatment for osteoarthritis of the hip, the condition will continue to worsen. Bone spurs might build up at the edges of the joint. Eventually, the cartilage may wear away completely, leaving the bones to rub directly against each other. This makes it very painful for you to move.

If you become less active to avoid the pain, the muscles controlling your joint get weak, and you may start to limp.

While you cannot reverse osteoarthritis, early treatment may help you avoid pain and slow progression of the disease. One common step is to follow a physical therapy program of gentle, regular exercise to keep your joint functioning. Another approach is to lose weight if you are overweight. Using a cane can also be beneficial.

If you have later stages of osteoarthritis your doctor may recommend total hip replacement surgery called arthroplasty.

DISLOCATION

A hip dislocation occurs when the head of your femur slips out of its socket in the pelvis. A hip dislocation is very painful.

A hip dislocation can have long-term consequences, if it disrupts the blood vessels as it moves out of socket. When blood supply to the bone is lost, the bone can die. The protective cartilage covering the bone may also be damaged, which increases the risk of developing arthritis in the joint.

To address a dislocated hip, your physician will manipulate the bones back into their proper position. This process is called a reduction. In some cases the reduction must be done in the operating room with anesthesia.

FRACTURES

ABOUT HIP FRACTURES

A hip fracture is a break in the upper quarter of your femur or thighbone. It may also involve a break in the socket or acetabulum in the pelvis. Normally, the bones require a great deal of force to break, but some medical conditions such as osteoporosis can weaken the bone and make the hip more susceptible to fracture.

The thin section of your thigh bone that connect the ball end of the bone to the main shaft is called the femoral neck. If this is where your hip is broken, it can cut off blood supply and lead to severe joint damage. Treatment for femoral neck fractures can be successfully achieved through a surgical procedure that replaces one half of the hip joint with a prosthetic, while leaving the other half intact.

ABOUT HIP SURGERY

Most hip fractures require surgical intervention to help the bones heal. These surgeries may involve surgical steel hardware such as compression screws, or in some cases implants to replace the damaged bone.

Because of the nature of hip surgery, many patients may find that a brief stay in a rehabilitation facility is necessary to assist them in regaining their ability to walk. The physical therapist will work with you to help you regain strength and learn how to safely return to normal activities.

DEVELOPMENTAL DYSPLASIA

Developmental dysplasia of the hip (DDH) is an abnormal formation of the hip joint. In DDH, the ball and socket are loose rather than firmly connected.
DDH tends to run in families. It is predominant in first-born girls and babies born in the breech position. While some babies born with a dislocated hip will show no outward signs, legs of different lengths, limping, toe-walking or a duck-like gait are all indicators of DDH.

Given the very real possibility of a limp, early onset of arthritis in the joint, and impaired mobility later in life, pediatricians screen for DDH at a newborn’s first examination and at every well-baby checkup thereafter. When the condition is detected at birth, it can usually be corrected through traction, casting or surgical intervention. However, even with appropriate treatment, hip deformity and osteoarthritis may develop later in life.

HIP REPLACEMENT

Hip replacement surgery is a safe and effective procedure (also called total hip arthroplasty) that can relieve your pain, increase motion, and help you get back to enjoying everyday activities.

In a total hip replacement, the damaged bone and cartilage is removed and replaced with prosthetic components. Southlake Orthopaedic surgeons routinely perform this procedure with outstanding results.

ARTHRITIS

Generally speaking, arthritis means inflammation of a joint, whether the result of a disease, an infection, a genetic defect, or some other cause. Although more than 100 types of arthritis have been identified, there are two primary types of arthritis that may affect your hips: osteoarthritis and rheumatoid arthritis (RA).

In addition to pain, the arthritis inflammation may produce fever or swelling at the affected joint. You may also feel a sensation of grating or grinding; this crepitation is caused by damaged cartilage surfaces rubbing against one another.

One form of treatment for arthritis is a steroid injection. These typically provide pain relief for several weeks. However, possible harmful side effects limit the number of times these types of injections can be used.

If nonsurgical treatment is unsuccessful, there are many surgical options to consider. If there is any way the joint can be preserved or reconstructed, this method is usually chosen. When the damage is severe enough, a joint replacement or a fusion (arthrodesis) is performed. As with any surgical procedure, you should consult with an orthopaedist who is well versed in current surgical techniques and discuss the best option for your particular needs.

Hip Arthroscopy

Hip arthroscopy is a surgical procedure that allows your doctor to view the hip joint without making a large incision (cut) through the skin and other soft tissues. Arthroscopy is used to diagnose and treat a wide range of hip problems.

Since the arthroscope and surgical instruments are thin, your surgeon can use very small incisions, rather than the larger incision needed for open surgery. This results in less pain and joint stiffness for patients, and it often shortens the time it takes to recover.

When Hip Arthroscopy Is Recommended

Hip arthroscopy may relieve painful symptoms of many problems that damage the labrum, articular cartilage, or other soft tissues surrounding the joint. Although this damage can result from an injury, other orthopaedic conditions can lead to these problems such as:

  • Femoroacetabular impingement (FAI), a disorder in which extra bone develops along the acetabulum (pincer impingement) or on the femoral head (cam impingement). This bone overgrowth can damage the soft tissues of the hip during movement, particularly the articular cartilage. Sometimes bone spurs develop in both the acetabulum and femoral head, and osteoarthritis can develop.
  • Hip Labrum Tears.
  • Dysplasia, a condition in which the hip socket is abnormally shallow. This puts more stress on the labrum to keep the femoral head within the socket and makes the labrum more susceptible to tearing.
  • Snapping hip syndromes, which cause a tendon to rub across the outside of the joint. This type of snapping or popping is often harmless and does not need treatment. In some cases, however, the tendon is damaged from the repeated rubbing and benefits from surgery.
  • Synovitis, which causes the tissues that surround the joint to become inflamed.
  • Loose bodies, fragments of bone or cartilage that become loose and move around within the joint.
  • Hip joint infection.
  • Tendon ruptures or disorders involving the hamstrings, or gluteus medius or minimus muscles.
  • Other sources of hip impingement that are not in the actual hip joint (ischiofemoral impingement)
  • Sciatic nerve compression by the hip/hamstring.

Femoroacetabular Impingement

Femoroacetabular impingement (FAI) is a condition in which extra bone grows (bone spurs) along one or both bones that form the hip joint — giving the bones an irregular shape. Because they do not fit together perfectly, the bones rub against each other during movement. Over time this friction can damage the joint, causing pain and limiting activity.

FAI occurs because the hip bones do not form normally during the childhood growing years. It is the deformity of a cam bone spur, pincer bone spur, or both, that leads to joint damage and pain.

Some people may live long, active lives with FAI and never have problems. When symptoms develop, however, it usually indicates there is damage to the cartilage or labrum and the disease is likely to progress.

Because athletic people may work the hip joint more vigorously, they may begin to experience pain earlier than those who are less active. However, exercise is not shown to cause FAI.

The most common symptoms of FAI include:

  • Pain
  • Stiffness
  • Limping

Pain often occurs in the groin area, although it may occur toward the outside of the hip. Turning, twisting, and squatting may cause a sharp, stabbing pain. Sometimes the pain can be just a dull ache.