Hip Pain

Hip pain can arise from the hip joint itself, from the tendons, muscles and bursae around it, or from elsewhere, particularly the lower back. Location is a useful guide. True hip joint pain is usually felt in the groin. Pain on the outer side of the hip most often comes from the gluteal tendons and bursa (greater trochanteric pain syndrome). Buttock pain commonly comes from the spine, sacroiliac joint or deep gluteal muscles.

Age shapes the likely cause: impingement, labral tears and stress fractures in younger active adults; osteoarthritis, avascular necrosis and tendon problems in middle and later life; and specific conditions in children. Most causes are managed with exercise and activity changes; surgery, from arthroscopy to joint replacement, is for defined structural problems.

Symptoms

• Groin pain, sometimes described by cupping the hip with the hand in a C shape
• Pain on the outer hip when lying on that side or climbing stairs
• Clicking, catching or locking deep in the groin
• Stiffness when putting on socks or getting in and out of a car
• A limp or shortened stride
• Pain referred down the front of the thigh to the knee
• Buttock pain with tingling down the leg, pointing to the back
• Night pain or pain at rest

Causes and risk factors

Inside the joint: osteoarthritis, femoroacetabular impingement with labral tears, hip dysplasia, avascular necrosis (linked to steroids, alcohol and sickle cell disease), inflammatory arthritis, infection and, rarely, tumours. Around the joint: gluteal tendinopathy, iliopsoas tendinopathy or a snapping hip, adductor strains and hamstring origin problems. Bone: stress fracture of the femoral neck in runners and in people with low bone density, and hip fracture after a fall in older people. Referred pain comes from a lumbar disc or spinal stenosis, the sacroiliac joint, an inguinal or femoral hernia, and gynaecological or urological conditions.

How it is diagnosed

• Examination: Range of movement, impingement test (flexion, adduction, internal rotation), single leg stance, palpation of the outer hip and an assessment of the lower back.
• X-rays of the pelvis and hip: Show arthritis, dysplasia, the bony shapes of impingement and fractures.
• MRI or MR arthrogram: Detects labral tears, early avascular necrosis, stress fractures and tendon tears.
• Ultrasound: Assesses the gluteal tendons, bursae and snapping tendons, and guides injections.
• Diagnostic local anaesthetic injection: Relief after an injection into the joint confirms the hip as the source.
• Blood tests: Inflammatory markers and other tests if infection or inflammatory arthritis is suspected.

Treatment options

• Load management and physiotherapy: Hip and gluteal strengthening is the main treatment for tendon problems, impingement symptoms and early arthritis.
• Practical changes for outer hip pain: Avoid crossing legs, standing hanging on one hip and lying on the painful side; place a pillow between the knees at night.
• Pain relief: Short courses of anti-inflammatories or paracetamol as appropriate.
• Image-guided injections: Steroid for trochanteric pain or an arthritic flare, to open a window for rehabilitation.
• Hip arthroscopy: Reshaping of impingement bone and labral repair in selected patients without significant arthritis.
• Periacetabular osteotomy: Reorients a shallow socket in young adults with dysplasia.
• Core decompression: Aims to preserve the femoral head in early avascular necrosis.
• Total hip replacement: For advanced arthritis, collapsed avascular necrosis and many hip fractures.

When it is urgent

Go to an emergency department locally if you cannot bear weight after a fall, if the leg looks shortened and turned outwards, if hip pain comes with fever and feeling unwell, or if a runner or someone with thin bones has groin pain that is worsening with every step, since a femoral neck stress fracture can displace. A child with a limp and fever, or a teenager with a new limp and hip or knee pain, needs same-day assessment.

Travelling to Türkiye for treatment

A short visit works well for a clear diagnosis when hip pain has dragged on: examination, imaging and a diagnostic injection can be completed within a few days. Planned operations such as hip replacement, arthroscopy or osteotomy are also reasonable to travel for, with stays from about 7 days for arthroscopy to 10 to 14 days for replacement. Tendon problems and early arthritis depend on months of exercise at home, and a trip adds little beyond the initial plan.

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Frequently Asked Questions