Helping You with Your Hip Pain
If you have hip pain, Mr Dan Arvinte can help you live a less painful life and is available for private consultations at two locations in Bedford.
As part of a complete and personalised treatment plan, Mr Arvinte is able to offer joint injections, hip
replacement surgery and revision hip replacement surgery.
In this article, Consultant Trauma and Orthopaedic Surgeon, Mr Arvinte explains the causes of hip pain and some proven approaches to reducing discomfort.
Written By Mr Dan Arvinte
Consultant Trauma and Orthopaedic Surgeon based in Bedford, UK
Phone: 01234 792 203
Hip pain can be caused either by a problem around the hip itself, or by a problem with another joint or a different part of the body, known as “referred pain”.
The pain given by the hip joint usually manifests itself as groin pain, but sometimes it can give pain around the buttock and lateral side of the hip too. It is not uncommon for hip pathology to cause knee pain too.
Taking a proper history, together with a thorough clinical examination, will determine the cause of the pain in more than 90% of cases. To support the clinical diagnosis, imaging investigations such as an X-ray, MRI, CT
or ultrasound (or a combination of these) may be necessary.
What problems around the hips can cause pain where you have no history of injuries?
- Inflammation of tendons or other soft tissues - tendinitis, tendinosis, bursitis
- Osteoarthritis - wear and tear of the cartilage stuck to the bones (articular cartilage); it can also be associated with meniscus tears (meniscus is the cartilage between the bones, which acts like a shock absorber
when walking or doing physical activities)
- Inflammatory arthritis such as rheumatoid arthritis, ankylosing spondylitis, gout and pseudogout, lupus, psoriatic arthritis
- Rare causes including infections, tumours, osteonecrosis (lack of adequate bone supply, for various reasons, leading to dead bone)
In the presence of injury, the hip can suffer fractures or damage to the ligaments, cartilage or tendons. These scenarios are usually treated in acute or subacute settings (such as an Emergency Department).
What problems around other joints or parts of the body can cause hip pain where you have no history of injuries?
- Spine osteoarthritis - usually associated with sciatic or femoral nerve type symptoms
- Sacro-iliac joint (joint connecting the spine with the pelvic bone) pathology
- Inguinal or femoral hernia
- Pinched nerve around the front of the hip - meralgia paresthetica
- Pinched nerve around the buttock area (deep gluteal pain syndrome)
So what can be done to help you?
Before any treatment begins, a correct diagnosis is crucial. For example, the last thing you want is to have major hip surgery and return later with the same sort of pain you had before surgery because the real cause of the pain was in fact your back,
or an inguinal hernia. Mr Dan Arvinte will see you, listen to you and conduct a comprehensive physical examination, with the goal of reaching an accurate diagnosis.
It is sometimes not easy to differentiate and identify the real source of pain. In this scenario, an injection with local anaesthetic into the hip joint will tell how much the hip is contributing to your pain - and what pain relief to expect if you proceed
with major surgery such as hip replacement. Mr Arvinte will guide you through all the treatment options and help you reach an informed decision.
Treatment should usually begin with the least aggressive path, unless there is strong evidence of severe cartilage damage, associated with severe pain. Consideration of weight loss, physiotherapy, pain killers and anti-inflammatory medication should be the first stage of treatment. Mr Arvinte has a close working relationship with a dedicated physiotherapy team.
Next, we can try intra-articular injections, but these often help only for a limited amount of time, depending on the severity of cartilage damage. Mr Dan Arvinte always performs intra-articular hip injections in strictly aseptic operating theatre environments,
guided by X-rays and adhering to aseptic precautions. He uses corticosteroid, long-acting local anaesthetic or hyaluronic acid (joint lubricant).
Total hip replacement surgery
If these treatments cannot control your pain, or the pain significantly interferes with your daily activities, or is preventing you from sleeping properly, then surgery (PDF document will open) may be required.
Before suggesting major surgery, such as a hip replacement, it is essential to corroborate the clinical findings, carefully considering these alongside the severity of pain and imaging from scans. It is true, however, that
severe osteoarthritis (severe cartilage damage) can be cured only by replacing the joint. Mr Arvinte will explain to
you in detail about this major type of surgical treatment. He is very experienced in hip replacement procedures and has excellent results in the UK National Joint Registry.
After the operation you will be assessed by a multi-disciplinary team including a physiotherapist, occupational therapist and doctor. This is to make sure your pain is under control, that you start mobilisation promptly and that everything at home is
adapted, to make your recovery as smooth as possible - and to ensure you get the full benefit from your surgery. Details of steps in rehabilitation after hip replacement surgery
can be found here.
Hip arthroscopy (keyhole surgery) is an area in which progress continues to be made. To date, the procedure has shown benefits only with particular patient selections and indications: younger patients with pain and limited hip movement caused by intra-
or extra-articular problems (labral tear- impingement syndrome, intra-articular loose bodies, tendon inflammations associated with mechanical symptoms), without signs of advanced arthritis and who have previously tried
other, non-surgical treatments. More information on this type of surgery can be found on the NICE website. Mr Dan Arvinte does not perform hip arthroscopy but, if Mr Arvinte recommends this procedure he will refer you to one of his colleagues with whom he works very closely.
Revision (re-do) hip replacements
Patients with previously replaced joints can also complain of pain. The situation is usually more complex than in the case of a native joint and has to be assessed by a specialist trained in revision (re-do) surgery, as Mr Dan Arvinte is. There are multiple
reasons why a replaced hip can become painful: infection, instability, impingement of soft tissues around the hip, peri-prosthetic fracture, aseptic loosening.
In these situations, a proper history and thorough clinical examination, alongside well-chosen imaging, can shed more light on a diagnosis - and exclude problems associated with another joint or a different part of the
body. Revision (re-do) surgery may be necessary. Revision hip replacement is bigger surgery than primary hip replacement and is associated with higher risks and less predictable results. Mr Arvinte will take you through
all the steps involved and will guide you through the decision-making process. The American Academy of Orthopaedic Surgeons provides a
useful guide to revision (re-do) surgery.