Hip conditions

Hip osteoarthritis is the progressive degeneration of joint cartilage. Pain is often felt in the groin or thigh, sometimes extending to the knee, and may be accompanied by stiffness, limping and reduced walking distance.

Assessment correlates symptoms and clinical findings with radiographs. Treatment may include therapeutic exercise, activity modification, weight management when relevant, a walking aid, and individualised medication or injection options. Hip replacement is considered when pain and functional limitation become substantial and conservative treatment no longer provides adequate relief.

The shape of the femoral head, acetabulum or both may cause abnormal contact during certain movements. Symptoms can include groin pain, stiffness, discomfort with flexion or rotation, and sometimes clicking or catching.

Radiographs assess bone shape, while MRI is used selectively for the labrum and cartilage. The plan usually begins with activity modification and rehabilitation; a joint-preserving procedure is considered only when symptoms, examination and imaging correlate.

Osteonecrosis occurs when the blood supply to part of the femoral head is impaired. Pain may precede radiographic changes, and progression can lead to collapse of the femoral head and osteoarthritis.

MRI is useful in the early stages. Treatment depends on lesion size and whether collapse has occurred: some early forms may allow joint-preserving procedures, whereas advanced damage may require hip replacement.

Pain on the outer side of the hip is often associated with the gluteal tendons and trochanteric bursa. It may worsen with walking, climbing stairs or lying on the affected side and does not automatically mean hip osteoarthritis.

The diagnosis is often clinical. Ultrasound or MRI is reserved for persistent or unclear cases, and treatment focuses on load management and progressive muscle strengthening.

In hip dysplasia, the acetabulum does not adequately cover the femoral head. The labrum and cartilage may be overloaded, leading to pain and earlier osteoarthritis.

Assessment includes properly measured radiographs and, selectively, MRI or CT. The plan depends on age, anatomy, symptoms and cartilage condition, and may range from rehabilitation to joint-preserving procedures or hip replacement.

New or persistent pain after hip replacement may arise from the joint, bone, muscles or spine. Infection, wear, component loosening, instability and periprosthetic fracture must be distinguished before treatment.

Assessment is systematic and may include radiographs, blood tests, joint aspiration or CT. Revision surgery is considered only after a correctable cause has been identified.

Severe pain after a fall or accident, inability to bear weight and an abnormal leg position require prompt assessment. Deformity, osteonecrosis or post-traumatic osteoarthritis may remain after healing.

Acute treatment depends on injury type, age, bone quality and functional level. For post-traumatic sequelae, investigations assess anatomy, bone healing and joint condition before possible reconstruction.