Hip
Hip Pain
Hip pain is the one most often blamed on the wrong thing. Pain from the hip joint itself is usually felt in the groin, and can travel down the front of the thigh towards the knee. Pain over the side of the hip or in the buttock usually comes from somewhere else. Which one you have changes the whole treatment plan.
By appointment only, at Kharar (Mohali) or Solan. Your confirmation says which.
Where the pain is tells you a lot
- Groin, and down the front of the thigh. Usually the hip joint itself: arthritis, or in younger patients impingement or a labral tear. Often with difficulty putting on socks and shoes, and a hip that no longer rotates.
- Over the bony point on the side. Usually gluteal tendon problems or bursitis. Painful to lie on that side, tender to press. Not a joint problem, and not helped by a hip replacement.
- Buttock, radiating below the knee. Usually the lower back, especially if there are pins and needles or numbness.
- Deep groin pain in a younger, active patient. Can be impingement, a labral tear or, in someone with the right risk factors, avascular necrosis, where the ball of the hip joint loses its blood supply.
Avascular necrosis is more common in India than in many places, and it can progress quietly. Steroid use, heavy alcohol use, sickle cell disease or a previous hip injury should all raise the question.
When it needs seeing sooner
- You cannot bear weight after a fall, particularly if you are older or have osteoporosis. A hip fracture needs a hospital the same day.
- The leg looks shorter or turned outwards after an injury.
- The hip is hot and painful and you feel unwell or feverish.
- Pain with fever, night sweats or unexplained weight loss.
- Sudden difficulty controlling the bladder or bowels alongside back and leg pain. That is a spinal emergency.
How it gets assessed
The examination looks at how you walk, how the hip rotates, and whether the pain comes from the joint or from the tissues around it. For arthritis, the most telling single test is usually internal rotation.
The back and the knee are examined too. Both can send pain to this area, and both are often the real source.
An X-ray of the pelvis comes first, and it is often all that is needed. An MRI is used when the X-ray looks normal but the story does not fit, for example with early avascular necrosis or a labral tear.
What treatment usually looks like
Hip arthritis that is not yet advanced is treated without surgery, and so is almost every problem in the tissues around the hip.
- Physiotherapy for hip abductor and core strength, the mainstay of treatment for gluteal tendon problems
- Load management and weight loss where relevant
- A walking stick in the opposite hand, which takes more load off the hip than most people expect
- Anti-inflammatory medication for a defined period
- Targeted injections in selected cases, sometimes also to confirm where the pain is coming from
Hip replacement is discussed when arthritis is causing pain at rest and at night, when you can walk much less far than you could, or when the joint has been structurally damaged by fracture or avascular necrosis.
Common questions
My pain is on the side of my hip. Do I need a replacement?
Almost certainly not. Pain over the bony point on the side of the hip usually comes from the tendons or the bursa there, and a hip replacement does nothing for it. It responds to a specific strengthening programme. Get the diagnosis right before anyone talks about surgery.
Why does my hip problem make my knee hurt?
The hip joint and the front of the knee share a nerve supply, so pain from the hip can be felt at the knee. It is common enough that anyone with knee pain and a normal knee examination has their hip examined as a matter of course.
Is avascular necrosis reversible?
If it is caught very early, before the bone surface collapses, there are procedures that can save the joint in selected patients. Once it has collapsed, replacement is usually what works. So if you are younger, have groin pain nobody can explain and have any of the risk factors, get it imaged. Do not wait it out.
Am I too young for a hip replacement?
Age is one factor among several; it is not a cut-off. A younger patient will probably outlive the implant and need a revision operation later. That matters, but so does spending a decade in pain, and the decision has to weigh both.
Related procedures
Where an operation does turn out to be the right answer, these are the ones this problem most often leads to.
Not sure what is causing it?
Finding out is what a consultation is for. Bring any imaging you already have, and any plan you have been given elsewhere. He sees patients by appointment only, in Kharar, Mohali, and on set days each month in Solan.