Question 1

What are the common causes of hip pain?

Accepted Answer

Hip pain in adults has several common causes. Osteoarthritis, or wear of the hip joint, is the most frequent, particularly with age. In younger and active adults, femoroacetabular impingement and labral tears are common. Pain on the outer side of the hip is often due to greater trochanteric pain syndrome, sometimes called trochanteric bursitis. Pain can also be referred to the hip from the lower back. Less commonly, conditions such as avascular necrosis affect the hip. Identifying which of these is responsible is the key to effective treatment.

Question 2

Where is hip pain usually felt?

Accepted Answer

The location of the pain gives important clues. Pain from the hip joint itself is most often felt in the groin or the front of the thigh, and sometimes towards the knee. Pain over the bony point on the outer side of the hip usually points to the soft tissues there, such as in greater trochanteric pain syndrome. Pain felt mainly in the buttock, or that travels down the back of the leg, often originates from the lower back rather than the hip. Mr Kosuge will examine you to determine the true source.

Question 3

How do the symptoms of hip arthritis differ from other causes?

Accepted Answer

Hip osteoarthritis typically causes groin pain and stiffness that is worse with activity and after rest, and difficulty with tasks such as putting on socks. Impingement and labral tears tend to cause groin pain with clicking or catching in younger, active people. Outer hip pain that is tender to touch and worse when lying on that side suggests a soft-tissue cause. Because these overlap, an accurate diagnosis usually needs examination and imaging.

Question 4

When should you see a specialist about hip pain?

Accepted Answer

It is reasonable to see a specialist when hip pain is disturbing your sleep, limiting the activities you want to do, or not settling with simple measures over a few weeks. Seeing a specialist does not commit you to an operation. It gives you an accurate diagnosis and a clear set of options. Pain following a significant injury, or that comes with fever or feeling unwell, should be assessed promptly.

Question 5

How is the cause of hip pain diagnosed?

Accepted Answer

Diagnosis begins with a careful history and examination, including movements that reproduce the pain. Plain X-rays show the joint and can reveal arthritis or impingement. An MRI scan gives more detail of the soft tissues, including the labrum. Where the source of the pain is uncertain, an injection of local anaesthetic into the hip can help confirm whether the joint is responsible.

Question 6

What can be done to treat hip pain?

Accepted Answer

Treatment depends entirely on the cause, and Mr Kosuge favours non-surgical measures first where appropriate. These include activity modification, physiotherapy, weight management where relevant, simple pain relief and, in some cases, an injection. Where a specific problem such as advanced arthritis or an impingement lesion is causing the pain and non-surgical measures are not enough, surgical options range from hip arthroscopy to hip replacement. The right treatment follows from the right diagnosis.

Question 7

Can hip pain come from the back?

Accepted Answer

Yes. Problems in the lower back can refer pain to the hip and buttock, and back and hip problems can coexist, which sometimes makes the picture confusing. Pain that is mainly in the buttock, travels below the knee, or comes with pins and needles is more likely to be coming from the back. Part of Mr Kosuge's assessment is distinguishing between the two so that treatment is directed at the true source.

Hip Pain