Understanding Hip Pain

Hip pain can be caused by factors unrelated to underlying disease, such as trauma, overuse, sprains and strains. But the majority of hip pain we see in our patients is attributable to some form of arthritis.

Arthritis is the leading cause of disability in the United States, and osteoarthritis (OA) is the most common form of arthritis, affecting tens of millions of people worldwide. It is a degenerative disease characterized by the breakdown and eventual loss of joint cartilage. This wearing away of joint cartilage causes the bones to rub together, resulting in extreme pain. OA resulting from “wear and tear” is the most common reason individuals need to undergo hip replacement surgery.

How do you know if the pain you're feeling in your joints is the result of arthritis or merely overuse?

In general, the pain associated with arthritis develops gradually, although sudden onset is also possible. The pain of arthritis may come from different sources. These may include inflammation of the synovial membrane (tissue that lines the joints), the tendons, or the ligaments; muscle strain; and fatigue. A combination of these factors contributes to the intensity of the pain.

The hip is prone to developing pain in part because its anatomy is complex—it is one of the largest and deepest joints in the body—and because it has a large range of motion. Some of these structures, including the bursae, muscles, tendons, or ligaments, are common causes of hip pain, even when the joint itself is fine.

comparison of a healthy hip joint to an arthritic hip joint

True hip pain is most commonly experienced in the groin, not the buttocks.

About 80 percent of patients with hip arthritis will have some pain in the groin or the front of the thigh; the pain can radiate down the front of the thigh and even down the thigh to the knee. This is because the hip and knee have an overlapping nerve supply. In fact, in some patients with hip disease, knee pain may be the only symptom!

Most patients with significant hip disease have a limp and one leg may feel shorter than the other.
You may feel your hip “creaking” when you walk, which can be caused by bone-on-bone contact in the joint socket.
Quite often the first step or two after prolonged sitting may be especially painful. Eventually you may have to “take a break” to ease the pain after walking only short distances.
You likely experience difficulty getting in and out of a car, climbing stairs, or tying your shoes.

When the arthritis is non-inflammatory, the pain is worse with use and usually worse at the end of the day. When the pain is due to inflammation, frequently pain and stiffness are greatest in the morning or after a long period of rest. They are relieved by heat and gentle exercise. Of course, the most important symptom of arthritis is decreased function, sometimes caused by pain, and sometimes because the joint does not move properly.

However, what you think is hip pain may actually be sciatica, a herniated disc, bursitis, a strain or sprain, or even back pain. Our physicians can help you determine which problem is causing the most pain.

What’s a good rule of thumb about whether you need to see a doctor about your hip pain?

If your pain is keeping you up at night, it’s time.

Frequently Asked Questions

What are alternatives to hip replacement?

Lifestyle modification: Decrease pounding activities; for example, ride a bike instead of walking.
- Exercise and physical therapy: Remain as active as your pain will comfortably allow. Studies suggest that people with hip arthritis who force themselves to remain active may do better in the long run than those who “baby themselves.” Being totally sedentary leads to a loss of muscle and bone strength.
- Weight loss: Any effort at weight loss will decrease the amount of force on the hip, slow the destruction of the hip joint and decrease pain. Each pound of weight loss equals three pounds of stress reduction on the hip during normal gait!
- Use an assistive device, such as a cane. A cane can reduce the force on the joint by several hundred pounds. Remember to hold the cane in the opposite hand (yes, the opposite hand) from the side with the hip problem and make sure the cane is the correct height. Any medical supply company that sells you a cane will adjust it to the correct length.
- Manage pain with medication: If your pain is mild, you may only need medicines you can buy without a prescription. Stronger medications that can help ease pain and relieve inflammation associated with hip osteoarthritis include:
  - Nonsteroidal anti-inflammatory drugs (NSAIDs) are a group of drugs that decrease the inflammation in arthritic joints.
  - Opioids
  - Corticosteriod Injections: Corticosteroids diminish inflammation and reduce pain.

When should I consider surgery?

Hip replacement surgery is one of modern medicine’s most successful operations. It is very effective at relieving pain and helping patients regain lost mobility. However, it’s also major surgery. In the procedure, your damaged bone and hip joint is removed and replaced with plastic and metal components; any failure of these components can result in pain and loss of function.

Total Hip Replacement surgery should be considered only when you have exhausted all reasonable non-operative measures to control pain. Ask yourself if you are physically and emotionally ready for the operation, as well as the subsequent rehabilitation period. The final decision rests with you.

Signs that it might be time for a Total Hip Replacement:

Pain in your hip prevents you from sleeping.
Medication and using a cane aren’t delivering relief.
Because of hip pain, you restrict social activities such as attending church, going shopping, going to sporting events, and/or travelling.
You have difficulty getting in and out of chairs, cars and bathtubs.
You have difficulty sitting for more than 30 minutes at a time.
You have difficulty walking or climbing stairs.
You feel a decrease in hip motion or the degree to which you’re able to bend.
You find intercourse and/or sexual activities painful.

What should I know when considering a hip replacement?

Hip arthritis is a progressive disease. Once you have it, it will never get better, and it generally will get worse. There are no exercises, diets, vitamins, or minerals that will make any difference.
The rate of joint deterioration varies greatly from person to person. As hip arthritis progresses, individuals will experience worsening pain and declining function, but some people will find this less debilitating than others.
Eventually, your pain and disability will no longer respond to medication. Although you often might experience days or weeks when your hip pain is minimal, this is not a sign your arthritis is “’getting better.”
Hip replacement surgery is an elective decision. You will never need a hip replacement if you are willing to live with the pain.
More than 98% of patients who have a hip replacement operation have no major complications that leave them in any way dissatisfied with their replacement.
There can be consequences to waiting too long: Trying to “save your joint” by becoming totally sedentary won’t slow down the disease’s progression; in fact, it will only accelerate the loss of muscle and bone strength. It’s also important to recognize that the combination of bone mass and bone quality determines a bone’s overall strength and ability to resist fracture. One in two women and one in four men over the age of 50 will have an osteoporosis-related fracture in his or her remaining lifetime. Hip fractures are associated with a 20% mortality rate in the first 12 months.
Recent studies suggest that people who choose to have surgery before advanced joint damage occurs tend to recover more easily and have better outcomes. If your pain and disability are not responding to conservative measures, and you realize that you are going to have to have the operation sooner or later anyway, you may reasonably conclude that there is no point in waiting.
Full recovery from the surgery takes about three to six months. Factors influencing your recovery include the type of surgery performed, your overall health, and the success of your rehabilitation.
You have a 90-95% chance that your joint will last 10 years, and an 80-85% chance that it will last 20 years.

What are the benefits of hip replacement?

Reduced hip pain. Following the initial surgery-related discomfort (which should disappear within a few weeks), you should expect that your hip pain will either be eliminated or significantly reduced.
Restored mobility. As your hip pain subsides, your legs will become stronger with increased use. That means better mobility, less fatigue and easier movement.
Improved quality of life. With less pain and greater mobility, you should be able to perform daily tasks more easily and lead a more active, more independent life.

What are the potential risks and complications of hip replacement surgery?

Joint replacement in general is highly successful and has a low rate of complications. However, as with any major surgical procedure, it is important for patients to be well informed about the possible risks of joint replacement surgery. These risks include:

Infection around an implanted joint
Urinary infections or difficulty urinating
Dislocation or instability of an implanted joint
Damage to nerves or blood vessels
Blood clots (deep vein thrombosis): In the post-surgical period blood clots may form in the calf or thigh. To reduce the number of clots and the chance that they will migrate to the lungs, Dr. Grimsley employ medications to reduce clotting and mechanical devices that encourage blood flow in the legs.
Wound irritation
Limb length discrepancies