2/17/2017 HipdisordersBetterHealthChannel

Hipdisorders

Summary
Thehipjointisthelargestjointofthehumanbody.
Thehipscanbeaffectedbyawiderangeofdisordersincludingarthritis,irritablehipsyndromeand
slippedcapitalfemoralepiphysis.
Painaroundthehipmaybeduetosofttissuepainsyndromesorreferredpainfromabackproblem.
Treatmentoptionsdependonthecausebutmayincludemedication,exercise,splintingandsurgery.

Thehipjointisthelargestjointofthehumanbody.Itisnecessarilycomplicatedsoastoallowawiderangeof
motionwhilestillsupportingtheweightofthebody.

Thehipisaballandsocketjoint.Thethighbone(femur)endswitharoundedprojectionorball(femoralhead),
whichfitsintothesocket(acetabulum)ofthepelvicgirdle.

Boththeballandsocketarelinedwithcushioningtissuecalledcartilage.Thejointissealedinsideatough
synovialcapsule,whichcontainslubricatingfluidtofurtheraidsmoothmotion.Theballisanchoredfirmlyintothe
socketwithtoughconnectivetissuecalledligaments.Themusclesofthelegsoverlaytheseligaments.

Symptomsofhipproblems

Thesymptomsofahipproblemmayinclude:

Paininthehipjoint(usuallyfeltinthegroinarea)
Referredpaintothethighandknee
Limping
Reducedrangeofmotion
Musclestiffness
Painwhentryingtoputweightthroughthelegontheaffectedside.

Causesofhipproblems

Somecausesofhipproblemsinclude:

Osteoarthritisthemostcommonformofarthritistoaffectthehips
Otherformsofinflammatoryarthritissuchasrheumatoidarthritisandankylosingspondylitis
Bonefracture

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Developmentalconditionssuchasdysplasiaofthehip
PerthesdiseasealsoknownasLeggCalvePerthesdiseaseoravascularnecrosisofthehip
Slippedcapitalfemoralepiphysis
Irritablehipsyndrome
Softtissuepain.

Osteoarthritis
Osteoarthritisisassociatedwithdegenerationofthejointcartilageandwithchangesinthebonesunderlyingthe
joint.Thecartilagebecomesbrittleandsplits.Somepiecesmaybreakawayandfloataroundinsidethesynovial
fluidwithinthejoint.Thiscanleadtoinflammation.

Eventually,thecartilagecanbreakdownsomuchthatitnolongercushionsthetwobones.Currenttheory
suggeststhatthecartilagelosesitselasticitybecauseofcellularchanges.Commonlyaffectedjointsincludethose
ofthehip,spine,shoulder,fingers,knees,ankles,feetandtoes.

Rheumatoidarthritis
Rheumatoidarthritisisanimmunemediatedconditionthatcausesinflammationinsynovialjoints.Although
peoplewhodeveloprheumatoidarthritismayhaveapredispositiontothecondition,thetriggerfordeveloping
symptomsisunknown.Inflammationinjointsresultsinanincreaseinsynovialfluid(swellingofthejoint),pain
andmorningjointstiffness.Jointsthatcanbeaffectedincludethoseofthehandsandwrists,elbows,shoulders,
neck,jaw,hips,knees,anklesandfeet.

Ankylosingspondylitis
Thisuncommonformofinflammatoryarthritiscantargetthespine,kneesandhips.Typicalsymptomsinclude
painandstiffnessfirstthinginthemorning.Thecauseisunknown,butgenesarethoughttoplayasignificant
role.Ankylosingspondylitiscanoccurbyitselforinassociationwithotherdisorders,includingCrohnsdisease,
ulcerativecolitisandpsoriasis.Caucasianmenagedbetween16and33yearsaremostsusceptible.

Bonefracture
Olderpeoplearemorepronetohipfracturesbecausebonesbecomelessdenseasweage.Insomecases,a
persondevelopsosteoporosisadiseasecharacterisedbytheexcessivelossofbonetissue.Thebonesbecome
softandbrittle,andpronetofracturesanddeformities.Morewomenthanmenexperienceosteoporosis.

Developmentaldysplasiaofthehip
Developmentaldysplasiaofthehipmeansthatthehipjointofanewbornbabyisdislocatedorproneto
dislocation.Thesocketisabnormallyshallow,whichpreventsastablefit.Slackligamentsmayalsoallowthe
femoralheadtoslipoutofjoint.Somepossiblecausesincludeabreech(feetfirst)delivery,familyhistoryand
disorderssuchasspinabifida.Around95percentofbabiesbornwithdevelopmentaldysplasiaofthehipcanbe
successfullytreated.

Perthesdisease
Perthesdiseaseisadiseaseofthehipjointthattendstoaffectchildrenbetweentheagesofthreeand11years.
Theballofthefemurissoftened,andultimatelydamaged,duetoaninadequatebloodsupplytothebonecells.
MostchildrenwithPerthesdiseaseeventuallyrecover,butitcantakeanywherefromtwotofiveyearsforthe
femoralheadtoregenerate.Thecauseisunknown.

Slippedcapitalfemoralepiphysis
Duringchildhood,thefemoralballisattachedtothefemurwithagrowthplateofbone.Insometeenagers,the
ballcanslidefromitsproperposition,causingthelegontheaffectedsidetoturnoutfromthebody.Possible
contributingfactorsincludetheshapeandlocationofthefemoralheadinrelationtothefemur,increasedsex
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hormonesduringpuberty,andweightgain.Withouttreatment,slippedcapitalfemoralepiphysiswillworsenand
thechildmayexperiencearthritisofthehipjointinlaterlife.

Irritablehipsyndrome
Irritablehipsyndrome(sometimescalledtoxicsynovitis)isatemporaryformofarthritis,whichtendstoaffect
prepubescentchildrenforunknownreasons.Boyswithtoxicsynovitisoutnumbergirlsfourtoone.Symptoms
includehippain(usuallyononesideonly),inabilitytowalk(orlimping),kneepainandfever.Mostcasesoftoxic
synovitisresolvebythemselveswithinoneortwoweeks.

Softtissuepainandreferredpain
Paincanappeartobecomingfromthehipjointbut,infact,mayberelatedtosofttissuestructuresaroundthe
hipsuchasmuscles,tendonsandbursae,ormaybereferredfromabackproblem.Painexperiencedoverthe
lateralaspect(side)ofthehipmaybeduetotrochantericbursitis.

Diagnosinghipproblems

Dependingonthecause,diagnosisofahipproblemcaninvolveanumberoftestsincluding:

Medicalhistory
Physicalexamination
Xrays
Ultrasoundscans
Bonescans
Biopsy
Bloodtests.

Treatmentoptionsforhipproblems

Treatmentmayinclude:

Forallformsofarthritistherearenonpharmacologicaltreatmentoptions(exerciseprograms,
educationandselfmanagementprograms)aswellasspecifictreatmentfordifferenttypesofarthritis.For
osteoarthritis,themostcommontypeofarthritis,simplepainkillingmedicationisofteneffective.Joint
replacementsurgery(hiporknee)maybethebestoptionforpeoplewithsevereosteoarthritis.
Rheumatoidarthritisandankylosingspondylitiswillusuallyrequiremorecomplexmedical
treatment,suchasantiinflammatorymedicationsanddiseasemodifyingmedicines.Somepeoplemay
alsorequiresurgicalprocedures.
Fracturetreatmentincludesadmissiontohospitalandsurgery.
Developmentaldysplasiaofthehipaspecialharnessiswornforbetweensixand12weekstohold
thejointinplacewhilethebabysskeletongrowsandmatures.
Perthesdiseaseoptionsincludebedrest,painkillingmedication,abraceorsplint(wornforbetween
oneandtwoyearstoencouragetheregrowingfemoralheadtositinsidethesocket)andsurgerytotreat
deformities.
Slippedcapitalfemoralepiphysissurgerycanrepositionthefemoralheadandscrewitfirmlyinto
place.
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Irritablehipsyndromeoptionsincludebedrest,painkillingmedicationsandnonsteroidalanti
inflammatorydrugs(NSAIDs).
Softtissuepainlocalsymptomaticmeasuressuchasanexerciseprogram,antiinflammatorycreams
andsimplepainrelievingmedicationsmayhelpsofttissuepain.

Wheretogethelp
Yourdoctor
Rheumatologist
Paediatrician
ArthritisVictoriaTel.(03)85318000or1800011041

Thingstoremember
Thehipjointisthelargestjointofthehumanbody.
Thehipscanbeaffectedbyawiderangeofdisordersincludingarthritis,irritablehipsyndromeand
slippedcapitalfemoralepiphysis.
Painaroundthehipmaybeduetosofttissuepainsyndromesorreferredpainfromabackproblem.
Treatmentoptionsdependonthecausebutmayincludemedication,exercise,splintingandsurgery.

References
Slippedcapitalfemoralepiphysis(SCFE)(2006)[onlinefactsheet],ChildrensHospital,Westmead,

Sydney.Moreinformationhere.

Hipabductionorthosis(2005)[onlinefactsheet],ChildrensHospital,Westmead,Sydney.More

informationhere.

Developmentaldysplasiaofthehip(DDH)(2006)[onlinefactsheet],ChildrensHospital,

Westmead,Sydney.Moreinformationhere.

Moreinformation

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Lastupdated:March2014

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