Hip pain

Hip pain in young, active adults is often different from the arthritis-related pain seen later in life. Two of the most common underlying causes are hip dysplasia and femoroacetabular impingement (FAI). Hip dysplasia occurs when the hip socket (acetabulum) is shallower than normal, providing less coverage and support for the ball of the femur. This can lead to instability, abnormal joint mechanics, and extra stress on the cartilage and labrum (the ring of cartilage that lines the socket), often causing pain with activity, a sense of the hip "giving way," or a deep groin ache. FAI, on the other hand, involves extra bone growth on the femoral head/neck (cam type), the socket rim (pincer type), or both, which causes the bones to abnormally pinch or rub against each other, particularly with deep hip flexion or rotation—think squatting, pivoting, or prolonged sitting.

Both conditions can cause groin pain, stiffness, clicking or catching sensations, and discomfort after sitting for long periods or during sports involving twisting and cutting motions. Because these issues affect the underlying shape and mechanics of the joint rather than being simple muscle strains, they often don't resolve with rest alone and can worsen over time if untreated, sometimes contributing to early labral tears or cartilage damage. If you're experiencing persistent hip or groin pain, especially with activity, a physical exam and imaging (such as X-rays) can help identify whether dysplasia, FAI, or another structural cause is contributing, so an appropriate treatment plan—ranging from physical therapy to activity modification to surgical options—can be discussed with Liam.

Hip Dysplasia

Femoroacetabular Impingement

Hip dysplasia refers to a hip socket that formed too shallow or angled incorrectly, and either went undetected in childhood or was mild enough not to cause problems until later in life. Because the socket doesn't fully cover and support the ball of the femur, the joint bears weight unevenly, putting extra stress on the cartilage and the labrum, the ring of cartilage that lines the rim of the socket. This condition is more common in women and often affects both hips to some degree.

The most common symptoms are groin or lateral hip pain that worsens with activity like walking, running, or standing for long periods. Symptoms often first appear in the teenage years to thirties, sometimes triggered by a specific injury or simply by cumulative wear, and they can be mistaken for other causes of hip pain. Diagnosis can be tricky, and without appropriate imaging and work-up, dysplasia can be misdiagnosed as trochanteric bursitis, tendinopathy or impingement.

To diagnose hip dysplasia, Liam combines the clinical history, examination findings and X-ray findings. MRI is used to assess for any labral tears or early cartilage damage, but shouldn't be relied upon for making the diagnosis of dysplasia.

Treatment depends on severity and how much joint damage has already occurred. Most cases are initially managed with physiotherapy to strengthen the muscles around the hip, activity modification, and anti-inflammatory medication for pain. If non-operative measures don't improve symptoms, especially in younger patients without much arthritis yet, a surgery called periacetabular osteotomy (PAO) can reposition the socket to better cover the femoral head and slow or prevent future joint damage.

In cases where arthritis has already developed, a hip replacement may be the better option. The right approach depends heavily on age, activity level, and how far the joint damage has progressed. Liam will guide you through these decisions and specialises in periacetabular osteotomy and hip replacement.