Everything you need to know about painful hips, and how to treat them
Hip pain is a common occurrence and can affect people of all ages. One in five of all people aged over sixty five can be affected and also younger patients, who may have pain that has been triggered by abnormalities from birth, or who have engaged in inappropriate exercises at a young age.
We’ve put together this short guide to help you recognise the main causes of hip pain and the surgical and non surgical options for remedy and recovery.
The hip joint is one of the largest joints in the body and serves in locomotion as the thigh moves forwards and backwards. The hip joint can also rotate when sitting and with changes of direction when walking.
The hip joint is where the ball of the thigh bone known as the femur joins the pelvis at a socket called the acetabulum. There is cartilage covering both the bone of the femur and the acetabulum of the pelvis in the hip joint. A joint lining tissue called the synovium tissue produces fluid that lubricates the joint and provides nutrients to the cartilage of the joint and the ligaments around the hip joint attach the femur bone to the bony pelvis. There are a number of muscles and tendons that glide around the hip joint and tiny fluid sacs called bursar which provide gliding surfaces for the muscles and tendons. Major arteries and veins also pass the front of the hip joint.
Symptoms of hip pain can vary such as limping, joint pain, groin pain, a loss of motion, warmth, swelling, tenderness in the area, and difficulty sleeping on the hip side at night. These symptoms can vary from being very mild to extremely severe and need the appropriate treatment in order to resolve.
Common causes of this type of hip pain include Osteoarthritis which causes joint pain, stiffness and the inability to move the joint, and rheumatoid arthritis which makes joints swollen, stiff and painful. Rheumatoid arthritis over time can damage not only the joints, but also cartilage and other nearby bone.
Causes can also include hip fractures which are cracks or breaks at the top of the thigh bone. These are usually caused by a fall or injury but may occasionally be due to health conditions such as cancer as this significantly weakens the hip bone.
Disorders that cause unusual bone growth can cause considerable hip pain and also conditions such as septic arthritis which is inflammation caused by bacterial infection or ankylosing spondylitis which is a long term condition where the spine and other areas of the body become inflamed.
There are various treatments available to combat hip pain. Surgery is usually only an option when the pain, swelling, and stiffness of the joint is severe and when it is seriously affecting the quality of life of the person on a day to day basis. For example everyday tasks become impossible and working and socialising is seriously hindered or made impossible.
Surgery options: Hip Replacement
A hip replacement can be carried out under a general anaesthetic but could also be performed with only an epidural. A surgeon will make an incision into the hip, remove the damaged hip joint and replace it with an artificial joint made of metal alloy or ceramic. Hip replacement is a common type of surgery and is necessary when the hip joint is worn or damaged to the extent where mobility is reduced and pain is experienced even whilst resting. Most hip replacements are carried out on people between the ages of sixty to eighty and a modern artificial hip joint is designed to last for at least 15 years and provides a significant reduction in pain and an increased range of motion.
In the replacement. The surgeon actually removes the existing hip joint completely. The upper part of the thigh bone/femur is removed and the natural socket for the head of the femur is hollowed out. A socket is fitted into the hollow in the pelvis. A short, angled metal shaft called the stem with a smooth ball on its upper end is placed into the hollow of the thigh bone. The cup and stem may be pressed into place or fixed with acrylic cement. The prosthetic parts can be cemented or uncemented.
Minimally Invasive Hip Replacement
This procedure mirrors the hip replacement but uses a smaller cut of around four inches and uses specially designed instruments to perform the surgery. As the incision is smaller, there is less post-operative pain.
In a resurfacing procedure (which is the treatment that Andy Murray had done), the femoral head is not removed but instead is trimmed and capped with a smooth metal covering. The damaged bone and cartilage within the socket is removed and replaced with a metal shell. There are advantages to this surgery in that it will be easier to revise at a later date if needed and there is a decreased risk of hip dislocation, however there are considerable disadvantages also. There is risk of femoral head fracture and a risk of metal ion released as there is friction between the two surfaces. Resurfacing is also not suitable for every patient. They are usually younger, less than 60 years of age, of larger frame, possessing stronger, healthier bone, and usually men. Older, smaller females would have serious risks of complication.
Hip replacements have become routine procedures, however like all surgery options, there are risks.
One of the risks of this type of surgery is loosening of the joint itself. This can happen in up to 10% of cases and causes pain and a feeling that the joint is unstable. Loosening can be caused by the shaft of the prosthesis becoming loose in the hollow of the thigh bone or due to thinning of the bone around the implant. It can occur at any time but usually occurs 10-15 years after the surgery. Hip dislocation occurs in up to 3% of patients. The hip joint comes out of the socket. This is most likely to happen in the first few months after surgery when the hip is still healing. Further surgery is then required to put the joint back into place and this is never easy.
Other risks include wear and tear of the artificial sockets, which may lead to replacement surgery, joint stiffening, where soft tissues harden around the implant causing reduced mobility, and blood clots and infections.
If the hip replacement joint starts wearing out, revision surgery will have to be performed and the joint replaced again. The original prosthesis may fail due to infection, dislocation, or a fracture to the thigh bone and will need revising. Hip revision surgery is more complicated and risky than the original surgery itself. This is because the surgeon has to first take out the existing artificial hip joint, may have to reconstruct some of the bone, and then replace with a new joint. The operation is larger, longer and does not always function as well as the original prosthesis.
The recovery after hip surgery depends on certain factors such as the patients age, original fitness, and the condition of the joints and muscles. Most hip replacement patients are able to walk within the same day or next day after surgery. Most patients can resume a normal level of activity within the first 3 to 6 weeks but once light activity becomes possible, healthy exercise must be incorporated to aid in recovery.
Recovery also depends on factors after surgery such as paying attention to diet and weight, exercise and physiotherapy to promote blood flow and prevent clots.
Alternative non invasive procedures
There are several options to be considered in order to avoid complicated surgery and still alleviate pain and regain motion:
Medication: Usually the first line of treatment for hip pain due to osteoarthritis.
Exercise: Exercise strengthens the muscles around the hip and can improve hip flexibility. This can lead to reduced pain and better function. In some cases, however, exercising can worsen hip pain.
Physical Therapy: A physical therapist can develop a program to reduce symptoms such as pain and swelling, strengthen the hip and improve function.
Weight Loss: The hips are weight-bearing joints. Those with hip arthritis are often overweight. The stress caused by excessive body weight multiplies with activities such as running or climbing up steps.
Physical Aids: Physical aids such as braces or walkers help take stress off the hips. They are recommended for those who have considerable pain or are in danger of losing balance and falling.
Injections: If pain is more intense, your doctor may recommend joint injections such as corticosteroids or hyaluronic acid. Corticosteroids help reduce inflammation and hyaluronic acid helps improve the lubricative properties of joint fluid.
PRP Therapy: newer regenerative medicine treatments such as platelet-rich plasma which harness the body’s healing potential. Cells from your own body are obtained, processed, and injected into the hip joint to promote healing and regeneration.
“Just 3 months after Lipogems® treatment, I can now walk down the stairs. The injections are 100% better to the point that I would never know I had pain there.” – patient testimonial.
1 hour treatment shows improvement in 75% of patients.
These minimally invasive regenerative alternatives offer pain relief when hip pain has become difficult to live with. In this hip stem cell therapy, Lipogems® adipose tissue transfer and platelet rich plasma provides a non surgical option for people with severe hip pain. This minimally invasive treatment decreases inflammation, stops the progression of arthritic damage and repairs joint cartilage.
This treatment has now helped over 30,000 patients worldwide with life changing results. The treatment consists of AMPP® injections which use your body’s own stem cells from a combination of Lipogems® and PRP therapy to treat the pain and inflammation. It is an alternative to surgery but can also be used after surgery to aid healing. It harnesses natural repair cells removed from body fat to target the problems affecting hip joints, tendons, ligaments and muscles.
PRP supports the body’s self healing processes. With a higher concentration of growth factors that are typically found in blood,these injections support the restoration of injured tissue and inhibit painful inflammation.
Dr Konrad Slynarski commentated on the development of this exciting and effective new therapy, ‘We can now offer stem cell therapy that is easy to do and non surgical. Injection therapy can become the first line treatment for patients for hip problems which helps improve pain and function that can last for many years.’