The hip is a frequent source of pain and disability. In this section we review some of the conditions of the hip that we treat. These conditions include bursitis and mild cartilage abnormalities that respond well to supportive measures (anti-inflammatories, activity modification, physical therapy, injections). Labral tears, hip impingement, loose bodies and several other conditions may respond to hip arthroscopy. Severe hip arthritis is also discussed as well as total hip replacement (anterior total hip replacement, posterior total hip replacement).
Anatomy
The hip is a ball and socket joint. The top of the femur (ball) makes up one side of the joint. The socket (acetabulum) makes up the other side. Both sides of the joint are coated with cartilage.
There are also many muscles which either attach or pass by the hip. The hip abductors (gluteal muscles) are important for walking and lifting the leg to the side. The external rotators attach to the hip and rotate the leg. The iliotibial band starts around the hip and passes down the side of the leg. Underneath it is the hip bursa (fluid sac).
All of the above structures are important sources of pain and disability around the hip.
Hip Bursitis
Hip bursitis is a frequent cause of pain. It can be the primary problem. However, it is frequently secondary (the result or effect of another problem).
Hip bursitis causes pain on the outside of the hip. Frequently that pain will radiate (move) down the side of the thigh and stop around the knee. We frequently find that patients have tight iliotibial bands, weak hip abductor muscles and core strength.
This condition responds well to a dedicated hip stretching program which focuses on the iliotibial band. Hip abductor and core strengthening is also beneficial. Cortisone injections and platelet rich plasma injections have also been useful for this condition.
This condition can also result from any problem affecting the back or legs. When another area is painful, it often causes compensation (increased stress) on the hip. This results in bursitis. Addressing the primary problem will often reduce or eliminate the bursitis.
Hip bursitis is also frequently associated with hip arthritis. Sometimes we can treat the hip bursitis and avoid joint replacement surgery.
Hip Impingement
Sometimes extra bone can grow around the hip. If this occurs when the hip is moved around (most commonly when it is flexed as in when the knee is brought to the chest), the bones can come into contact with each other. This most commonly results in groin pain. This can respond to a hip arthroscopy in which the extra bone is removed.
Labral Tear
The labrum is a soft tissue ring that runs around the hip socket. It deepens the joint. Labrum tears are very common. Some of those tears result in hip pain. If the labral tear is the source of the pain a hip arthroscopy can either repair or remove the damaged tissue.