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Hip pain

What’s causing your hip pain, and what can you do to relieve it?

Hip pain is a common complaint that can affect people of all ages, although it’s more prevalent as we get older. You can often manage hip pain by making small lifestyle changes.

But, in more severe cases, you may require decisive treatment like surgery to recover from hip pain and maintain a good quality of life. Many people suffering from hip pain visit the Alexandra Hospital in Manchester for diagnosis and treatment each year.

Our specialist team of orthopaedic surgeons is on hand to help them manage their pain and regain movement in their hip. 

The most common cause of hip pain is osteoarthritis, affecting approximately 1 in 9 adults over 45 years old.

Healthy joints contain cartilage. This cushions the surface of your bones, allowing them to move smoothly and freely without friction. When osteoarthritis develops, the cartilage thins and deteriorates, eventually causing bones to rub together. It can also cause scarring to the soft tissue joint capsule, causing muscle and tendon weakness around the affected joint.

Dr Tahir Mahmud, Consultant Orthopaedic Surgeon explains, “Osteoarthritis is a progressively degenerative condition which will inevitably get worse over time, although the rate of progression can vary greatly between individuals.”

Osteoarthritis symptoms

Pain is the most common symptom of hip osteoarthritis. It can vary from a dull ache, to severe pain radiating down the leg. Joint stiffness is also regularly reported among osteoarthritis sufferers. 

Pain can worsen during periods of activity or at the end of the day. Joints can also stiffen after rest, but will loosen up once you begin moving around. Levels of discomfort vary for no apparent reason, but you may notice specific movements or activities exacerbate your symptoms.

Osteoarthritis can cause swelling in your hip joint, which often appears as solid and knobbly. It is caused by the joint thickening and fluid build-up inside the joint capsule. You may also notice a grating or cracking sound when you move.

Risk factors for osteoarthritis

While the exact cause of osteoarthritis is unknown, certain risk factors impact the likelihood of developing the condition. The most widely agreed upon include:

Age

Ageing causes changes that affect joint function and structure, often referred to as “wear and tear.” While age increases susceptibility to the condition, other risk factors usually contribute to osteoarthritis development:

Weight

The heavier you are, the more load you place on your hip, back, and knees. A high body mass index (BMI) is more commonly noted as a risk factor for knee osteoarthritis but increases the likelihood of developing the condition in all weight-bearing joints.

Prolonged overload on these joints results in excessive wear and tear and a worsening of symptoms. Reducing your weight to a healthy level will help reduce these symptoms.

Genetics

Several studies conclude genetics play an important role in predicting the development of osteoarthritis. One particular study demonstrated having a first, second, or third-degree relative who undergoes a total hip replacement (referred to as total hip arthroplasty) increases the risk of requiring the treatment yourself.

Occupation

Physically demanding careers involving heavy manual labour, such as building or gardening, are linked to a higher risk of osteoarthritis later in life. Participating in high-impact sports, which put your joints under repetitive stress and overload, is also a risk factor.

Previous trauma

Those who have suffered previous fractures or soft tissue injuries to the hip are at increased risk of osteoarthritis. This is due to changes in how the joint is loaded after an injury.

While osteoarthritis is the most common cause of hip pain, it is by no means the only potential cause of your symptoms. Other conditions widely associated with hip pain are:

Hip bursitis

Bursa are fluid-filled sacs located in various body parts and act as a cushion between bones and other soft tissues like muscles and tendons. Each of your hips has two bursae.

One is on the outside of the hip, known as the trochanteric bursa, and the second located on the inside of the hip, called the iliopsoas bursa.  Hip bursitis is the inflammation of one or both of these bursae.

When the bursa located on the outside of the hip is inflamed, it’s known as trochanteric bursitis (or greater trochanteric pain syndrome - GTPS), which is treated easily. 

Hip bursitis affects approximately 5 in every 1000 adults and is more likely to impact those above middle age. Overuse of the hip joint causes friction which can cause this painful condition, so those who regularly run or cycle are particularly susceptible.

Hip impingement (femoroacetabular impingement)


This is characterised by an abnormal fit between the ball and socket of your hip joint. This can be due to minor abnormalities in the structure of either.

The symptoms of this condition are stiff joints, reduced range of motion, and pain felt in the groin. In the early stages of hip impingement, you may not experience symptoms, so this condition can remain undiagnosed until you begin to experience pain.

Anyone can develop hip impingement, but it’s more common in younger adults who are particularly active. Sporting activities or manual labour can exacerbate symptoms.

Hip impingement may increase the risk of osteoarthritis in later life, but no significant studies have taken place to verify this.

Gluteal tendinopathy


This commonly causes pain on the outside of the hip, which can radiate down the leg. It results from repeated or sudden compression (squashing) of tendons around the hip joint.

Tendons are built to absorb a steady load throughout our lifetime, but sudden, awkward force caused by a fall or sports injury can damage tendons resulting in hip pain.

Gluteal tendinopathy can affect anyone, but it’s more common in women than men at a ratio of 3:1. Patients are commonly 30 - 40 years old and may have put on weight, become less active, or may be approaching menopause.

Sitting with your legs crossed for long periods or standing with your weight on one side can contribute to gluteal tendinopathy.

Hip flexor strains


Your hip flexors are a group of muscles located at the front of the hip. They are the muscles that allow you to raise your leg and lift your knee towards your body. Hip flexor strains are the result of overstretching or tearing one of these muscles.

Referred pain


While pain felt on the outside of the hip or buttock area is likely due to a hip condition or injury, it could be your hip pain is actually caused by referred pain from another part of your body. Most commonly, the pelvic floor, lower back, or knee.

If you’re worried about your symptoms, you should arrange to see a specialist. Especially if any of the following apply:

  • Your hip pain is disrupting your sleep or stopping you continue your normal daily activities
  • Your pain worsens or keeps returning after periods of being pain-free
  • You have had continuous hip pain for more than two weeks
  • Joint stiffness lasts for longer than 30 minutes after waking
  • You sustained an obvious injury to your hip or the surrounding area

Most cases of hip pain can be diagnosed by an experienced specialist, who will investigate the background of your symptoms and complete a thorough physical examination.

Other practical diagnostic tests are used to analyse your joint and tissue structures to find the cause of your pain.

X-rays can show any degenerative changes to the hips and can determine the extent of those changes. X-rays can also be used to evaluate the shape and angles of hip joints. This helps provide your specialist with information about whether there are any defects in your hip (a potential cause of hip impingement) or whether there is any sign of a hip fracture.

CT scans are very similar to X-rays, but provide a detailed 3D perspective of your bone structure. It will show any fractures or bone defects and can also show bone density – providing useful information about the strength and condition of your bones.

MRI scans are often used where a soft tissue injury is suspected. Commonly, hip cartilage (labral) tears or where the suspected cause of the hip pain is in tissue outside the hip itself.

Ultrasound is particularly useful for seeing muscle and tendon pathology and is therefore used in place of an MRI where those kinds of injuries are suspected.

“Could my hip pain be bone cancer?”

In very rare cases, hip pain can be attributed to cancer. Primary bone cancer is one of the rarest forms of cancer and affects approximately 550 people in the UK each year.

Primary bone cancer means the tumour originates in the bone. This is different from secondary bone cancer, which spreads to your bones from another body area. 

Common symptoms of bone cancer:

Bone pain - This pain can be a persistent, dull ache that is the same during the day and night. You may also find the area tender to touch, and it may also become swollen. If you experience this type of pain for two or more weeks, you should see a specialist as soon as possible.

Weakened bones -
Cancer can cause weakening of the bones, which means they’re easier to fracture. These fractures can occur even if you haven’t had an obvious accident or trauma to the bone. Hip fractures can also occur due to osteoporosis (where the bones lose density and begin to wear away) so you should also consider this.

Increased calcium level
- Cancer can cause calcium from your bones to leak into your bloodstream. This is known as hypercalcaemia and will be detected by a blood test.

Common symptoms of hypercalcaemia are tiredness, nausea, constipation, increased thirst, and confusion.

The cause of your hip pain largely determines your treatment options. Most soft tissue injuries will resolve themselves with rest, gentle mobility, and pain management.

Your specialist will discuss your options if your diagnosis shows you have a long-term condition like osteoarthritis. While there’s no cure for osteoarthritis, the condition can progress slowly, and there are several treatments available to help relieve your symptoms.

Your primary treatment options are:

Lifestyle changes - Carrying excess weight will worsen your osteoarthritis symptoms because being overweight places additional load and strain on your joints. It’s important you lose weight slowly and safely, so discuss any new diet plans with your specialist or GP before starting them.

Exercise is also important for those with osteoarthritis. You may think exercise would worsen your symptoms; however, keeping as active as possible will help improve strength, flexibility, and stability around your joints.

Pain management - A combination of painkillers, physiotherapy, assistive devices, or surgery can significantly reduce your symptoms.

Your doctor might suggest taking an over-the-counter painkiller such as Paracetamol while you’re awaiting diagnosis. If Paracetamol doesn’t control your pain, they may prescribe a non-steroidal anti-inflammatory drug (NSAID), such as Ibuprofen. These medicines are particularly effective for reducing inflammation in the joints.

Some NSAIDs come in cream form and can be applied directly to the affected joints. Many of these are available over the counter, without a prescription.

Mr Amit Kumar, Consultant Orthopaedic & Oncological Surgeon at The Alexandra Hospital suggests, “Optimising your analgesic requirements is paramount, and you should discuss this with your doctor. Exercise and weight loss are important, and physiotherapists play an important role to strengthen the hip girdle and back muscles. Your clinician may also be able to offer you a hip injection to help with hip pain whilst you wait for treatment.”

Steroid injections - If you cannot control your pain with over-the-counter medicines, your clinician may prescribe steroid injections. Steroids can be used to treat particularly painful hip problems and are sometimes offered when other treatments have failed to manage symptoms.

The injection is administered directly into the affected area, but you will usually be given a local anaesthetic to numb and minimise sensation. Steroid injections are fast-acting and can reduce pain for several weeks or even months.

Assistive devices - If osteoarthritis is making mobility difficult, several devices could help you.

Special footwear or clinical insoles for your shoes can help spread your weight evenly and reduce the impact on your joints as you walk.

If hip osteoarthritis makes walking painful, you may be offered a walking aid, like a stick or cane. Holding it on the opposite side of your body to the affected joint will help relieve some of the weight being placed on it.

Hip replacement (total arthroplasty) - If your quality of life is significantly impacted and pain management isn’t relieving your symptoms, a hip replacement might be your best option.

During arthroplasty, your orthopaedic surgeon will remove your affected joint and replace it with an artificial joint made of special clinical metals and plastics. These artificial joints can last up to 20 years before beginning to wear out. For this reason, specialists rarely offer hip arthroplasty to younger patients.

A newer type of joint replacement surgery has been developed, which is more suited to younger patients called resurfacing. This type of surgery only uses metal parts for the new joint.

Minimally invasive hip replacement -
In some cases, your surgeon may prefer what is known as a minimally invasive approach to your hip replacement surgery.

Your surgeon uses smaller incisions to access your hip joint. They then use specially designed equipment to help perform a hip replacement.

The potential benefits of minimally invasive hip replacements are smaller scars, less post-operative pain and less risk of damage to surrounding muscles and tendons.

Minimally invasive surgery is not always the best option for everyone but ask your specialist if you want to know more about it

At The Alexandra Hospital in Manchester, our Orthopaedic specialists have many years of experience - in both treating painful hip conditions and helping people reduce their symptoms while regaining movement and joint function.

Any hip problem can potentially affect your ability to do the things you enjoy. As a result, your quality of life is impacted, which in turn affects your physical and emotional wellbeing.

The Alexandra’s dedicated orthopaedic team can help with all mobility problems. With painful hips affected by daily movements such as getting out of bed or into a car, it’s reassuring to know we are just a call away to help you.

We also cover the regions around Greater Manchester, including Trafford, Stockport, Cheshire East Tameside, and the surrounding areas

Specialists offering Hip pain

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Mr Amit Kumar

Consultant Orthopaedic Surgeon

BSc (Hons) MBBS (Lond) MRCS PgCert FRCS Ed (Tr&Orth)

The Alexandra Hospital 1 more The Highfield Hospital

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Mr Soulat Naim

Orthopaedic & Trauma Surgeon

MBBS, MS (Orthopaedics), MCh (Orthopaedics, Liverpool), FRCS (Trauma & Orthopaedics) Knee Fellowship (Exeter Knee Reconstruction Unit)

The Highfield Hospital 1 more The Alexandra Hospital

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Mr Simon Ghalayini

Consultant Orthopaedic and Trauma Surgeon

MB ChB, MRCS, FRCS (Trauma & Orthopaedics)

The Alexandra Hospital

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Mr Derek Lang

Consultant Orthopaedic Surgeon

MB ChB FRSC(Lon) FRCS(Orth)

The Alexandra Hospital

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Mr Michael O'Connor

Consultant Orthopaedic & Trauma Surgeon

MB ChB, FRCS, FRCS (Tr & Orth)

The Alexandra Hospital

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Mr Adam Hoad-Reddick

Consultant Orthopaedic Surgeon

MB ChB FRCS FRCS(Tr & Orth)

The Alexandra Hospital

View profile Book online

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