Osteoarthritis and bursitis are two musculoskeletal conditions that can afflict the hips. Hip osteoarthritis is a degenerative condition affecting the joints of the hips, while hip bursitis is an inflammation of the bursa at the lateral point of the greater trochanter (the bony point on the side of the body that we normally associate with the hip). Treatment for osteoarthritis of the hip and treatment for bursitis of hip should be undertaken with the assistance of a trained health professional.
The hip is a ball-and-socket joint, a joint in which the rounded surface of one bone is inserted into the hole of another. This structure is what gives the pelvis so much of its stability, because the femoral head (the uppermost part of the femur, or thigh bone) is held in place by the pelvic acetabulum, a large rounded depression. However, the hip also maintains a surprising amount of flexibility in the frontal (abduction / adduction), sagittal (flexion), and transverse (rotation) planes of motion.
The acetabulum is a convergence of the ilium, ischium, and pubis bones of the pelvis. Where the acetabulum meets the head of the femur, the joint of the hip emerges. Collectively, these bones comprise what is commonly known as “the hip bone.” The articular surface of the cartilage in the acetabulum possesses a thick rim along its edges that deepens the depression and lends support without sacrificing flexibility. This cartilage also allows the tissues to rub against one another without causing injury.
Also assisting in the lessening of friction are small sacs called bursae that are found throughout the body wherever joints are located. The bursae of the shoulders, hips, knees, and elbows contain a special lubricating fluid that moisturizes the joint area and cushions bones and soft tissues. In the hips there are two prominent bursae: the trochanteric bursa on the bony point of the hip, and the iliopsoas bursa on the inside (groin side) of the hip. (If the iliopsoas bursa becomes inflamed, the patient will experience pain in the groin area). Other bursae include the gluteus medius bursa, a smaller bursa lying in between the gluteus medius muscle and the greater trochanter, and the ischial bursa that lies between the base of the pelvis and the hamstring tendons.
The most common cause of musculoskeletal pain, osteoarthritis is a progressive disease that affects over 15 percent of the world’s population. Characterized by pain in the joints, hip osteoarthritis results from degeneration of the articular cartilage in the hips. This, in turn, causes a thickening of the bone beneath the cartilage, the formation of bony outgrowths known as osteophytes, and synovial inflammation.
The primary initiating causes of osteoarthritis are not well understood, but what is clear is that some people are at greater risk for developing hip osteoarthritis than others. Risk factors for osteoarthritis of the hip include joint misalignment, trauma, old age, obesity, continual lifting or moving of heavy objects, and sports that place tremendous pressure on the lower half of the body (for example, professional running).
Bursitis is a condition in which the bursae become swollen and inflamed. Hip bursitis commonly afflicts the ischial, iliopsoas, and greater trochanteric bursae. Generally these bursae are injured either as a result of inflammation due to excessive friction or post-traumatic injury. Direct blows can cause bleeding into the bursae, resulting in the formation of hematoma.
The iliopsoas bursa is the largest bursa in the body. Athletes engaged in sports that require constant and repetitive use of the hip flexors, such as soccer and ballet, are especially prone to iliopsoas bursitis.
Athletes may experience severe groin pain that radiates to the front of the hip or thigh, necessitating groin pain treatment. The pain may become so great that it disrupts the patient’s gait, rendering walking difficult and causing a limp. Motion is sometimes accompanied by a loud snapping sound.
For those suffering from greater trochanteric bursitis, pain is usually felt posterior to the greater trochanter. Additionally, it will often radiate into the lateral buttock. Risk factors for developing greater trochanteric bursitis include a broad pelvis, leg-length discrepancy, and excessive pronation (inward turning) of the foot. Symptoms may include pain when running, climbing stairs, or standing for long periods. Pain may be exacerbated by rotation, adduction, and abduction of the hip.
Ischial bursitis may occur as a result of a direct blow to the ischial tuberosity or as a complication from an adjacent hamstring injury. Athletes with ischial bursitis will feel pain while sitting and tenderness during physical examination.
Physicians rely on both clinical and radiographic findings to diagnose osteoarthritis accurately. Imaging techniques that reveal evidence of joint degeneration are more effective in diagnosis than clinical criteria by itself. Historically, osteoarthritis has been diagnosed using radiographic evidence of cysts and osteophytes, although more recently the primary determining factor has been joint space width, which is a reliable predictor of the thickness of cartilage. Studies have found that joint space width that is less than or equal to two millimeters was closely associated with hip pain in over 3,000 elderly patients. Another recent study has indicated that cartilage space narrowing is the most reliable indicator of hip osteoarthritis.
Prior to prescribing hip osteoarthritis treatment, a physician will inquire about the patient’s physical symptoms. Generalized hip pain and pain in the thigh or groin may indicate osteoarthritis. So also may impaired gait, decreased range of motion, and pain during leg rotation. In the earliest stages of the condition patients may experience pain only intermittently and when the joints are in use; however, as it progresses they will feel pain and stiffness even when at rest. In the most advanced stages some victims will develop crepitus, a continual creaking that may require snapping hip treatment.
The main goal of hip and groin pain treatment is to reduce pain and impairment, improving mobility and preventing the need for surgical treatment. The best treatment for osteoarthritis of the hip combines both pharmocologic and non-pharmocologic modalities.
Non-pharmocologic treatments include exercise, physical therapy, and weight reduction for the overweight or obese. A consistent regimen of strengthening and aerobic exercises has been shown to reduce pain and improve function in patients suffering from hip osteoarthritis. Recent studies have indicated that the improvement in muscle strength gained from an exercise program may slow the progression of osteoarthritis. In particular, hydrotherapy (water-based physical therapy) and strength training have all proven demonstrably effective in treating patients with hip problems. Both high-intensity and low-intensity aerobic exercise are equally beneficial to gait and functional status. For best results, patients should begin with a low-intensity exercise program and gradually progress to one with a higher intensity.
Assistive devices are also recommended for patients for patients with osteoarthritis of the hip. These may include canes to improve balance when walking and insoles that limit the advance of disease by reducing the pressures exerted on the hip joint.
Pharmologic hip and groin pain treatments include acetaminophen, non-steroidal anti-inflammatory medications (NSAIDs), and analgesics. When tested against placebos, acetaminophen has been shown to significantly reduce pain and improve function in patients. NSAIDs may be substituted in the lowest possible doses for patients who don’t respond well to acetaminophen. Several trials have shown that NSAIDs effectively relieve pain in the knees and hips. However, they are sometimes accompanied by unfortunate gastrointestinal side effects.
In the majority of cases, bursitis of the hip can be treated with conventional, non-surgical treatments. NSAIDs will help to control local inflammation in patients with greater trochanteric and ischial bursitis. Ice massages, heat, physical therapy, and steroid injections have also proven effective.
The New York DNR provides some of the best treatment for hip bursitis and hip osteoarthritis in New York City. We use biofeedback motor control training to treat injuries and conditions of the knees, legs, and hips. Making use of real-time force-plate analysis, motor control training has proven effective in treating injuries incurred in high-intensity recreational activities like uphill running, figure skating, and ballet. We also employ extracorporeal shockwave therapy (ESWT), a low-intensity shockwave treatment that uses pressure waves to get blood circulating and trigger the body’s own self-healing mechanisms. Finally, Computer-Assisted Rehabilitative Environment is a fully immersive environment that uses both virtual reality and feedback training to correct abnormalities in the gait cycle and restore walking and weight-bearing.