Hip Disorders

The hip is a ball and socket joint with multi-directional movement. It is a major weight bearing joint and the forces in it during normal walking are several times body weight.
Any hip disorder of significance will therefore generally cause an abnormal gait or limp. This is true of childhood hip problems to adult hip disease. Most disorders are also associated with some loss of movement of the joint whether it be temporary such as that caused by fluid collections in the child’s hip or permanent due to altered shape of the femoral head in adult arthritis.

SURGICAL PROCEDURES

Surgery on the hip is undertaken when conservative treatment has either failed or is inappropriate to correct the underlying problem. Surgery can be open and invasive, minimally invasive and arthroscopic (keyhole). Some conditions are suited to keyhole surgery where as others, such as femoral resurfacing, require an invasive approach.
There are also several types of approaches to the hip joint. Mr Thomas favours the posterior approach for hip joint replacement as this is associated with a much lower rate of limping post-operatively.

BABY HIP PROBLEMS

Babies are at risk of hip problems and need prompt diagnosis. The hip can either be dislocated at birth or soon after, or can be under-developed, leading to problems later in life. Clinical examination and ideally Hip Ultrasound is essential to diagnose problems as early on in life as possible. If treatment commences within the first few months of life, then it is possible to create a normal hip joint by walking age.

CHILDRENS HIP PROBLEMS

It is generally easy to diagnose a child with a hip problem as when they walk, they tend to have a noticeable limp. This problem requires prompt attention and referral to a doctor. Investigations are usually necessary to exclude the most serious childhood hip problem which is bacterial infection. Perthes disease is a disorder that tends to start as a painless limp which then progresses with time. This usually affects children from 3 -8 yrs.

ADOLESCENT HIP DISORDERS

Adolescents frequently present to their GP with knee pain which can frequently be referred from the hip. It is therefore very important to examine any child/adolescent with knee pain thoroughly. Hip examination is therefore mandatory.
The main condition to exclude in the 8-16 yr olds is Slipped Upper Femoral Epiphysis as this is a condition that if caught early can be easily treated surgically. If the slip progresses then treatment is much more invasive and difficult.

SPORTS RELATED DISORDERS

Sports which involve a lot of twisting and kicking frequently can cause pain in or around the hip. Problems can arise as a result of repetitive type movements or due to high impact injuries such as in contact sports.
The majority of these problems can settle with rest and physiotherapy, but others will require surgical intervention eventually.

YOUNG ADULT HIP DISORDERS

It is commonly misconceived that arthritic problems in the hip only affect the elderly. This is untrue as certain childhood hip problems such as Dysplasia, Perthes and SUFE can cause the hip to be an abnormal shape and this leads to abnormal wear. This can cause arthritis in the young adult.
Hip impingement is another problem which frequently starts o cause groin pain in younger age. This asphericity of the femoral head again leads to damage inside the socket and eventual arthritis.
Rheumatoid arthritis can affect young adults and even children. Primary treatment is with modern drugs ( disease modifying agents), but surgery is frequently necessary in the form of joint replacement.

ADULT HIP DISORDERS

Osteoarthritis affects the vast majority of the population above the age of 60 and is one of the commonest diseases known. It can be severely disabling but joint replacement surgery can resolve the problem and make a huge difference to a patients quality of life.
Some less common and less intrusive causes of hip pain include trochanteric bursitis. This is inflammation of the bursa and is usually associated with pain on lying directly on the affected hip. Other tendons such as the psoas and adductors can also become inflamed in the active adult.