Some of the specific conditions that affect the hip are:
Osteoarthritis
Osteoarthritis is one of the most common causes of hip pain in adults. It mainly affects the joints in the fingers, knees and hips.
Your hip joint can become painful, swollen and stiff because OA thins the cartilage that stops your bones rubbing together and causes bony lumps known as osteophytes to form on the bones of the joint.
You can feel a great deal of pain from osteoarthritis of the hip which can restrict your movement and sometimes makes you limp.
Osteoarthritis of the hip can cause a great deal of pain, restricted movement and a limp. In extreme situations, the leg can become shorter and the hip can become fixed in a bent position, making movement difficult.
For more information, see our section on osteoarthritis.
Paget’s disease of bone
Paget’s disease affects the way bone develops and renews itself, causing it to become weaker. It usually affects the pelvis, causing it to grow out of shape. This can often lead to hip pain, but it is treatable with a group of drugs called bisphosphonates.
Bisphosphonates are drugs used to prevent the loss of bone mass and treat bone disorders such as osteoporosis and Paget’s disease.
For more information see our sections on Paget’s disease and bisphosphonates.
Other types of arthritis
Inflammatory conditions, such as rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis can all cause hip pain. This can be managed with specific medications for each condition.
For more information see our sections on rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis.
Hip fractures
If you’ve fallen and hurt your hip you should see your doctor urgently, as fractures around the hip are very common, particularly in elderly people with osteoporosis.
Osteoporosis makes bones less dense and fragile, so they break or fracture more easily. You may need surgery to fix the damage.
For more information see our section on osteoporosis.
Avascular necrosis (osteonecrosis)
Avascular necrosis is a rare and painful condition that can affect any joint in the body in young-to-middle-aged adults. It occurs in the hip when the blood supply to the ball at the end of the thigh bone is lost. This causes the bone to die and the ball to collapse, which results in arthritis.
This could be a permanent or temporary loss of blood flow. Sometimes steroid treatment, for illnesses like cancer or asthma, can cause avascular necrosis as a side-effect. Alternatively, you could have a really bad fracture that affects the flow of blood to the end of the bone.
This loss of blood flow causes the bone and the tissue around it to gradually die – changing the shape of the ball at the end of the bone and making your hip painful and stiff. It can cause the ball in the joint to collapse, which results in arthritis.
It’s often referred to as idiopathic, which means that it doesn’t have any clear cause. However, it’s linked with the following:
- Drinking too much alcohol.
- Long-term use of high doses corticosteroids, such as prednisone.
- Sickle cell disease (an inherited condition that stops red blood cells from carrying oxygen through the body properly).
- Radiotherapy.
If your doctor thinks you have avascular necrosis, it’s important they refer you for an urgent MRI scan to confirm the diagnosis. As soon as you have a diagnosis, you can start treatment, which may stop the condition causing any more damage and stop you developing arthritis.
Femoroacetabular impingement (FAI)
Femoroacetabular impingement (FAI), is a condition where the ball and socket don’t move freely through their normal range of movement. This may be because the top of the ball isn’t completely round or because the socket is too deep.
It’s not fully understood why this happens, and in most circ*mstances no specific treatment is needed.
In some cases, surgery can improve the range of movement in the hip, but it’s not clear whether this helps prevent arthritis developing in the long-term.
If x-rays and scans of the hip joint are normal, then the symptoms may be caused by referred pain from the back. Pain caused by a problem with the lower back may only be felt in the buttocks, down the back of the legs, over the outer side of the hip joint and occasionally in the front of the hip.
Soft tissue conditions
Lateral hip pain
There are a number of conditions that can affect the outside of your hip joint. Your diagnosis will depend on how wide the affected area is.
Trochanteric bursitis
Bursae are small fluid-filled pouches, which act like cushions to reduce friction where parts of the body move over one another, for example where tendons or ligaments pass over bones.
If you have tenderness over the bony part of your hip joint, you may have trochanteric bursitis. This is caused by inflammation of the bursa at the top of the thighbone. Inflammation is a normal reaction to infection or injury and causes the bursa to become swollen, hot and painful.
It’s a very common condition, but there’s usually no obvious cause. You may just feel pain over this bony point, but it can spread down the leg or it may seem to be coming from the hip joint itself.
Trochanteric bursitis often happens in both hips. It usually improves with rest, painkillers and physiotherapy.
Very occasionally the condition can last for longer than expected, and it’s sometimes linked to problems with the area of the lower back known as the lumbar spine. Paying attention to your posture can make a big difference. The condition is common and often chronic and in many cases it’s an over-looked diagnosis.
It’s now known to affect your muscles and tendons around the trochanteric area as well, not just the bursa. This can mean you may be referred to a specialist in sports medicine, orthopaedics, rheumatology or spinal medicine.
There are also now a number of names given to this condition, depending on what type of doctor diagnoses it and how wide the area affected is. You may be told you have greater trochanter pain syndrome, trochanteric tendinobursitis or gluteal tendinopathy.
Iliopsoas tendonitis
Iliopsoas tendonitis is inflammation of the iliopsoas tendon that runs over the edge of the pelvis and helps you bend your leg up. This usually gets better on its own.
Snapping iliopsoas tendon
A snapping iliopsoas tendon doesn’t usually cause hip pain. ‘Snapping’ refers to a clicking noise you may be aware of as the tendon flicks over the edge of your pelvis when you move, it doesn’t mean the tendon breaks.
Some people say the sensation feels like their hip is popping out of place. If your doctor thinks you have this condition they’ll usually recommend you rest and use painkillers until it settles. Tests and surgery are rarely needed.
Torn acetabular labrum
The acetabular labrum is a thick ring of cartilage around the hip socket. It can be torn if the ball or socket of the hip are misshapen. This can be the result of hip problems in childhood or changes to the shape of the hip as it develops, but in most cases the cause is unknown.
If the ball of the hip joint is affected, it’s called a cam lesion. When the socket is affected, it’s known as a pincer lesion. We don’t yet know whether treating these problems with surgery prevents you from getting osteoarthritis in later life.
If your doctor thinks you have a torn acetabular labrum, they may recommend you have an arthrogram investigation. This is where a small amount of dye is injected into the hip joint before an MRI or CT scan. This gives a clear image of the surface of the bones, soft tissues and cartilage in the joint.
Other causes of groin pain
Groin pain is very commonly caused by problems with the hip. However, it can also be a symptom of other conditions, such as:
- a hernia – a painful lump, often in the groin, which may need surgery
- lymph nodes in the groin – these usually occur if there’s infection in the lower leg
- gynaecological problems, which can occasionally be felt as hip pain.
