About Hip Pain

Hip pain is pain or discomfort you feel in or around your hip joint.

A joint is a place in your body where two bones meet. Your hip joint is where your thigh bone (femur) connects to your pelvis. Your hip joint is one of the largest joints in your body, and you use it constantly to move, support your weight and maintain your balance.

Hip pain can range from a temporary, short-term annoyance to a bigger issue that needs treatment from a healthcare provider. Where you feel the pain depends on which part of your hip joint is damaged. You might feel hip pain:

• Close to the surface above or around your hip (usually an issue with your muscles, tendons or ligaments).
• Deeper inside your hip joint (pain that comes from your bones or cartilage).
• In your lower back. Hip pain can sometimes spread (radiate) to other areas like your lower back or groin.

The pain might come and go. For example, you might feel hip pain when you’re walking or moving, but it gets better when you rest. Some people also feel pain during different parts of the day. You could feel more pain first thing in the morning when you wake up. It’s also common to feel hip pain at night, especially if you sleep lying on the same side as your painful hip.

You can usually treat hip pain at home by taking a break from physical activities and by taking over-the-counter pain relievers. Visit a healthcare provider if you’re feeling hip pain that’s bad enough to affect your daily routine or that’s making it hard to move. See a provider if you’re feeling pain that lasts more than a few days without getting better.

Types of Hip Pain

• Osteoarthritis: Degenerative joint disease causing cartilage loss and bone friction.
• Bursitis: Inflammation of fluid-filled sacs (bursae) near the hip joint.
• Labral Tears: Damage to cartilage lining the hip socket, common in athletes.
• Hip Impingement: Abnormal bone growth limiting joint movement.
• Tendonitis: Overuse-induced tendon inflammation, especially in active individuals.
• Referred Pain: Originates from spine (e.g., sciatica), pelvis, or gynecological issues.
• Inflammatory Arthritis: Includes rheumatoid arthritis, psoriatic arthritis, or ankylosing spondylitis

Hip Pain : Signs & Symptoms

Hip pain can present in various ways depending on the underlying cause. Recognizing the pattern and nature of symptoms helps in early diagnosis and effective management.

1. Localized Pain

Discomfort may be felt in different regions around the hip:

• Groin pain often indicates issues within the hip joint itself, such as arthritis or labral tears.
• Outer hip pain is frequently linked to bursitis or tendonitis.
• Buttock pain may point to problems in the sacroiliac joint or deep gluteal muscles.
• The pain usually worsens with movement or weight-bearing activities like walking, climbing stairs, or prolonged standing.

2. Stiffness

A common symptom in degenerative and inflammatory conditions:

• Patients often experience reduced range of motion, particularly in the morning or after periods of inactivity.
• Conditions like osteoarthritis and ankylosing spondylitis commonly present with stiffness that eases gradually with movement.

3. Radiating Pain

Sometimes hip pain isn't confined to the joint area:

• It can radiate to the thigh, knee, or lower back.
• Sciatica, herniated discs, or spinal arthritis may refer to pain in the hip region, creating confusion about the source.
• Nerve-related causes may also lead to numbness, tingling, or burning sensations.

4. Systemic Signs

When hip pain is part of a larger medical condition:

• Fatigue, fever, or general malaise can accompany infections (like septic arthritis) or autoimmune disorders (such as rheumatoid arthritis or lupus).
• Swelling, warmth, and redness around the joint may indicate inflammation or infection and require urgent evaluation.

Hip Pain Causes

• Degeneration: Age-related cartilage breakdown (osteoarthritis).
• Injuries: Fractures, dislocations, or repetitive stress (sports hernia, tendonitis).
• Autoimmune Disorders: Rheumatoid arthritis attacking joint linings.
• Infections: Septic arthritis or post-surgical complications.
• Structural Issues: Hip dysplasia, avascular necrosis, or slipped capital femoral epiphysis (in children)

Hip Pain Risk Factors

• Age: Osteoarthritis risk increases after 50.
• Obesity: Excess weight stresses hip joints.
• Activity Level: High-impact sports (e.g., running, soccer) or repetitive motions.
• Genetics: Family history of arthritis or hip dysplasia.
• Comorbidities: Diabetes, lower back disorders, or autoimmune diseases.

Hip Pain Complications

Complications of Untreated or Severe Hip Conditions

If left unaddressed, chronic hip conditions can lead to serious, sometimes irreversible, complications that significantly impact mobility, independence, and overall health.

1. Chronic Disability

Prolonged, unmanaged conditions like osteoarthritis or avascular necrosis can lead to:

• Progressive joint degeneration and cartilage loss
• Joint space narrowing and collapse, making daily activities like walking or standing extremely painful

Loss of mobility, muscle atrophy, and dependence on walking aids or wheelchairs

2. Infection Spread

In cases of septic arthritis, especially when not promptly diagnosed or treated:

• The infection can rapidly destroy joint structures, leading to permanent damage
• Bacteria can enter the bloodstream, resulting in sepsis, a life-threatening condition that affects multiple organs
• Immediate medical intervention is critical to prevent systemic complications

3. Joint Deformity

Chronic inflammatory disorders such as ankylosing spondylitis can cause:

• Spinal fusion, where the vertebrae begin to fuse together, leading to a rigid and hunched posture
• Hip joint stiffness and contractures, severely restricting mobility
• Over time, such deformities can affect balance, increase fall risk, and compromise respiratory function due to restricted chest expansion

Hip Pain Diagnosis

Accurately diagnosing the cause of hip pain requires a comprehensive approach that combines clinical evaluation with advanced diagnostic tools. Understanding the root cause helps guide effective treatment and prevent complications.

• Physical Examination
  A detailed physical exam provides initial clues to the underlying issue:
  
  • Pain location and pattern help narrow down potential causes (e.g., groin pain for joint issues, outer hip pain for bursitis).
  • Gait assessment evaluates how the patient walks, looking for limping or asymmetry that may indicate joint damage or muscle weakness.
  • Range of motion tests determine flexibility and detect stiffness or joint instability.
  • Special maneuvers (e.g., FABER or FADIR tests) may be used to reproduce symptoms and localize the problem.
• Imaging Studies Imaging helps visualize both bone and soft tissue structures:
  
  • X-rays are often the first-line imaging test to detect:
    
    • Arthritis
    • Fractures
    • Bone deformities or joint space narrowing
  • MRI (Magnetic Resonance Imaging) or CT (Computed Tomography) scans provide a more detailed view:
    
    • Ideal for assessing labral tears, ligament or tendon damage, cartilage loss, and nerve impingement
    • CT scans are particularly useful for evaluating complex bone anatomy or subtle fractures
• Laboratory Tests Blood tests may help uncover systemic or inflammatory conditions:
  • C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) indicate inflammation or infection
  • Rheumatoid factor (RF) and anti-cyclic citrullinated peptide (anti-CCP) are markers for rheumatoid arthritis
  • Uric acid levels may be checked in suspected gout cases
• Synovial Fluid Analysis
  When joint infection or crystal-induced arthritis is suspected, fluid from the hip joint may be aspirated and analyzed:
  
  • Presence of urate crystals confirms gout
  • Calcium pyrophosphate crystals suggest pseudogout
  • Bacterial growth or elevated white blood cells indicate septic arthritis, which requires urgent treatment

Hip Pain Treatment

• Medications:
  • NSAIDs: Reduce inflammation (e.g., ibuprofen).
  • Corticosteroids: Injections for severe bursitis or arthritis.
  • DMARDs/Biologics: Slow autoimmune arthritis progression.
• Physical Therapy: Strengthen hip muscles, improve flexibility.
• Lifestyle Modifications: Weight loss, activity adjustments, low-impact exercises.

Note: Medications are only advisable under doctor’s consirderation. 

Surgical Options:

Joint Replacement (Total Hip Arthroplasty)
Recommended for patients with advanced osteoarthritis, avascular necrosis, or severe joint deformity:

• The damaged hip joint is replaced with an artificial implant made of metal, ceramic, or plastic
• Significantly improves pain relief, mobility, and quality of life
• Modern implants can last 15–20 years or more, especially with improved materials and techniques
• May be performed using robotic assistance or minimally invasive methods to enhance precision and reduce recovery time.

Arthroscopy
A minimally invasive surgical procedure used to diagnose and treat a variety of hip problems:

• Involves the insertion of a small camera and instruments through tiny incisions
• Used to repair labral tears, remove bone spurs, trim damaged cartilage, or treat impingement (femoroacetabular impingement or FAI)
• Typically associated with shorter recovery times and less post-operative pain compared to open surgery
• Ideal for younger, active patients with early joint damage