Aches and pains are common in patients of all ages who are working to stay active. Occasionally, those aches and pains can become severe enough to limit activity. 

When a major joint such as the hip becomes irritated, even simple activities such as sitting or turning a corner can become difficult.

Fortunately, we now have a much better understanding of disorders about the hip that can lead to irritation and soreness.  

Steven Olson, MD, a hip surgeon and trauma specialist at Duke Orthopaedics, discusses causes of hip pain and new approaches to treating hip injuries.

Steven Olson, MDHip pain is increasingly seen as a treatable condition in active people. Alterations in the shape or structure of the ball and socket that comprise the hip joint are now recognized as the primary cause of hip pain.

Alterations of the shape of the hip joint can occur in either the socket (acetabulum) or the ball (femoral head and neck).

Problems in the socket can result from the socket being too shallow (dysplasia) or too deep (impingement). Occasionally, the ball can be an irregular shape that can result in contact (impingement) with the rim of the socket, leading to wear-and-tear changes.

The inside of the socket and surface of the ball are covered with a specialized layer of tissue know as articular cartilage. Articular cartilage is the material responsible for nearly frictionless motion of our joints throughout our lifetimes. 

The edge of the socket is lined with a unique tissue known as the acetabular labrum. The labrum has multiple roles in the hip. It can act as a gasket or seal for the ball and socket joint. The labrum also acts as a cushion or bumper when the ball contacts the edge of the socket. 

When the labrum tears it becomes very painful. Review of regular x-rays will often show no signs of arthritis in the hip with a labral tear.

Not so long ago, hip pain without arthritis was a condition without viable treatment options. In the 1980s, it was recognized that patients who developed hip arthritis have an underlying alteration in the shape of either the ball or socket that make up the hip joint. 

In the late 1990s and 2000s, newer techniques were developed to modify the effects resulting of these alterations.

This area of treatment has become known as hip preservation surgery. 

Hip preservation refers to the care of the hip and preservation of hip function. Patients with hip pain often cannot recall a specific event that lead to the hip problem. 

Evaluation consists of obtaining a history of how the patient’s hip hurts with specific activities. A careful physical examination can identify potential sources of the hip pain. Plane radiographs are important. The majority of abnormal shape or structure of the hip can be detected on regular x-rays. 

Occasionally, patients will also require a magnetic resonance imaging (MRI) study of the hip as well. Once this information is available, the orthopaedic surgeon can determine the best course of treatment. 

Treating Hip Pain

Treatment can include many options. Non-operative hip treatment can involve physical therapy to improve muscle strength and increase range of motion. Non-steroidal anti-inflammatory agents, such as ibuprofen or other arthritis medications, can help reduce pain and joint inflammation. 

Adjunctive intra-articular injections in the hip joint with a numbing medication (like a dentist uses) and a steroid medication can be both diagnostic and therapeutic -- diagnostic in defining where the cause of the hip pain is and therapeutic in reducing inflammation. Finally, a cane or crutch can reduce excessive loads on the sore hip.

Operative options are targeted to treat the specific problems.

The range of operative treatment includes hip arthroscopy which is a procedure performed through small incisions using a camera and instruments in the hip joint. Labral repairs, trimming of bone of either the ball or socket, and trimming torn articular cartilage can be performed using his technique.

Open repairs of the hip through a technique known as a surgical dislocation is also available. In this technique, a small cut is made in the bone about the hip to release the abductor muscles. This release allows the ball to be dislocated or moved out of the socket safely, and repairs to the labrum or cartilage can be performed. The ball is reduced and the abductor muscles repaired. 

In cases where the socket is too shallow, a periacetabular osteotomy can be performed. In this procedure, the hip socket is cut free from the pelvis and turned to change the orientation of the socket.

The range of procedures available for hip problems has increased in the past years. In many ways, trauma surgeons bring a unique perspective to this field. As a trauma surgeon, we are frequently asked to care for broken bones that involve the major joints. The repair of such fractures is another form of joint preservation surgery. 

At Duke Orthopaedics, the entire spectrum of hip care is available from pediatric hip issues to geriatric hip complaints.    

Steven Olson, MD, has been working in the area of hip preservation throughout his career. Beginning by training with masters in hip surgery including Emile Letorunel, Rinehold Ganz, and Joel Matta, Olson learned to care for the hip from the pelvis to the entire femur. Olson is experienced in treating conditions about the hip including fracture fixation, surgical dislocation of the hip, periacetabular osteotomy, hip arthroscopy, and total hip arthroplasty.