Second Opinion on Hip Joint Conditions

As the link between the legs and the trunk, the hip bears the human body weight in standing and walking, so it is particularly susceptible to injuries and exhaustion. Damage- and age-related disorders that occur in this heavily stressed joint may result in severe pain and limited motion. A variety of treatment options are available, but there can be different strategies regarding their timing and selection, and a second opinion will be the right choice in a great number of hip joint issues.  

A glimpse into anatomy

The hip joint is a movable connection between the femur and the pelvis. It is surrounded by the joint capsule and held in place by strong ligaments that nevertheless allow a high range of motion in different planes.

The opposing bone surfaces of the joint are covered by a layer of cartilage, which absorbs shocks and enables frictionless gliding (together with the synovial fluid).

How are hip disorders diagnosed?

The starting point is taking the patient's medical history (anamnesis), including the nature and duration of complaints which help the orthopedics specialist identify if the pain is caused by the hip joint, or it is associated with other diseases (spine diseases, inguinal hernia, etc.)

A key imaging exam is X-ray. It can detect dislocations, wear of the joint, arthrosis, calcium deposits, and other conditions. Sonography/ultrasound diagnostics shows effusion, bursitis, muscle injuries, or calcifications. Magnetic resonance imaging is required in some cases for a more precise assessment. Computed tomography and bone scan are used to evaluate blood flow and tissue metabolism. The latter may be of major importance in revealing hip replacement complications. Other common issues that the above-mentioned exams can identify include arthrosis, necrosis of the femoral head and joint inflammation.

Hip arthrosis (coxarthrosis)

Arthrosis of the hip joint is a frequent wear and tear disease of the hip joint. If the cartilage is constantly worn away due to overloading, dislocation, metabolic or acute/chronic inflammatory disorders, bones rub against each other, causing pain and discomfort.

Therapy options at early stages comprise physiotherapy, drugs, magnetic field therapy and intra-articular injections, including autologous plasma substances.

Surgery may involve hip arthroscopy, a minimally invasive procedure that is particularly successful when the disease has not gone too far. However, with severely damaged cartilage, only joint replacement can bring relief.

Femoral head necrosis

If the blood supply to the femoral head (the highest part of the hip bone) is disrupted, its tissues die. The condition is called osteonecrosis. Most frequently it is the result of an injury (fracture of the femoral neck with injury to the blood vessels), or metabolic disorders such as diabetes, as well as cortisone therapy, tumor chemo- or radiation therapies. Management tactics depend on the extend of the disease. Initially, restriction of weight-bearing activities and drugs may be considered to slow down progress. However, with severe damage, only surgery will help. The options of choice are hip preserving procedures (core decompression with or without bone grafting, rotational osteotomy) or hip joint replacement.

Hip implant failure

If pain in the hip area occurs some time after joint replacement surgery, the reason may be implant loosening. It is caused either by abrasion of its material (aseptic loosening, e.g. due to inadequate initial fixation) or an infection, which can very rarely occur during implantation (septic loosening). If diagnostics confirm loosening, revision surgery is recommended in most cases.

Inflammation in the hip area

Not only the joint itself, but also the attaching tendons and synovial bursa can become inflamed. The most common inflammations include bursitis and irritation of the soft tissues that lie over the upper aspect of the thigh bone (the so-called greater trochanteric pain syndrome). Therapies vary from anti-inflammatory drugs, painkillers, physiotherapy and cortisone injections to shock wave therapy or ACP (autologous conditioned plasma).

Remote consultations on hip problems

In a great number of hip joint conditions, the key question is whether the issue can be handled without major surgical intervention (hip replacement). The procedure is widely used and has become a routine; however it is not an easy one, especially for elderly patients. Thus, the goal is to avoid it whenever conservative methods or smaller surgeries may still be effective. To see if there are still any non-invasive options left, patients often seek an opinion different from the primary physician’s view. Relevant imaging can easily be transmitted at any distance, and the necessary clinical data can be taken by a questionnaire or during an online conference, so expert medical advice on hip disorders can easily be provided at a distance.  

A second opinion is especially recommendable in the case of hip implant problems. General practice orthopedists may not have the adequate expertise to detect implant loosening/failure, and only highly qualified hip joint surgeons can identify the issue and recommend the correct strategy.