If you’ve experienced persistent hip pain for months or years, it’s time for an intervention– and an education. Learn about how the hip joint works, the parts of the hip that are injury-prone, and where your hip pain is coming from. Discover the treatments available and determine whether you might be the right candidate for a total hip replacement (THR).
Anatomy of the Hip Joint
The hip is an important load-bearing joint. That’s why a hip joint that isn’t working correctly can cause so much pain and discomfort. The hip joint is where the top of the thigh bone (the femoral head) meets a socket inside the pelvis (the acetabulum). Ligaments connect the femoral head to the acetabulum. The joint is lined with synovium, a membrane that produces fluid to lubricate the joint and keep it moving smoothly. The joint is cushioned by fluid-filled sacs, or bursae, designed to remove friction between the surrounding muscles, tendons, and bones.
Common Hip Injuries
There are several common hip injuries that might be a source of hip or leg pain. They include:
- Broken hip: Broken or fractured hips are more common in people aged 65 or older, particularly women. Conditions like osteoporosis weaken bones over time so that even minor slips or falls can cause a broken hip. Younger people involved in serious accidents may also experience hip breaks or fractures.
- Bursitis of the hip: Characterized by swelling or inflammation in the bursae, bursitis is a common cause of aches and pain in the hip. Typical symptoms include stiffness in the hip, pain that increases when you move or press on the joint, or a joint that looks swollen and red. The possible underlying causes of bursitis include repetitive motions that put stress on the hip joint, injury to the hip, or inflammatory arthritis.
- Hip dislocation: Usually caused by major falls or accidents, dislocation occurs when the femoral head slips out of place in the socket. Birth defects such as congenital hip dysplasia or an unusually shallow hip socket make dislocation more common.
- Labral tear: A labral tear in the hip stems from damage to the ring of cartilage around the bony edge of the hip socket. This cartilage helps to hold the femoral head in place and cushions the socket. Underlying causes include repetitive motion from playing a sport, the beginning stages of osteoarthritis, or an injury that caused a twisting of the hip joint. The common symptoms of a labral tear may include a clicking or catching sensation when moving the hip, pain in the hip or groin area, and a limited range of motion in the hip.
Hip Pain, Leg Pain, Lower Back Pain: Which Is It?
If you’re experiencing chronic pain in the hip, leg, or lower back, make sure you know where it’s really coming from. Sometimes, the pain you feel in one part of your body is referred pain from somewhere else. Pain in the hip might actually stem from an issue in the back or the leg– or pain in the leg might stem from an issue in the hip. Make sure you’re addressing pain at its source so you can find the right treatment.
- Piriformis syndrome: A common cause of pain in the hip, lower back, and buttocks, this syndrome occurs when the small piriformis muscle (located behind the gluteus maximus) presses on the sciatic nerve that runs down the back of the leg. The piriformis muscle may be small, but it’s an important one: you use it almost every time you move your lower body. So injury or irritation to the muscle can cause pain with every one of those movements. Repetitive motions such as running, walking, or even sitting for long periods of time might irritate the muscle. An irritated piriformis leads to sciatica, or pain and numbness down the back of the leg from pressure on the sciatic nerve.
- Herniated disc: Also known as a slipped disc, a herniated disc occurs when one of the discs in the spinal cord bulges or ruptures. The herniated disc then presses on the sciatic nerve, as with piriformis syndrome. You might feel sciatic pain in the hip, but when a herniated disc is the culprit, you’ll experience shooting pains down the back of your leg, and pain that worsens when sitting but improves when walking. Herniated discs may be caused by a lower back injury or by the simple wear and tear that comes with age.
Arthritis of the Hips
Arthritis is another cause of hip pain, stiffness, and swelling. The most common types are:
- Osteoarthritis: The most common chronic joint condition, osteoarthritis (OA) causes the cartilage cushioning the bones in a socket to break down. Over time, friction between the bones may cause growths known as bone spurs. Pieces of bone or cartilage may also chip and come loose in the joint. In the final stages of OA, when the cartilage has been completely worn off, the bones in the joint rub against each other, causing pain and further damage to the joint.
- Rheumatoid arthritis: RA is an autoimmune disease affecting the joints. It happens when the body’s immune system attacks the synovium membrane that lines the joint or joints in question. If left untreated, RA can lead to loss of mobility in the affected joints.
- Ankylosing spondylitis: This form of arthritis affects the spine, causing stiffness, inflammation, and chronic pain. Ankylosing spondylitis can lead to stiffness and pain where the hip meets the spine.
When Is a Total Hip Replacement Necessary?
A total hip replacement, or THR, could be in order in patients with chronic hip pain. Osteoarthritis, rheumatoid arthritis, severe hip injury, or bone tumors are all possible indicators for hip replacement. But because a THR is a complicated and invasive surgery, in which the entire hip is removed and replaced with an artificial joint, it isn’t typically the first method of treatment for these conditions. First, your doctor might suggest pain medication, physical therapy, and walking with a cane as forms of treatment. In some cases, your doctor might also recommend a less invasive surgery called an osteotomy to reposition the injured hip joint. But if these methods don’t help treat the pain or become less effective over time, further intervention might be needed.
To determine if a THR makes sense for you, your doctor will first order X-rays to look for damage to the hip joint. It’s best to perform a total hip replacement only when the possible benefits outweigh the potential risks. In osteoarthritis cases, the University of Maryland Medical Center recommends a total hip replacement only when X-rays show that the hip cartilage has worn away and the bones of the joint are touching. Your doctor will also look for the significant impact of hip pain on your daily life, such as trouble sleeping or an inability to climb stairs.
Other health factors also matter. Patients with severe muscle weakness, conditions such as Parkinson’s disease, or who are at high risk for infections are not good candidates for the surgery. They are more likely to experience complications and less likely to successfully recover.
The Total Hip Replacement Recovery Process
Physical therapy begins soon after the surgery is completed, usually within a day or two. A physical therapist will teach exercises designed to regain functionality and range of motion in the hip. However, it’s important to remember that an artificial hip will have a reduced range of motion, and patients may need to learn new ways of moving about their daily lives. Hospital stays following a total hip replacement are usually 10 days or less, but the total recovery process may take between 3 and 6 months.
A successful hip replacement should eliminate pain and disability. That success is achieved through physical therapy. During recovery, your physical therapist will monitor your progress and help you to remain active and exercise every day, both in the hospital and at home. At first, you might need an aid such as a cane or walker to help you move, but as you practice the exercises, you’ll gradually be able to walk without assistance.
If you need physical therapy following a total hip replacement, we can help. Contact our team at Cawley Physical Therapy and Rehab at 570-208-2787 or email us at cawleyptfrank@gmail.com for more information or to set up an appointment.
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