One side of the hip joint hurts when walking

Bone diseases are very common among middle-aged and elderly people. If you don't pay attention, your hip joint will experience pain. Hip pain is usually caused by diseases such as lumbar disc herniation or periostitis. So if you find pain in one side of your hip joint when walking, it is best to go to the hospital for an X-ray to check the cause and treatment of your illness.

Hip pain is often seen in common diseases such as femoral head necrosis, hip osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, etc. However, regarding hip pain that occurs in young and middle-aged people who love sports, Director Du Bin of Jiangsu Provincial Hospital of Traditional Chinese Medicine reminds us that we cannot ignore the following disease.

Femoroacetabular syndrome (FAI) is an unfamiliar term to many people. It is a disease that has only gradually been recognized in recent years and is one of the causes of early osteoarthritis of the hip joint.

Classification: Femoroacetabular impingement is divided into three types: Pincer type, Cam type and mixed type.

1. Medical history: Patients often have no obvious history of trauma, alcoholism, or hormone use, but a small number of patients can describe a single injury in the hip flexion and internal rotation position. The main symptom is groin pain, but thigh pain and greater trochanter pain may also occur. It is more obvious during exercise or squatting, often manifesting as difficulty in squatting on the toilet or riding a bicycle. The main reason is that this position requires excessive flexion and internal rotation of the hip joint. Most patients have a history of recurrent attacks, and hip joint movement is still limited after the acute phase.

2. Physical examination: The most important manifestation is a positive impact test, which needs to be compared with the contralateral side. It can be bilateral. Most cases show limited internal rotation during excessive hip flexion.

A small number of patients may present with limited external rotation of the hip joint in hyperextension position.

3. Imaging examinations: The following are some typical imaging examinations for patients with impaction sign.

① The right acetabulum deepens and the outer edge proliferates (black arrow); there is a bony protrusion at the junction of the right femoral head and neck (white arrow); the lateral space becomes narrower;

② Bilateral compound impingement, with the bilateral acetabulum showing an "8" sign, the bilateral femoral heads becoming non-spherical (black arrows), and the joint space becoming narrower;

③ "Gun-handle" changes in the proximal right femur;

④ The oblique axial CT film of the patient with Cam-type FAI clearly shows the left femoral neck hernial fossa, which is not visible in the pelvic pedicle and frog position;

⑤ Hyperplasia of the outer edge of the left acetabulum and ossification of the outer free edge;

⑥ Lateral radiograph of the hip joint shows the indentation sign at the junction of the right femoral head and neck and the surrounding cortical hardness.

At the same time, MRI is also a necessary examination for the diagnosis of FAI.

4. Treatment of femoroacetabular impingement syndrome

Currently, the treatment of femoroacetabular impingement syndrome is still in the exploratory stage. Treatment options mainly include surgical resection of dysplastic bone and correction of biomechanics. If secondary osteoarthritis is a possibility, arthroscopic repair of cartilage damage or even hip replacement may be necessary.

The choice of surgery must be made with caution. Generally, surgical treatment is only decided for patients whose disease course exceeds 6 months, who have not responded to regular analgesic treatment for more than 3 months, and who are clearly diagnosed with FAI.