The hip is a complex ball and socket joint. Problems with
the hip joint, often give rise to discomfort or pain in the
buttock region, the groin, or the side of the hip. Trouble
in the hip joint can occasionally cause knee pain.

The commonest cause of hip pain is osteoarthritis.
Other causes of hip pain include:
Rheumatoid arthritis
Trochanteric bursitis
Tendonitis
Osteonecrosis (avascular necrosis)
Muscle strains
and Problems with the back (lumbar spine pathology).

Although currently there are no cures for osteoarthritis,
the symptoms of pain and swelling in the majority of cases
are very well controlled with non surgical measures such
as pain killers and avoiding over-stressing of the affected
joints. If or when these measures fail, surgery should be
considered. The types of

hip surgery

 used for the treatment of arthritis include:
Keyhole surgery (arthroscopy)
Osteotomy (realignment surgery)
or Joint replacement.

The commonest problem with the hip joint is osteoarthritis.
Patients often complain of groin pain, which is worse on
walking. They often complain of stiffness, first thing in the
morning and have symptoms related to stiffness of the hip,
such as difficulty in cutting their toenails, difficulty getting in
and out of a bath or a car etc. These symptoms can often
lead to misery, reducing the quality of life for patients.

Normal Hip

• Smooth weight bearing surfaces
• Smooth cartilage

 

 

Arthritic Hip

• Rough bone
• Bone spurs
• Irregular weight-bearing surfaces
• Worn cartiliage
• Narrow joint space

X-ray of normal hip and a hip with arthritis

What is it?
Femoro-acetabular impingement or FAI is a condition
where there is subtle mismatch between the two bones in
the hip joint. Basically, the ball (femoral head) and socket
(acetabulum) impinge (jam together) creating local areas of
high pressure, thus damaging the hip joint. The damage
can occur to the articular cartilage (joint surface of the ball
or socket) or the labral cartilage (soft tissue of the socket).

How is it diagnosed?
The diagnosis can be straightforward or a diagnosis of
exclusion. Most patients can be diagnosed with a good
history, physical examamination, and plain x-ray films. A
patient’s history will generally involve complaints of hip
pain (front, side, or back), particularly with certain
movements and loss of hip motion. Sometimes a clicking
or catching is felt in the hip. The physical exam will
generally confirm the patient’s history and eliminate
other causes of hip pain. The plain x-ray films are used
to determine the shape of the ball and socket as well as
assess the amount of joint space in the hip. Less joint
space is generally associated with more arthritis.

Often an MRI arthrogram of the hip is used to confirm a
labral tear or damage to the joint surface. A CT scan can
sometimes also be useful to confirm the pathology.

Trochanteric bursitis is a common disorder that affects
the (lateral) outside of the hip or hips.

The trochanter is part of the “hip bone” formed at the
end of the femoral neck (the femur bone, or thighbone).
Each trochanter has a bursa (lubricating sack of fluid) on
its outer side, and when one or both of those becomes
inflamed, trochanteric bursitis may develop.

In addition to the hip, bursitis is frequently found in the
knee, elbow heel and toes. The condition is discovered
more commonly in women than men. Trochanteric bursitis
usually strikes people when they are middle-aged or
elderly.

Causes of Trochanteric Bursitis
Overuse of the trochanteric bursa and or an inflammation
of the bursa may cause trochanteric bursitis. Other
possible causes of the condition include:

• A direct fall on the side of the hip
• Repetitive movements
• Prolonged or excessive pressure to the hip area (bucket car seats may aggravate the problem)
• Some infections such as staphylococcus and tuberculosis and diseases like gout and arthritis increase are associated with trochanteric bursitis
• Underlying surgical wire, implants or scar tissue in the hip area
• Differences in leg length

Symptoms of Trochanteric Bursitis
The overriding symptom of trochanteric bursitis is pain in
the thigh and trochanter area. The pain may increase over
time and it may last for months, even years. The pain may
be more intense when you are lying on your side. In long-
term cases, you may not be able to pinpoint the exact
location of the pain.

People suffering from trochanteric bursitis may not be able
to walk at all because of the pain. If they are able to walk,
it will most likely be with a limp.

Your doctor will need to perform a physical examination in
order to diagnose the condition. It is important to rule out
other sources of the pain before making a diagnosis. He
or she will place pressure on the great trochanter to see if
that causes discomfort. In addition, the doctor will ask
about your past medical history.

X-rays of the hip or hips may also help to confirm the
diagnosis. If you suffer from other forms of bursitis or
tendon disorders, your doctor may also look for another
condition, in addition to trochanteric bursitis, called
fibromyalgia. Fibromyalgia is a common rheumatic
syndrome that causes pain and weakness in the muscles.

There are two major types of cartilage in the knee. One
form of cartilage covers the surface of the bone that forms
part of the joint, this is called hyaline cartilage.

Another type of cartilage found in the knee is fibrocartilage
which forms the disc shaped material that lies between the
ends of each bone (meniscus). There are two menisci, one
on the inner aspect of the knee joint (medial) and one on
the outer aspect (lateral). These menisci are a C shaped
disc and they serve to cushion and improve the contact
surface area between the curved shaped surfaces of the
femur (end of the thigh bone) and the relatively flat
surface of the tibia (top of the shin bone).

Tears of the meniscus are more common following an
injury than tears of the cartilage that lines the bone
(hyaline), which are called osteochondral defects (OCD).
Meniscal tears often can cause symptoms of pain in the
knee associated with swelling; occasionally they can be
associated with locking of the knee or jamming and can
also cause the knee to suddenly give way. Tears of the
hyaline cartilage can occur but are less common.

Ligaments are rope like structures that connect one
bone to another across joints. Their purpose is to provide
stability for joints as they move.

Ligaments can be sprained (a partial tear) or they can
be completely ruptured (a complete tear). Common knee
ligament injuries occur after ski injuries and sports injuries.

The medial collateral ligament (MCL) is a ligament
connecting the femur (thigh bone) to the tibia (leg bone).
This is a strong ligament on the inside of the knee that is
commonly injured in twisting injuries.

The anterior cruciate ligament (ACL) also connects the
femur and the tibia along with the posterior cruciate
ligament. The two cruciate ligaments are deep in the
knee and cross each other. The anterior cruciate ligament
is the more commonly injured of the two cruciate
ligaments. It is often injured in ski injuries and sports
injuries from a twisting force applied to the knee.

Osteoarthritis is wear and tear within a joint due too
cartilage damage. When it affects the knee, it often
results in aching pain. The knee may feel stiff particularly
after periods of rest or first thing in the morning. The pain
may be global or it may be localised to a certain area.
Depending on where the arthritis is, symptoms may be
aggravated by certain activities such as using stairs or
walking for prolonged periods of time.

Over time, the knee shape can change, such as getting
bow-legged or knock-kneed or it may just appear swollen.
The knee is often stiff and patients can feel creaking in the
joints.

Arthritis of the knee can usually be diagnosed by the
doctor taking a simple history and examination of the
patient, followed by basic x-rays.

Depending on the symptoms and the patient, treatment is
tailored to meet individual patient needs. This can include
activity modification, pain killing tablets, key-hole surgery,
and joint replacement surgery.

Problems from the knee give rise to symptoms such as
pain, swelling, instability, catching difficulty negotiating
stairs and stiffness. Symptoms of knee pain or instability
can occur, if the knee has been injured or affected by
disease such as arthritis. Following a knee injury,
ligaments, tendon, cartilage and even the bone may
be damaged.

Occasionally the components of the knee, such as the
patella (knee cap) may not glide in the correct position
as the knee moves (patella maltracking) this too can
cause symptoms of knee pain and instability.

Knee pain and instability can also arise from disease
processes such as arthritis.

The London Orthoapedic Clinic boasts extremely
experienced traumatologists which will diagnose
and treat a wide variety of Fractures.

All fractures of the Upper and Lower limb are extremely
common and a regular occurrence. Our consultants will
be available, especially with our after hours/emergency
service to fix all fractures.