Sanjeev Bhatia, MD
Sanjeev Bhatia, MD, orthopedic surgeon at Northwestern Medicine Central DuPage Hospital in Winfield, Illinois. He serves on the Northwestern Medicine Hip and Knee Joint Preservation Center Team.
If your normally active life is suddenly upended by hip pain, your response may depend on your age. A middle-aged runner may assume it’s a severe injury, while a retiree might suspect arthritis and the need for hip replacement.
But there’s good news for people of any age: The most common causes of hip pain are usually managed successfully with no surgery required.
Hip pain can arise from structures that are outside of the actual ball-and-socket joint (extra-articular) or from the cartilage inside the joint (intra-articular). The location of your pain can provide clues to what is occurring and guide treatment decisions.
Front of the hip. If you have pain in the front of your hip, it’s likely to be an intra-articular condition. If you feel a sharp pain after twisting, squatting, pivoting, or getting in and out of the car, you may have hip impingement. This condition strikes when the bones of the ball and socket don’t fit together properly. The mismatch can lead to tears in the labrum, a ring of cartilage on the rim of the hip-joint socket. Hip impingement and labral tears can cause pain, but they can also hinder normal motion, destabilize the hip joint, and, in severe cases, lead to advanced arthritis.
Side of the hip. If you feel pain when lying on your side, sitting with your legs crossed, walking, or climbing stairs, greater trochanteric pain syndrome (GTPS) may be to blame.
This extra-articular condition affects structures that surround the large bony prominence on the side of the hip (the trochanter). GTPS is one of the most common causes of side hip pain in adults and affects women more than men. One study in adults ages 50 to 75 found that 15 percent of women and 6.6 percent of men were affected.
In the past, it was called trochanteric bursitis, because it was generally accepted that it was caused by inflammation of the bursae—fluid-filled sacs that keep tendons and muscles from rubbing directly against the trochanter. Recent ultrasound and MRI studies, however, suggest that the pain is often caused by inflammation of the gluteal abductor tendons in addition to bursitis and tightness in the iliotibial band. The iliotibial band is a stretch of fibrous tissue that runs from the hip to under the knee.
Back of the hip. Hip pain that is more posterior in nature often arises from extra-articular causes such as discomfort in the sacroiliac joint, which connects the hip bone to the sacrum, or conditions such as sciatica that stem from the lumbar spinal nerve roots (lumbar radicular pain).
Muscular causes of posterior hip pain can include tendinopathy of the muscles in the back of the thigh (hamstring). Tendinopathy can be caused by the inflammation of a tendon (tendinitis) or degeneration of a tendon’s collagen (tendinosis).
Nonsurgical treatment is almost always the first choice for hip pain, and the success rate is as high as 90 percent for extra-articular conditions and 50 percent for intra-articular causes. Although the intra-articular rate is lower, it still suggests that a nonsurgical approach may be beneficial.
Nonsurgical treatments include physical therapy, over-the-counter medications such as acetaminophen (Tylenol) and ibuprofen (Advil and Motrin), prescription antirheumatic drugs and biological response modifiers, and injections and infusions of medications such as corticosteroids. Dietary supplements such as glucosamine and chondroitin may help as well. Many people benefit from losing excess weight and participating in low-impact exercise.
Several studies have shown that mental and emotional factors, such as stress and anxiety, can affect the perception of hip pain, especially in the postoperative period. As such, stress reduction techniques may be beneficial.
This type of integrative approach to musculoskeletal pain may become the norm in the future as more research begins to support these efforts.
If these efforts fail, it doesn’t mean hip replacement is needed. Advances in minimally invasive procedures mean that surgeons can address issues such as hip impingement, labral tears, and gluteus medius tears with only tiny incisions in same-day procedures.
Another option, orthobiologic therapy, uses injections of substances like bone marrow or plasma that are already in your body to relieve pain and promote healing. Consider platelet-rich plasma therapy. A small amount of your blood is drawn and run through a centrifuge to concentrate the platelets. When those concentrated platelets are injected into the joint or tissue, they release growth factors and cytokines that boost healing and regenerate injured tissue. Similarly, stem cells may be taken from your bone marrow and injected into the site of injury to regrow tissue.
One of the best things people can do to prevent pain is to help their cartilage remain healthy with a low-impact exercise program that preserves motion and strengthens the hip. That includes things like using elliptical machines, swimming, biking, yoga, and practicing Pilates. Additionally keeping one’s core, gluteal, and lumbar back muscles strong helps decrease the incidence of extra-articular hip problems.
