Hip pain

Hip pain is a very common complaint, with a large number of us experiencing it as we grow older. The majority of cases are due to ‘wear and tear’ on the joints due to your lifestyle over time, but a number of other causes are possible.

If you have hip pain when walking, exercising or at rest, The Park Hospital can help.

Our specialist hip surgeons, supported by a full multidisciplinary team of pain specialists, nurses and physiotherapists, will diagnose the cause of your discomfort and recommend a treatment plan built around you.

This article will explore the causes of hip pain, how it can be investigated and what can be done to manage it. 

The hip is what is known as a ‘ball and socket’ joint. The ‘ball’ sits at the top of the thigh-bone (femur). This fits into the ‘socket’ which is a cup-shaped depression in the bones of the pelvis.

The surfaces of the joint are covered in cartilage, which is smooth to allow easy movement. The inside of the joint is lubricated by synovial fluid.

A capsule surrounds the joint, and the whole is held together by tendons and muscles.

The hip joint is essential to everyday function, allowing locomotion (walking and running) and is also critical to the stability of the upper body.

Pain from the hip joint can be felt in more than one location. Whilst it is commonly perceived overlying the hip, it can also be felt in the groin, deep within the hip or even in the back, knee or buttocks.

Pain in the hip can also be caused by other joints nearby — in this case, if there are problems in your back or in your knee.

The most important step in getting you out of hip pain is to get an accurate diagnosis.

Hip pain can be frustrating to live with, but the good news is that effective treatments are available. An assessment by one of our experienced Circle Health Group consultants will help determine the cause of your hip pain.

History and examination

Whilst the majority of hip joint pain is caused by ‘wear and tear’ on the joint after a lifetime of use, you should still visit a hip pain specialist to ensure that there is no other explanation for your pain and to ensure that you receive the best possible management to maximise your quality of life.

When you visit a specialist, they will ask a number of questions about your hip pain including how and when it started, how it has progressed, whether anything makes it better or worse, and how it affects your activities of daily living.

These will not only help the specialist diagnose the cause of your pain, but will also help determine the best course of management. Additional questions will also be asked about your general health and any medical treatment you may be receiving.

After taking a full history, the specialist will want to examine both your hip and other joints. Depending on your presentation, they may also want to examine the nerves in your leg.

Investigations

Your specialist may want to take images of your hip joint to understand the underlying cause of your pain. These can include:

• X-Rays: these can be used to look at the bones of the hip joint
• CT scans: are excellent for looking at the bones from all angles and can also be used to examine some of the soft tissues
• MRI scans: provides high-quality images of the soft tissues of the joint

Depending on your pain and any other symptoms, your specialist may also request other investigations, such as blood tests. 

The cause of hip pain can often be simple, such as a sprain or strain. There are numerous other reasons to feel hip pain, some of which are more common than others.

There are two main groups of patients when it comes to hip pain causes. Younger patients are more likely to have sports-related soft-tissue injuries, whereas older patients may have degeneration or inflammation of the hip or surrounding structures.

Osteoarthritis

Osteoarthritis is a very common cause of hip pain, especially as you get older. It is often referred to as ‘wear and tear’ on the hip joint. Over time, the cartilage covering the surfaces of the hip joint gets damaged and worn away.

This leads to rough surfaces coming into contact with each other, which can cause pain that is worse on moving.

Other forms of arthritis

Arthritis is inflammation involving one or more joints. There are a number of different types of arthritis that can cause hip pain, and the management is undertaken by specialists. Pain caused by arthritis is often associated with stiffness in the joint that is worse on waking and may improve over the day.

Types of arthritis can include rheumatoid arthritis and psoriatic arthritis.

Soft tissue causes of hip pain

Damage to any of the structures surrounding the joint can lead to hip pain. The damage can be due to direct trauma, inflammation from overuse or other causes.

Examples include trochanteric bursitis, iliopsoas tendonitis and a torn acetabular labrum.

These can occur in anybody, but some forms may be far more common in people who play regular high-energy sports.

Infectious causes of hip pain

Very rarely, the hip joint can become infected. This can occur if there has been trauma or if the immune system is impaired in some way.

If you have a hip joint infection, the overlying skin may be hot, red or swollen. You may feel unwell with a high temperature.

If your hip pain is associated with the above symptoms, you should contact a medical professional urgently for treatment.

Traumatic causes of hip pain

Damage to the bones of the hip joint can result after trauma caused by a fall, accident or other cause. If a fracture has occurred, then there will be severe pain, especially on movement of the hip. Walking is usually impossible.

If you have significant hip pain after a fall or accident, you should contact medical assistance.

Dr Reshid Berber, a consultant orthopaedic surgeon at The Park Hospital, advises that “patients should see a surgeon if their pain is not well controlled”.

The procedures and treatments that you need to help your hip pain will very much depend on the underlying cause. This is why it is important to consult a specialist to exclude causes which may need interventions like surgery, and to ensure that you are on the best treatment for your hip pain.

Many patients will have already tried painkillers and simple exercises by the time they seek specialist help.

Pain relief medications

Painkillers that are suitable for hip pain can include over the counter drugs such as paracetamol and (if appropriate) ibuprofen. Under the guidance of a specialist, stronger drugs can be prescribed such as other anti-inflammatories, opioids and neuropathic (nerve pain) medications.

It is important to note that pain medications do not treat the underlying cause of any hip pain. A specialist can advise you if other treatments or interventions may be more appropriate than stronger painkillers.

Physiotherapy and occupational health

Physiotherapy can often help with hip pain.

Physiotherapists and occupational therapists are key members of the team that will help you manage your hip pain.

Physiotherapists can advise exercises and movements that will build up strength in your hip if you have injured it. They can also help with improving your physical condition before an intervention like a joint replacement, and will support you to get back to full health after an operation.

Occupational therapists are experts in helping you adapt to be able to continue to perform everyday tasks, work or meaningful activities.

Specialist pain management for hip pain

If it is felt that your hip pain would not be improved by surgery, or you continue to have pain after an operation, a pain specialist may advise you regarding management.

They will be able to prescribe specialist medications that may help with your pain and can, if appropriate, offer specific injections to reduce your pain.

Surgery for hip pain

Not all hip pain will require an operation, but some causes will benefit from hip surgery.

This is why it is important to see a specialist who can diagnose the cause of your pain and advise you regarding the best course of management for you.

Dr Berber explains — “I like to be as honest as possible about the likelihood of success”.

Operations and procedures for hip pain can include:

• Hip injections – these can contain local anaesthetics and steroids to reduce pain and swelling
• Hip arthroscopy – this involves passing a small camera into the hip joint under anaesthetic. It allows the surgeon to visualise the joint surfaces and diagnose problems inside the joint
• Hip resurfacing – usually performed for arthritis of the hip, it involves trimming the femoral head (the ball at the head of the thigh-bone) and fitting it with a smooth covering. A shell is placed in the socket for the ball to fit in
• Total hip replacement – the top of the thigh-bone is removed and replaced with metal, plastic or ceramic components. A shell is fitted into the socket to provide a smooth surface for the new joint to move over
• Hip replacement revision – if a prior hip replacement needs to be removed and replaced, for instance, if it has worn out, this is called revision surgery

The most suitable treatment for you will depend on the cause and severity of your hip pain.

There are a number of actions that you can take to help try and make your hip pain better. If you find that simple actions like these are not improving your symptoms, or the hip pain is getting worse, then you should see a specialist.

• Keep active – When you start to experience pain you may feel the need to rest. While reducing the amount of physical activity you undertake may be needed to heal sprains and strains, it is not advisable to stop activity completely. Muscles reduce in strength with lack of use and this may make an injury more likely to occur.
• Painkillers – drugs like paracetamol, when taken regularly, can help to keep you moving and stop you from becoming stiff and deconditioned.
• Lifestyle changes – this can involve simple things such as reducing heavy lifting at work, ensuring that you have well-fitting cushioned shoes and making sure that you are not sitting for long uninterrupted periods.
• Lose weight – if you are carrying extra weight it puts stress on joints which can lead to pain. Our experts can support you in losing weight, either to reduce pain or as a prelude to an intervention for your hip pain.

If your pain has not resolved with simple treatment within a few weeks, is getting worse, or is interfering with your activities, then a specialist opinion should be sought.

“The Park Hospital is a beautiful location to come and have your treatment.” – Dr Reshid Berber, consultant orthopaedic surgeon

The Park Hospital is a centre of excellence for the management of hip pain. Our experts have many years of experience managing hip pain in patients of all ages and from different causes.

Our surgeons have a personal approach to your diagnosis and management, taking the time to find out what is important to you and how your hip pain has affected your life.

Our surgeons are backed by a full multidisciplinary team including nurses, physiotherapists, occupational therapists, and radiologists to ensure the best outcome for you. Our friendly and relaxed team will ensure that you are safe and feel well looked after for the duration of your treatment.

If you need an operation, our experts will be there to guide you every step of the way, from diagnosis to surgery and through recovery back to health.

Facilities at The Park Hospital, Nottingham

The Park Hospital is a state-of-the-art facility set in the grounds of a country park. The hospital has five modern theatres for any procedures you might require.

If you need to stay after an operation, there are 66 en-suite rooms offering complete privacy for your recovery. With nursing and medical cover 24 hours a day, we will ensure that your stay is safe and comfortable. 

There are many reasons to have hip pain, including injuries, wear and tear and other causes of inflammation. Some of these respond well to simple pain relief and gentle exercise. If the pain does not improve, it is important to seek specialist advice to see if there is an underlying problem that requires intervention.

Our experts at The Park Hospital will help diagnose and treat your hip pain in a supportive and friendly atmosphere. If you need to have an operation, then the modern facilities of the hospital will aid in your recovery.

If you are concerned about your hip pain, book your consultation online today.