Now that you know a little bit more about hip anatomy (from part one), it’ll be a little easier to understand why hip pain and other symptoms occur and what changes they can cause in the joint and the structures that support it. Careful evaluation of the joint and a thorough review of the symptoms are the first essential steps in helping to determine the best course of treatment to relieve symptoms and, hopefully, restore normal function of the joint.
Diagnosing the cause of hip pain
Just as surgical techniques have improved significantly during the past decade or so, the techniques used for evaluating and diagnosing the causes of hip pain have also evolved. Today, the joint can be carefully examined through noninvasive diagnostic imaging like x-ray, CT imaging and MRI imaging, as well as minimally-invasive arthroscopy methods that use special instruments to see inside the joint.
In fact, arthroscopy can help not only to pinpoint and refine the understanding of the cause of his symptoms but also provide critical information to help plan surgery so patients can experience the best possible outcomes.
During an arthroscopic diagnostic procedure, the surgeon will insert a very thin scope into the joint using a very small incision and guided into the joint space using an imaging technique like an x-ray. A few fluid pumps into the joint to gently open the joint space for better viewing.
The end of the arthroscope features a very tiny camera that can take clear images of the joint interior, transmitting those images back to a computer and monitor so they can be viewed both during the procedure and afterward to aid in treatment planning.
Because it uses a tiny incision, arthroscopy performs without general anesthesia, either while you’re lying on your back on your side, depending on the angle needed to obtain the most accurate images.
In addition to diagnosing hip problems, arthroscopy can also perform some types of surgical repairs. (We’ll cover these in parts three and four of the series).
Common causes of hip pain
One of the most common causes of hip pain is osteoarthritis (and less commonly, rheumatoid arthritis). Arthritis causes a destruction of the joint surfaces, breaking down the protective layer of cartilage so friction between the femoral head and acetabulum (the socket portion) is increased.
As arthritis progresses, the bones can even become worn and damaged, and pain tends to substantially increase, along with stiffness and decreased range of motion. Arthritis can affect patients of any age, but it’s more common among older men and women and among athletes who place a lot of strain on the joint. Rheumatoid arthritis is an immune-mediated disease that develops when the immune system attacks healthy joint tissue.
Of course, fractures and dislocations can also cause considerable pain, especially when any type of weight applies to the joint. Most fractures and dislocations undergo diagnostic imaging.
Soft tissue injuries like torn or strained ligaments or tears to the labrum, the ring of cartilage that surrounds the socket, often diagnoses with CT scanning, but sometimes arthroscopy provides more in-depth information or even to provide treatment.
Less commonly, diseases and conditions like rickets, osteoporosis (“brittle” bones), osteonecrosis (death of bone tissue) or osteomyelitis (deep infection) can cause pain and ache in and around the joint. And finally, some hip pain may not be directly related to your hip joint at all, but instead may be due to herniated discs or other back problems or problems affecting the knees.
Getting the best treatment
Yep, that’s a lot of causes. That’s why a thorough evaluation by an orthopaedist is so critical in ensuring the most appropriate course of treatment. In parts three and four, we’ll look at some of the treatments – surgical and non-surgical – used to relieve hip pain and improve joint function and mobility.