The hip is a ball and socket joint where the thigh bone (the femur) slots into the pelvis. The ‘ball’ is the round femoral head and the ‘socket is’ the pelvic acetabulum. We each have two of these vital joints and as they endure so much wear and tear on a daily basis, it’s likely we’ll all experience an issue with one of our hips and some point. This being said, hip issues are generally associated with people of an older persuasion as the hip joint deteriorates over time. Whilst there is some truth in this, there are also a number of common hip problems, unrelated to wear and tear over time that can affect anyone regardless of their age.
In this article we have teamed up with London Hip Specialists to outline three common hip problems you may not necessarily be aware of.
Femoroacetabular impingement (FAI) is a condition where the femoral head rubs abnormally against the inside of the pelvic acetabulum. This prevents a normal range of motion in the hip joint and can cause pain, stiffness and decreased mobility for the sufferer.
Femoroacetabular impingement occurs when there is bone overgrowth (known as a bone spur) either on the femoral head or along the acetabulum. In turn this prevents the two bones from slotting together properly and the joint working smoothly during activity. Over time the abnormal contact between the two can cause damage to the labral cartilage (labium) that covers the pelvic acetabulum. As is displayed in Figure 1 there are three types of FAI, ‘Pincer’, ‘cam’ and ‘combined’. ‘Pincer’ occurs when there is an overgrowth on the rim of the acetabulum. Over time this starts to crush and damage the labral cartilage. ‘Cam’ impingement occurs when a bone spur grows on the femoral head so it is no longer spherical. As a result the femoral head grinds against the labral cartilage and stops it rotating smoothly in the acetabulum. ‘Combined’ impingement is when both ‘Pincer’ and ‘cam’ occur in the hip joint.
Bone spurs occur during the ‘growth years’ of childhood when the hip bones don’t form properly. Unfortunately this means little can be done to prevent the deformities. There are however a range of treatments available, both surgical and non-surgical, to correct FAI and negate the problems associated with it. Non-surgical treatments include rigorous physiotherapy and pain relieving medications. If impingent persists following non-surgical treatments a doctor may consider arthroscopy. This is a surgical procedure where a surgeon uses an arthroscope camera to view the inside of the hip. Through small incisions they then attempt to repair the labral cartilage and shave down the bone overgrowth.
‘Bursae’ are fluid filled sacks that are located throughout the body in areas such as joints where moving tissues such as bone, tendons and muscles come into contact with one another. They are designed to act as small cushions, reducing friction between a bone and any opposing surface. There are two major bursae in the hip. One is called ‘the great trochanter’ and is located at the bony point of the hip. The other is called the ‘iliopsoas bursa’ and is positioned on the inside of the hip. Both are displayed in Figure 2. ‘Bursitis’, the most common cause of hip pain, is when a bursa becomes irritated or inflamed. Inflammation of the great trochanter is known as ‘trochanteric bursitis’. Inflammation of the iliopsoas bursa is called ‘iliopsoas bursitis’.
Trochanteric bursitis produces pain on the outer part of the hip and thigh. As trochanteric bursitis develops it will progress from sharp and intense pain in a specific area to a wide-spread ache. The pain associated with trochanteric bursitis is at its strongest after the sufferer has been stationary for a long period. When there is an inflammation of the iliopsoas bursa pain will normally be felt towards in the front of the hips towards the groin area. Pain will sometimes radiate down the thighs towards the knees and even into the buttocks. In both cases it is likely the sufferer will notice swelling, stiffness in the joint and discomfort when carrying out physical activity.
Before hip bursitis treatment can be administered a consultant will first take an initial fluid sample known as ‘aspiration’ to test the level of bacteria present in the bursa. This will determine any underlying conditions causing the inflammation. If a bursa is found to be not infected then the patient will undergo physiotherapy and massage treatments. If a bursa is infected it is likely they will then be prescribed a course of antibiotics. If this treatment isn’t proven to be effective a Bursectomy (surgical removal of the bursa) may be considered.
Like any other joint in the body the hip is surrounded by cartilage, muscles, ligaments and tendons that provide stability and prevent over-extension. As with any other joint they too are susceptible to injury. The femur and pelvis which make up the ‘ball and socket’ serve as anchors for several major muscles that move across the abdomen and buttocks (hip flexors, gluteals) or down the thigh to the knee (abductors, adductors, quadriceps, hamstrings). Within the hip itself there are also various ligaments, tendons and tissues that help to stabilise the joint and hold it together ( see figure ). They too can be damaged when stretched beyond their normal limit or after contusion from a blow. One such tissue is the labrum.
As touched upon previously, the labrum is the cartilage lining of the hip’s ball and socket joint and is essential to its stability during everyday movements. Like the ligaments, tendons and muscles that surround it, the labrum can be torn. This is known as a ‘laberal tear’. Whilst it is widely perceived as an injury induced by sporting activities, a laberal tear can also be an indirect product of structural abnormalities in the hip that weaken the laberal cartilage over time. Symptoms generally include a clicking and locking sensation in the hip joint, stiffness when moving and pain radiating down to the groin.
Following diagnosis the treatment administered depends on the severity of the symptoms. In the majority of cases physiotherapy is all that is required to maximise the range of hip motion and improve strength and stability. In more serious cases arthroscopic surgery may be required to repair or remove the torn tissue. This is normally a day procedure with anchors placed in the bone to move the labrum back in position and allow it to heal in the right location.
Saturday Clinic Now Open
Consultant Orthopaedic surgeon Mr Sujith Konan from the London Orthopaedic Specialists with a special interest in knee and hip is holding a Saturday Clinic for appointments. Opening times from 8am – 12pm. To book an appointment please call our friendly team on 020 7078 3811