Physical Examination of the Hip
The hip joint is a ball and socket joint. The ball is the head of the femur (thighbone) that fits in the acetabulum (the hip socket). Tendons, muscles, and ligaments hold the joint in place. Articular cartilage covers the acetabulum and the femoral head. The synovial membrane of the hip joint secretes the synovial fluid which lubricates the joint enabling smooth movement.
Hip pain may be caused due to a variety of reasons such as osteoarthritis, labral tears, impingement, fractures, etc. Hip pain may be felt in the anterior, posterior or lateral part of the hip.
Physical examination of the hip is the key component in diagnosing the cause of your hip pain or hip pathology.
Patient’s Medical History
Prior to conducting the physical examination of the hip, your doctor enquires about any injury or trauma which may have caused the hip pain, the onset of pain and the localization of pain. You must also discuss with your doctor the activities which increase or decrease the pain.
Physical Examination of the Hip
The physical examination of the hip by your doctor includes a visual inspection of your hip, palpation of the hip to diagnose tenderness or any abnormality, etc; and testing range of motion of the hip.
Inspection (Looking): Your hip will be carefully observed while standing which may reveal any deformity or leg length discrepancy. You may also be asked to stand on one leg to see if your pelvis tilts to one side which may be an indication of hip instability or muscle weakness. You will also be asked to walk to look for an abnormal gait pattern.
Palpation (Feeling): Your pelvic region will be carefully palpated for an abnormal mass or any irregularities.
Range of Motion Tests (Movement): The various range of motion tests may include:
Forward flexion of the hip: While lying on your back on the examination table, your leg will be straightened and raised as high as possible.
Abduction of the hip: While lying on your side, your straight leg will be raised as high as possible.
Internal rotation of the hip: While lying on your back with your knee bent, your thigh is rotated in the inward direction as far as possible.
External rotation of the hip: While lying on your back with your knee bent, your thigh is rotated in the outward direction as far as possible.
The eliciting of pain or abnormal movement during these tests may give your doctor an indication of the underlying hip problem.
Differential Diagnoses of Hip Pain
Anterior Hip Pain and Groin Pain: Hip labral tears, osteoarthritis, impingements, fractures, osteonecrosis, etc.
Posterior Hip Pain: Piriformis syndrome, lumbar radiculopathy, sacroiliac joint dysfunction or ischiofemoral impingement.
Lateral Hip Pain: Greater trochanteric pain syndrome.
Activities After Hip Replacement
Hip replacement is a surgery performed to replace parts of a diseased hip joint with a prosthesis. The goal of hip replacement is to eliminate pain and enable you to return to your normal activities. You can help in the recovery and improve the outcomes of the procedure by following certain precautions and changing the way you carry out your daily activities.
After the Surgery
You will be discharged from the hospital once you have sufficient pain control and are able to perform basic activities on your own, such as getting in and out of bed, going to the bathroom and walking with an assistive device such as crutches or a walker. If you are unable to perform these activities, you will be transferred to a skilled nursing or rehabilitation center.
At home, have a family member or caregiver to assist you with your activities for a few weeks. Ensure that furniture is rearranged so as not to interfere with your movement and cause falls. To avoid bending or reaching out, items that you use frequently can be placed within easy reach. Try to sit on a high chair so that your knees are not lifted above the level of your hip. Do not cross your legs or lean forward while sitting. A shower chair or gripping bar may be helpful in the bathroom. Make use of long shoehorns, long-handled sponges, and other devices that can help you reach objects without bending. Try to sleep with a pillow between your legs. Your doctor will advise you on correct sleeping positions.
Keep the wound clean and dry. Your doctor will let you know when you can shower or bathe. Swelling may be present for 3 to 6 months following hip replacement and can be controlled with ice and by elevating your legs slightly. You may be asked to bear only partial weight on the leg for a while. Follow your physical therapy program for at least 2 months. Walking, stationary bicycling and swimming are good exercises but ensure that your wound is completely healed.
You must be aware of the signs of infection or blood clot formation and quickly return to the hospital should you develop more than normal pain, swelling, redness, fever, chills or drainage from the wound.
Your doctor will decide when you can engage in your regular activities, resume work, start driving and return to sexual activity depending on your condition and progress with therapy.