Home / Treatment / Pain in the hip joint

Pain in the hip joint

What if there was pain in the hip joint?

The hip joint is the junction of the femur with the pelvis. It is arranged in such a way that allows freedom of foot movements in all planes. The hip joint is the largest joint in the body and plays a crucial role in providing upright posture. It accounts for the pressure of the entire upper half of the body.

All these features lead to the fact that he is very often subjected to different damage. Any problems in the hip manifests itself in the form of pain. Painful changes can be all of its component parts: the bones; the muscles surrounding place joint hip and pelvis; articular cartilage; tendons; vessels and nerves, pulling it off the joint.

The most common causes of pain in the hip joint are:


Infectious inflammation or suppurative arthritis

One of the most common in medical practice of diseases of the hip joint.

Reasons

Purulent inflammation in the joint may be:

  • primary;
  • secondary.

Primary purulent inflammation develops with the direct penetration of microbes into the joint cavity, for example, when wounded in the hip (stab, drop on sharp object).

Secondary infectious arthritis is the result of introduction of microorganisms into the joint cavity from blood in sepsis , or from surrounding tissue in that case, if there is a hotbed of purulent inflammation (abscess of the thigh, furuncle, abscess).

Symptoms

Like any other suppurative inflammation, septic arthritis is characterized by 5 classic signs:

Starts purulent arthritis with a sharp rise in temperature to 38-40 C and the emergence of chills. Symptoms of intoxication: weakness, headache, nausea. The joint swells, the skin over it acquires a crimson hue. Anatomical boundaries of the joint are smoothed out, it increases in size. Pain if infectious arthritis is a sharp, worried sick as in motion and at rest. It is due to the accumulation in the joint cavity of the purulent content. Due pain syndrome of movement in the hip joint becomes impossible: the patient lies, nor sit, nor stand, he can not.

Diagnosis

The doctor may suspect a purulent arthritis in listening to the complaints and the inspection region of the hip joint. To clarify the diagnosis helps the patient has a General infectious disease or foci of purulent inflammation of tissue around.

To confirm the suspicion will help radiography of the hip joint in frontal and lateral projections.

Treatment

The mainstay of treatment of septic arthritis of the hip joint is a powerful antibacterial therapy. Used a combination of 2-3 antibiotics of different groups. As a rule, they are introduced in the form of intravenous systems. If the infection got into the joint from inflammation in the surrounding soft tissues, excision of abscesses, installation of drainage systems.

An important aspect of treatment is to provide complete rest to the leg. This is achieved by splinting or a plaster cast.

If the joint cavity has accumulated a lot of purulent content, that is puncture and lavage with antibiotics.

After an acute phase of inflammation physiotherapy: ultrasound, UHF. During the recovery period to prevent the development of intra-articular adhesions and limitation of movements in the hip joint is assigned a set of exercises of physiotherapy.

Surgical treatment can be necessary if medical therapy has not been successful or developed serious complications. During the operation revealed the joint cavity and cleaned from purulent masses. The most serious complications of septic arthritis is the purulent fusion of the femoral head. In this case, after calming down inflammation make replacement hip joint prosthesis.


Is the most common cause of disability among all diseases of the hip joint.

Reasons

In the basis of degenerative coxarthrosis (destruction) and dystrophic (malnourished) processes in the hip joint. As a result, the joint ceases to perform its function – disrupts the movements of the legs.

Osteoarthritis of the hip joint can affect people at any age, but more often it occurs in the age group "older than 40". Although the mechanisms of development of abnormal changes in the hip are not fully understood, it is possible to allocate the main stages of development of the disease.

The hip joint is subjected to huge daily loads. With age the articular cartilage covering the femoral head, begins to lose its elasticity, it reduces the water content slow down the process of replacement of old cells with the new. All this leads to the fact that the cartilage is under load gradually wears away, it becomes thinner and can no longer provide for smooth movement of the femoral head in the acetabulum. The painful process exacerbated by the fact that simultaneously with the thinning of the cartilage decreases production of synovial fluid that acts as lubrication. The friction of bone on bone leads to the development of aseptic (noninfectious) inflammation in the joint cavity. In response to this, the edges of the articular surfaces begin to appear bony growths, which are the protective reaction of the body and reduce the amount of patient movement in joint. The deformation of the joint.

In addition, the development of osteoarthritis of the hip joint contribute to a violation of posture, flat feet, sports injuries, congenital subluxation of the hip, diabetes mellitus, use of hormones, moved suppurative arthritis.

Symptoms

Osteoarthritis unlike arthritis never develops suddenly. Its symptoms are manifested over a long time. Depending on the severity of the changes that have occurred in the joint, there are 3 stages of coxarthrosis.

For 1 stage is characterized by pain in the hip joint that occur during excessive exertion: walking up the stairs with a load in hand, Hiking on the distance of 2-3 kilometers run. Pain subside after a short rest. At rest the patient did not bother. Upon inspection of the form of the joint neizmenenny, the movement in it is unlimited.

2 stage coxarthrosis pain begin to give in the groin, inner and anterior side of the thigh, often coming down to the knee. They arise after a normal daily load, but the rest do not bother. After a long walk patients beginwalk with a limp. At this stage, a disturbed rotational movement of the leg in the hip joint to the inside and bringing her side. Such a forced position leads to a disruption of the muscles of the thigh, buttocks reducing tone and strength.

With 3 stages of hip pain bother patients even at rest, night. Noticeable pronounced limp that forces to use a cane. The leg on the affected side is shortened, the muscles of the buttocks and thighs decrease in size – atrophy.

Diagnosis

In most cases, the diagnosis of coxarthrosis is not difficult. It is made on the basis of patient complaints, objective examination of the patient's legs and confirmed on x-rays.

Treatment

The choice of methods of treatment of osteoarthritis of the hip depends on the severity of changes in the joint. 1 and 2 the degree of disease can be treated, as a rule, conservative. Appointed anti-inflammatory drugs, cartilage protectors, drugs that improve blood circulation in the joint, physiotherapy, remedial gymnastics.

2 the degree of osteoporosis can be treated and surgical methods. The operations goal is to improve stability of the hip joint and removal of the bone growths.

Stage 3 is treated only with surgery. Patients who are unable for health reasons to postpone joint replacement with artificial, conduct a hip replacement. Patients with severe concomitant diseases (cardiac, renal failure, advanced diabetes) or the very elderly who are contraindicated for installation of the prosthesis, are palliative (auxiliary) operations.

On topic: All the information about the hip!


Dislocation

Hip dislocation often occurs in children.

Reasons

Dislocation of the hip joint at the origin divided into congenital and acquired. Congenital hip dislocation occurs in utero due to improper formation of the bones of the pelvis.

Acquired is the result of trauma. Can occur when you fall on the hip from a height, hitting the lower half of the body while bent at the knee and hip joints legs, for example, during a car accident. Also spontaneous dislocation of the hip joint are observed in patients with paralysis of the lower extremities after stroke, spinal injuries or polio.

Symptoms

Congenital dislocation of the hip

Diagnosed in newborns, as a rule, at the first examination in the hospital. It is characterized by asymmetry of the folds of skin under the buttocks, shortening of the leg on the affected side. When you try to breed to the sides knees bent feet there is a sharp pain in the hip joints that causes a newborn to cry.

Traumatic dislocation of the hip

The main symptom of hip dislocation – a sharp pain in the hip joint, which does not allow to make movements, the patient is not sitting and not getting up. Immediately after injury, edema of the tissues over the joint, the appearance of hemorrhages. If the femoral head slips out of acetabulum anteriorly, the bad leg is turned outwards and healthy longer. In posterior dislocation there is a sharp turn feet inwards and shortening it.

Diagnosis

Congenital dislocation of the hip

Is defined as a pediatrician or a podiatrist during the inspection. Determined with the help of ultrasound diagnosis of the hip joint and x-rays.

Traumatic dislocation of the hip

It indicates features of injury and information obtained during the inspection of the joint. Confirmed dislocation of the hip by x-ray examination of the joint in 2 projections.

Treatment

Congenital dislocation of the hip

Can be treated as by applying an orthopedic structures to hold the legs in the correct position, and by operations. The choice of method depends on the severity of the disease.

The most common orthotic devices to correct congenital dislocation of the hip are:

  • tires-spacers;
  • Pavlik's stirrups;
  • pillow frejka.

They record the baby's legs in a flexed and separated position.

In the absence of success of conservative treatment can be applied surgical techniques. They are aimed at the prompt reduction of the femoral head and correction of defects shape of the hip joint.

Traumatic dislocation of the hip

Be its reduction with the use of local anesthesia and medications, relieves muscle tone, or under General anesthesia in the case if there was a strong shift of the femur relative to the pelvis.

On topic: All the information about the dislocation!


Fractures

The most common fractures that lead to pain in the hip joint is the hip fracture.

Reasons

A hip fracture occurs as a complication of reductionbone strength in osteoporosis. Most often develops in women after age 60. In 90% of cases the fracture occurs at unsuccessful fall from the height of its growth, for example, for ice.

Symptoms

Sharp pain in the hip joint during movement and pressure on him, gives in the groin, inner thighs. Develops rapidly swelling, some bruising may develop over the area of the hip joint. The foot is turned outwards. The patient cannot raise a straightened leg from the supine position, randomly rotate it inward. Marked shortening of the leg on the side of the fracture.

Diagnosis

Suspect a hip fracture enables the patient's age, the fact of injury (falling), data obtained during the inspection of sore feet. Confirmed diagnosis based on x-rays.

Treatment

A doctor orthopedist-traumatologist has both conservative methods of treatment of femoral neck fracture and surgical technique. Non-operative treatment methods have very low efficiency and are used only in patients who for health reasons cannot undergo surgery. Such practices include the imposition of a plaster bandage on leg from the waist to the heel. Due to the fact that recovery after 60 years pass slowly, the accretion of the femur occurs in very rare cases. In addition, this patch makes elderly patients spend most of the time lying down, which contributes to the development of respiratory and heart failure, bedsores.

Therefore, preferred operational methods. The most common methods are:

  • osteosynthesis, when the head is sealed with the body of the bone using surgical screws or pins;
  • total joint replacement prosthesis.

On topic: All the information about the fractures!

Aseptic necrosis of the femoral head

If a hip fracture is typical for older women, aseptic necrosis of the femoral head affects, as a rule, young men. More cases occur in the age of 20-45 years.

Reasons

The basis of aseptic necrosis is a violation of the blood supply of the femoral head, resulting in bone cells deprived of nutrition, begin to die. Over time, the process extends to the wholehead, disrupting the function of the hip joint.

This can happen:

  • spontaneously, without any apparent reason (1/3 of cases);
  • after large doses of alcohol;
  • in patients receiving corticosteroid hormonal drugs;
  • after the radiation therapy;
  • chronic injuries.

Symptoms

The main symptom of avascular necrosis is the sudden appearance of pain in the hip joint on the background of complete health. The pain experienced in the groin, anterior thigh, can spread to the lumbar region. It is so severe that the patient cannot bear weight on leg, sit. This condition lasts for several days, then the pain gradually subside.

With the progression of the disease pain attacks recur often start to develop visible changes in the muscles of the thigh: they shrink, lose strength. Appears limp.

If untreated, atrophy descends to the calf muscles. The pain does not leave the patient even at rest, during sleep. Greatly disturbed gait.

Diagnosis

Aseptic necrosis of the femoral head to treat the most difficult to diagnose diseases of the joints. It is most often confused with osteoarthritis. To help make the correct diagnosis enables the thorough questioning of the patient: characteristic of bone necrosis is a sudden appearance of pain without any precursors. Helper methods are: x-rays, MRI (magnetic resonance imaging), measurement of the circumference of the limb.

Treatment

It is usually done with the help of drugs. Treatment goals are:

  • the restoration of normal blood flow in the femoral head;
  • early resorption of the necrotic areas;
  • prevention of muscle atrophy;

  • the preservation of full range of motion in the hip joint.

For these purposes, use anti-inflammatory drugs, vitamins, absorbable, drugs that improve the flowing properties of blood (antithrombotic), a vasodilator, physiotherapy, complexes of medical gymnastics, massage, orthopedic shoes and relying on a cane while walking.

A good therapeutic effect is demonstrated minimally invasive surgical techniques. These include decompressive surgery: the femoral head drill several narrow holes. It stimulates the bone ingrowth of new blood vessels and improves blood flow. In addition, this method reduces the intraosseous pressure, which completely relieves pain in 70% of patients.

In thosecases when the necrosis has spread to a significant portion of the femoral head and restoration of normal structure of the joints medication is not possible, use a complete replacement joint prosthesis.


Inflammation of periarticular bags, or bursitis

Is the most "harmless" cause of pain in the hip joint.

Reasons

Inflammation of the lining that covers the joints can occur due to the following reasons:

  • the ingress of microorganisms into the tissue bags during the puncture wound;
  • to switch the inflammatory process from the surrounding tissues or the bloodstream;
  • after surgery, prosthetic hip joint;
  • violations of posture, gait;
  • professional Cycling;
  • osteoarthritis of the hip joint with formation of bone growths and accumulation of salts in the tendons of muscles to the femur bone in the periarticular bags.

Symptoms

The main symptom of bursitis is pain that spreads down to the knee on the outside of the legs. Painful is the feeling of the thigh in the projection of the greater trochanter. In the initial period of the disease is acute pain increases sharply during attempted movement of the leg in the hip joint. For bursitis is characterized by a rapid increase of the symptoms from the first signs to acute pain it can take more than 1 day.

Pain associated with the accumulation of inflammatory fluid bag and the resultant friction of the tendons on the surface of the femur.

May be an increase in thigh circumference due to edema, increased body temperature.

Diagnosis

The diagnosis of bursitis is made only after other causes of pain in the hip sustaianble.

The distribution of pain on the outer surface of the foot and tenderness at the location of the patient's trochanter on the femur help to establish the diagnosis. It is confirmed by radiographic studies.

Treatment

The goal of treatment is to relieve pain and eliminate inflammation. For this purpose, use methods of drug: nonsteroidal anti-inflammatory drugs in the form of injection course. In the acute phase of the disease, limited mobility in the hip joint in the form of bed rest.

Severe pain is an indication for the introduction of corticosteroids inside periarticular bags. Thus, we achieve rapid anti-inflammatory effect.

When purulent inflammation of the surgical opening of the bags and the cleansing of the cavity with the establishment of drainage. This helps to prevent the transition of inflammation directly in the joint.


With the failure of attempts at conservative treatment may be a question of surgical removal of the entire altered periarticular bags. Most often, this is done using endoscopic techniques.

On topic: All information on bursitis!


Noninfectious inflammation in autoimmune connective tissue diseases

The most common of this group of diseases is rheumatoid arthritis of the hip joint.

Reasons

The basis of all arthritis caused by autoimmune diseases is damage to the connective tissue membranes surrounding the joint. Rheumatoid arthritis is never purulent, it is a potent precipitating factor in the development of coxarthrosis.

The basis of this disease is damage to the synovial membranes of the joints autoimmune complexes, which are antibodies produced by the body on its own cells. In other words, the body takes the normal tissue of the joint in a painful object and seek to destroy.

To provoke rheumatoid arthritis:

  • genetic peculiarity of the immune system where the body is constantly there is increased readiness for autoimmunity;
  • infectious diseases, mainly viral (measles, rubella, retrovirus);

  • start autoimmune responses can stress, hypothermia, overheating (beach, Solarium), some medicines.

Symptoms

Rheumatoid arthritis of the hip can be 3 stages:

  1. Stage 1 is characterized by primary damage to the synovial membranes. This is reflected in the swelling, swelling at the site of projection of the joint, pain in hip joint when walking. May be a local increase in temperature above the location of the joint. Stage 1 can occur with exacerbations and remissions and can last for several years.

  2. Phase 2 the characteristic proliferation of connective fibers in the synovial membrane of the joint, whereby it becomes thickened, loses its elasticity, "chained"the joint in the armour. At this stage patients concerned about the stiffness of the joints in the morning that you have to "walk around" for 20-30 minutes. May appear spontaneous pain at rest or during sleep.

  3. Stage 3 runs the hip with deformity of the joints, overgrowth of the bony protrusions, the violation of motion in the hip joint.

Rheumatoid arthritis usually affects two joints simultaneously.

Diagnosis

To distinguish rheumatoid arthritis from other diseases that cause pain in the hip is not so simple. Used for the diagnosis of biochemical and General blood analysis with the detection of rheumatoid factor, the level of erythrocyte sedimentation rate, white blood cells. Rheumatoid arthritis confirmed by radiographic images.

Treatment

To date not developed the only effective drug against rheumatoid arthritis. However, there is a treatment regimen that can slow the progression of the disease and maintain mobility in the hip joint. The earlier treatment is started, the more chances of success in the fight against rheumatoid arthritis.

The medical standard includes:

  • nonsteroidal anti-inflammatory drugs;
  • Antirheumatic agents;
  • corticosteroids;
  • the cytostatics.

Their use should begin gradually and the replacement of one means to another is only possible with the ineffectiveness of more "light" drug. Treatment should begin with nonsteroidal anti-inflammatory drugs of the second generation.

The most powerful drugs that can only be used when the absolute ineffectiveness of the other three groups is cytostatics.

Surgical techniques in rheumatoid arthritis applied at the latest stages of the disease when there is a strong limitation in the hip joint. Apply arthroplasty or fixation of the joint (arthrodesis).


Tuberculous arthritis

Occupies a special place among the causes of pain in the hip joints in children.

Reasons

Develops under the influence of Mycobacterium tuberculosis. Can be primary, in this case, the focus of tuberculosis directly localized to the joint, or secondary, when bacilli are entered into the hip joint through the blood from the lungs or other affected organs. This files most often occurs in debilitated children.

Symptoms

Tuberculous arthritis is characteristically slowprogressive course. In the initial stages the child complains of fatigue, little runs. Then comes smoothing the gluteal folds and the gradual atrophy of the thigh muscles. Appears limitation of motion of the hip joint. Further, the increase in pain, the foot on the affected side appears longer than the healthy. In the joint cavity is accumulated inflammatory fluid, which suppurate. Dissolving the synovium of the hip joint, the pus flows between the muscles and forms a cold abscess.

Diagnosis

Conducted a complete examination to identify foci of tuberculosis in other organs. To establish the degree of destruction of the femoral head will help x-rays.

On topic: All the information about the TB!

Treatment

In children conservative treatment is indicated. It includes a limitation in the hip joint by applying high casts, exciting the body from chest to feet. Is assigned to a combination of anti-TB drugs.

Surgical treatment is carried out in case of abscess formation in the soft tissues. It opened and installed a drainage.

Pain arising in the hip joint can be a manifestation of completely different diseases. In order not to lose time, and time to begin treatment, you must contact the podiatrist at the first sign of trouble in this joint.