Chronic hip pain in adults: Current knowledge and future prospective

Abstract

Chronic hip pain is distressing to the patient as it not only impairs the daily activities of life but also affects the quality of life. Chronic hip pain is difficult to diagnose as patients often present with associated chronic lumbar spine and/or knee joint pain. Moreover, nonorthopaedic causes may also present as chronic hip pain. The accurate diagnosis of chronic hip pain starts with a detailed history of the patient and thorough knowledge of anatomy of the hip joint. Various physical tests are performed to look for the causes of hip pain and investigations to confirm the diagnosis. Management of chronic hip pain should be mechanistic-based multimodal therapy targeting the pain pathway. This narrative review will describe relevant anatomy, causes, assessment, investigation, and management of chronic hip pain. The focus will be on current evidence-based management of hip osteoarthritis, greater trochanteric pain syndrome, meralgia paresthetica, and piriformis syndrome. Recently, there is emphasis on the role of ultrasound in interventional pain procedures. The use of fluoroscopic-guided radiofrequency in periarticular branches of hip joint has reported to provide pain relief of up to 36 months. However, the current evidence for use of platelet-rich plasma in chronic hip osteoarthritis pain is inconclusive. Further research is required in the management of chronic hip pain regarding comparison of fluoroscopic- and ultrasound-guided procedures, role of platelet-rich plasma, and radiofrequency procedures with long-term follow-up of patients.

Radiofrequency Ablation of the Trochanteric Branches of the Femoral Nerve for the Treatment of Greater Trochanteric Syndrome

“… 2 , 3 Not only is this pain debilitating, often impairing an individual’s ability to sit and stand, but it often becomes chronic, increasing in incidence with increasing age. 4 The high prevalence of chronic hip pain might be partially explained by the difficulty clinicians experience in diagnosing the pain. The hip joint is innervated by articular branches of the obturator, femoral, superior gluteal, and sciatic nerves, which complicates the diagnosis of hip pain, as pain is often referred to the hip via these nerves.…”

“…GTPS encompasses several disorders of the lateral, peritrochanteric space of the hip, including tears of the gluteus medius and minimus, external coxa saltans tears, and trochanteric bursitis. 4 Like generalized hip pain, GTPS is relatively common and has a broad differential diagnosis. 4 , 9 , 10 A multicenter observational study conducted by Segal et al estimated the prevalence of unilateral and bilateral GTPS to be 15% and 8% in women and 6.6% and 1.9% in men ages 50–79, respectively.…”

“… 4 Like generalized hip pain, GTPS is relatively common and has a broad differential diagnosis. 4 , 9 , 10 A multicenter observational study conducted by Segal et al estimated the prevalence of unilateral and bilateral GTPS to be 15% and 8% in women and 6.6% and 1.9% in men ages 50–79, respectively. 11 Many patients who present with GTPS will continue to experience chronic pain following both conservative and surgical intervention.…”

“… 11 Many patients who present with GTPS will continue to experience chronic pain following both conservative and surgical intervention. 4 Given the complexity of hip joint pathology, which commonly results in groin and thigh pain, it is often difficult to manage the pain of patients who suffer from GTPS.…”

Comparación de resultados quirúrgicos de artroscopías realizadas en pacientes con pinzamiento femoroacetabular tipo cam.

“…El dolor crónico de cadera es un síntoma que modifica la funcionalidad y la calidad de vida de las personas, por lo que inevitablemente genera algún grado de alteración en cualquier nivel de actividad, una de las principales causas de dolor en la articulación coxofemoral en las personas adultas jóvenes es el síndrome de pinzamiento femoroacetabular o FAIS por sus siglas en inglés, el cual puede progresar hasta generar coxartrosis, convirtiéndose en la causa principal de la osteoartritis (OA) de cadera1-3. De hecho, las mujeres se ven afectadas doblemente por la osteoartrosis respecto a los hombres (4).…”