Hip disorders are among the most important and common causes of long-term and severe functional disability. Unlike in other parts of the body, hip pathologies can occur at any stage of life, such as infancy, childhood, youth, and especially old age.
What are the causes of hip pain?
The causes are osteoarthrosis (arthritis), arthritis (seronegative polyarthritis, rheumatoid arthritis, infectious arthritis), tumors, metabolic bone diseases (osteomalacia, osteoporosis), soft tissue disorders (bursitis, tendonitis), childhood diseases (temporary synovitis, juvenile chronic arthritis, Legg-Perthes disease), fascia lata fasciitis, piriformis syndrome, meralgia paresthetica, osteitis pubis, and pain spreading from other places to the hip.
Coxarthrosis (hip calcification)
Symptoms often occur in older ages. 5% of those over the age of 55 have coxarthrosis, and about half of them require surgical intervention. The main symptom of coxarthrosis is pain. Initially there is an insidious, blunt pain. Pain is felt in the buttocks, groin and thigh. The pain can occur in the knee with only knee pain. As the disease progresses, it increases. It is exacerbated by overloading the hip. The pain also happens at rest and can wake the patient up at night. Resting pain is characteristic for coxarthrosis. Sitting, getting up and climbing stairs are very difficult in active and advanced stages of the disease. For treatment, fat patients are recommended to lose weight. The cane and crutch also take up a portion of the load on the hip. Soft-soled shoes reduce symptoms by increasing the absorption of the load. Patients should sit on chairs rather than standing and avoid squatting and kneeling. PRP, ozone and physical therapy are used in the treatment of mild to moderate coxarthrosis. Symptoms are reduced with the walks including resting periods and longer distances can be covered. Although painkillers and muscle relaxants reduce pain, they can further promote degenerative changes when used for a long time. Good results are obtained with appropriate surgical procedures in patients over 60 years of age whose pain cannot be relieved despite the conservative therapy and whose joint contracture affects daily life.
Bursae are the sacs filled with fluid around the joint. Bursae reduce friction. There are many bursae around the hip joint. The inflammation of the bursae is called bursitis. Liquid in the bursae increases abnormally. A pain occurs around the hip and it increases with movement. The pain is exacerbated by pressing on the inflamed bursae. Cold is applied in the acute period and superficial and deep heat is applied in the chronic period. Pain medications can provide adequate healing. Local corticosteroid injections are performed in resistant cases.
Osteonecrosis (avascular necrosis)
Osteonecrosis is the death of cells in the bone and adjacent bone marrow as a result of decreased blood. It is also named as avascular necrosis and aseptic necrosis. The most common and serious involvement of osteonecrosis is the femoral head. The disease is more common in men than in women. Most cases are under 50 years of age. In many cases, the disease is completely asymptomatic, that is, the patient has no complaints. Diagnosis is often made when the radiograph is taken for another reason. Some patients may have pain lasting weeks or months before radiographic changes are observed. In painful cases, the pain is most often felt in the groin, and may also hit the buttocks, inner thigh, and even the knee. Usually, the pain increases with weight, but often continues at rest. Then, limping and loss of movement begin. Drug treatment can be tried as the disease may recur in the early stages. Using crutches, the load on the patient hip should be removed for at least 4-8 weeks. Analgesics are given for pain. Magnetic field therapy can be tried. Early decompression surgery reduces pressure and improves blood circulation. Thus, immediately after surgery, the pain is reduced, or it completely disappears.
It is the osteonecrosis of the femur head in children. It is most commonly seen between the ages of 3 and 12. It is approximately four times more prevalent in boys than in girls and is most commonly seen at the age of 5-8 years. Most of the children with Legg-Perhes limps. Patients may complain of the pain in the groin, thigh and inner knee. Pain increases with movement, walking and running, and decreases with rest. Limping is the most important early finding, as many children walk with limping before complaining of pain. The aim of treatment in Legg-Perthes disease is to prevent deformity of the femoral head. Symptomatic treatment in younger children with less involvement is the limitation of competition sports and activities that may overload the femur. When symptoms are exacerbated, crutches and traction at home can be used for 1-2 weeks. Children should be monitored clinically once a month and radiographically every 2-3 months. In advanced cases, casting and surgical treatment are performed.
Those who practice sports by opening their legs are more prone to adductor tendinitis. It is especially seen in people who do not do warm-up exercises sufficiently before these sports. Pain in the inner face of the hip and thigh is typical. Treatment consists of rest and ice application in the acute period. Drugs are added if necessary. Crutches should be given to severe cases. Physical therapy is applied after the acute period. Local corticosteroid injections are performed in resistant cases.