When does a sore hip need prompt care?

Which warning signs can't wait?

Fever plus a hip that feels hot and looks swollen needs urgent care. After a fall, groin pain and trouble putting weight on the leg may mean a hidden break.

A shortened or outward-turned leg also needs quick care. Weak legs, numb skin or bladder or bowel trouble with back pain needs immediate help.

Don't drive yourself if weakness or a fall makes the leg unsafe. Tell the urgent-care team when the change began and whether it came on suddenly.

What if soreness changes after a procedure?

Call the treating team when soreness grows worse quickly instead of easing over the next few days. Ask whether another exam or new X-ray is needed before normal activity starts again.

Tell the doctor the dates of past procedures and any planned hip replacement. A hip procedure within 3 months before replacement may raise the risk of infection around the new joint.

Ask whether your own dates leave enough time between the two procedures. The doctor can answer from the care you had and the surgery being planned.

What should you tell the doctor?

Say exactly where the hip hurts and when the soreness began. Include falls, fever, night pain, weakness and how far you can walk.

Take your medicine list, details of earlier care and any planned operation. These facts help the doctor decide whether the joint, outer hip or back needs attention.

Mention any recent procedure and whether the soreness changed afterward. Don't leave out a small fall merely because there was no bruise.

Tell the doctor whether night pain changes when you move in bed. That detail helps separate steady pain from soreness caused by pressure.

Sources

1. In 45 volunteers with no history of hip pain, symptoms, injury or surgery, blinded 3.0-T MRI found abnormalities in 73% of hips - labral tears in 69%, chondral defects in 24%, subchondral cysts in 16% and osseous bumps in 20%. A labral tear on MRI is therefore not by itself an explanation for hip pain.

   Register B, et al. — Prevalence of abnormal hip findings in asymptomatic participants: a prospective, blinded study.. American Journal of Sports Medicine, 2012. DOI: 10.1177/0363546512462124.

2. In a three-arm randomized trial of 204 people with MRI-confirmed gluteal tendinopathy, an eight-week physiotherapist-led education and exercise programme produced success on global rating of change in 51/66 participants at 8 weeks versus 38/65 for a single corticosteroid injection and 20/68 for wait-and-see. Education plus exercise beat the injection at 8 weeks (risk difference 19.9%) and still beat it at 52 weeks (20.4%).

   Mellor R, et al. — Education plus exercise versus corticosteroid injection use versus a wait and see approach on global outcome and pain from gluteal tendinopathy: prospective, single blinded, randomised clinical trial.. BMJ, 2018. DOI: 10.1136/bmj.k1662.

3. A meta-analysis of 28 studies covering 480,532 patients found a significant association between pre-operative intra-articular corticosteroid injection and periprosthetic joint infection after TOTAL HIP arthroplasty (OR 1.55, P=.001), with higher risk when the injection was given within 3 months of surgery (OR 1.20, P=.045). No such association was found for knee arthroplasty. Timing of a hip injection matters if replacement may follow.

   Albanese J, et al. — Infection Risk Increases After Total Hip Arthroplasty Within 3 Months Following Intra-Articular Corticosteroid Injection. A Meta-Analysis on Knee and Hip Arthroplasty.. Journal of Arthroplasty, 2023. DOI: 10.1016/j.arth.2022.12.038.

4. Pooled analysis of national joint registries (Australia and Finland, 215,676 hip replacements) put 25-year all-cause construct survival at 57.9% (95% CI 57.1-58.7); pooled case series gave 77.6% (95% CI 76.0-79.2). The authors conclude patients and surgeons can expect a hip replacement to last 25 years in around 58% of patients.

   Evans JT, et al. — How long does a hip replacement last? A systematic review and meta-analysis of case series and national registry reports with more than 15 years of follow-up.. The Lancet, 2019. DOI: 10.1016/S0140-6736(18)31665-9.

5. A population-based analysis of 63,158 total hip replacements found 10-year implant survival of 95.6% and 20-year survival of 85.0%, but the LIFETIME risk of revision rose sharply with younger age at surgery - about 5% for those operated after 70, up to 35% (95% CI 30.9-39.1) for men in their early 50s, with a median time to revision of 4.4 years in those operated before 60.

   Bayliss LE, et al. — The effect of patient age at intervention on risk of implant revision after total replacement of the hip or knee: a population-based cohort study.. The Lancet, 2017. DOI: 10.1016/S0140-6736(17)30059-4.