Hip Pain
Groin Pain
What causes groin pain?
Many things can cause groin pain. Common causes related to orthopaedics included muscle strain, hip joint problems and even knee and back problems.
When should I see a specialist?
You should see a specialist is the pain is severe and persistent. Based on the clinical history and examination, your surgeon will have a good idea of what the problem is. They may send you for further scans to confirm the diagnosis.
Will I have to have surgery?
No. Depending on the cause of the pain, you may be treated with non operative methods such as pain killers, anti inflammatories and targeted physiotherapy.
Osteoarthritis of the Hip
About the joint
The hip joint is a type of ball and socket joint. It is made up of two bones; the femur with the head at the top (the so called ball) and the acetabulum (the so called socket) which arises from the pelvis. Both the ball and the socket are lined with cartilage. In addition to the bones, there are several ligaments and a capsule around the joint which help stabilise and lubricate the joint.
What is cartilage?
Cartilage is an important type of connective tissue. It covers the surfaces of almost all joints in the body and acts as a smooth surface and a source of lubricant to allow the moving joint to glide seamlessly and painlessly over each other. The process of arthritis can lead to loss of cartilage causing pain and swelling of the joint.
What is arthritis?
Loss of cartilage due to degeneration is known as arthritis. Sometimes this can cause small flaps of cartilage to detach and even float around the joint. When cartilage is lost, the bones may end up rubbing directly on one another. This process can cause pain and swelling of the joint.
What can be done about it?
Depending on the severity, your surgeon may recommend operative or non operative treatment.
What non operative treatments can be done?
This may include lifestyle changes such as weight loss, in combination with pain killers and targeted physiotherapy.
Can the cartilage be replaced?
Currently it is not possible to replace loss cartilage. There are new and emerging techniques trying to solve this problem but they are still in the experimental phase.
What surgical treatments can be done?
In some cases, a hip arthroscopy can be performed to removed small flakes or pieces of loose cartilage. In moderate to severe osteoarthritis, you may be a candidate for a hip replacement.
Do supplements such as glucosamine and vitamins help?
There is no high quality scientific evidence to prove that supplements help, however many patients report some improvement in their symptoms The Anterior cruciate ligament (ACL) is one of the most important ‘stabilisers’ of the knee joint. If you have torn (ruptured) this ligament, the knee can collapse or ‘give way’ during twisting or turning movements.
Trochanteric Bursitis
What is trochanteric bursitis?
A bursa is a fluid filled sack. The trochanteric bursa is located on the upper outside part of the femur, between the insertion of two important muscles (the gluteus medius and gluteus minimus). It works as a shock absorber and as a lubricant for the movement of the muscles adjacent to it.
How will I know if I have this condition?
Normally, patients complain of pain with or without swelling on pressing over the outer upper part of the thigh. It may also cause pain on walking or running. What causes it? Many things. It may be the result of an injury to the muscles. Sometimes it is linked to other conditions such as rheumatoid arthritis. Occasionally no obvious cause is found.
How is it diagnosed?
Your surgeon will make the diagnosis based on clinical history and examination. Sometimes a scan such as a MRI or ultrasound will help confirm the diagnosis.
How is it treated?
It is usually treated with non operative methods such as avoidance of high impact exercise, anti inflammatory medications and targeted physiotherapy.
What if it does not settle with non operative treatment?
In this case, steroid injections or an arthroscopy can be performed. In very rare cases, a small operation to remove the bursa, called a bursectomy, may be performed.
Hip Fractures
What is a fracture?
A fracture is a broken bone
Do only old people break their hips?
No. It is far more common in the elderly to sustain a break but it can occur in younger people, usually as a result of a high energy injury.
Do I have to have an operation?
Yes. Hip fractures need to be treated with an operation. With a broken hip, one cannot walk. This will lead to a prolonged period of bed rest which may cause other problems such as pressure sores, chest infections and even blood clots. The aim of the operation is to get patients back on their feet as soon as possible.
Are all hip fractures treated in the same way?
No. The type of operation performed depends on several factors such as the fracture pattern, location and also the patient age and activity levels. Different types of operations include a plate and screws, a long metal rod down the bone (intramedullary nail), half a hip replacement (hemiarthroplasty) or even a total hip replacement. Your surgeon will best advise you on the type of operation.
How soon will I be able to walk again after the operation?
The aim of the operation is to get patients back on their feet as soon as possible. You will be encouraged to sit out of bed a few hours after the procedure and begin to take your first steps the next day, under the strict supervision of physiotherapists and nursing staff.
What are the risks of the operation?
There are risks associated with every operation. The main risks of a hip operation is that of blood clot formation, infection and pain.
How are these risks minimised?
The risk of clots is minimised by early mobilisation and you may be given a medication to thin the blood slightly. Early mobilisation will also reduce the chance of infection and pain. All operation are done under sterile conditions and you will be given a dose of antibiotics before the initial incision.
What is osteoporosis and do I need to take medications for this after the injury?
Osteoporosis is a process where the bone weakens due to loss of the internal ‘scaffolding’. It is more common in women and the elderly and closely linked to the amount of circulating hormones in the body. Most people over the age of fifty who break their hip may be advised to take medications to help protect and strengthen the bone but your surgeon will discuss the need to with you.
Hip Arthroscopy
What is a hip arthroscopy?
Arthroscopy refers to a type of operation whereby a camera and specially designed instruments are inserted through small cuts into a joint. It is also known as key hole surgery.
What can the surgeon do during such a procedure?
Firstly it will allow the surgeon to directly view the inside of the hip joint and inspect the cartilage on the ball and socket that make up the joint. This will allow them to evaluate the degree of cartilage loss, but also inspect the soft tissues around the joint. At the same time, any cartilage flaps of loose bodies can be removed.
What is cartilage?
Cartilage is an important type of connective tissue. It covers the surfaces of almost all joints in the body and acts as a smooth surface and a source of lubricant to allow the moving joint to glide seamlessly and painlessly over each other. The process of arthritis can lead to loss of cartilage causing pain and swelling of the joint.
What are the benefits of a hip arthroscopy?
If indicated, a hip arthroscopy has the benefit of safe and relatively painless procedure. There is usually no need to stay in hospital and you can full weight bear immediately afterwards. Aside from removing loss bodies, it will allow the surgeon to plan any further treatment options. I am still in pain after my hip arthroscopy.
What next?
Depending on what your surgeon finds during the procedure, they will then advise you on more treatment. If for example they note moderate to severe osteoarthritis then they may recommend a joint replacement. If there is evidence of ligament or muscle strain then you may require targeted physiotherapy.