Hip conditions

+ Arthritis

Arthritis of the hip can be extremely painful and can have a significant impact on your ability to perform daily tasks such as walking or driving. Although often referred to as a single disease, there are actually over 100 different types of arthritis, and although it is possible to have more than one type of arthritis, the most common form is Osteoarthritis, accounting for two-thirds of diagnoses, followed by Rheumatoid arthritis, with each different type of arthritis characterised by a unique set of symptoms. The prevalence of arthritis increases with age, from <3% data-preserve-html-node="true" of people aged under 45 years to 39.9% for men and 57.3% for women aged over 65 years.

In osteoarthritis, the cartilage in the hip joint gradually wears away over time. As the cartilage wears away, it becomes frayed and rough, and the protective joint space between the bones decreases. This can result in bone rubbing on bone. To make up for the lost cartilage, the damaged bones may start to grow outward and form bone spurs (osteophytes).

Cause

Osteoarthritis has no single specific cause, but there are certain factors that may make you more likely to develop the disease, including:

• Increasing age
• Family history of osteoarthritis
• Previous injury to the hip joint
• Obesity
• Femoral Acetabular Impingement (FAI)
• Improper formation of the hip joint at birth, a condition known as developmental dysplasia of the hip (DDH)

You can still develop osteoarthritis even if you don't have any of the risk factors listed above.

Symptoms

The most common symptom of hip osteoarthritis is pain. This hip pain develops slowly and worsens over time, although sudden onset is also possible. Pain and stiffness may be worse in the morning, or after sitting or resting for a while. Over time, painful symptoms may occur more frequently, including during rest or at night. Additional symptoms may include:

• Pain in your groin or thigh that radiates to your buttocks or your knee
• Pain that flares up with vigorous activity
• "Locking" or "sticking" of the joint, and a grinding noise (crepitus) during movement caused by loose fragments of cartilage and other tissue interfering with the smooth motion of the hip
• Decreased range of motion in the hip that affects the ability to walk and may cause a limp

Imaging Tests

Imaging tests provide detailed pictures of dense structures, such as bones. X-rays of an arthritic hip may show a narrowing of the joint space, changes in the bone, and the formation of bone spurs (osteophytes).

Treatment

Although there is no cure for osteoarthritis, there are a number of treatment options that will help relieve pain and improve mobility.

+ Femoroacetabular Impingement (FAI) and Labral Tears

In FAI, bone prominences develop around the femoral head and/or along the acetabulum. This extra bone causes abnormal contact between the hip bones, and prevents them from moving smoothly during activity. Over time, this can result in tears of the labrum and the breakdown of articular cartilage (osteoarthritis).

Types of FAI

There are three types of FAI: pincer, cam, and combined impingement. Pincer. This type of impingement occurs because extra bone extends out over the normal rim of the acetabulum. The labrum can be crushed under the prominent rim of the acetabulum. Cam. In cam impingement the femoral head is not round and cannot rotate smoothly inside the acetabulum. A bump forms on the edge of the femoral head that grinds the cartilage inside the acetabulum. Combined. Combined impingement means that both the pincer and cam types are present.

Cause

FAI occurs because the hip bones do not form normally during the childhood growing years. It is the deformity of a cam bone spur, pincer bone spur, or both, that leads to joint damage and pain. When the hip bones are shaped abnormally, there is little that can be done to prevent FAI.

It is not known how many people have FAI. Some people may live long, active lives with FAI and never have problems. When symptoms develop, however, it usually indicates that there is damage to the cartilage or labrum and the disease is likely to progress.

Because athletic people may work the hip joint more vigorously, they may begin to experience pain earlier than those who are less active. However, exercise does not cause FAI.

FAI will be diagnosed following a physical examination and a review of X-rays or Computerized Tomography (CT) scan. Your surgeon may also require an MRI (magnetic resonance imaging) in order to identify damage to the labrum and articular cartilage. Injecting dye into the joint during the MRI may make the damage show up more clearly. Local anesthetic. Your doctor may also inject a numbing medicine into the hip joint as a diagnostic test. If the numbing medicine provides temporary pain relief, it confirms that FAI is the problem.

+ Avascular necrosis

Avascular necrosis is the death of bone tissue due to a lack of blood supply. Also called osteonecrosis, it can lead to tiny breaks in the bone and the bone's eventual collapse.

A broken bone or dislocated joint can interrupt the blood flow to a section of bone. Avascular necrosis is also associated with long-term use of high-dose steroid medications and excessive alcohol intake. Anyone can be affected, but the condition is most common in people between the ages of 30 and 50.

Symptoms

Many people have no symptoms in the early stages of avascular necrosis. As the condition worsens, your affected joint might hurt only when you put weight on it. Eventually, you might feel the pain even when you're lying down. Pain associated with avascular necrosis of the hip might center on the groin, thigh or buttock.

Causes

Avascular necrosis occurs when blood flow to a bone is interrupted or reduced. Reduced blood supply can be caused by:

• Joint or bone trauma. An injury, such as a dislocated joint, might damage nearby blood vessels.
• Cancer treatments involving radiation also can weaken bone and harm blood vessels.
• Fatty deposits in blood vessels. The fat (lipids) can block small blood vessels, reducing the blood flow that feeds bones.
• Certain diseases. Medical conditions, such as sickle cell anemia and Gaucher's disease, also can cause diminished blood flow to bone.

For about 25 percent of people with avascular necrosis, the cause of interrupted blood flow is unknown.

Risk factors

Risk factors for developing avascular necrosis include:

• Trauma. Injuries, such as hip dislocation or fracture, can damage nearby blood vessels and reduce blood flow to bones.
• Steroid use. Use of high-dose corticosteroids, such as prednisone, is a common cause of avascular necrosis. The reason is unknown, but one hypothesis is that corticosteroids can increase lipid levels in your blood, reducing blood flow.
• Excessive alcohol use. Consuming several alcoholic drinks a day for several years also can cause fatty deposits to form in your blood vessels.
• Bisphosphonate use. Long-term use of medications to increase bone density might contribute to developing osteonecrosis of the jaw. This rare complication has occurred in some people treated with high doses of these medications for cancers, such as multiple myeloma and metastatic breast cancer.
• Certain medical treatments. Radiation therapy for cancer can weaken bone. Organ transplantation, especially kidney transplant, also is associated with avascular necrosis.

+ Deep Gluteal Syndrome

Deep gluteal syndrome is pain and numbness you feel in your buttocks (bottom) that can sometimes go down the back of your leg. This pressure sends signals to the brain that can cause severe pain. Small amounts of pain that go away after a few days or a week are normal, but deep gluteal syndrome causes pain that is usually more severe and doesn’t go away, even with rest and basic care at home. Some other conditions are similar to deep gluteal syndrome, part of it, or have many of the same symptoms. These include: 

• Piriformis syndrome. 
• Sciatica.

Symptoms

• Tenderness or aching in the buttock. 
• Tingling or numbness that extends down the back of your leg. 
• Having a hard time sitting. 
• Feeling pain that gets worse the longer you sit. 
• Pain that gets worse with activity like walking or exercise. 

The symptoms of deep gluteal syndrome are usually caused by the muscles, bones, or other parts of your gluteus pushing on the nerves in that part of your body, including the sciatic nerve. This can happen because the gluteal muscles get irritated or injured, which can make them swell and spasm. Muscles can be hurt for many reasons, including:

• Sitting for long periods
• Exercising too much
• Repetitive activities like running, walking, or climbing a lot of stairs
• Playing sports, especially contact sports like football
• Lifting heavy objects

In addition to these everyday activities, you might also damage the muscles in your gluteus with trauma that can be caused by: ??

Treatments

In many cases, deep gluteal syndrome goes away on its own. You can help the healing process with some basic home care, like rest, ice, compression, and elevating your leg. Other basic treatments include:

• Exercising safely. You should always use proper form and equipment when doing sports, but making sure to exercise correctly while you have deep gluteal syndrome can help you heal faster.
• Taking medicine. Over-the-counter pain medicine like ibuprofen, naproxen, and paracetamol can reduce swelling and pain in the affected areas.
• Applying ice and heat. Using an ice pack and/or heating pad can reduce the swelling that irritates the nerve and can help decrease the amount of pain you feel.
• Stretching.

If your symptoms are more serious, your healthcare provider might recommend other treatments to relieve pain and help you feel better:

• Muscle relaxants. These medicines relax the muscle in your gluteus, reducing pain and giving you a chance to stretch and exercise muscle.
• Hydro dilation – radiologist can dilate space available for the nerve to leave the pelvic muscles and reduce tension on the nerve.
• Electrotherapy. Electrotherapy like TENS can help reduce severe pain and stop muscle spasms in your gluteus.
• Surgery. Surgery usually is not necessary. But if no other treatment works, your healthcare provider might recommend surgery to relieve pressure on the nerve that is causing you pain.