Diagnosis and Treatment Options for Hip Pain
What Could Be Causing My Hip Pain?
Often, patients come in to see me in clinic with hip pain. Now, hip pain can be a multifactorial problem. There can be multiple different things causing your hip pain. You can have things such as actual hip arthritis or labral tears or other intra-articular or things causing the pain from inside the joint. You can also have multiple things outside of the joint causing your pain. You could have muscular injuries, you could have bursitis, there’s things in your back that can present as hip pain such as in layman’s term, sciatica or lumbar radiculopathy. Basically a pinched nerve in your back, and all these things could have happened acutely with trauma or they could be a long process over time.
How Do You Make a Diagnosis? (0:39)
When you come into clinic with hip pain, we start out with the simplest thing to try to figure out what is going on. The first thing is your history. When did this pain start? When does it bother you? Is it when you’re standing up or sitting down? Is it when you do certain activities or when you are in a certain position?
The physical exam is also extremely important. Is there an area that is tender? When I move your leg around and examine your hip, where do you hurt? Is it in the groin? Is it on the outside of the hip? Is it in the buttock? Multiple different areas could be affected and could hurt for different reasons.
And then we get imaging. Usually, the easiest thing is an x-ray. X-ray is a very simple test, and we can do it right in the clinic, and most of the time that’s all that is needed to diagnose most of the hip problems that you have, along with the physical exam. Sometimes more advanced imaging is needed, but this isn’t always the case.
What Are Some Treatment Options? (1:35)
Treatment can vary greatly depending on what is causing your hip pain. Usually, first line treatments for virtually all the problems that I talked about earlier, is non-steroidal anti-inflammatories or Tylenol, over-the-counter Ibuprofen, that kind of thing. Also, physical therapy is a very good starting point. Now, depending on what is causing your hip pain, if those things fail and do not take care of the problem, then it can change, and I’d like to focus on intra-articular problems or things with the actual hip joint itself and if there something only on inside of there. If you’re a young person with minimal degenerative change, almost no arthritis, it’s possible that an MRI and a possible hip scope may be necessary. If you do have degenerative change or arthritis, the next step is injections to see if you start feeling a little better. If those don’t work, the final and end result is a hip arthroplasty, or a hip replacement.
A New Approach to Hip Replacement (2:30)
The Direct Superior Approach
If you’re seeing me in clinic and you are diagnosed with hip arthritis and we’ve exhausted these non-operative measures, and you as the patient decide you are ready to go through with a hip replacement, I do, a newer technique. It is called the direct superior approach. It allows me to spare muscles and tendons more than any other approach in town, primarily the piriformis muscle and the iliotibial band, which I do not disrupt. The advantage is post-operatively, there are no hip precautions to avoid in case of dislocation, which you have to avoid in other approaches. Also with the minimal muscle disruption, you have less pain and get back to activities faster, needing less pain medicines, and rarely do you even need physical therapy after surgery.