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Hip

Hip Anatomy

The hip joint is the largest weight-bearing joint in the human body. It is also referred to as a ball and socket joint and is surrounded by muscles, ligaments, and tendons. The thigh bone or femur and the pelvis join to form the hip joint.

Any injury or disease of the hip will adversely affect the joint’s range of motion and ability to bear weight.

Conditions

Hip Injuries & Tears

Snapping Hip

Snapping hip syndrome is a condition in which you hear or feel a snapping sound in the hip while swinging your legs, running, walking or while getting up from the chair. Movement of the muscles or tendons over a bony protrusion in the hip region gives rise to the snapping sound, which can occur in the back, front or side of the hip. It is usually painless and harmless, but may be accompanied with pain and weakness in some.

Hip Pain

Hip pain, one of the common symptoms patients complain of, may not always be felt precisely over the hip joint. Pain may be felt in and around the hip joint and the cause for pain is multifactorial. The exact position of your hip pain suggests the probable cause or underlying condition causing pain. Pain felt inside the hip joint or your groin area is more likely to be because of the problems within the hip joint.

Muscle Strains

A tear in the muscle fibers caused by either a fall or direct blow to the muscle, overstretching and overuse injury is called a strain. Muscle strains often occur in the hip region whenever a muscle contracts suddenly from its stretched position. It can be mild, moderate or severe and depends on the level of injury. The chances of having a hip muscle strain becomes high if you have had a previous injury in the area or if there is no warm-up before exercising.

Hip Bursitis

Hip bursitis is a painful condition caused by inflammation of a bursa in the hip. Bursae are fluid filled sacs present in joints between bone and soft tissue to reduce friction and provide cushioning during movement.

Femoroacetabular Impingement

Femoroacetabular impingement (FAI) is a condition where there is too much friction in the hip joint from bony irregularities causing pain and decreased range of hip motion. The femoral head and acetabulum rub against each other creating damage and pain to the hip joint. The damage can occur to the articular cartilage (the smooth white surface of the ball or socket) or the labral tissue (the lining of the edge of the socket) during normal movement of the hip. The articular cartilage or labral tissue can fray or tear after repeated friction. Over time, more cartilage and labrum is lost until eventually the femur bone and acetabulum bone impact on one other. Bone on bone friction is commonly referred to as Osteoarthritis.

Avascular Necrosis

Avascular necrosis, also called osteonecrosis is a condition in which bone death occurs because of inadequate blood supply to it. Lack of blood flow may occur when there is a fracture in the bone or a joint dislocation that may damage nearby blood vessels. Chronic use of high doses of steroid medications and heavy alcohol consumption are the two main risk factors of avascular necrosis. Initially, small breaks appear in the bone that may eventually collapse. Hip joint is most commonly affected; however, the knee and shoulder may also be involved.

Hip Fracture

Hip fracture is a break that occurs near the hip in the upper part of the femur or thigh bone. The thigh bone has two bony processes on the upper part - the greater and lesser trochanters. The lesser trochanter projects from the base of the femoral neck on the back of the thigh bone. Hip fractures can occur either due to a break in the femoral neck, in the area between the greater and lesser trochanter or below the lesser trochanter.

Hip Dislocation

The hip joint is a ball and socket joint. The “ball” is the head of the femur, or thigh bone, and the “socket” is the cup shaped acetabulum. The joint is surrounded by muscles, ligaments, and tendons that support and hold the bones of the joint in place. Hip dislocation occurs when the head of the femur moves out of the socket. The femoral head can dislocate either backward (posterior dislocation) or forward (anterior dislocation).

Gluteus Medius Tear

A gluteus medius tear is a condition characterized by severe strain on the gluteus medius muscle that results in partial or complete rupture of the muscle.

The gluteus medius is one of the major muscles of the hip and is essential for movement of the lower body and keeping the pelvis level during ambulation. The gluteus medius muscle arises from the top of the pelvic bone and attaches to the outer side of the thigh bone or femur at the greater trochanter by the gluteus medius tendon.

Hip Labral Tear

A hip labral tear is an injury to the labrum, the cartilage that surrounds the outside rim of your hip joint socket. The hip joint is a ball and socket joint in which the head of the femur is the ball and the pelvic acetabulum forms the socket. The labrum helps to deepen the socket and provide stability to the joint. It also acts as a cushion and enables smooth movements of the joint.

Chondral Lesions or Injuries

The hip joint is one of the largest weight-bearing joints in the body, formed by the thigh bone or femur and the acetabulum of the pelvis. It is a ball and socket joint with the head of the femur as the ball and the pelvic acetabulum forming the socket. The joint surface is covered by a smooth articular cartilage which acts as a cushion and enables smooth movements of the joint. A chondral injury refers to an injury of the articular cartilage, covering the joint.

Hip Instability

The hip plays an important role in supporting the upper body weight while standing, walking and running, and hip stability is crucial for these functions. The femur (thigh bone) and acetabulum (hip bone) join to form the hip joint, while the labrum (tissue rim that seals the hip joint) and the ligaments lining the hip capsule maintain the stability of the hip. Injury or damage to these structures can lead to a condition called hip instability. Hip instability happens when the hip joint becomes unstable causing various symptoms.

Loose Bodies

Loose bodies are small loose fragments of cartilage or a bone that float around the joint. The loose bodies can cause pain, swelling, locking and catching of the joint. Loose bodies occur if there is bleeding within the joint, death of tissues lining the joints associated with tuberculosis, osteoarthritis, and rheumatoid arthritis. Other causes include fractures, trauma, bone and cartilage inflammation, and benign tumors of the synovial membrane.

Hip Groin Disorders

Hip and groin disorders are more common in athletes, caused by rapid acceleration and deceleration motion.

The rehabilitation time for hip and groin injuries are longer than most other injuries, therefore early and accurate diagnosis is essential.

Hip Distraction

Hip distraction is indicated for the treatment of avascular necrosis in adolescents. The hip distraction procedure may be recommended as a conservative surgery for the treatment of arthritis in younger people. The procedure may also be advised for people suffering from femoroacetabular impingements (a condition where the hip bones have an abnormal shape) and Perthes disease (avascular necrosis of the hip in childhood). Hip distraction is also indicated for the treatment of chondrolysis (gradual degradation of hyaline cartilage in the hip joint).

Subtrochanteric Hip Fracture

A hip fracture is a break that occurs near the hip in the upper part of the femur or thigh bone. The thigh bone has two bony processes on the upper part - the greater and lesser trochanters. The lesser trochanter projects from the base of the femoral neck on the back of the thigh bone. Hip fractures can occur either due to a break in the femoral neck, in the area between the greater and lesser trochanter or below the lesser trochanter.

Hip Abductor Tears

Hip abductors are a major group of muscles found in the buttocks. It includes the gluteus maximus, gluteus medius, gluteus minimus, and tensor fascia lata muscles.

The tear or rupture of the gluteus medius muscle is commonly seen in runners and athletes involved in high-impact sports such as soccer or basketball due to sudden bursts of activity or poor flexibility of the gluteus muscle. Any traumatic or overuse injury, or degenerative changes may lead to partial or complete tear of the gluteus muscle.

Hip Synovitis

Hip synovitis, also called transient hip synovitis or toxic synovitis is a condition in which there is inflammation of the synovial tissues surrounding the hip joint causing hip pain. It is the most common reason for sudden hip pain occurring in young children between the age of 2 and 9. It affects boys more commonly than girls and most of the times, the hip joint on only one side is affected.

Irritable Hip

Irritable hip, also known as acute transient synovitis, is a common disorder of childhood characterized by onset of hip pain and limping. The term transient means that it does not usually last long. It usually occurs before puberty and affects only one hip. Boys aged between 4 to 10 years are most often affected 2 to 4 times more than girls.

Hip Tendonitis

Tendons are strong connective tissue structures that connect muscle to bone. Hip tendonitis is a condition associated with degeneration of the hip tendons. This condition is mainly caused due to strain on the tendons which may be due to overuse, or biomechanical problems.

Hip Pointers

The hip joint consists of 2 bones, the hip bone and the leg bone. An injury or bruise to one of these bones or the surrounding muscles or tissues is termed a hip pointer. This type of injury is mainly caused due to a sudden blow or hit on the hip which can occur from sports activities such as football, rugby, volleyball, basketball, cycling or skating.

Developmental Dysplasia

Developmental dysplasia of the hip (DDH) or Hip dysplasia is a condition which is seen in infants and young children because of developmental problems in the hip joint. The femur (thigh bone) partially or completely slips out of the hip socket causing dislocation at the hip joint. It is most common in first born baby with family history of the disorder. The exact cause for hip dysplasia is not known. Genetic factors play an important role in causing this birth defect. DDH can be mild or severe and can affect one or both hips. It is more common in girls and usually affects the left hip. DDH does not cause any pain and so the condition may not be noticed until the child starts to walk.

Legg-Calve-Perthes-Disease

Legg-Calve-Perthes Disease (LCPD) or Perthes disease is a disorder of the hip that affects children, usually between the ages of 4 and 10. It usually involves one hip, although it can occur on both sides in some children. It occurs more commonly in boys than girls.

Slipped Capital Femoral Epiphysis

Slipped capital femoral epiphysis (SCFE) is an unusual disorder of the hip where the ball at the upper end of the thigh bone (femur) slips in a backward direction. This is caused due to weakness of the growth plate. This condition is commonly caused during accelerated growth periods such as the onset of puberty.

Hip Arthritis

Osteoarthritis of the Hip

Osteoarthritis, also called degenerative joint disease is the most common form of arthritis. It occurs most often in older people. This disease affects the tissue covering the ends of bones in a joint (cartilage). In a person with osteoarthritis, the cartilage becomes damaged and worn out causing pain, swelling, stiffness and restricted movement in the affected joint.

Inflammatory Arthritis of the Hip

Inflammation of the joints is referred to as arthritis. The inflammation arises when the smooth covering (cartilage) at the end surfaces of the bones wears away. In some cases, the inflammation is caused when the lining of the joint becomes inflamed as part of an underlying systemic disease. These conditions are referred to as inflammatory arthritis.

Transient Osteoporosis of the Hip

Transient osteoporosis of the hip is a rare condition that causes bone loss temporarily in the upper part of the thighbone (femur). It is mostly found in young or middle aged men between the ages of 30 and 60, and women in their later stages of pregnancy or early postpartum period (following childbirth). It is characterized by abrupt onset of pain that increases with activity.

Procedures

Non-Surgical Treatments

Hip Injections

Hip joint injections involve injecting medicine directly into the hip joint to diagnose the source of pain or treat pain due to conditions such as arthritis, injury or mechanical stress of the hip joint. Hip pain may be experienced in the hip, buttock, leg or low back. The injection contains a combination of a numbing medicine and cortisone (an anti-inflammatory agent).

Physiotherapy

Physiotherapy or physical therapy is an exercise program that helps you to improve movement, relieve pain, encourage blood flow for faster healing, and restore your physical function and fitness level. The main aim of physical therapy is to make your daily activities, such as walking, getting in and out of bed, or climbing stairs, easier. It can be prescribed as an individual treatment program or combined with other treatments.

Platelet Rich Plasma Therapy

Platelet Rich Plasma Therapy is a relatively new method of treatment for several orthopedic conditions such as muscle, ligament, and tendon injuries; arthritis; and fractures. PRP injections can help alleviate painful symptoms, promote healing and delay joint replacement surgeries.

Shock-wave therapy

Shock wave therapy is application of the sound waves to treat musculoskeletal conditions and sports-related injuries. It is an effective treatment for trochanteric bursitis. Trochanter bursitis also called hip bursitis or greater trochanter bursitis is a common problem caused by inflammation of the bursa that overlies the greater trochanter (bony prominence at the outer side of the hip). The condition causes pain in the outer portion of the upper thigh.

Surgical Treatment

Hip Arthroscopy

Arthroscopy, also referred to as keyhole or minimally invasive surgery, is a procedure in which an arthroscope is inserted into a joint to check for any damage and repair it simultaneously.

Hip Replacements

Total Hip Replacement

Total hip replacement is a surgical procedure in which the damaged cartilage and bone is removed from the hip joint and replaced with artificial components. The hip joint is one of the body’s largest weight-bearing joints, located between the thigh bone (femur) and the pelvis (acetabulum). It is a ball and socket joint in which the head of the femur is the ball and the pelvic acetabulum forms the socket. The joint surface is covered by a smooth articular cartilage which acts as a cushion and enables smooth movements of the joint

Others

Injury, wear-and-tear and certain diseases can result in the wearing away of the cartilage tissue, causing painful rubbing of bones.Hip replacement surgeries have long been the choice of treatment, where the damaged parts of the joint are removed and replaced with a prosthesis. However, in young active patients, the prostheses are highly prone to wear-and-tear, and the need for repeat surgery. Hip preservation is a surgery that overcomes the limitations of joint replacement.

Hip Resurfacing

The hip joint is also known as a ball and socket joint, where the ball (femoral head) of the thigh bone fits into the socket (acetabulum) of the pelvis bone.

Damage to the hip bones can be treated by hip resurfacing, which is a surgical procedure in which the damaged parts of the femoral head are trimmed, and the socket is removed and replaced with metal caps.

Health & Safety

Planning for your hip surgery prepares you for the operation and helps to ensure a smooth surgery and easier recovery. Here are certain pre-operative and post-operative guidelines which will help you prepare for hip surgery.

Providers

Affiliations

  • Texas Orthopedic Hospital
  • Joe W. King Orthopedic Institute
  • American Academy of Orthopaedic Surgeons
  • The American Board of Orthopaedic Surgery