Normal Anatomy of the Hip joint
How does the Hip joint work?
Find out more in this web based movie.
Femoroacetabular Impingement (FAI)
Femoroacetabular Impingement (FAI) is a condition resulting from abnormal pressure and friction between the ball and socket of the hip joint resulting in pain and progressive hip dysfunction. This when left untreated leads to the development of secondary osteoarthritis of the hip.
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The hip joint is a “ball and socket” joint. The “ball” is the head of the femur or thighbone and the “socket” is the cup shaped acetabulum. The joint surface is covered by a smooth articular surface that allows pain-free movement in the joint.
Hip fracture is a break that occurs near the hip in the upper part of the femur or thighbone. The thigh bone has two bony processes on the upper part – the greater and lesser trochanters. The lesser trochanter projects from the base of the femoral neck on the back of the thighbone. Hip fractures can occur either due to a break in the femoral neck, in the area between the greater and lesser trochanter or below the lesser trochanter.
Hip fracture is most frequently caused after minor trauma in elderly patients with weak bones, and by a high-energy trauma or serious injuries in young people. Long term use of certain medicines, such as bisphosphonates to treat osteoporosis (a disease causing weak bones) and other bone diseases, increases the risk of hip fractures.
Signs and symptoms of hip fracture include
- Pain in the groin or outer upper thigh
- Swelling and tenderness
- Discomfort while rotating the hip
- Shortening of the injured leg
- Outward or inward turning of the foot and knee of the injured leg
Your doctor may order an X-ray to diagnose your hip fracture. Other imaging tests, such as the magnetic resonance imaging (MRI), may also be performed to detect the fracture.
Depending on the area of the upper femur involved, hip fractures are classified as
- Intracapsular Fracture
- Intertrochanteric Fracture
- Subtrochanteric Fracture
Hip fractures can be corrected and aligned with nonoperative and operative methods:
Traction may be an option to treat your condition if you are not fit for surgery. Skeletal traction may be applied under local anesthesia, where screws, pins, and wires are inserted into the femur and a pulley system is set up at the end of the bed to bear heavy weights. These heavy weights help in correcting the misaligned bones until the injury heals.
Hip fractures can be surgically treated with external fixation, intramedullary fixation, or by using plates and screws.
Hip bursitis is a painful condition caused by inflammation of a bursa in the hip. Bursae are fluid-filled sacs present in joints between bone and soft tissue to reduce friction and provide cushioning during movement.
The bony prominence of the hip is called greater trochanter and is present on the outer side of the upper thighbone or femur. The bursa overlying it is called trochanteric bursa. Another bursa is located towards the groin region and is called iliopsoas bursa. Bursitis of the trochanteric bursa is more common than that of iliopsoas bursa.
Trochanteric bursitis is often seen in people involved in sports such as football and soccer which involve a lot of running. This can lead to overuse and irritation of the bursa causing inflammation. Bursitis may sometimes result from an injury or fall to the hip or after a surgical procedure of the hip. Spine disease, rheumatoid arthritis, and leg length inequality increases the risk for developing hip bursitis.
Trochanteric bursitis results in pain on the outer side of the hip which usually increases with prolonged walking or climbing stairs. The pain is felt more while getting up from a chair and in the night when lying on the affected side. Inflammation of the iliopsoas bursa however results in pain in the groin region.
Tenderness and swelling in the area of pain over the bursa during the physical examination of the hip confirms the diagnosis of hip bursitis. To check for any bone spurs that could be causing irritation of the bursa your doctor may order an X-ray. If the reason for the pain is not very clear the doctor may order an MRI to view the soft tissues and structures not visible on X-ray.
Conservative Treatment Options
Treatment goals for bursitis are focused on resolving the inflammation and pain. Rest is advised and activities causing the bursitis pain are restricted. Anti-inflammatory medications are prescribed to reduce the inflammation and pain. Physical therapy and treatments with heat, ice, and ultrasound sometimes are recommended. An injection of corticosteroid medicine may be administered to reduce the inflammation. Sometimes a second injection is necessary if the pain returns after a few months. These nonsurgical treatments provide relief from hip bursitis in the majority of cases.
Sometimes, however, your doctor may recommend surgical removal of the bursa if you do not respond to conservative treatment measures.
Chronic Pelvic Pain
What is chronic pelvic pain?
Chronic pelvic pain is a constant pain felt in the lower abdominal region and the pain may persist for longer duration, for more than six months.
What is the cause of chronic pelvic pain?
Chronic pelvic pain can be caused by different conditions that may or may not be related to reproductive organs such as pain due to urinary tract conditions. Cause for the pain may be unknown in some cases.
What are the symptoms?
The common symptoms include pain during periods, ovulation, intercourse, and pain when passing urine or bowel movements or lower back pain.
How is chronic pelvic pain diagnosed?
Colonoscopy, and sigmoidoscopy are performed to find out the cause of your pain.
What are the treatment options?
There are several treatment options to relieve chronic pelvic pain. They include medications, physical therapy, nutrition, and surgery. Lifestyle changes such as maintaining a good posture and regular exercise can help reduce pain. Pain medications such as non-steroidal anti-inflammatory drugs may relieve pelvic pain. Vitamin B1 and magnesium supplements may help reduce pain. Surgery to destroy nerves and block pain signals may be considered when all other treatment methods are unsuccessful.
Hip arthroscopy is a relatively new surgical technique that can be effectively employed to treat a variety of hip conditions.
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Total Hip Replacement (THR)
Total Hip Replacement (THR) procedure replaces total or part of the hip joint with an artificial device (prosthesis) to alleviate pain and restore joint movement.
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Hip Resurfacing or bone conserving procedure replaces the acetabulum (hip socket) and resurfaces the femoral head. This means the femoral head has some or very little bone removed and replaced with the metal component. This spares the femoral canal.
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Revision Hip Replacement
This maybe because complete or a part of your previous hip replacement needs to be revised. This operation varies from a very minor adjustment to a massive operation replacing significant amount of bone and hence is difficult to describe in full.
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Direct Anterior Approach Total Hip Replacement
Total joint replacement surgery is one of the most advanced successful procedures in patients dealing with severe hip pain. The goal of the surgery is to relieve pain and restore the normal functioning of the joint and help patients resume normal activities.