What Causes Hip Pain?
The hip joint is a “ball and socket” joint composed of two bones. The ball is called the femoral head. The femoral head is connected to the shaft of the femur (thigh bone) by the femoral neck. The cup-shaped socket is called the acetabulum, which is a part of the pelvis. Covering the bones of the hip is a shiny cartilage that is called articular cartilage. This is the type of cartilage you see on the end of a chicken bone. The articular cartilage is important for providing a cushion and a smooth surface when the bones move on one another. Surrounding the cup (acetabulum) is a cartilage called the labrum, which forms a ring around the cup like a gasket. It helps to form a suction seal between the ball and cup similar to suction cup. Surrounding the hip joint is a soft tissue envelope composed of a thick capsule of ligaments and 27 different muscles.
Common Causes of Hip Pain
Intra Articular (Inside the hip joint) problems:
- Labral tears
- Femoroacetabular impingement
- Osteoarthritis
- Sub spine impingement
- Ligamentum teres tears
- Capsular laxity
- Lateral impact and chondral injuries
- Osteochondritis dessicans
- Loose or foreign bodies
- Synovitis
- AVN
- Synovial chondromatosis
- Infection
Extra Articular (Outside the hip joint) problems:
- Coxa Sultans (Snapping hip syndrome)
- Interna (Psoas Tendon)
- Externa (Iliotibial band)
- Hip instability
- Adhesive capsulitis
- Recalcitrant trochanteric bursitis
- Gluteus medius tears
- Piriformis syndrome
Treatment Options for Hip Pain
Sometimes there is confusion as to where the pain is coming from. One way to tell is if the pain resides in the hip groin area or about the hip joint. Pain above the waist is typically back pain. It is not uncommon to find patients with a previous diagnosis of groin strains, sports hernias, disc herniations, bursitis, piriformis syndrome, iliotibail band syndrome who also have a labral tear of the hip that is the causing pain. Initial conservative treatment often includes activity modification, use of non-steroidal anti-inflammatory medications (NSAID’s) and physical therapy. Injections with numbing medicine and cortisone into the hip joint may also be recommended to help diagnosis and treat the pain. If you have a painful condition that does not respond to nonsurgical treatment then Dr. Gambacorta may recommend hip arthroscopy.
Arthroscopic Hip Surgery:
Hip arthroscopy is a minimally invasive surgical technique that allows a clear view inside of hip joint. During hip arthroscopy, Dr. Gambacorta inserts a small camera, called an arthroscope, into your hip joint. The camera displays pictures on a television screen, and he uses these images to guide miniature surgical instruments. It allows the surgeon to address intra-articular derangements that were previously undiagnosed and untreated. Over the last decade, the indications for hip arthroscopy have increased due to an increased awareness of hip pathology, improvements in diagnostic imaging and surgical equipment.
Arthroscopic Hip Surgery:
After you are asleep in the operating room Dr. Gambacorta will place you leg under traction in order to access your hip joint. A few small incisions will be placed in your hip. A sterile solution will be used to fill the hip joint and rinse away any cloudy fluid, providing a clear view of your hip.
Dr. Gambacorta will then insert the arthroscope to properly diagnose your problem, using the TV image to guide the arthroscope. If surgical treatment is needed, the surgeon can use a variety of small surgical instruments (e.g., scissors, clamps, motorized shavers and burrs) through another small incision to remove or repair any torn or damaged cartilage. In addition, Dr. Gambacorta can also re-contour the bone abnormalities. This includes over coverage of the cup (acetabulum) and bump on the ball (femur), remove any loose pieces of cartilage or bone that may be causing symptoms, release scar tissue, and treat some cartilage problems with microfracture surgery. This part of the procedure usually lasts 1-2 hours.
At the conclusion of your surgery, your incisions will be closed with sutures and coved with a bandage. You will be moved to the recovery room. Usually, you will be ready to go home in one or two hours. You should have someone with you to drive you home.
Hip Surgery Recovery
Many patients are able to return to full unrestricted activities after arthroscopy. Your recovery depends on the type and extent of damage that was present in your hip. For example, if you damage your hip from jogging and the smooth articular cushion of the weight-bearing portion of the hip has worn away completely, a full recovery may not be possible. You may be advised to find a low-impact alternative form of exercise. An intercollegiate or professional athlete often sustains the same injury as a weekend recreational athlete, but the potential for recovery may be improved by the over-development of hip muscles. Physical exercise and rehabilitation will play an important role in your final outcome. A formal physical therapy program is utilized to optimize your final result. Sometimes, the damage can be severe enough that it cannot be completely reversed and the procedure may not be successful.
A return to intense physical activity should only be done under the direction of your surgeon. It is reasonable to expect that by four to six months you should be able to engage in most of your former physical activities. This will be dependent on how fast your body heals.
If you are a student, you will likely be able to return to school about one week after your surgery. If your job involves heavy work, such as a construction laborer, you may require more time to return to your job than if you have a sedentary job.
If you are unsure what type of pain you are experiencing and would like to schedule a consultation appointment with Dr. Gambacorta,
contact us at (716) 636-1470.
For more information on this and other injuries see our website at www.northtownsorthopedics.com.
This information is intended for education of the reader about medical conditions and current treatments. It is not a substitute for examination, diagnosis, and care provided by your physician or a licensed healthcare provider. If you believe that you, your child, or someone you know has the condition described herein, please see your healthcare provider. Do not attempt to treat yourself or anyone else without proper medical attention.