Why Does My Hip Hurt? Where Does It Hurt?

An arthritic hip is painful because the joint has broken down. The articular cartilage on the surfaces of the joint has worn away leaving raw bone exposed. Movement between the two joint surfaces is no longer smooth and friction free. As a result, the tissues within the joint become inflamed and the joint begins to hurt. An excess amount of joint fluid may be produced and the resultant swelling of the joint adds to the symptoms.

The exposed raw bony surfaces have a greater nerve supply than the articular cartilage and pressure on these surfaces causes pain. As the joint becomes stiffer, greater strain is placed on the hip muscles as they move the joint. This too can be painful. The friction between the exposed bony surfaces can cause grinding and a feeling of discomfort.

When the joint in inflamed, there may be pain both with activity and when the joint is at rest. Anatomically, the hip joint fits deep in the groin. For this reason, groin pain may be the first sign of an arthritic hip. The pain may radiate to the outside or lateral side of the hip or to the back or posterior aspect of the hip. It will often extend to the mid portion of thigh and down to the knee. Since the ball of the hip, the femoral head, is part of the femur the pain travels down the length of the entire bone and will be felt in the thigh and the knee.

When the pain goes below the knee, it is often a sign of a different problem, such as sciatica or poor circulation.

When Will I Have Hip Pain?

An arthritic hip can hurt any time. Much of the time pain will occur after prolonged standing, walking, or any other weight bearing activity. It may also come from activities that put stress on the hip such as bending, twisting, running, and climbing stairs.

Sometimes the pain may develop spontaneous and be present when you are doing nothing at all. This is called resting pain. Frequently,  this kind of pain can occur at night and can awaken you from sleep.

People who have osteoarthritis will sometimes complain of pain in an affected joint when there is a change in the weather. An episode of pain may last for several days and then recede. It is not clear what triggers the inflammatory response that causes the pain.

In many people with advanced osteoarthritis, the pain is constant and is present all the time. It is unrelieved by rest, by any change in position, or by medication.

Why does my hip sometimes make a crackling noise when I try to move it?

A crackling or snapping of the hip joint can be disconcerting. It feels uncomfortable and it makes a loud noise that sometimes other people in the room can hear. The medical term for crackling or snapping is crepitus.

In simplest terms, crepitus occurs because bone is rubbing against bone. The joint cartilage has broken down and the joint surfaces become irregular. When this happens, the joint no longer moves smoothly. There is friction between the two bones. The joint may catch or get stuck momentarily before it starts to move again. Crepitus is often painful when hip joint gets stuck. It may make you stop in your tracks as you are trying to move forward. It may make it especially hard for you to go up and down stairs.

Factors other than osteoarthritis can cause crepitus. Sometimes, the presence of a loose body or fragment of bone or cartilage moving in the joint can cause momentary friction. You can also get a grinding sensation if there is disruption in the joint surface such as from an old fracture.

The presence of crepitus in an arthritic joint is usually a sign that arthritis is advanced and will soon require hip replacement.

Call (+65) 6471 2674 (24 Hour) to make an appointment to see our orthopaedic specialist for your hip pain treatment.

What is Arthritis Secondary to Childhood hip disease?

There are three major types of childhood hip problems that can lead to arthritis in adult years:

  • Developmental dysplasia of the hip (DDH)
  • Perthes disease
  • Slipped capital femoral epiphysis (SCFE)

Dislocated Hip

Each of these diseases that develops early on life. DDH is present at birth and is usually diagnosed at that time or within the first year of life. Perthes disease presents as hip pain or a limp between ages 3 and 8 years. Slipped capital femoral epiphysis occurs in young adolescents between ages 11 and 14 years. All of these diseases may be treated successfully during childhood years but may then cause symptomatic arthritis later on. After treatment, patients may have normal function with little or no pain until early adult years or middle age. Some may have a limp or residual rotation of the leg. Most patients, however, are active and participate in sports and athletic activities well into their adult years.

As with other forms of arthritis, the time to consider surgery is when you can no longer tolerate the pain. Disease may be unilateral or bilateral if both hips were affected by the disease. Surgery in these situations may be more complicated because of the residual anatomic deformity.

In DDH, the hip joint socket may be relatively high and shallow. The hip may be dislocated and form a false socket above the normal anatomic level. The femoral canal may be small and narrow. The angle of the femoral neck (anteversionmay be abnormally high. Custom components may be needed in these situations. Additional reconstruction, such as shortening of the femur to bring the hip back to its natural socket, may be necessary.

In Perthes disease, the femoral head may be wide and flat, and the neck of the femur may be unusually large. The acetabulum may be deformed to accommodate the abnormal shape of the femoral head. All of these changes need to be considered when the surgeon plans his procedure.

In SCFE the femoral neck may be deformed and sometimes rotated backward (retroverted). Patients with this disease may turn their leg outward or have an external rotation gait. They have frequently undergone a surgical procedure such as pinning or osteotomy as part of treatment for the disease. Both the deformity and the hardware are factors when surgery is planned.

While the symptoms of these diseases are similar to those of osteoarthritis, hip replacement can be more challenging due to the variable anatomy.

Call (+65) 6471 2674 (24 Hour) to see our othopaedic specialist regarding your hip pain today.

Rheumatoid arthritis is a systemic disease that affects multiple joints in the body. Unlike osteoarthritis, which is due to age and wear, rheumatoid arthritis is the result of a disease process throughout the entire body. As a rule, multiple rather than single joints are affected.

Rheumatoid arthritis usually develops between ages 30 and 60 years, but can also present earlier as juvenile arthritis in childhood. Women are more than twice as likely to have the disease as men. There may be a genetic predisposition to getting the disease. Some evidence suggests that rheumatoid arthritis may be an autoimmune phenomenon, but it is unclear as to what triggers the immune response.

The source of the disease is the synovium, the lining tissue of the joint. In a healthy joint, synovium provides lubricant and nutrition to the surrounding tissues. In rheumatoid arthritis, the synovium becomes inflamed and proliferates. The resulting tissue layer is called pannus. Pannus invades the joint surfaces and causes destruction of the cartilage and underlying bone. Inflammatory factor in the synovial fluid may also damage the cartilage.

The diagnosis of rheumatoid arthritis is based largely on clinical factors, but blood tests may also be positive. The rheumatoid factor, an antibody found in blood, is present in most patients with rheumatoid arthritis. The erythrocyte sedimentation rate (ESR) is a less specific test that is often elevated in RA.

The American College of Rheumatology lists seven criteria for the diagnosis of rheumatoid arthritis. Four of these have to be positive in order to confirm the diagnosis. The seven criteria include:

  • Morning stiffness
  • Arthritis in at least three joints
  • Arthritis in the hands
  • Joint involvement on both sides of the body
  • Positive rheumatoid factor
  • Rheumatoid nodules
  • X-ray changes consistent with rheumatoid arthritis

Joints with rheumatoid arthritis are warm, swollen, and sometimes contracted. Other clinical features include rheumatoid nodules beneath the skin and tenosynovitis or thickening of the tissue that covers tendons.

The hip is one of many joints in the body that can be affected by RA. Like OA, the onset is gradual. The main symptoms are pain, stiffness, loss of motion, and limping. Usually the diagnosis of rheumatoid arthritis is known to the patient by the time symptoms present in the hip.

The surgical treatment for RA is the same as for OA. If the joint is destroyed total hip replacement is required.

Rheumatoid bone is often osteoporotic and of poor quality. This may affect the choice of components and the type of fixation. If the bone is very soft it may not be possible to press fit components and cement may be required. Patients with rheumatoid arthritis are not candidates for resurfacing because of the risk of bone collapse and failure.

Call (+65) 6471 2674 (24 Hour) to see our specialist regarding your rheumatoid arthritis hip joint today.

Osteoarthritis Hip
  • Osteoarthritis
  • Rheumatoid arthritis
  • Post-traumatic arthritis
  • Avascular necrosis
  • Arthritis secondary to childhood hip disease

Each of these conditions is different in how it changes the anatomy and biology of the normal hip joint. All of them can create the need for hip replacement.

What is Osteoarthritis?

Osteoarthritis is the most common diagnosis for patients having total hip replacement. It is also the most common type of arthritis. The vast majority of all patients, men and women, undergoing hip replacement have osteoarthritis.

Osteoarthritis is arthritis due to age, repetitive activity, or simple everyday wear and tear. It affects only one joint or a few joints in the body at one time. It is not a systemic process like rheumatoid arthritis. It affects only joints, not other organs in the body.

More than 30 million people in the United States are estimated to have osteoarthritis. Symptoms may develop at any time, usually after age 40 years, and the incidence increases with age. It is more common in women. As the population becomes older more people will develop the disease.

No one knows what triggers the onset of osteoarthritis. Besides age and overuse, other factors include being overweight, joint laxity, joint deformity, and abnormal articular cartilage. Long-term high impact activities such as sports can also cause damage to the joint surfaces.

The hips, knees hands, neck, and lower back are the areas most affected by osteoarthritis. It is estimated that by age 65 half of the population has x-ray changes of osteoarthritis in at least one joint. A smaller percentage, however, are actually symptomatic. Symptoms do not always correlate directly with the amount of damage seen on x-ray. You may have severe pain even though an x-ray shows only mild damage to the joint.

The main cause of osteoarthritis is breakdown of the joint surface, the articular cartilage. As the body gets older the cartilage loses its elasticity. It can no longer absorb shock and compressive forces as it once did. It loses the ability to repair itself. When this happens, the joint surface starts to collapse. The underlying bone called subchondral bone reacts by becoming hard or sclerotic. It has a dense or thick white look on x-ray. Bone cysts called subchondral cysts may form in this location. The bone becomes deformed and forms prominences called spurs or osteophytes at the edges of the joint.

Osteoarthritis Hip

 

When the joint cartilage has completely worn away an x-ray will show bone on bone. One bone in the joint can be seen rubbing up against another with no joint space left in between.

Pain is the main symptom of an arthritic joint. Stiffness, loss of motion, and weakness develop as the disease gets worse. The progress of the disease gets worse. The progress of the disease varies among individuals and even from joint to joint in the same person. Some people may go along for years with the same level of pain and no x-ray changes. Others have complete destruction of a joint and need surgery within a few short months.

Surgery is indicated when you can no longer tolerate the pain and limitation caused by an arthritic joint. In the hip, total hip replacement or arthroplasty is the procedure most often performed for osteoarthritis.

See What is Rheumatoid Arthritis?

Call (+65) 6471 2674 (24 Hour) to appointment with our orthopaedic specialist regarding your hip pain today.

Total Hip Replacement Implant Components

What is a Hip Replacement?

A hip replacement is the removal of all of part of the hip joint and insertion of an artificial ball or an artificial ball and socket. The diseased bone and joint surfaces are replaced with new or prosthetic parts.

The new parts are called components or implants. They are called implants because they are inserted or implanted in a patient’s body.

A hip replacement may be partial or total. In a total hip replacement, both the ball of the hip joint (femoral head) and the hip joint socket (acetabulum) are removed and replaced. In a partial replacement, only the femur is replaced and the socket is left intact.

In the 40 years since hip replacements were first performed, millions of people around the world have experienced relief from disabling hip disease. They have been able to walk and to resume normal function pain free. Total hip replacement has been considered a modern medical miracle.

Total Hip Replacement Implant Components

Why Should I Have a Hip Replacement?

The main reason to have a hip replacement is relief of pain. When your hip joint is damaged or diseased it can be severely painful. Along with the pain, you can lose motion in your hip and have difficulty walking. It becomes harder to perform your routine activities. In short, your diseased or damaged hip interferes with the quality of your day-to-day life.

A painful hip can affect other parts of your body. You may develop back pain as you try to compensate for loss of motion in your hip. You may feel pain in your knee or in your opposite leg as you try to relieve pressure on your bad side. If you mobility is limited, you may gain weight because you are unable to exercise.

Hip replacement can relieve pain and improve the strength and motion in your hip. In some cases the results are dramatic. Many patients note that even a day or two after the procedure they have pain in their incision, but the joint pain they had before surgery is largely gone.

For most people, hip replacement surgery is elective. It is done for conditions such as osteoarthritis, which are not life threatening but affect your life in other ways. It is a procedure that is planned and scheduled ahead of time. It is not something you have to do, but is something you choose to do. Unlike an appendectomy, it is not an emergency procedure. The decision to have a hip replacement is made after consultation with an orthopaedic surgeon, but ultimately, the decision is yours.

For a few patients, hip replacement has to be done on an urgent basis. If a hip is broken (fractured), surgery should be done as soon as possible to relive pain and allow the patient to get out of bed. Hip replacement is the treatment of choice for some fractures. Bone tumours in the hip also require urgent treatment because the tumour will continue to grow and cause further damage to the bone.

There is more to hip replacement than just the surgical procedure. There is preoperative planning, testing, and medical evaluation. After surgery there is time in the hospital, therapy and rehabilitation. And of course life is different with an artificial joint in your body.

As you consider surgery, take time to learn about your hip, what treatment is available and why you would be a candidate for hip replacement.

When were the first total hip replacement done? How many are done each year?

Hip replacement surgery has been a work in progress fore more than 80 years.

In the United States, more than half a million hip replacement procedures are done each year.

As our population ages and medical advances help people live longer it is expected that the number of hip replacements done annually will continue to grow.

Call (+65) 6471 2674 (24 Hour) to fix an appointment to see our orthopaedic surgeon regarding hip replacement today.