Some of the specific conditions that affect the hip include the following:
Osteoarthritis is one of the most common causes of hip pain in adults. It’s often linked to earlier fractures, trauma or childhood hip problems, although it can often occur randomly. We don’t yet fully understand why osteoarthritis develops without any pre-existing problems, but it can cause a great deal of pain, restricted movement and a limp.
In extreme situations, the leg can become shorter and the hip can become fixed in a bent position, making mobility significantly worse.
Paget’s disease of bone
Paget’s disease affects the way bone develops and renews itself, causing it to become weaker. It usually affects the pelvis and causes the structure to become deformed. This can often lead to hip pain, but it can be very well treated with a group of drugs called bisphosphonates.
Other types of arthritis
Rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis can all cause hip pain. This can be managed with specific medication for each condition.
If you’ve had a fall which resulted in hip pain, you should see your doctor urgently as fractures around the hip are very common, particularly in elderly people with osteoporosis. You may need surgery to fix the damage.
Avascular necrosis (osteonecrosis)
Avascular necrosis is a condition that causes hip pain in young-to-middle-age adults. It’s often referred to as idiopathic, which means that it doesn’t have any clear cause. However, it’s also linked with the following:
- drinking too much alcohol
- using steroids
- sickle cell disease
Avascular necrosis can occur when the blood supply to the ball of the hip (the femoral head) is lost. This causes the bone tissue to die and the femoral head to collapse, which results in arthritis. If your doctor thinks you have avascular necrosis, it’s important that they refer you for an urgent MRI scan to confirm the diagnosis.
As soon as you have a diagnosis, you can start treatment, which may stop the condition progressing and prevent arthritis developing.
Referred back pain
Pain caused by a problem with the lower back may only be felt in the buttocks and often down the back of the legs, although it can be felt over the outer side of the hip joint and occasionally in the front of the hip. If x-rays and scans of the hip joint are normal, then the symptoms may be caused by referred pain from the back.
Soft tissue conditions
Bursae are small fluid-filled pouches, which act like cushions to reduce friction where parts of the body move over one another, for example where tendons or ligaments pass over bones. If you have tenderness over the bony part of your hip joint, you may have trochanteric bursitis, which is inflammation of the bursa next to the greater trochanter at the top of the thighbone.
It’s a very common condition, but there’s usually no obvious cause. The pain is usually felt over this bony point, but it can spread down the leg or it may seem to be coming from the hip joint itself.
Trochanteric bursitis often occurs in both hips (bilateral). It usually improves with rest, painkillers and physiotherapy. Very occasionally the condition can last for longer than expected, and it’s now known that it’s sometimes linked with problems with the lower back (the lumbar spine). Paying attention to your posture can make a big difference.
Iliopsoas tendinitis is inflammation of the iliopsoas tendon that runs over the brim of the pelvis to help bend the leg up. This usually gets better on its own (self-limiting).
Snapping iliopsoas tendon
A snapping iliopsoas tendon isn’t a common cause of hip pain. ‘Snapping’ refers to the clicking noise as the tendon flicks over the pelvic brim when you move – it doesn’t mean that the tendon breaks. Some people say the sensation is like their hip popping out. It rarely needs tests to diagnose it, and it usually settles with rest and painkillers. Surgery is very rarely needed.
Torn acetabular labrum
The acetabular labrum is a thick ring of cartilage around the hip socket. It can be torn if the ball or socket of the hip are deformed. This can be the result of hip problems in childhood or changes to the shape of the hip as it develops, but in most cases the cause is unknown.
Hip joint deformities are called cam lesions when the ball is affected and pincer lesions when the socket is affected.
We don’t yet know whether treating these deformities with surgery prevents osteoarthritis in later life.
Other causes of groin pain
Although groin pain is very commonly caused by problems with the hip, it can also come from the following:
- a hernia – a painful lump, often in the groin, which may need surgery
- lymph nodes in the groin – these usually occur if there’s infection in the lower leg
- gynaecological problems – very occasionally gynaecological problems can make themselves felt as hip pain, but your doctor will want to ask questions to rule out a problem in the hip itself.