Hip

What is the hip made of?

The hip joint is a ball-and-socket joint and the second largest human joint. The hip socket is shaped like a nutshell and the femoral head measures around five centimetres in diameter. The acetabulum and femoral head are covered by a layer of cartilage around five millimetres thick, which ensures pain-free and low-friction mobility of the hip joint.

Unfortunately, the joint cartilage no longer grows back in adults. The load on the hip joint when standing is four times the body weight. When walking down stairs, the hip joint is subjected to eight times the body weight. This is the reason why patients with incipient hip joint arthrosis (coxarthrosis) first feel pain when walking down stairs.

What are common hip complaints?

Hip pain and discomfort can be very different and depend on age and sporting activity. Common pain patterns include pain and restriction with certain movements or exertion, sharp pain with certain movements, electrifying pain radiating to the thigh, pain on the outside of the hip, limping gait, guarding of the hip and a popping tendon with movement. These hip complaints can occur suddenly, e.g. due to an accident or overloading, and usually become more severe over time. Hip pain caused by osteoarthritis is particularly common, especially in older people. Osteoarthritis is a wear and tear of the cartilage and also affects the hip joint. If the hip pain does not improve significantly within two weeks despite taking it easy, the symptoms should be investigated further.

What are possible causes of hip pain?

The causes of hip pain are as varied as the causes themselves. The discomfort can come from the joint, the muscles and their nerves. An accident, a congenital deformity, overuse, wear and tear, a metabolic disorder, an incarceration or an infection can trigger acute or chronic hip pain with restricted movement:

• Fracture of a bone, e.g. femoral neck fracture
• Traumatic hip dislocation (dislocation of the hip joint due to an accident)
• Hip arthritis (inflammation of the hip joint) caused by bacteria (septic coxitis, infection), rheumatism (rheumatoid arthritis) or an inflammatory episode (activated osteoarthritis)
• Hip dysplasia (congenital malalignment of the hip)
• Advanced coxarthrosis (osteoarthritis of the hip joint)
• Hip impingement (painful blockage of the hip joint caused by bone spurs: called pincer impingement on the acetabulum and cam impingement on the femoral neck. This bony deformation of the acetabulum and/or femoral head painfully impairs the mobility of the hip joint, especially flexion.
• Labral tear (tear of the joint labrum, important sealing ring of the hip joint)
• Bursitis (inflammation of the bursa), e.g. bursitis trochanterica (inflammation of the bursa on the trochanter)
• Periarthropathia coxae: wear-related disease of the tendon insertion of stabilising hip muscles on the greater trochanter
• Coxa saltans, also known as a fast hip, caused by a tight tendon ligament (iliotibial tract), which gets caught on the greater trochanter when the hip is flexed and thus snaps over it jerkily.
• Meralgia paraesthetica: nerve compression of the sensitive lateral femoral cutaneous nerve under the inguinal ligament. Patients suffer from paresthesia, burning pain and sensory disturbances on the front or outside of the thigh.
• Femoral head necrosis: Death of bone at the femoral head. This can occur without a recognisable trigger (idiopathic) or as a result of cortisone tablets or injections, alcohol abuse, metabolic disorders or arterial occlusive disease.
• Perthes' disease: necrosis of the femoral head that occurs in childhood.
• Juvenile femoral head dislocation (epiphysolysis capitis femoris): Slippage of the femoral head along the growth plate during puberty.

How is the hip examined?

When someone with hip pain goes to the doctor, it is important to ask detailed questions and carry out an examination: How long has the pain been present? What causes it? Where exactly can the hip pain be localised? How does the pain feel? Is it stabbing, pulling, dull or electrifying?

This is followed by a detailed examination of the mobility of the hip. Can the hip pain be triggered by certain movements of the hip joint? To what extent is the mobility restricted? Are there specific pressure points? How good is the muscle strength?

An X-ray of the hip shows the bony situation of the hip. Targeted injections of local anaesthetic into or around the hip joint can also help to establish a diagnosis. Further examinations include MRI (magnetic resonance imaging) or CT (computer tomography).

Once all examinations have been carried out, they are discussed and explained in detail and possible conservative to surgical (hip surgery) therapies are explained.

What therapies are available?

Hip pain can be treated conservatively (without surgery) or surgically.

Conservative treatment focuses on the following measures:

• Ultrasound, shock wave therapy, massage, muscle training, etc.
• Anti-inflammatory medication and lubricants
• Hyaluronic acid or cortisone in the hip joint or around the joint (e.g. for bursitis)
• Cartilage-supporting medication or appropriate nutritional supplements for the joint

In hip surgery, a distinction is made between joint-preserving surgery and joint replacement with an artificial hip joint:

Joint-preserving hip operations:

• Fixation of fractures with plates, screws or nails
• Stitching of torn tendons
• Removal of bursae and bone spurs
• Arthroscopy of the hip joint with suturing or removal of the labrum (joint lip) and removal of bone spurs in the case of hip impingement

Artificial hip joint replacement:

• If the wear and tear caused by osteoarthritis has destroyed the hip joint, it can be replaced with an artificial hip joint.

Book a consultation appointment

We guarantee rapid, expert clarification and advice as well as treatment using the most modern methods.

Dr Andreas L. Oberholzer is a recognised expert in hip problems and has extensive experience in the field of artificial hip joints and alternative treatment methods.

Book your appointment directly online here or call us on +41 44 388 16 16. You are also welcome to come to us for a second opinion.