Hip Pain in Birmingham
Causes, symptoms, and when to see a hip specialist.
Mr Shakir Hussain, Consultant Hip Surgeon at the Royal Orthopaedic Hospital Birmingham, provides expert assessment and treatment for adults with persistent hip pain across Birmingham and the West Midlands.
What is causing my hip pain?
Hip pain in adults has five common explanations: hip osteoarthritis, femoroacetabular impingement (FAI), acetabular labral tears, trochanteric bursitis or gluteal tendon disease, and referred pain from the lumbar spine. The location of the pain, the activities that provoke it, and whether mechanical symptoms (clicking, locking, giving way) are present help identify which structure is involved.
The hip is a deep ball-and-socket joint formed by the head of the femur (the top of the thigh bone) and the acetabular socket of the pelvis. It is surrounded by a thick capsule, powerful muscles, large bursae, and overlapping nerve supply from the lumbar spine. Pain in or around the hip can therefore arise from the joint itself, the soft tissues around it, or from a more distant source such as the lower back.
Identifying the right cause matters because the treatments differ. Hip osteoarthritis eventually requires joint replacement; impingement and labral problems sometimes need surgical management of the structural cause; bursitis usually settles with targeted physiotherapy and occasionally an injection; and referred lumbar pain is treated at the spine, not the hip. A careful clinical assessment combined with a standing pelvic X-ray identifies the source in the majority of cases.
Where the pain is felt is the single most useful clue. Pain felt deep in the groin, sometimes radiating to the front of the thigh or knee, almost always comes from the hip joint itself. Pain on the outer point of the hip is usually trochanteric bursitis or gluteal tendon disease. Pain in the buttock that radiates down the back of the leg below the knee is typically lumbar spine in origin.
What does your hip pain feel like?
The pattern of hip pain points strongly to the cause. Deep groin pain that worsens on walking and climbing stairs suggests hip arthritis. Sharp groin pain on twisting or deep flexion suggests impingement or a labral tear. Pain on the outer hip that is worse lying on that side suggests trochanteric bursitis. Pain that wakes you at night signals significant joint damage and warrants specialist assessment.
The patterns below are the ones that come up most often in clinic. They are not diagnostic on their own, but they help direct examination and imaging.
Deep groin pain on walking
The most reliable indicator of true hip joint pathology. Worse on getting up from a chair, walking on uneven ground, and climbing stairs. May radiate to the front of the thigh, sometimes as far as the knee. Most common cause in adults over 50 is hip arthritis.
Sharp pain on twisting or pivoting
Pain provoked by getting in and out of a car, golf swings, or activities that take the hip into deep flexion and rotation. Often associated with clicking or catching sensations. Typical of hip impingement (FAI) and acetabular labral tears.
Pain on the outer point of the hip
Tenderness over the greater trochanter, worse lying on that side at night, made worse by walking and climbing stairs. Most often trochanteric bursitis or gluteal tendinopathy. Usually responds well to physiotherapy and occasionally a guided injection; surgery is rarely required.
Hip pain that wakes you at night
One of the strongest indicators of significant joint damage. Inflammation accumulates at rest and lying on the affected side compresses the inflamed structures. Common in advanced hip arthritis, late-stage labral tears, and avascular necrosis.
Stiffness in the morning
Morning stiffness lasting less than 30 minutes is typical of osteoarthritis. Stiffness lasting more than an hour, particularly in someone under 50, raises suspicion of inflammatory arthritis such as rheumatoid arthritis or ankylosing spondylitis.
Buttock pain radiating down the leg
Pain centred in the buttock that travels down the back of the leg below the knee is usually referred from the lumbar spine, not from the hip joint. True hip pain rarely radiates below the knee. This pattern needs assessment of the lower back, not the hip.
When should I see a specialist about hip pain?
Hip pain that disturbs your sleep, causes a limp, limits how far you can walk, or has not improved after six weeks of rest, physiotherapy, and anti-inflammatory medication should be assessed by a hip specialist. Sudden severe hip pain after a fall, hip pain with fever, or inability to bear weight on the leg needs urgent assessment in A&E, not a routine outpatient consultation.
Urgent (A&E) red flags
- Sudden severe hip pain after a fall or trauma, particularly in an older patient, may indicate a hip fracture and requires urgent X-ray.
- Inability to bear weight on the leg, or a leg that appears shortened and externally rotated, suggests a fracture or dislocation.
- Hip pain with fever, sweats, or feeling generally unwell may indicate joint infection (septic arthritis), which is a surgical emergency.
- Sudden numbness or weakness in the leg, particularly with loss of bladder or bowel control, requires immediate assessment for a spinal cause.
- Severe pain in a patient on long-term steroids, with sickle cell disease, or after recent chemotherapy can indicate avascular necrosis and needs prompt imaging.
Outside of these urgent situations, hip pain can usually be assessed in an unhurried outpatient consultation. The right time to book a specialist appointment is when the pain is changing your daily life, your sleep, or your ability to do the things you value, and conservative measures have not helped over a reasonable period.
Reasons to book a specialist hip consultation include: pain that has been present for more than six weeks; pain that wakes you at night or stops you sleeping on one side; a developing limp; difficulty putting on socks and shoes; difficulty getting in and out of a car; pain that is reducing the distance you can walk; or a previous diagnosis of arthritis, dysplasia, or impingement that is now getting worse.
Common causes of hip pain in adults
The conditions below account for the great majority of persistent hip pain in adults. Each is covered in more detail on its own page, with symptoms, diagnosis, conservative treatment, and the point at which hip replacement surgery in Birmingham or hip resurfacing becomes the right step.
Hip osteoarthritis
The most common cause of persistent hip pain over 50. Cartilage in the joint wears down over years, causing deep groin pain on walking, morning stiffness, and a gradual loss of rotation. End-stage arthritis is treated with hip replacement.
Hip arthritis: symptoms, causes, and treatmentFemoroacetabular impingement (FAI)
Extra bone forms on the femoral head or socket rim, pinching the labrum and cartilage with hip flexion and rotation. Typical in young active adults. Causes sharp groin pain on deep squatting, twisting, and prolonged sitting.
Hip impingement (FAI): assessment and treatmentAcetabular labral tear
The fibrocartilage ring around the socket tears, causing groin pain, clicking, and reduced internal rotation. Almost always associated with FAI or hip dysplasia. Long-standing tears accelerate hip arthritis.
Hip labral tear: symptoms, diagnosis, and treatmentTrochanteric bursitis & gluteal tendinopathy
Inflammation of the bursa over the bony point of the hip, often with degeneration of the gluteus medius tendon. Causes outer hip pain, worse lying on that side. Usually settles with targeted physiotherapy.
Soft-tissue hip pain often coexists with arthritis: read the arthritis pageAvascular necrosis (AVN)
The blood supply to the femoral head is interrupted, leading to bone death and joint collapse. Linked to steroid use, alcohol, sickle cell disease, and previous trauma. Often progresses quickly and requires hip replacement.
Hip avascular necrosis: diagnosis and surgical treatmentAdult hip dysplasia
The acetabular socket is too shallow to cover the femoral head, causing increased contact stress, labral tears, and early-onset hip arthritis. Often presents as groin pain in active adults in their 20s to 40s.
Adult hip dysplasia: symptoms, causes, and treatmentPost-traumatic hip arthritis
Hip pain following an old acetabular fracture, dislocation, or femoral head injury. The damaged joint surface wears prematurely, often becoming symptomatic 10 to 20 years after the original injury.
Post-traumatic hip arthritis: assessment and treatmentInflammatory and infective causes
Rheumatoid arthritis, ankylosing spondylitis, and joint infection (septic arthritis) can all cause hip pain. Suggested by morning stiffness lasting over an hour, multi-joint involvement, fevers, or unexplained weight loss.
Rheumatoid arthritis of the hip: treatment optionsWhat to expect at your hip consultation
A first hip consultation usually takes 30 to 45 minutes. It combines a focused history (pain pattern, activities affected, prior treatment), a clinical examination (gait, range of motion, specific tests for impingement and bursitis), and same-visit imaging where required. Most patients leave the consultation with a clear diagnosis and a written treatment plan.
History. Mr Hussain will ask about the character and location of the pain, what makes it better or worse, how it affects walking distance, stairs, sleep, and your ability to do the things you value. Previous physiotherapy, injections, scans, and any family history of joint problems are all relevant.
Examination. Standing alignment and gait are observed. Hip range of motion is measured in flexion, abduction, and rotation. Specific tests such as the FADIR test (for impingement and labral pathology) and the Trendelenburg test (for gluteal weakness) help identify the source. The lumbar spine is examined briefly when referred pain is suspected.
Imaging. A standing pelvic X-ray is the single most useful investigation for hip pain in adults. It shows joint space loss in arthritis, structural abnormalities in dysplasia and impingement, and bony changes in AVN. MRI is reserved for cases where soft-tissue pathology is suspected, such as labral tears, gluteal tendon tears, or early AVN. Mr Hussain organises imaging at the time of consultation where required, with reports available within 24 to 48 hours.
Treatment plan. The vast majority of patients seen for hip pain do not require surgery. A typical plan covers activity modification, physiotherapy referral, weight management where relevant, anti-inflammatory medication, and, where appropriate, a guided joint or bursal injection. Surgical options are discussed openly when joint damage has reached the point where conservative measures are no longer sufficient.
How is hip pain treated?
First-line treatment for almost all causes of hip pain is non-surgical: weight optimisation, physiotherapy, low-impact exercise, and short courses of anti-inflammatory medication. Surgery is reserved for end-stage joint damage and selected structural problems. The two definitive surgical options for hip joint damage are total hip replacement and, in carefully selected younger active patients, hip resurfacing.
Conservative measures are the right starting point for almost everyone. They include physiotherapy focused on hip abductor and core strength, weight loss where relevant (every kilogram lost reduces hip joint loading by roughly four kilograms during walking), low-impact aerobic exercise such as swimming or cycling, short courses of paracetamol and anti-inflammatory medication where safe, and occasionally a guided steroid injection into the joint or bursa. Around 60 to 70 per cent of patients with early-to-moderate hip pain improve significantly with structured conservative treatment.
Surgery becomes the right step when joint damage is structural and no longer responds to conservative measures. The two definitive surgical treatments for the worn or damaged hip are described below.
Total Hip Replacement
The damaged ball and socket are replaced with a metal stem, ceramic head, and highly cross-linked polyethylene liner. The most reliable operation in orthopaedics, with implant survival over 95 per cent at 15 years in the UK NJR.
- Suitable for most adults with end-stage hip arthritis
- Most patients walk with crutches within 24 hours
- Return to driving at four to six weeks
- Full recovery six to twelve months
Hip Resurfacing
The femoral head is preserved and capped with a ceramic-coated surface rather than removed. Bone-conserving, preserves natural hip biomechanics, and supports higher-impact activities than conventional replacement.
- Suitable for younger active patients with good bone stock
- Preserves the femoral head and hip biomechanics
- Supports return to running, racquet sports, and skiing
- Mr Hussain trained at the international reference centre, ENDO-Klinik Hamburg
Expert hip pain assessment in Birmingham
Consultant at the Royal Orthopaedic Hospital
Mr Hussain practises at the Royal Orthopaedic Hospital Birmingham, one of the largest specialist orthopaedic hospitals in Europe, alongside Priory Hospital Edgbaston and Harborne Hospital. Read more about Mr Hussain's training and background.
Both hip replacement and hip resurfacing
Many surgeons offer only one technique. Mr Hussain trained in both, allowing the choice to be tailored to the individual patient rather than to a single technique.
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Frequently asked questions about hip pain
For more questions about surgery, recovery, fees, and what to expect, see the full frequently asked questions page or read recent patient testimonials.