When should I See a Doctor for Hip Pain?

What is hip pain?

The hip joint is a ball-and-socket joint with a layer of cartilage that helps the bone move smoothly. Over time, problems can develop – the cartilage wears down or muscles and tendons get overused. With age, falls are more common which can damage the hip bone. All of these can contribute to hip pain, which may also be felt in the groin, thigh or lower back.

What are the causes of hip pain?

Some of the common causes of hip pain include:

• Arthritis

  Arthritic hip pain may be attributed to osteoarthritis, in which the cartilage surrounding the joints is worn down, or rheumatoid arthritis, in which the body's immune system attacks the joint cartilage. Other forms of arthritis that may lead to hip pain are infectious arthritis, caused by an infection in the joint, or traumatic arthritis caused by injury.

• Hip bursitis

  Also known as trochanteric bursitis, this cause of hip pain means the bursa, a sac filled with liquid that is located near the hip joint, has become inflamed. This inflammation may have different causes such as joint injury, overuse or posture problems.

• Hip fracture

  Fracture is more common in older persons and those with conditions that weaken the bones, such as osteoporosis. A hip fracture usually requires surgery, followed by physiotherapy.

• Hip tendonitis

  Tendonitis, or inflamed tendons, is usually caused by overwork such as too much exercise.

Less common causes are may include dislocation or bone cancer.

What are the symptoms of hip pain?

Symptoms of hip pain may vary from person to person and also depends on the cause. For example, hip pain caused by osteoarthritis leads to pain and stiffness while hip fractures cause sudden and severe pain.

General symptoms of hip pain include:

• Limping
• Loss of motion in the hip joint
• Pain in the groin
• Sensation of warmth around the hip joint
• Swelling of the hip joint
• Tenderness in the hip joint

In some situations, mild pain may improve with rest, ice or heat therapy, or over-the-counter pain medication. However, if the pain does not improve or gets worse, you should see a doctor to check if it may be something more serious.

How is hip pain diagnosed?

As causes of hip pain vary, your doctor will need to conduct a thorough medical examination. This is likely to include a physical examination and medical history to check how long you have been experiencing hip pain, when it feels worse, and how much it affects your daily activities.

Imaging tests such as X-ray, computed tomography (CT) scan, magnetic resonance imaging (MRI) scan or ultrasound will allow your doctor to look at your hip joint and the surrounding area. Further lab tests may be recommended to examine blood, urine or joint fluid to make a diagnosis.

How is hip pain treated?

Treatment for hip pain would depend on its cause. Anyone who experiences sudden or severe hip pain, especially after a fall, should seek medical attention immediately, says Dr Andrew Dutton.

"If we look at the elderly population, who are more likely to experience pain in the hip joint, I would recommend they see a doctor immediately, especially after a fall, as the incidence of hip injuries is higher in this age group," he advises.

Treatment for hip pain caused by a sports injury

Medication

For younger patients who experience hip pain as a result of a sports injury, Dr Dutton recommends rest, ice, and over-the-counter pain relieve such as paracetamol or a short course of anti-inflammatory medication. If the pain continues for longer than 2 or 3 days, then it's best to get a check-up from a doctor.

Physiotherapy

Depending on the nature of the injury, physiotherapy may be part of a non-surgical treatment plan to relieve pain and strengthen the muscles surrounding the joint.

Physiotherapy is also an important part of your recovery following hip replacement surgery, to help you regain strength, improve mobility and increase your range of movement. While you will initially require assistance in standing and walking, physiotherapy will help you to gradually move about without the use of a walking aid.

Surgery

For more serious injuries such as hip fracture, surgery may be required to repair or replace the hip. Surgical options include:

• Arthroscopy, a minimally-invasive procedure using small surgical tools inserted into a small incision
• Open surgery, which requires a larger incision to repair the hip joint
• Debridement, a procedure to smoothen joint surfaces by removing loose, frayed, or damaged cartilage in the hip joint
• Hip replacement, in which the damaged part or the entire joint is replaced with a manufactured joint

What to expect during a doctor's visit

Your doctor will ask how and when your injury occurred, what type of sports you play and how active you are.

"We also recommend that you bring in any regular medications you may be taking so that the doctor will be informed, as we don't want to prescribe anything that can interact with those medications," says Dr Dutton.

"We will then conduct a full physical examination. For the assessment of the hip there are 2 main imaging tests that we use. One is a simple X-ray and for the elderly usually that's sufficient to see either fractures or arthritis of the hip. For younger patients, who may have more subtle injuries such as muscle tears or ligament tears, then an MRI scan would be more suitable to pick those injuries up.”

For more information about hip pain, speak to your doctor.

Dr Andrew Quoc Dutton is a USA fellowship-trained consultant orthopaedic surgeon with subspecialty interests in keyhole and sports surgery, knee and hip replacements, cartilage regeneration and stem cell therapeutics in orthopaedics