Hip & Thigh

The hip & thigh play an integral role in the function of walking, sitting, standing and bending. It is one of the largest weight-bearing joints in the body. This ball-and-socket joint allows the leg to move and rotate while keeping the body stable and balanced. Florida Orthopaedic Institute’s hip & thigh specialists concentrate on restoring function, preventing and reducing pain in hip-related injuries or conditions.

Technologies and procedures for care and repair of the hip have evolved significantly in recent years, and the hip & thigh specialists at Florida Orthopaedic Institute are among only a handful in the world qualified to provide state-of-the-art therapies and surgery across the broad spectrum of hip treatments. From minimally invasive surgical techniques to total hip replacement, our team of board-certified surgeons diagnoses and treats patients with the right approach at the right time.

Our goal is to first explain to patients every available treatment option and then customize a treatment plan specific to the patient’s need. Factors we consider include the injury, activity goals, job requirements and recovery timeline. If conservative treatment options are not effective, we may offer patients the latest advancements in hip surgery, including total hip replacement.

Total hip replacement is a surgical procedure that removes the damaged cartilage from the hip joint and replaces it with an artificial implant. The goal is to replace the damaged parts of the hip joint, relieve a patient’s pain and get them back to living a normal, active life.

Minimally invasive hip surgery is performed through one or two small incisions, allowing patients to have typically less pain than with a traditional total hip replacement.

Total Hip Replacement with MAKO

For patients suffering from non-inflammatory or inflammatory degenerative joint disease of the hip, MAKO robotic-assisted surgery can be used for Total Hip Replacement.

MAKO technology provides surgeons with patient-specific 3-D models to pre-plan hip replacements. Surgeons guide the MAKO robotic arm during surgery, based on a patient-specific plan. MAKO technology helps with the removal of diseased bone, preserving healthy bone, and assists the surgeon in positioning the total hip implant based on the patient’s anatomy.

Thigh Muscle Strains

The thigh has three sets of strong muscles: the quadriceps muscles in the front, the hamstring muscles in the back of the thigh, and the adductor muscles on the inside. The quadriceps and hamstring muscles work together to straighten and bend the leg, while the adductor muscles pull the legs together. The hamstring and quadriceps muscles are particularly at risk for muscle strains because they cross both the hip and knee joints.

A muscle strain (also called a muscle pull or tear) is a common injury, when the fibers in a quadriceps muscles are overstretched. Once the fibers are overstretched to a certain point, muscle tears occur. These can vary from a minor strain to a full thickness muscle tear.

Hip Muscle Strains

When one of the muscles supporting the hip joint is stretched beyond its limit or is torn, it can cause a hip muscle strain or hip strain. Depending on the extent of the injury, they can be mild, moderate, or severe. Severe strains can limit your ability to move your hip.

Most strains occur during sports activities, but anyone can experience a hip strain just doing everyday tasks.

Many hip strains improve with simple home treatments – severe strains may require physical therapy or other medical treatment.

HAMSTRING INJURIES

The three powerful muscles (semitendinosus, semimembranosus, and biceps femoris) that travel along the back of your thigh are the hamstrings. They extend your leg behind your body and help bend your knee. When you strain or pull one of these muscles, it is a hamstring injury, also called a hamstring strain.

Because the hamstring muscles handle high loads of stress and are susceptible to stretching and tearing, hamstring strains are common among athletes who play sports that require sudden starts and stops.

You may be more likely to get a hamstring injury if you are a runner or dancer or play soccer, basketball, football, or tennis.

Iliopsoas Tenotomy

Iliopsoas tenotomy is surgery on the iliopsoas tendon in the hip to reduce pain and improve range of motion. This procedure is used on snapping hip syndrome, also known as dancer’s hip. In snapping hip syndrome, a snapping sensation is felt when the hip is extended and flexed. This sensation can be accompanied by pain or discomfort that starts around the front of the hips and radiates down your thighs to the knees. Some people experience stiffness and tightness in the mornings and have pain in their buttocks. Rest and reduced activity often decrease the pain.

Snapping hip syndrome is commonly classified by the snapping location as either extra-articular or intra-articular.

Open surgery and endoscopic release (a minimally invasive approach) are the two types of surgical release of the iliopsoas tendon.

Piriformis Syndrome

Piriformis syndrome is a condition in which the piriformis muscle in the buttocks irritates the sciatic nerve. It is fairly common, with more than 200,000 cases in the U.S. per year.

Symptoms include numbness, tingling, or pain in the buttocks and down the leg. These symptoms can worsen after sitting for a long time, climbing stairs, walking, or running.

Treatments include massage, stretching exercises, anti-inflammatory drugs, or surgery.

Groin Strains and Pulls

An injury or tear to any of the adductor muscles of the thigh (the muscles on the inner side of the thigh) is a groin strain or pull.

Sudden movements such as kicking, twisting to change direction while running, or jumping usually trigger a groin strain, making athletes more at risk for this injury.

A severe strain may take a long time to recover from, but most groin strains aren’t usually serious.

Pelvic Ring Fractures

Located at the base of the spine, the pelvis is the sturdy ring of bones near to major blood vessels and organs. It is an anchor for the hip, thigh, and abdomen muscles. the pelvic ring protects blood vessels, nerves, and portions of the bowel, bladder, and reproductive organs from injury. Because its location, pelvic fractures can cause extensive bleeding and other injuries requiring urgent treatment.

The majority of pelvic fractures are caused by traumatic, high-energy events, such as car collisions. For high-energy pelvic fractures, surgery is used to reconstruct the pelvis and restore stability to the pelvic region.

Lower-impact events, such as minor falls, may not cause a pelvic fracture. Depending on the severity of the injury, lower-energy pelvic fractures can often be managed with proper care.

Thigh Fractures

The thighbone (femur) is located directly below your hip and, due to its length and strength, is difficult to fracture or break. It typically takes a high impact accident to break the thighbone (also known as a Femoral Shaft Fracture.)

Osteoporosis

Osteoporosis is a condition in which bones become weak and brittle. It is very common, with more than 3 million US cases per year. In the U.S., 1 in 2 women and 1 in 4 men over the age of 50 will break a bone because of osteoporosis-caused bone weakness.

The body constantly absorbs and replaces bone tissue. With osteoporosis, new bone creation doesn’t keep up with old bone removal. Treatment can help, but Osteoporosis can’t be cured. Many people have no symptoms until they have a bone fracture.

Avascular Necrosis (Osteonecrosis) of the Hip

Osteonecrosis is when the hip bone tissue dies due to a lack of blood supply. Also known as Avascular Necrosis, it is often associated with injuries, long-term steroid use and drinking too much alcohol.

Early stages may be symptom-free but people can experience pain in the hip, buttocks, groin, knee, or thigh. Eventually the affected joint can hurt when weight is put on it or when lying down. It is also common for patients to collapse or limp.Treatment can help, but the condition can’t be cured.

Hip Arthroscopy

Hip arthroscopy allows doctors to view the hip joint without making a large cut through the skin and other soft tissues. This surgical procedure is used to diagnose and treat a wide range of hip problems and the surrounding soft tissues.

A small camera, called an arthroscope, is inserted into the hip joint displaying images on a video monitor. Your surgeon uses these images to guide miniature surgical instruments.

Both the arthroscope and surgical instruments are small so very small incisions are used, rather than the larger incisions needed for open surgery. This minimally invasive approach results in less pain for patients, less joint stiffness, and often shortens the time it takes to recover and return to favorite activities.

HIP POINTERS AND TROCHANTERIC BURSITIS

A hip pointer is a deep bruise to the iliac crest (the ridge of bone on the upper outside of your hip). Hip pointers are usually caused by a sudden impact (a direct blow or a hard fall) that is hard enough to bruise your iliac crest or greater trochanter or cause damage to the soft tissue of your hip.

Pain and tenderness are the typical hip pointer symptoms.

Trochanteric bursitis is an irritation or swelling of the trochanteric bursa. This small, fluid-filled sac on the outer side of the femur acts as a cushion for the iliotibial band (the thick tendon in your leg). Trochanteric bursitis is fairly common, with over 200,000 cases per year in the U.S.

Symptoms include pain on the outside of the hip that worsens when standing, walking, or running. Trochanteric bursitis can affect the hip’s outer area or the outer part of the upper leg, along the thigh from the hip to the knee.

Hip Dislocation

A hip dislocation is an injury in which the hip bone is displaced from its normal position. Hip dislocations are rare, with fewer than 200,000 cases in the US per year, and are most often the result of severe trauma.

Motor vehicle accidents are a common cause of hip dislocation, but other common causes include falls from a height and catastrophic sports injuries. The condition may occur as a result of congenital looseness in the joint in infants.

Hip Fractures

A hip fracture is a break in the upper quarter of the thighbone, near the hip joint. Hip fractures are common, with more than 200,000 cases in the United States every year.

In some, they can cause life-threatening complications. People over age 65 are most at risk because bones weaken and the risk of falling increases with age. Maintaining bone density and avoiding falls help prevent hip fractures.

Symptoms include severe hip or groin pain and the inability to move after a fall. Hip fractures almost always requires surgery and physical therapy.

Hip Hemiarthroplasty

Generally used to treat a fractured hip, a hip hemiarthroplasty is a surgical procedure that replaces half of the hip joint. Arthroplasty refers to “joint replacement” and hemi refers to “half.”

The head of a damaged thigh bone (femur) is replaced with an implant designed to stabilize the femur and restore hip function. Only the ball is replaced in this procedure unlike total hip replacement in which both the ball of the femur and the hip socket are replaced.

Labral Tears Of The Hip (ACETABULAR LABRUM TEARS)

A labral tear of the hip is an injury of the hip labrum, located in the pelvic bone. The hip labrum is a tough, crescent-shaped cartilage structure lining the rim of the hip socket (called the acetabulum).

Also known as the acetabular labrum, the hip labrum should not be confused with the labrum of the shoulder (called the glenoid labrum).

Besides cushioning the hip joint, the labrum acts like a gasket to help hold the ball at the top of the thighbone securely within the hip socket.

The hip labrum can become torn or even detached from the acetabular socket for a variety of reasons, such as repetitive motions, traumatic injuries, sudden impact on the hips, and other conditions of the hip that are especially susceptible to labral tears.

Osteoarthritis of the Hip

Osteoarthritis of the hip, also called degenerative arthritis, is a gradual breakdown of hip joint cartilage – the tough, flexible connective tissue that protects the ends of bones in the joints. Bony growths called “bone spurs” can also form in the joint. This type of arthritis is also called degenerative joint disease.

Osteoarthritis is common in the hip because the hip bears the weight of the body. Pain from osteoarthritis can keep you from being as active as you like.

TOTAL HIP REPLACEMENT – ANTERIOR APPROACH

Total hip replacement with an anterior approach is a surgery done from the front of the hip. They are also called mini, modified, minimally invasive, or muscle-sparing operations.

Anterior hip replacement surgery offers several advantages, including less damage to major muscles, less post-operative pain, faster recovery, and fewer post-surgical precautions.

While anterior hip replacement may offer some advantages, there are also potential limitations or disadvantages.

If you are considering hip replacement surgery, speak with a Florida Orthopaedic Institute surgeon about the potential advantages and disadvantages in the context of your specific circumstances, such as the type of hip arthritis, anatomy, overall health, and lifestyle.

HIP FLEXOR STRAINS

Hip flexor strains typically cause pain in front of the hips with lifting the leg, sprinting, kicking, changing directions, with your leg straight behind you, or simply sitting for a while.

A muscle strain is also called a pulled muscle and occurs from microscopic tears within the muscle tissue. This usually happens from overstretching or when the demand imposed on the muscle is greater than its capacity.

Most hip flexor strains can be managed with gentle exercises and home remedies. Typically, only the severest cases require surgery.

HIP IMPINGEMENT LABRAL TEARS

The labrum is ring of cartilage on the outside rim of your hip joint socket. It cushions the hip joint and helps hold the ball at the top of your thighbone securely within your hip socket.

Trauma (from car accidents or from playing contact sports), congenital abnormalities (hip birth defects can accelerate wear and tear of the joint and cause a hip labral tear), and repetitive motions (from sports such as football, ice hockey, soccer, golf, and ballet) can lead to a hip labral tear.

NEXT STEPS

Talk to your Florida Orthopaedic Institute physician today to learn more about hip and thigh injuries and treatment options.