Referred pain from back and pelvis to the hip — such as lumbar radiculopathy, pelvic diseases, ovarian problems, and hernias — can mimic primary hip pathology.
Primary Tissue Disorders
- Bone – AVN, bone marrow edema, tumors, infections, fractures
- Cartilage – skeletal dysplasias, chondropathy
- Synovium – synovitis, rheumatological diseases
- Neuromuscular – muscular dystrophy, myopathy, neuropathy
Mechanical Hip Pain
Morphological variations of the femur and acetabulum can cause pain with movements. Morphology and mechanics often go together. Most morphological variations are well compensated and do not cause any problem until one of the following essential requirements of good hip function are affected.
- Good articular cartilage surface – osteochondral defects, foveal loading, loose bodies
- Stable femoral head – acetabular dysplasia, coxa valga, version changes, impingement-induced instability
- Impingement-free motion – coxa vara, breva, plana, magna, aspherical head, protrusio, retroversion, overgrown GT, LT, AIIS
- Adequate motor control – coxa vara, breva, version problems, snapping over bone prominence, strains secondary to hip stiffness
Almost all morphological variations are visible on plain x-rays. Clinical examination is often adequate to understand their role in causing pain. CT, MRI, and diagnostic injections can be used when necessary.
Activity modification decreases mechanical pain. The goal of elective surgical treatment is to relieve pain and improve function by correcting the likely causes. Labral tears are secondary to dysplasia and impingement and are addressed as needed.