Hip pain in adolescents and adults is quite common. There are many causes and the most important factor is determining the reason and cause of the pain. Pain in the hip can be as a trauma as simple as a muscle strain or sprain, to an overuse injury such as a stress fracture, to loss of blood supply called avascular necrosis, to a hip that developed too shallow (hip dysplasia) to a hip that may be mal-oriented or too deep and causing hip impingement.
Therefore hip pain cannot be lumped into one and each condition has its own unique management features. For instance, a hip sprain many need exercises and physical therapy while hip dysplasia requires surgical reconstruction of the hip.
Hip Dysplasia is often not diagnosed until the teenage years or adulthood and presents as a shallow socket (acetabulum) and/or a rotated femur (excessive anteversion or retroversion). Hip dysplasia can put pressure on the side of the acetabulum (cup of the hip) causing a labral tear (the shock absorber of the hip). Patients often complain of pain with increased activity such as hiking. Once the labrum actually tears, pain occurs even with sitting.
There are many causes of hip pain in adulthood. Some are inborn, such as a shallow hip and hop impingement, while others may be related to trauma or overuse. Some causes of hip pain are unique such as Avascular Necrosis and Slipped Capital Femoral Epiphysis. These are discussed separately.
Physical examination will often reveal the diagnosis. Along with x-rays, CT Scan and MRI when needed, a definitive diagnosis for the hip pain should be made.
Having reconstructed over 600 such hips in my career, it is very possible to eliminate the pain and the limp associated with this problem. Surgical solutions such as a Triple Innominate Osteotomy in childhood or the similar osteotomy popularized by Reinhold Ganz and minimally invasive femoral rotational osteotomies are specialized procedures that preserve the hip and are performed in very few centers in the US. If one were simply to repair the labrum, the tear will occur again due to the abnormal mechanics of the hip. The best management if there is a torn labrum is to utilize hip arthroscopy to repair the labrum and then perform a periacetabular osteotomy to repair the mechanical problem of the hip. If this is performed before arthritis has set in, the patient can be pain free for many years and in many cases never needing a hip replacement. A torn labrum with or without hip impingement can often be treated by hip arthroscopy.
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