Hip pain in Bromley

Hip pain is a common condition that affects people of all ages. However, it tends to be even more common as you get older, particularly after the age of 60.

There are several conditions that could be causing your hip pain, and there are also many ways of treating it. Finding the best treatment for you will likely depend on the cause.

You might have lots of questions about hip pain.

What are some of the more common causes of hip pain in adults, and what are the symptoms? How is hip pain diagnosed and what are some of the things you can do to relieve the pain?

In this article, we answer these questions. We also review the treatments for hip pain that are available at Circle Health Group’s The Sloane Hospital in Bromley.

There are many possible reasons why you may be experiencing hip pain. Below are some of the more common causes of hip pain in adults.

Osteoarthritis

Osteoarthritis is one of the most common causes of hip pain in adults. Osteoarthritis is a chronic degenerative condition in which the cartilage of the joint breaks down which leads to pain, stiffness and reduced mobility. In osteoarthritis of the hip, the symptoms are:

• Constant and deep pain in your groin that starts gradually
• Pain that gets worse with prolonged standing or with weight-bearing activities
• Reduced mobility
• Sometimes you may develop a limp

Treatments for osteoarthritis of the hip include:

• Painkillers and anti-inflammatories
• Physiotherapy
• Lifestyle changes such as losing weight or exercising more
• Prescribed opioids for relieving pain
• Hip replacement surgery for advanced osteoarthritis

Rheumatoid arthritis

Rheumatoid arthritis is probably the “second most common cause of hip pain, after osteoarthritis,” says Dr Dominic Davenport, Consultant Orthopaedic Surgeon at Circle Health Group’s The Sloane Hospital and Blackheath Hospital in Bromley.

Rheumatoid arthritis is an autoimmune inflammatory condition that affects the joints. It occurs when the part of the joints that secrete synovial fluid — a substance that normally helps lubricate the joints — releases chemicals that attack the cartilage in the bone.

Symptoms of rheumatoid arthritis of the hip are:

• Pain and stiffness in the groin or outer thigh
• Pain is worse in the morning and gets better with activity
• Developing a limp

One or both hips may be affected in this condition.

Fracture

Common signs of a fracture include:

• Sharp pain when doing weight-bearing activities such as walking, hiking, jogging, climbing stairs or getting in and out of a car
• Sharp pain when rotating the hip outward
• Being unable to put full weight into the foot after trauma or injury to the hip
• A shorter leg on the side of the affected hip

The treatment for fractures will depend on the severity of the fracture and what caused it. Treatments include:

• Simple bed rest and avoiding weight-bearing activities
• Bone reconstructive surgery
• Physiotherapy
• Partial or total hip replacement

Labral tears

Your hip socket is lined with a ring of cartilage — this is called the labrum. When there is a tear in this cartilage, you may experience:

• A ‘knife sharp’ pain in your groin
• A painful ‘giving way’ sensation in your hip
• A painful clunk in your hip joint
• A snapping hip
• Pain when rotating your hip outward
• Pain when your knee is brought up to your chest and rotated inward

Treatments for labral tears include:

• Injections with anaesthetic or steroids to your hip
• Physiotherapy
• Painkillers, rest, and avoiding the movements that bring on the pain
• Arthroscopic surgery

Femoroacetabular impingement (hip impingement)

Femoroacetabular impingement tends to affect young and middle-aged physically active adults. It occurs either because of an abnormal shape of the top of the thigh bone (the hip head) or an abnormal shape of the hip cup (or hip socket).

“This abnormal contact between the two parts of the hip can lead to labrum tear and early degeneration in the hip,” Dr Davenport explains. Symptoms include:

• Pain in the front of the groin
• Pain that gets worse when sitting down, rising from the seat, when flexing the hip upward or when leaning forward
• Occasionally the pain may radiate to the side of the hip or the front of the thigh

Greater trochanteric pain syndrome (trochanteric bursitis)

This condition affects a region on the side of the hip called the greater trochanter. This is the bony bump on the side of your hip. Inflammation or physical trauma in this area can cause the following symptoms:

• Pain that comes and goes
• Mild stiffness in the morning
• An inability to sleep on the side that hurts

Treatment with rest, physiotherapy, or corticosteroid injections works in 90% of the cases.

Iliopsoas tendinitis (Iliopsoas bursitis)

The iliopsoas is a tendon that runs from your lower back through to your pelvis and attaches to the greater trochanter. It is a hip flexor, which means that this tendon helps you bend your hip and allows you to do things like climbing stairs or getting in and out of cars.

Sacs filled with fluid, called bursae, cushion the tendon and protect it from friction. When the tendon is inflamed or strained due to overuse, or when the bursae become inflamed (bursitis), you may experience the following symptoms:

• Hip flexor pain that gets worse with activity
• The pain starts in the groin area and may continue down the inner thigh
• A snap or clunk in your hip
• Tenderness when touching the area
• A crackling sound in the joint
• Difficulty putting socks on or climbing stairs

Iliopsoas tendinitis usually gets better on its own. You can treat it successfully by:

• Resting
• Applying ice
• Avoiding painful activity
• Doing stretching exercises
• Seeing a physiotherapist
• Raking over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs)

Degenerative lumbar spine with nerve root impingement

This is the most common form of ‘referred’ pain from the hip, according to Dr Davenport. Referred pain is the name given when the pain is felt in the hip, but the cause is actually elsewhere in the body.

Degenerative lumbar spine disease, also called degenerative disc disease in the lumbar spine or in the lower back, happens when the discs in your spine wear off and start causing pain.

The discs between our vertebrae are cushioned pads made of cartilage and tissue that provide our spine with support and flexibility. Over time, however, the wear and tear of these discs may lead to lower back pain that can sometimes travel through to your hip and radiate down the leg.

Nerve root entrapment or impingement refers to any condition in which a nerve in the lower back becomes trapped, compressed, or irritated.

Treatment for this condition ranges from the usual non-operative options like anti-inflammatory medication and physiotherapy to surgery for more advanced disc degeneration.

Avascular necrosis of the femoral head (osteonecrosis)

Avascular necrosis of the femoral head, also called osteonecrosis of the hip, is a condition in which the blood supply to the thigh bone is cut off. When the femoral head, or the top of the thigh bone, does not receive blood anymore, the bone can degenerate. This may lead to arthritis.

There are many possible causes of osteonecrosis, and they range from fractures, hip dislocations, chronic steroid use, chronic alcohol consumption to autoimmune conditions or congenital problems, among others. Often, the cause remains unknown.

There are four stages to the disease, and symptoms range in severity across these stages. Symptoms include:

• Hip pain that can radiate to the groin and thigh
• Pain that gets worse with activity such as walking and climbing stairs and gets better with rest
• In later stages, people may still have hip pain when resting

It is key to start treating the condition as early as possible, as it can progress quite rapidly. Treatment options will depend on the specific circumstances of the patient, and range from non-operative treatments to surgery for more advanced stages.

Non-operative treatment includes NSAIDs, avoiding weight-bearing activities and eliminating the cause (e.g. stopping steroid or alcohol use). Surgery includes hip replacement, which accounts for 10% of all avascular necrosis cases.

Rare causes of hip pain

Very rarely, Dr Davenport explains, hip pain can be caused by infection or tumours.

Infection

Also called septic arthritis, this is a medical emergency. Signs that you have an infection are severe pain when you move your hip, finding it impossible to bear weight on the affected hip and leg, feeling seriously ill, and having a high temperature.

Tumours

Very rarely, hip pain and fractures can be a sign of cancerous tumours. These can be bone tumours due to bone cancer or tumours resulting from other cancers that have spread to the bone. Older adults are at higher risk of this. Treatment includes bone reconstruction, hip replacement and treatment of the cancer. 

Hip pain that radiates down the thigh or leg may be caused by a problem with the hip or a problem with the lower back. The two areas are closely linked, explains Dr Davenport.

“I think the important point [to note] is that with any joint in the body,” he says, “including the spine, you can get a crossover where the joints above or below an area of pain can be the problem.” If you are getting pain down the back of your leg and thigh, and down the back of the leg in particular, then the cause may lie in your lower back.

“The key thing to rule out there is [...] degenerative lumbar spine disease, and nerve root entrapment or nerve root impingement,” says Dr Davenport.

On the other hand, if the pain “is at the front of the thigh, or on the side of the thigh, that is more commonly associated with a hip-related problem,” he notes.

This is not necessarily always hip arthritis, but it is more likely that the pain is caused by one of the hip problems highlighted above in this article.

There are several conditions that tend to affect women more than men. These include:

• Osteoporosis, which may lead to stress fractures
• Greater trochanteric pain syndrome is more common in women aged 40–60 years
• Osteoarthritis of the hip is twice as common in females than in males
• Rheumatoid arthritis affects women more than men
• Hip dysplasia, a congenital condition that may lead to arthritis in adulthood, is also more common in females, explains Dr Davenport

In addition, there are situations in which the pain is felt in the hip, but the cause is the pelvis. In women, this referred hip pain may be caused by gynaecological disorders such as:

• Endometriosis (a condition in which the tissue that lines the uterus grows outside of it)
• Fibroids

Talking to a consultant about your hip pain symptoms will help them to investigate and diagnose the underlying cause of your hip pain.

There are two main things to consider when deciding whether to see a doctor for hip pain. One is the pain itself, and the other is how it affects your daily activities.

According to Dr Davenport, you should see a hip consultant if you are experiencing:

• Groin pain, particularly during physical activity that involves weight-bearing
• Stiffness around the hip and the groin
• Any pain that goes down the leg into the thigh which could be coming from the hip

You should also see a doctor if:

• The pain is interfering with your daily activities (for example, if you cannot work without pain)
• You can no longer do the activities you used to enjoy (for example, you can no longer engage in physical activity or play with your grandchildren)

To find what’s causing your hip pain, your consultant will ask you a series of questions. This will help them establish your medical history and point them in the right direction.

Medical history

Some of the things that your hip consultant may ask to narrow down possible causes include:

• Your age
• Any congenital conditions that you may have been born with
• Any history of trauma or injury
• Where is the pain located and how did the pain start
• If you had an injury, how did it happen
• What activities bring on the hip pain
• What worsens the pain and what relieves the pain
• How easy or difficult it is to do regular activities such as getting in and out of a car, putting on shoes, walking, running or climbing stairs.

Physical examination

Next, your consultant may want to do a physical examination. They will look for issues in the hips, the back and the stomach, and any problems with blood vessels and nerves. Your consultant may ask you to walk, stand, sit or lie in different positions.

Imaging tests

Depending on the suspected cause, your hip specialist may request one or several of the following imaging tests:

• X-rays
• Computerised tomography (CT) scans
• Magnetic resonance imaging (MRI) scans
• Ultrasound scans

Different imaging tests will be recommended depending on the suspected cause. For example, MRI scans can help to diagnose soft tissue problems, while an X-ray can detect bone fractures, and so on.

Circle Health Group’s The Sloane Hospital has very quick access to convent investigation and diagnosis.

As Dr Davenport explains, the hospital’s quick turnaround of high-quality investigations is one of the key factors that distinguishes The Sloane Hospital from other private healthcare institutions.

“As orthopaedic surgeons, we have a very close working relationship with our radiology colleagues and physiotherapists.

At Sloane Hospital, patients get access to the corrective care [they need] in a very timely manner, all in the same place.” 

At The Sloane Hospital, a spectrum of treatments can follow from your hip clinician visit.

Physiotherapy

If you are in the early stages of hip arthritis and are of a younger age, the hospital can offer an on-site physiotherapist. This specialist will guide you through an exercise programme that can treat your hip pain.

Hip injections

Injections can be used in some cases to reduce hip pain and inflammation.

“Examples of this would be pain on the outer part of the hip, related to trochanteric pain syndrome. [This] can be treated with steroid and local anaesthetic injection, and with ultrasound guidance, which is usually performed by one of our consultant radiologists,” says Dr Davenport.

Less commonly, tendinitis around the hip may require ultrasound-guided injection therapy, which takes place in the operating theatre.

Hip injections can be used not only to treat the hip, but also to help diagnose the cause of hip pain.

Hip surgery

Some surgeons at The Sloane Hospital offer hip arthroscopy, or keyhole surgery, for labral tears, Dr Davenport says.

Hip replacement surgery is recommended for established osteoarthritis, he adds.  

Costs are an important part of your treatment journey.

Like all Circle Health Group hospitals, The Sloane Hospital offers fixed price packages that include the initial consultation, treatment, and aftercare, should you require surgery.

You can pay for your private healthcare using your health insurance if you have it, or you can pay via self-pay.

At Circle Health Group, you have the option to spread the cost of your treatment through a flexible instalment plan. Paying in instalments makes private health care a lot more affordable than you might think. 

Content reviewed by Mr Dominic Davenport in May 2022. Next review due May 2025.