Hip

Some hip problems can be improved or healed by following a regimen recommended by a physician. Others may require surgery. Following is a list of common hip problems with brief information on cause, prevention and treatment. Only a physician can diagnose specific injuries.

Hip tendonitis
Tendonitis is an inflammation of the tendon, which connects muscle to the bone. Major causes of hip tendonitis are acute trauma and overuse resulting from repetitive movements.

Hip tendonitis is often related to trochanteric bursitis or snapping hip. Trochanteric bursitis is inflammation of the bursa located at the point of the hip referred to as the greater trochanter, which lies on the outside of the upper thigh. Inflammation of this bursa causes pain in the hip, usually on the outer side of the leg. Though it can be annoying, snapping hip is usually painless and harmless. It is a common occurrence among young athletes and dancers. If pain accompanies the snapping, an orthopedist should be consulted to evaluate the situation.

Cause:
The most common causes of hip tendonitis are acute injury and overuse injury. The acute injury often involves eccentric contraction of the hip muscle or rapid flexion against extension force/resistance but also may result from direct trauma. If overuse is the issue, care must be taken to rest.

Prevention:
Avoid repetitive motion to the hip. Rest and give the hip time to heal. When returning to activity, stretch, incorporate nonweight-bearing exercise, and back off if pain returns.

Treatment:
The primary objective is to alleviate pain, spasm, and swelling. A combination of medication, ice, rest, and gentle stretching assists these goals in coming to fruition. A pack of crushed ice in a damp cloth-covered ice bag applied for 20 minutes every 1-2 hours also can provide relief of pain, spasm, and inflammation.

If snapping is bothersome, apply ice and reduce activity levels. Stretching exercises may also help, and ibuprofen may reduce discomfort. If the snapping hip is painless, no treatment is needed.

Developmental dysplasia and perthes
Hip dysplasia describes a problem with formation of the hip joint in children either at the ball of the hip joint, the socket of the hip joint or both. Perthes is a rare childhood disease which happens when the blood flow to the head of the thighbone is interrupted, which causes the bone cells to die.

Cause:
Hip dysplasia occurs in about 0.4% of all births, and is most common in first-born girls. Risk factors include: family history, babies born in breech position, and problems resulting from the in-utero position of the baby. Perthes disease most commonly affects boys between 4 and 8 years old, and will be present in both hips in one-fifth of those affected.

Treatment:
The goal of treatment for hip dysplasia is to properly position the hip joint. In the first six months of age, the standard of care is a Pavlik harness, which holds the hips bent up and out but allows for motion as the child kicks the legs. If the hip does not remain in the socket, then surgery may be needed.

In general, treatment of Perthes disease is aimed at relieving symptoms, maintaining hip motion, and keeping the hip in the proper position. Occasionally, surgery is needed to keep the femoral head inside the hip joint, but most often treatment of Perthes Disease is nonsurgical.

Hip fracture
When a break occurs where the top of the thighbone angles into the hip socket, the hip is fractured. Typically, hip fractures affect the elderly with weakened (osteoporotic) bone, but higher energy trauma can cause hip fractures even in young healthy patients with good bone. The injury makes it too painful to stand. Hospitalization and surgery are required.

Causes:
Ninety percent of hip fractures result from falls, usually in the home. Only one in four patients recover completely.

Prevention:
Taking steps to avoid falls is critical. Here are some suggestions:
• Participate in regular exercise to increase strength and balance
• Have prescription and over-the-counter medicines reviewed to reduce side effects and interactions
• Have annual eye exams
• Reduce hazards that could cause a fall in the home

Treatment:
Following surgery, the goal is to get the patient moving, even while the bone is healing. The orthopedist can reposition the fracture, holding it in place with plates and screws, or screws alone. A doctor will determine when it is appropriate to start standing and walking after surgery. Patients may need crutches, a walker or other help. Physical therapy or rehabilitation exercises may be used to help the patient return to normal levels of activity.

Avascular necrosis
Avascular necrosis is more common in men than in women and usually affects people before age 50. It is progressive, worsening with time; managing it is a lifelong process. Avascular necrossi, the death of bone tissue due to a lack of blood supply, can cause tiny breaks in the bone resulting in the bone's eventual collapse. Avascular necrosis most often affects the head of the thighbone (femur), causing hip pain. But it may affect other bones as well.

Cause:
Blood supply to the bone can be temporarily interrupted or completely cut off for a number of reasons, but the most frequent cause is trauma, including a broken bone (fracture). People who drink heavily may develop fatty deposits to form in blood vessels, which can restrict the flow of blood to bones. High doses of corticosteroids over long periods of time may also lead to avascular necrosis.

Prevention:
Various situations can lead to avascular necrosis: overweight, direct trauma including fractures, drinking too much alcohol, or using steroids.

Treatment:
Preventing further bone loss is the goal of treatment. Early stages of avascular necrosis may benefit from more conservative treatment, while later stages may require surgery.

Initial treatment may include nonsteroidal anti-inflammatory drugs (NSAIDs), rest including the use of crutches to keep weight off the joint for one to three months, exercises developed by a physical therapist, or electrical stimulation of bone growth.

Arthritis of the hip
There are two types of arthritis that affect the hip joint. Both types eventually cause pain and stiffness that can worsen over time. The first type of arthritis is osteoarthritis. This type is the wear and tear arthritis where the smooth covering on the ends of the bones (cartilage) wears down, leaving the bone rubbing on bone. The second type is known as rheumatoid, or inflammatory, arthritis. In this disease, the body reacts against the cartilage and causes the cartilage to dissolve in the hip joint, leaving bone rubbing against bone. Both types of arthritis can be treated with medication, walking aides, and activity and lifestyle changes, but when the pain becomes severe, hip replacement surgery is often needed.

Causes:
Result of disease that is present in the body.

Prevention:
The effects of osteoarthritis cannot be reversed, yet early nonsurgical treatment may slow its progression, helping patients avoid pain and disability.

Treatment:
Treatment will vary depending on the orthopedist’s diagnosis. A range of anti-inflammatory medications may be prescribed. Physical therapy may help increase a patient’s range of motion, and strengthening exercises could help maintain muscle tone. Swimming is a good exercise. Devices can make it easier for patient to go about daily life, e.g., cane, walker, reacher, etc. Surgery may be recommended if lifestyle changes don’t improve the situation. There are various options, including total hip replacement and bone grafts.