Hip Injuries and Disorders

Types of hip pain, disorders, and injuries, their causes, and how hip disorders are successfully treated non-surgically and arthroscopically. Hip injuries and disorders can originate from various different parts of the hip joint, causing pain which can limit your mobility and drastically affect your activity level and overall well-being. The hip joint is a highly complex mechanism surrounded by almost 30 muscles. Understanding how the hip joint functions will assist you in determining the precise area of your hip pain.

Anatomy of the Hip

The hip is a ball and socket joint comprised of bone, muscle, ligaments, cartilage, and lubricating fluids. The rounded end of the femur (thighbone) is the ball portion of the hip joint, which fits into a socket formed by a cavity in the acetabulum (pelvic bone). Cartilage, a strong, yet flexible substance which lines the joint and covers the ends of the bone, prevents friction between the femoral head and the acetabulum. The hip joint is encapsulated by a lubricating fluid which allows the hip to move smoothly. A rubbery fibrocartilage (labrum) seals in the joint fluid.

Movement of the hip joint is controlled by powerful muscles attached to the bones, including:

• Gluteal muscles: The buttocks muscles which attach to the back of the hip bones
• Abductor muscles: Located on the inner thigh
• Rectus femoris muscle: Quadriceps muscle located on the front of the thigh
• Iliopsoas muscle: The hip flexor which is attached to the upper thigh bone

Muscles are attached to the iliotibial band, a long tendon on top of the muscles which starts at the pelvis and runs down the leg.

Healthy hip function depends on all the bones, tendons, ligaments, muscles, cartilage, and fluids working together to provide range of motion and stability. Hip disorders and injuries can affect any one of these components, causing pain and limiting mobility.

Causes and Symptoms of Hip Injuries and Disorders

Hip disorder symptoms will vary depending on what joint component is affected and the cause of the hip disorder. Hip disorder symptoms can include:

• Hip pain
• Reduction in hip joint movement
• Limping
• Muscle stiffness
• Referred pain (usually in leg)
• Leg pain with applied weight

Common Causes of Hip Pain 

• Arthritis
• Tendinitis
• Muscles strain
• Bone fracture
• Bone spurs and other hip malformations

Types of Hip Disorders

Most hip disorders are caused by chronic or development conditions or injuries. Hip disorders can arise from congenital abnormalities, trauma to the hip joint, as well as wear and tear as a patient ages. Common hip disorders include:

• Osteoarthritis: Degeneration of the joint cartilage in which brittle pieces of worn cartilage break off lessening the bone cushion and causing inflammation and pain. Damaged bone may then grow outward forming bone spurs.
• Bursitis: Condition in which the fluid-filled sacks (bursae) that cushion muscles, tendons, and bones become damaged or inflamed from infection or injury.
• Iliopsoas tendinitis (snapping hip syndrome): Condition in which the patient feels a snapping sensation, and possibly an audible popping noise, when flexing or extending the hip. Most common in athletes due to physically demanding, repetitive movement.
• Femoroacetabular impingement (hip impingement syndrome): Normal range of motion is hindered due to abnormally shaped hip bones.
• Slipped capital femoral epephysis: The hip joint becomes separated from the femur at the growth plate. Surgically stabilizing the joint with pins is typically required.
• Soft tissue pain/referred pain: Condition or injury in which the soft tissues outside the hip are affected.
• Labral tear: Tear in the labrum, which is the ring of cartilage that follows the outside rim of the hip joint socket and acts as a seal to hold the ball at the top of the femur securely within the hip socket.
• Developmental dysplasia: Condition seen in newborns in which the hip is easily dislocated due to a shallow hip socket.
• Irritable hip syndrome: Hip pain displayed in children after an upper respiratory infection. Typically resolves with no treatment.
• Perthes disease: Disease affecting children ages 3-11 in which femoral bone cells die due to reduced blood supply.

Diagnosing Hip Pain and Disorders

Hip disorders can cause chronic pain, as well as seriously affect your mobility. Obtaining an accurate diagnosis is key in your successful hip treatment and care. Diagnosing your hip pain will include a physical examination by your doctor, as well as manipulation of the leg to help determine resistance, popping, range of motion, and pain source. If a hip injury or disorder is suspected, your doctor may recommend additional tests, such as:

• X-rays: To determine bone density and check for bone fractures and abnormalities.
• Bone scan: To identify bone diseases or new bone growth.
• Ultrasound: To check for developmental dysplasia or evaluate abnormalities without the use of radiation.
• MRI: To check for tears or fraying in the labrum or cartilage.
• CT scan: To obtain a more detailed image of the hip joint.
• Bone biopsy: To determine bone and tissue abnormalities by taking a small sample of bone through a needle.

The skilled staff at OSMI is committed to accurately diagnosing and treating your hip pain in order to achieve the optimal outcome in hip treatment resulting in restoration of mobility.

Treating Hip Injuries and Disorders

Treatment of hip injuries and disorders will depend on the severity and type of condition causing your pain. At OSMI, non-surgical treatment for hip disorders is always our first consideration. Hip pain can often be resolved with a combination of treatments, including:

• Rest: Minimizing weight bearing activity of the hip to allow it to heal.
• Use of non-steroidal anti-inflammatory drugs (NSAIDs): Typically used for mild to moderate pain and inflammation associated with tendonitis, arthritis, bursitis, synovitis, and muscle or labral tears.
• Physical therapy: To strengthen muscles, decrease inflammation, increase flexibility, restore range of motion, and assist in pain management.
• Injections: Cortisone injections are precisely guided (using ultrasound) directly into the affected area to relieve pain and inflammation. Psoas injections may be prescribed for a symptomatic psoas tendon and trochanteric bursa injections can be used to provide relief for bursitis on the hip.
• For hip pain and disorders which are unresponsive to physical therapy, injections, and a regiment of anti-inflammatories, hip surgery or arthroscopy may be recommended.

Hip Arthroscopy

Hip arthroscopy is a minimally invasive surgical procedure in which a tiny camera (arthroscope) is inserted into the hip joint in order for your surgeon to view hip damage and allow for repairs to be done using small surgical instruments. Hip arthroscopy can be used to repair soft tissue damage around the hip joint. This damage includes tears and inflammation and can be caused by an injury, wear-and-tear from repeated use, or orthopedic conditions (such as bone spurs, dysplasia, snapping hip syndrome, hip impingement syndrome, or loose fragments of bone and cartilage).

Research has shown that athletes tend to be satisfied with outcomes after hip arthroscopy. According to a 2013 study published in the Journal of Sport Rehabilitation, athletes reported that they were generally able to return to their sport and happy with their outcome a year after surgery. [1]

Hip arthroscopy has a low risk for complications and typically requires only 2-3 small incisions. Through these incisions your surgeon can remove loose pieces of bone or cartilage, cauterize structures, shave tissue, or repair cartilage using a technique called microfracturing, which promotes the formation of fibrocartilage. Hip arthroscopy procedures include:

• Chondroplasty: Removal of loose pieces of cartilage with a grasper or motorized shaver. Procedure is commonly associated with treatment of arthritis.
• Arthrotomy: Hip joint is opened to remove loose fragments, bone spurs or tumors, or to repair a fracture.
• Osteotomy: Reshaping or repositioning the femur to alleviate impingement and allow a more natural hip movement.
• Iliotibial band (ITB) release: Cutting of the ITB to lengthen the tissue.
• Gluteus medius repair: Tendon repair in which an anchor in the femur is sutured around the tendon, pulling it into normal position and then tying it over the bone.
• Trochanteric bursectomy: Debridement of inflamed bursa tissue using a motorized shaver.
• Osteochondroplasty (CAM decompression): Removal of a cam lesion (spur at the femur) to restore the shape of the femoral head.
• Acetabuloplasty (acetabular rim trimming/decompression): Pincer lesions (spurs at the acetabulum) are resectioned which can require the labrum to be detached. After the rim resection, labral tissue is anchored to the acetabular rim.
• Synovectomy: Removal of inflamed tissue inside the hip joint.
• Labral debridement: Trimming away poor labral tissue using a rotating shaver.
• Labral refixation: Placement of an anchor into the bone, then attaching the labral tissue with a suture. Scar tissue then replaces the suture keeping the labral tissue in place.
• Partial psoas release: Lengthening the psoas tendon by cutting it and allowing scar tissue to grow in and add length.

Recovering from Hip Arthroscopy

Hip rehabilitation time will vary depending on the type of hip arthroscopy performed. Crutches or a walker (typically for 2-6 weeks) will be required during your recovery, as well as wearing a brace during weight bearing activities. Your surgeon may recommend:

• Continuous passive motion (CPM) machine: Moves the hip joint without using the patient’s muscles in order to restore range of motion. Usually prescribed for 4 hours per day during the first 4 weeks after surgery.
• Ice machine: Ice cooling system recommended to ease pain and swelling after surgery. Regiment is typically 4-6 times daily for 20-30 minutes per treatment.
• Physical therapy will be an invaluable component in your successful recovery after hip arthroscopy. Your OSMI team will create an individualized therapy program suited to your needs and recovery goals. Your physical therapy treatment plan may include:
• Rehabilitation education
• Core stability exercises
• Behavior modification
• Abdominal and gluteal strengthening
• Stretching

The professional team at OSMI is highly trained and qualified to evaluate, diagnose, and treat your hip condition by using the least invasive and most effective methods available. If you are experiencing hip pain or are concerned that you may have a hip injury or disorder and would like to schedule an appointment, please submit an online appointment request or contact our office at 817-529-1900.

Reference:

{1} Lovett Carter D, Kennedy N. What Are Athletes’ Perceptions of Rehabilitation Outcome One Year Post Hip Arthroscopy? Journal of Sport Rehabilitation [early online publication]. October 23, 2013.