Hip pain in adults

Hip pain in adults is a frequent clinical presentation and may arise from local musculoskeletal structures, referred pain, systemic diseases, or degenerative processes. The hip joint, being a weight-bearing ball-and-socket synovial joint, is susceptible to trauma, inflammation, and wear-and-tear changes. Identifying the underlying cause is crucial for selecting appropriate management.

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Common Causes of Hip Pain in Adults

1. Degenerative/Chronic Conditions

• Osteoarthritis – Most common cause in older adults; results from cartilage degeneration, leading to stiffness, pain, and reduced mobility.

• Rheumatoid arthritis – Autoimmune inflammation of synovial joints causing hip destruction.

• Avascular necrosis (AVN) – Loss of blood supply to the femoral head, often associated with corticosteroid use, alcohol abuse, or trauma.

2. Trauma and Mechanical Causes

• Fractures – Particularly femoral neck fractures in elderly patients with osteoporosis.

• Labral tears – Damage to the fibrocartilaginous rim of the hip joint, common in athletes.

• Muscle or tendon strain – From overuse, exercise, or lifting.

3. Inflammatory and Infective Causes

• Septic arthritis – Infection of the hip joint, presenting with fever, acute pain, and inability to bear weight (emergency).

• Bursitis (trochanteric bursitis) – Inflammation of the bursa over the greater trochanter, causing lateral hip pain.

• Tendinitis – Inflammation of hip flexor or gluteal tendons.

4. Referred Pain

• Lumbar spine pathology – Sciatica, spinal stenosis, or degenerative disc disease.

• Pelvic or abdominal conditions – e.g., hernias, gynecological disorders, or urological conditions.

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Symptoms

• Deep groin pain (suggests intra-articular pathology such as arthritis or AVN).

• Lateral hip pain (bursitis, tendinitis).

• Pain radiating to thigh/knee (common in hip arthritis).

• Stiffness, reduced range of motion.

• Swelling, warmth, or redness (infective/inflammatory causes).

• Acute inability to walk after trauma (fracture or dislocation).

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Diagnosis

• History & Examination – Onset, duration, activity correlation, systemic symptoms.

• Imaging

  • X-ray (first-line for suspected arthritis or fracture).

  • MRI (for soft tissue injuries, AVN, labral tears).

  • Ultrasound (to assess bursitis or effusion).

• Laboratory tests

  • Inflammatory markers (CRP, ESR) for arthritis or infection.

  • Joint aspiration in suspected septic arthritis or crystal arthropathy (gout, pseudogout).

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Management of Hip Pain

1. General Measures

• Rest and activity modification.

• Use of walking aids (cane, walker) if needed.

• Weight loss to reduce joint stress.

• Heat or cold therapy depending on cause.

• Physiotherapy to strengthen surrounding muscles.

2. Pharmacological Treatment

• Analgesics

  • Paracetamol (acetaminophen) – 500 mg to 1 g every 6–8 hours (max 4 g/day).

• NSAIDs

  • Ibuprofen 400–600 mg every 6–8 hours.

  • Naproxen 250–500 mg twice daily.

  • Diclofenac 50 mg 2–3 times daily.

• Topical NSAIDs for localized bursitis or strain.

• Opioids (short-term use only) – Tramadol or codeine for severe pain not relieved by NSAIDs.

• Corticosteroid injections – Intra-articular for arthritis or bursitis when conservative therapy fails.

• Disease-modifying antirheumatic drugs (DMARDs) – For rheumatoid arthritis (e.g., methotrexate).

• Antibiotics – For septic arthritis (choice depends on culture results).

3. Surgical Options

• Hip arthroscopy – For labral tears or cartilage damage.

• Core decompression – For avascular necrosis (early stage).

• Osteotomy – Realignment for structural abnormalities.

• Hip replacement (arthroplasty) – Definitive treatment for advanced arthritis or severe hip damage.

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Precautions

• Avoid long-term NSAID use in patients with renal impairment, hypertension, or GI ulcers.

• Prompt treatment is essential in septic arthritis to prevent joint destruction.

• Post-fracture patients need fall-prevention strategies and osteoporosis management.

• Consider bone density testing in elderly adults with recurrent hip issues.

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Drug Interactions

• NSAIDs + ACE inhibitors/ARBs → Increased risk of kidney injury.

• NSAIDs + anticoagulants (warfarin, DOACs) → Higher bleeding risk.

• Corticosteroids + NSAIDs → Increased GI ulceration risk.

• Methotrexate + NSAIDs → Risk of toxicity.

• Opioids + benzodiazepines/alcohol → Severe respiratory depression.