Understanding Hip Pain

The hip joint is the largest joint in your body, and is prone to developing pain because of its complex anatomy and wide range of motion. A painful hip joint can compromise your ability to walk.


How do you know if the pain you’re feeling in your joints is the result of arthritis or merely overuse?

In general, the pain associated with arthritis develops gradually, although sudden onset is also possible. The pain of arthritis may come from different sources. These may include inflammation of the synovial membrane (tissue that lines the joints), the tendons, or the ligaments; muscle strain; and fatigue.  A combination of these factors contributes to the intensity of the pain.

The hip is prone to developing pain in part because its anatomy is complex—it is one of the largest and deepest joints in the body—and because it has a large range of motion. Some of these structures, including the bursae, muscles, tendons, or ligaments, are common causes of hip pain, even when the joint itself is fine.

True hip pain is most commonly experienced in the groin, not the buttocks. About 80 percent of patients with hip arthritis will have some pain in the groin or the front of the thigh; the pain can radiate down the front of the thigh and even down the thigh to the knee. This is because the hip and knee have an overlapping nerve supply. In fact, in some patients with hip disease, knee pain may be the only symptom!

  • Lifestyle modification: Decrease pounding activities; for example, ride a bike instead of walking.
  • Exercise and physical therapy: Remain as active as your pain will comfortably allow. Studies suggest that people with hip arthritis who force themselves to remain active may do better in the long run than those who “baby themselves.” Being totally sedentary leads to a loss of muscle and bone strength.
  • Weight loss: Any effort at weight loss will decrease the amount of force on the hip, slow the destruction of the hip joint and decrease pain. Each pound of weight loss equals three pounds of stress reduction on the hip during normal gait!
  • Use an assistive device, such as a cane. A cane can reduce the force on the joint by several hundred pounds. Remember to hold the cane in the opposite hand (yes, the opposite hand) from the side with the hip problem and make sure the cane is the correct height. Any medical supply company that sells you a cane will adjust it to the correct length.
  • Manage pain with medication: If your pain is mild, you may only need medicines you can buy without a prescription. Stronger medications that can help ease pain and relieve inflammation associated with hip osteoarthritis include:
  • Nonsteroidal anti-inflammatory drugs (NSAIDs) are a group of drugs that decrease the inflammation in arthritic joints.
  • Opioids
  • Corticosteriod Injections: Corticosteroids diminish inflammation and reduce pain.

Hip replacement surgery is one of modern medicine’s most successful operations. It is very effective at relieving pain and helping patients regain lost mobility. However, it’s also major surgery. In the procedure, your damaged bone and hip joint is removed and replaced with plastic and metal components; any failure of these components can result in pain and loss of function.

Total Hip Replacement surgery should be considered only when you have exhausted all reasonable non-operative measures to control pain. Ask yourself if you are physically and emotionally ready for the operation, as well as the subsequent rehabilitation period. The final decision rests with you.

Signs that it might be time for a Total Hip Replacement:

  • Pain in your hip prevents you from sleeping.
  • Medication and using a cane aren’t delivering relief.
  • Because of hip pain, you restrict social activities such as attending church, going shopping, going to sporting events, and/or travelling.
  • You have difficulty getting in and out of chairs, cars and bathtubs.
  • You have difficulty sitting for more than 30 minutes at a time.
  • You have difficulty walking or climbing stairs.
  • You feel a decrease in hip motion or the degree to which you’re able to bend.
  • You find intercourse and/or sexual activities painful.
  • Reduced hip pain. Following the initial surgery-related discomfort (which should disappear within a few weeks), you should expect that your hip pain will either be eliminated or significantly reduced.
  • Restored mobility. As your hip pain subsides, your legs will become stronger with increased use. That means better mobility, less fatigue and easier movement.
  • Improved quality of life. With less pain and greater mobility, you should be able to perform daily tasks more easily and lead a more active, more independent life.

Joint replacement in general is highly successful and has a low rate of complications. However, as with any major surgical procedure, it is important for patients to be well informed about the possible risks of joint replacement surgery.   These risks include:

  • Infection around an implanted joint
  • Urinary infections or difficulty urinating
  • Dislocation or instability of an implanted joint
  • Damage to nerves or blood vessels
  • Blood clots (deep vein thrombosis): In the post-surgical period blood clots may form in the calf or thigh. To reduce the number of clots and the chance that they will migrate to the lungs, Dr. Grimsley employ medications to reduce clotting and mechanical devices that encourage blood flow in the legs.
  • Wound irritation
  • Limb length discrepancies
  • Most patients with significant hip disease have a limp and one leg may feel shorter than the other.
  • You may feel your hip “creaking” when you walk, which can be caused by bone-on-bone contact in the joint socket.
  • Quite often the first step or two after prolonged sitting may be especially painful. Eventually you may have to “take a break” to ease the pain after walking only short distances.
  • You likely experience difficulty getting in and out of a car, climbing stairs, or tying your shoes.

When the arthritis is non-inflammatory, the pain is worse with use and usually worse at the end of the day. When the pain is due to inflammation, frequently pain and stiffness are greatest in the morning or after a long period of rest. They are relieved by heat and gentle exercise. Of course, the most important symptom of arthritis is decreased function, sometimes caused by pain, and sometimes because the joint does not move properly.

However, what you think is hip pain may actually be sciatica, a herniated disc, bursitis, a strain or sprain, or even back pain.  Dr. Grimsley can help you determine which problem is causing the most pain.