Lumbar radiculopathy, greater trochanteric pain and sacroiliac pain all present as 'hip pain' and coexist with radiographic arthritis. Groin pain reproduced by internal rotation of the flexed hip points to the joint; buttock pain below the knee, lateral tenderness over the trochanter, or a positive straight-leg raise point elsewhere.
Where the picture is mixed, an image-guided intra-articular local anaesthetic injection that abolishes the pain is a useful confirmation before surgery.
- Ask where the pain is: groin suggests the joint; buttock or lateral thigh suggests elsewhere
- Examine the lumbar spine and trochanter, not only the hip
- Check whether internal rotation of the flexed hip reproduces the patient's pain
- Consider a diagnostic intra-articular injection when the source is unclear
Why it matters
Pain from outside the joint is a common reason a technically good replacement disappoints.
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