Anatomy
The bones that make up the hip are the:
• Pelvic bones
o Make up the joint socket or acetabulum
o Include the ilium, pubis and ischium
• Femur (thigh bone)
o There are several parts, including the:
- Femoral head
- Femoral neck
- Greater trochanter
- Lesser trochanter
- Diaphysis
The femoral head and acetabulum are lined by articular cartilage, which is the smooth bearing surface. Lubrication is provided by the synovial fluid, which
is secreted by the joint lining (synovium).
The hip is stabilised by the:
• Shape of the femoral head (ball) and acetabulum (socket)
• Joint capsule & ligaments
• Acetabular labrum, which is a fibrocartilage ring around the acetabulum, that deepens the hip socket
The conditions that affect the structural components of the hip, lead to symptoms, which often require treatment.
Conditions Treated
Arthritis
• Damage to the articular cartilage (bearing surface), which lines the joint surfaces
• Severe osteoarthritis may require hip replacement surgery
Femoroacetabular Impingement (FAI)
• Abnormal shape of the acetabulum and/or femur
• This leads to impingement of the bones, against each other, in the functional range of movement
• Impingement can lead to structural damage in the joint & accelerated hip osteoarthritis
Greater trochanteric pain syndrome
• Is characterised by pain and tenderness on the side of the hip
• It is associated with muscle weakness and dysfunction, which exacerbates the problem
• The structural changes can include:
- Trochanteric bursitis
- Hip abductor (gluteus medius and minimus) degeneration and tears
• Treatment focuses on controlling pain, improving function and dealing with the structural changes
Hamstring tendon tears
• Occur with a traumatic event
• Lead to severe pain and usually significant bruising, in the back of the thigh
• Complete tears of the attachment to the pelvis, often require surgical re-attachment
• Surgical treatment is helped by early identification of the injury
Labral Tears
• Can occur with a traumatic injury or be part of the degenerative process within the hip
• Loss of the labrum, predisposes to damage of the articular cartilage (hip osteoarthritis)
• Labral tears may require hip arthroscopy, to:
- Remove debris within the hip
- Repair the labrum
Meralgia Paraesthetica
• Compression of the lateral femoral cutaneous nerve of the thigh
• Causes numbness over the front and outside of the thigh
Osteonecrosis
• Loss of blood supply to some of the bone around the joint
• This can lead to bone collapse and articular cartilage damage
• Severe disease may require hip replacement surgery
Common Hip Surgeries
The types of hip surgery performed include:
• Total hip replacement
• Revision total hip replacement
• Fracture treatment
• Hip conserving surgery
• Osteotomies
• Tendon repairs
- Hamstring tendon avulsion
- Hip abductor (gluteus medius and minimus)
Non-operative Treatment
Many hip problems are treated without the need for surgery. Some of the treatments used are:
Medications
• Simple pain relievers, such as paracetamol
• Anti-inflammatory medications
Injections
• Corticosteroid
• Platelet rich plasma (PRP)
- Can be particularly useful for conditions that involve tendon degeneration
Activity modification
Walking aids, such as crutches, walking sticks or frames
Physiotherapy
Low impact exercise
Weight loss