Hip pain or hip pain is an annoying and disabling complaint. The hip joint consists of the femoral head and the acetabulum, which is part of the pelvis and the upper leg. Coxalgia is hip pain due to a condition of the hip joint and the tissue around the hip joint. The most common causes of hip pain are hip osteoarthritis and bursitis. Other possible causes include tumors, bone fractures, femoral head abnormalities and infections. In osteoarthritis, pain is usually prominent, especially when starting a movement and when straining. Bursitis in the hip causes pain on the outside of the hip, where the pain can radiate to the side of the leg towards the knee. This may be accompanied by local redness, swelling and warmth. Hip pain after running may indicate bursitis in the hip. This is a well-known running injury. But even if you never run, this bursa can become inflamed.

• What is hip pain or coxalgia?
• What are the possible causes of hip pain?
• Hip pain due to hip osteoarthritis

• Secondary osteoarthritis
• Primary osteoarthritis

• Hip pain due to bursitis

• Women
• Fall on the hip

• Trochanteric pain syndrome
• What are the signs and symptoms?

• Bursitis
• Hip osteoarthritis
• Trochanteric pain syndrome

• Treatment of painful hips

• Treatment of bursitis
• Treatment of hip osteoarthritis
• What to do with trochanteric pain syndrome

• Consult your GP

What is hip pain or coxalgia?

Coxalgia is pain in the hip or pain around the hip joint due to a condition of the hip joint and the tissue around the hip joint.

What are the possible causes of hip pain?

Hip pain can have many causes. The most common causes of hip pain are:

• hip osteoarthritis (coxarthrosis); and
• bursitis (trochanteric bursitis).

Other causes of hip pain include:

• tumors (rare);
• bone fractures;
• femoral head abnormalities; and
• infections.

Hip pain due to hip osteoarthritis

When the cartilage of the hip joint is affected by wear and tear, it is called ‘arthrosis’. The height of the cartilage layer decreases, as a result of which the joint becomes more compressed. Osteoarthritis is characterized by complaints such as stiffness and joint pain.Two types of osteoarthritis of the hip are distinguished:

• primary osteoarthritis; and
• secondary osteoarthritis.

Secondary osteoarthritis

Secondary osteoarthritis can occur at a younger age and is the result of a pre-existing abnormality, such as:

• congenital hip abnormalities (for example, an abnormality in the shape of the hip socket, where it is too shallow, which is called ‘dysplasia’);
• previous hip infections;
• certain diseases of the hip in childhood (for example Perthes disease and epiphysiolysis capitis femoris);
• trauma such as a broken hip (fracture) or dislocation of the hip (luxation);
• a femoral head necrosis, also called osteonecrosis of the femoral head or avascular necrosis (death of the femoral head).

Primary osteoarthritis

With a gradual, regular reduction in the height of the cartilage layer of the femoral head, this is referred to as primary osteoarthritis. Older women in particular suffer from this. In secondary osteoarthritis, not only does a reduction in the height of the cartilage occur, but bone growths at the joint (osteophytes) are also seen.Running woman / Source: Istock.com/Martinan

Hip pain due to bursitis

What is it?A bursa is a fluid-filled sac, a kind of cushion that sits on protruding bone parts and helps to reduce friction between bones and tendons, which makes movement easier. Inflammation of the bursa located between muscle and bone usually occurs due to overload, for example by walking (stairs) or as a result of a running injury due to, for example, an incorrect training structure or incorrect running technique.

Women

Bursitis of the hip is more common in middle-aged women. This is because women normally have a wider pelvis than men and their feet are slightly closer together, which creates slightly more pressure at the bursa.

Fall on the hip

A fall on the hip can also cause bursitis. Recovery from this is often a lengthy matter.

Trochanteric pain syndrome

Trochanteric pain syndrome causes pain on the outside of the hip and the pain is often worse when you walk or lie on your hip. In many cases, this pain syndrome occurs as a result of changes where the tendons attach to the bone, or the bursa is inflamed. The pain syndrome is named after a protrusion of the bone in the upper leg, the so-called ‘trochanter’.

What are the signs and symptoms?

Bursitis

Bursitis causes pain on the outside of the hip, where the pain can radiate to the side of the leg towards the knee. This may be accompanied by local redness, swelling and warmth. The pain in the hip increases when you walk or climb stairs, but the pain is also present at rest. Usually the pain gets worse when the leg is extended.

Hip osteoarthritis

Hip osteoarthritis can cause pain and stiffness, especially with the following activities:

• getting out of bed or from a chair;
• when getting into a car;
• when climbing stairs.

Pain with hip osteoarthritis is often experienced in the groin and upper leg, with pain radiating to the buttock and knee. Moving the joint gradually becomes more painful and difficult. A limping gait pattern develops. Actions such as putting on shoes and tying shoelaces are becoming an increasingly difficult task. At some point the pain may be such that it disrupts your sleep. With osteoarthritis, the joints can be stiff, especially in the morning. This is also called ‘morning stiffness’.

Trochanteric pain syndrome

With trochanteric pain syndrome you experience pain on the outside of the hip. This pain can last for weeks to months and sometimes radiates to the side of the entire thigh up to the knee. Sometimes the pain radiates to the lower back or buttock. When you walk or lie on the affected hip, you feel the pain.

Treatment of painful hips

Treatment of bursitis

Relative rest, i.e. reducing or changing the load, in combination with a training program of stretching and muscle strengthening exercises, is sufficient in most cases. If necessary, the pain can be controlled with anti-inflammatory medication. Sometimes physiotherapy is prescribed and an injection into the bursa or tendon can help temporarily. Surgery is almost never necessary.

Treatment of hip osteoarthritis

Physiotherapy or heat therapy often provides relief from the complaints. Anti-inflammatory drugs (NSAIDs) combat the ‘inflammatory symptoms’ of the joint capsule, thereby relieving pain. Sometimes there is an indication for a ‘new hip’, a so-called total hip arthroplasty.

What to do with trochanteric pain syndrome

Trochanteric pain syndrome can go away on its own. Physiotherapy can help and the pain may require an injection of analgesic and anti-inflammatory medications. If this does not provide sufficient relief, surgery by an orthopedic surgeon may help.

Consult your GP

Consult your doctor if you have persistent hip pain or hip pain.

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