Monday, August 27, 2012

Two Common Answers to “Why do I have hip pain?” Hip Arthritis and Bursitis and How They Differ


Hip pain is extremely common and has multiple sources.  It can be complicated and frustrating.  However, let’s narrow down two of the most common sources and talk about their typical presentation and options for treatment. 

First, bursitis is inflammation of a small sack on the outer aspect of the hip over the bony prominence called the trochanter.  Typically the bursa helps tissues glide past each other, however, when the bursa becomes inflamed it can quite painful and limit function and activity.  Many patients complain of pain over the outer aspect of the hip and thigh that’s worse with increased activity and other activities like sitting in a car a long time, sleeping on the affected side, and going up and down stairs.  Most patients don’t recall a specific injury.  Often the symptoms start without a specific incident.  The good news is that hip bursitis is typically treated without surgery and responds well to other treatments.

In many cases bursitis is self-limiting and may respond to moderation of activity.  However, when symptoms persist, we will often start treatment with anti-inflammatories and basic stretching exercises.  Additional treatment includes formal physical therapy programs.  And lastly, many patients respond very nicely to a steroid injection, which can often be curative.  If symptoms recur another round of additional treatment as noted above is often successful.

In contrast to hip bursitis, hip arthritis usually presents differently.  Hip arthritis is loss of the smooth cartilage surface of the hip joint due to age or previous trauma.  Hip arthritis symptoms are often described as a more gradual, aching onset of pain that worsens with increased activity, such as prolonged walking.  In addition, as symptoms progress, decreased motion and stiffness are common.  An important difference is the location of pain.  As opposed to hip bursitis that is often on the outer aspect of the hip, hip arthritis typically presents with pain more localized to the groin and upper thigh area. In some cases, because of the nerve distribution in the hip joint, symptoms can extend to the knee as well and masquerade as knee symptoms.

Initial treatment for mild to moderate hip arthritis is usually moderation of activity, weight loss, and anti-inflammatories.  As we’ve talked about previously with knee arthritis, weight loss can significantly decrease hip arthritis symptoms.  For some patients that develop more advanced arthritis but want to delay surgery, a hip steroid injection can provide some relief, but it’s often relatively short-lived.  Once symptoms begin to affect daily life and function, patients will often consider total hip replacement.  And while there are risks with hip replacement surgery, it’s one of our most successful and rewarding orthopedic surgeries.

Dane Glueck, MD
Images from AAOS (orthoinfo.aaos.org)

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