By Mr Tahir Khan
Hip joint is pivotal to normal bipedal ambulation. Any deformity in the articulation leads to significant disability in young, active individuals. Patients with hip problems, typically complain of the following:
- Groin pain after physical activity
- Dull ache or Discomfort after walking, running, dancing or prolonged sitting
- Stiffness affecting hip movements
If hip symptoms last longer – underlying hip joint problem may need to be investigated promptly and comprehensively. Advanced imaging may detect hip pathologies before they lead to irreversible damage
Young adults (typically aged 16–50 years) with persistent hip pain and no signs of hip joint arthritis present a diagnostic challenge for the un-initiated. Our understanding of the causes of hip pain in young adults has increased significantly over the last decade. This has led to the recognition that subtle hip abnormalities can cause symptomatic soft tissue damage and may initiate OA. Therefore identifying and treating young adults with pre-arthritic symptoms (the ‘at-risk’ hip) is now possible.
Early diagnosis and treatment is extremely important to minimize symptoms and prevent premature onset of hip joint deterioration.
Hip conditions in young adults
Some of the causes of hip pain are listed below;
- Abductor and Gluteus muscle injuries
- Piriformis syndrome
- Snapping hip (ITB or iliopoas)
- Trochanteric bursitis
- Inguinal ligament strain
- Referred pain from Lumbar spine
- Femoro–acetabular impingement (FAI)
- Avascular necrosis of the femoral head (AVN)
- Developmental Dysplasia of the hip (DDH)
- Legg Calve Perthe’s Disease
- Acetabular Labral tear
- Osteo-Chondral defect
- Ligamentum teres injury
The term FAI describes deformities in hip joint morphology that results in impingement between the femoral neck and acetabulum. The impinging surfaces can irritate and damage the soft tissues of the hip joint, in particular, the acetabular labrum and the adjacent articular cartilage. Three types of deformities in the hip joint have been described;
- CAM type – Asphericity of the femoral head; term borrowed from the cam-lobes on engine cam-shafts
- Pincer type – over coverage of the anterosuperior acetabular wall; a deep socket. Similar to the tips of pincer forceps
- Mixed type
Patients with hip pain have a higher prevalence of articular anatomy abnormality. A retrospective review of the pelvic radiographs of 157 patients aged 18–50 years revealed that 87% were found to have a hip shape abnormality.
Early specialist referral may be indicated in athletes where the prevalence of hip shape abnormality has been shown to be substantially higher than in the general population.
Treatments often involve targeted physiotherapy, which has shown good short-term outcomes in pain and function for patients with mild FAI, although there is limited experimental data.
Surgical management may be considered for extra- and intra-articular hip pathologies when patients do not improve with non-operative care and where the symptoms are judged severe enough to justify the risks of surgery.
Arthroscopic Hip surgery may help with the management of trochanteric bursitis, the snapping hip, and morphological corrections for the treatment of FAI as well as soft tissue repairs (e.g. labral repair/reconstruction, microfracture and repair of ligamentum teres injuries).
A growing body of literature now exists showing favourable outcomes of arthroscopic surgery for FAI in young adult and adolescent populations.
For more information contact please contact the Royal National Orthopaedic Hospital Private Patient Unit:
020 8909 5114