Hip
Hip Pain
Hip pain is the one most often blamed on the wrong thing. Genuine hip joint pain is usually felt in the groin and can travel down the front of the thigh towards the knee, while pain over the side of the hip or in the buttock generally comes from somewhere else entirely. Sorting out which is which 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 rather than the hip, particularly with 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 blood supply to the femoral head is compromised.
Avascular necrosis matters here because it is more common in India than many places, and it can progress quietly. A history of steroid use, significant alcohol intake, sickle cell disease or a previous hip injury raises 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 reproduces from the joint or from the tissues around it. Range of movement, particularly internal rotation, is usually the most telling single test for arthritis.
The back and the knee are examined too, because both refer pain to this area and both are commonly the real source.
X-rays of the pelvis are the first imaging and often enough. An MRI is used where the X-ray looks normal but the story does not fit, which includes early avascular necrosis and labral tears.
What treatment usually looks like
Hip arthritis that is not yet advanced, and almost everything around the hip rather than in it, is treated without surgery.
- Physiotherapy focused on hip abductor and core strength, which is the mainstay for gluteal tendon problems
- Load management and weight reduction where relevant
- A walking stick used in the opposite hand, which unloads the hip more 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 walking distance has dropped markedly, 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 is usually tendon or bursa related, and a hip replacement does nothing for it. That pattern responds to a specific strengthening programme, and it is worth getting the diagnosis right before anyone discusses surgery.
Why does my hip problem make my knee hurt?
The hip joint and the front of the knee share nerve supply, so hip pain is genuinely felt at the knee. It is common enough that a patient presenting with knee pain and a normal knee examination gets their hip examined as a matter of course.
Is avascular necrosis reversible?
Caught very early, before the bone surface collapses, there are procedures that can preserve the joint in selected patients. Once it has collapsed, replacement is usually the option that works. That is precisely why unexplained groin pain in a younger patient with risk factors is worth imaging rather than waiting out.
Am I too young for a hip replacement?
Age is one factor among several, not a rule. A younger patient will likely outlive the implant and need it revised, which is a real consideration, but so is spending a decade in pain. The conversation is about weighing both honestly.
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?
That is what a consultation is for. Bring any imaging you already have, and any plan you have been given elsewhere.