Anatomy
The hip joint consists of the acetabulum and the femoral head (caput femoris). The articular surfaces are covered with a few millimetres of cartilage to reduce stress on the articular surfaces. Around the edge of the joint is a joint lip/meniscus (labrum) that stabilises the hip joint.
Cause of the problem
Repeated strain can damage first the cartilage and then the bone under the cartilage (osteoarthritis). This can also be caused by a single, severe trauma. In some cases, the osteoarthritic changes can lead to an ‘inflammation’ of the synovial membrane (synovitis), which causes fluid formation, swelling, restricted movement and pain in the hip joint.
Symptoms
There is reduced mobility and pain in the hip joint, primarily with rotation and movement in all extreme positions. Mild degrees of osteoarthritis are often asymptomatic. In severe cases, there is rest pain.
Examination
Diagnosis is made on X-ray, which in younger patients (< 45 years) should be of the pelvis, as hip pain in that age group often has causes other than osteoarthritis. General clinical examination shows reduced mobility of the hip joint in all directions.
In many cases, there are creases on the joint lip, which are best seen on MRI scans. Fluid accumulation in the hip joint or in the iliopectineal bursae can be seen on ultrasound and MRI scans.
Treatment
Treatment primarily includes relief from pain-inducing activity, stretching and graduated rehabilitation within the pain threshold. Rehabilitation primarily aims to strengthen the muscles around the hip joint and maintain joint mobility.
There is no treatment that can restore the damaged cartilage (and bone). If there is swelling in the hip joint, arthritis (synovitis) can be reduced with arthritis pills (NSAIDs) or by trying to drain the synovial fluid and ultrasound-guided injection of adrenal cortex hormone in the hip joint (and possibly in the synovial bursa at the hip joint).
Pain without joint swelling is treated with paracetamol (which has fewer side effects than NSAIDs). For severe osteoarthritic changes with pain at rest (at night), it may be necessary to replace the hip joint. There is no evidence that being active makes the osteoarthritic changes themselves worse.
Complications
Osteoarthritic changes in the weight-bearing parts of the joint often lead to the discontinuation of sports that put a lot of weight on the hip joint. Cycling and swimming are significantly less stressful for the hip joint than running.
You should consider whether this could be the case:
- Inflammatory arthritis (arthritis)
- Brupture of the superficial hip flexor
- Rupture of the deep hip flexor
- Outer snapping hip
- Inner snapping hip
- Fluid accumulation in the joint
- Fatigue fracture of the femoral neck
- Bursitis on the front of the hip joint
- Inguinal hernia
- Sportsman’s hernia
- Nerve entrapment
- Piriformis syndrom
- Lumbargo
