Greeting from the garden of England Kent. I am spending some time with my family as the ‘London Pain Clinic’ is closed due to the current Covid- 19 situation in Sri Lanka.
England has got things under control for the time being due to the extensive vaccination program and I think that is what Sri Lanka should do as well.
Hip joint is a ball and socket joint. This is made up of the upper end of the long bone femur and the acetabulum in the pelvis. It’s surrounded by ligaments muscle and fatty tissue.
Degeneration of the hip joint is common amongst the Caucasians. It is a lesser problem amongst the Sri Lankan’s. This could be due to the genetic variations and the life style in the two groups.
Squatting position helps the hip joint but not the knee joint. This may be a reason that we come across more issues with the knee joint and not many hip problems in Sri Lanka.
Pain in the hip can be due to many causes. It can be due to problems in the joint socket, ligaments, and muscles around the joint, pain from other areas which is radiated to the hip.
Main causes of hip pain
1 Osteoarthritis of the hip joint
2 Trochanteric bursitis -Caused by inflammation of the trochanteric bursar of the outer hip. Often affects both hip joints.
3 Fracture - A crack in the hip socket can occur mainly in the elderly with osteoporosis.
4 Malignancy-Cancer of the bone
5 Arthritis-Degeneration of the hip joint i.e. Rheumatoid arthritis, trauma.
6 Meralgia parasthetica - This is neuralgic condition with the lateral cutaneous nerve of the thigh. Causes pain in the outer aspect of the thigh.
7 Pagers disease - Genetic disorder with enlarged or deformed bones in the hip.
8 Septic arthritis - Infection of the hip joint. Rare condition. Mainly occur in immuno comprised patients.
9 Referred pain as in Sacro Iliac joint pain, Sciatica, Radiculopsthy.
Diagnosis
1 A good clinical examination of the hip joint
2 Blood test - ESR, CRP, Rheumatoid factor, WBC/DC
3 X ray of the hip joint - Single most useful test. Degeneration can be seen.
4 MRI and CT scans in rare cases
5 Bone density scans - To see any osteoporosis and risk of fracture
The commonest pain in the hip joint is due to osteoarthritis. Osteoarthritis is the commonest form of arthritis in our body. It affects the weight bearing joints. Mainly the knee joint followed by the hip.
X ray if a worn out right hip which needs a replacement
Osteoarthritis of the hip makes the cartilage in the hip joint go thinner. This makes surfaces of the hip joint rougher which leads to oedema and pain.
Patients do complain of pain specially whilst walking. A simple X ray of the pelvis will demonstrate the severity of the problem. If the joint is worn out badly a replacement of the hip joint is the solution. This is one of the commonest major joint replacements carried out in the United Kingdom. Less so in Sri Lanka due to many factors.
If patients who are not fit to have major surgery due to health issues or the patents who are reluctant to have hip joint replacement managing the pain becomes challenging.
An injection under X ray guidance can be carried out using Depomedrone. This will reduce the inflammation and reduce the pain. Patient may need to have the injection repeated.
Simple pain killers can be used for long term use.
In rare cases opiates are used as patches. I.e. Butrans or Fentanyl patches which are prescription only medication. Butrans is not available in Sri Lanka.
Radio frequency of the hip joint
Radio frequency of the nerves supplying the hip joint is one of the options available to treat the hip pain. I was inundated with referrals from orthopaedic surgeons in England to treat hip pain in patients who are not going to have hip replacements due to various reasons. .
Dr. NAMAL SENASINGHE
MBBS, FFARCS, Dip in pain med, FFPMCA, CCST (UK)
Consultant in Pain Medicine London Pain Clinic
31, Horton Place
Colombo 7
Sri Lanka
Hot line 0767155716 (SL)
[email protected]
GMC (U.K.) 4498708 (specialist registration)
SLMC (SL) registration 10475