Hip pain may be a result of referred pain from the low back or it may be a result of abnormality about the hip joint. Groin pain is a particularly important type of hip pain that warrants further investigation. Patients with femoroacetabular impingement (FAI) have hip bones that do not fit together due to their abnormal shape. The hip is a joint known as a ball-and-socket where the ball, the femoral head, fits into the socket, formed by the acetabulum. This joint is covered in cartilage that allows the joint to move smoothly and keeps the bones from grinding. FAI occurs when excess bone develops around the joint, which forces the hip bones to rub against each other, which eventually wears down the cartilage and causes a labral tear. This is seen among dancers, runners, cyclists and other athletes with repetitive hip flexion activities.
There are three types of FAI, pincer, cam, and combined. The pincer impingement is caused by an extension of extra bone over the socket. When the ball joint is not round, it cannot fit correctly into the socket causing cam impingement. Because of the shape of the femoral head, a bumpy area forms on the ball that grinds and wears down the cartilage inside the socket. Combined impingement is when both pincer and cam impingements are in the hip bone.FAI-hipCam FAI is found more often in males, while pincer impingement is usually found in females. A study was presented in October 2014 that shows a relation between sex and impingement types. Cohorts of 50 men and 50 women who had symptomatic FAI and were to undergo surgery. Results showed that the females suffering from FAI, who were assessed using various outcome measures had a greater disability prior to surgery. They also had greater flexion and rotation of the hips, while having less cam impingement.
The males that were studied showed more likely to have acetabular cartilage lesions, and labral tears much larger than those in females. Males were also about two times more likely than females to have pincer impingement as a result as having combined FAI impingement. The conclusion of the study showed that while females had a greater disability, they also have lesser abnormalities. Males, on the other hand, had less disability, but with more pronounced abnormalities and combined FAI.
Those suffering from FAI have hip pain in the groin area. A dull ache or sharp stabbing pain that occur with movement is common, especially with twisting and pivoting. Over the counter medications such as ibuprofen or other NSAIDS can help relieve pain and inflammation, along with rest and less activity. If pain does not decrease from home remedies, a doctor or orthopedic surgeon should be consulted. FAI that is not treated can cause more damage over time.
There are different treatment types for FAI, such as changing daily activities, NSAIDS, prescription medicines, and physical therapy. If these methods do not help, hip arthroscopy may be needed. In fact, physical therapy may at times cause the FAI symptoms to flare. The surgeon makes small incisions into the damaged area, and inserts an arthroscopic camera to assess the extent of the damage in the hip. The surgeon can clean the damage from the site and trim any bumps or ridges on the femoral head or acetabulum. For more severe cases, open hip surgery will be needed to alleviate the issue.


Our hips extend and knees bend due to a group of three muscles located in the back of the thigh called the hamstrings. These muscles, if not stretched properly prior to exercise can stretch too far, pull, or even tear. These are very common in athletes and often occur during running, jumping, and in sports like basketball, soccer, wrestling, where stopping and starting occur in spurts. Pain associated with a hamstring strain can range from a mild irritation to a severe pain that leaves one unable to stand. If you feel a sudden snap, pop, or pain in the back of the thigh, it is most often the hamstring.
The hamstring muscle group crosses over and effects the hip and knee joints but it also affects the legs, and back. Hamstrings that are not stretched properly prior to running and exercise can not only cause leg and knee pain, but also lower back and hip pain. Hip pain can come in the form of burning, dull aches, or a popping sensation. Hip pain can affect mobility and compensating for the pain causes strain on other muscles.
Even though hamstring strains are one of the most common injury that athletes face, there is still not a definitive answer on how to manage them. Doctors have looked to plasma-rich platelet (PRP) injections for a possible treatment. Platelet-rich plasma is plasma that contains 5 to 10 times greater the amount of platelets than in blood. Platelets promote healing, prevents blood loss, and tissue repair. To obtain the PRP, blood is drawn from the patient and is then centrifuged in a machine that separates the plasma from other blood cells. The plasma is recombined with the rest of the blood and injected into the patient.
A controlled trial using platelet-rich plasma injections (PRP) was done on twenty-eight patients each having an acute hamstring injury. The purpose was to see if this treatment had any effect on pain management, along with shortening the healing time. Patients were divided into two groups, one group receiving PRP injections combined with a rehabilitation program, while the control group was given rehabilitation only. Those receiving the PRP injections and rehabilitation recovered fully and return time to their activities was 26.7 ± 7.0 days, while those in the control groups return time was 42.5 ± 20.6 days. Lower pain severity scores were recorded throughout the trial, although the difference of pain scale between the two groups was not significant. The end conclusion is that PRP injections in addition to a rehabilitation program is more effective than a rehabilitation alone for treating acute hamstring injuries. This is extraordinarily promising.
Hamstring and hip pain can be avoided by properly stretching before activities. Not all injuries occur due to sports, simply gardening and chores can result in an injury if muscles are tight. Routine stretching is an effective tool against hip pain and hamstring tears. If you are concerned about hip pain, contact our renowned sports medicine orthopedists to be evaluated at Orthopedic Surgery San Diego.


Obesity is intricately linked with multiple medical problems, knee pain, and hip pain. With more than 74% of its population considered overweight or obese, the United States is the ninth-most corpulent nation on Earth, according to the World Health Organization.

A recent study by the Centers for Disease Control and Prevention suggested that the problem is getting worse. The researchers wrote that “the waists of men, women, blacks, whites and Mexican-Americans all grew significantly from 1999 to 2012.”

The average man’s waistline expanded from 38.9 inches to 39.7 inches, while the typical woman’s measurement grew from 36.3 inches to 37.8 inches, according to the study (published in the Journal of the American Medical Association).

USA Today reported that researchers detected an increase in “abdominal obesity” in 43 percent of men and 64 percent of women. In 1999, the statistics were 37 percent of men and 55 percent of women.

The study involved 32,816 adults, including African-American women in their 30s, Mexican-American women older than 70, Mexican-American men in their 20s, African-American men in their 30s and white women in their 40s.

The Washington Post noted that “obesity calculated from body mass index, which measures body fat based on height and weight, (has) remained relatively stable.” However, BMI does not measure the distribution of weight. Patients with normal BMIs can have large waistlines, which leave them more vulnerable to cardiovascular disease.

Patients with abdominal obesity also are more likely to experience hip pain or knee pain. They have an elevated risk of osteoarthritis developing in their hips and knees, which sometimes requires joint replacement.

In a story by The Associated Press, Dr. William Dietz (an obesity expert formerly with the CDC) said: “Even though the obesity rate may be stable, fat distribution may be changing. The seemingly contradictory trends are puzzling. It could be that Americans are exercising less and getting flabby. But because fat weighs less than muscle, they are not necessarily getting heavier.”

To prevent abdominal obesity, it is necessary to adopt a healthy diet and engage in regular exercise. The body stores carbohydrates as fat, often in the lower part of the torso. Reducing carb intake is key to staying in shape.

A balanced diet consists primarily of vegetables, fruits, whole grains and lean protein. These foods contain few calories, but provide the vitamins, minerals and fiber essential to fitness. Spinach and other green, leafy veggies are the best because they deliver nutrients while burning fat.

Studies have linked sedentary behaviors, like spending too much time sitting, with a number of illnesses and diseases. Couch potatoes also are more susceptible to hip or knee osteoarthritis, which causes pain and limits mobility.

The solution is to stay active and adopt a regimen of daily exercise. Effective workouts can be as simple as walking or running in place, or on a treadmill, while watching television.

Other popular options include walking or running outside, swimming in a pool, and playing sports like tennis or golf. Cardio exercises, those that sustain an elevated heart rate for 20 minutes, burn the most fat.  If you need help addressing your knee pain or need help developing a proper exercise regimen, contact our renowned sports medicine team at San Diego Orthopedic Surgery today.



Knee and Hip pain is 70% more common in patients with elevated BMI (body mass index).  In preparation to undergo a hip replacement or knee replacement for joint pain, it is imperative to shed any extra weight you may have.  Despite our active lifestyles in San Diego, sometimes it becomes necessary to utilize a diet. Here in America, it seems like most people are always on one type of weight loss diet or another. Comparing which diet helps you lose the most weight is a common topic of conversation these days. But, the answer remains unclear, as each diet has its benefits as well as disadvantages, based on the dieters’ needs. And, when it comes to overweight and obese adults, those needs tend to vary. Oftentimes, the need to eliminate pain is the biggest issue.

How Obesity or Being Overweight Affects Knee and Hip Pain

One thing is clear, though, the heavier you are, the more weight your hips and knees have to carry around all day and night. So, if you’re obese, or very heavy for your body frame, your weight is probably the cause of much of your body pain. If you’ve been having Knee and Hip pain that simply will not go away, your weight is adding to your orthopedic problems. And, even if your orthopedic surgeon recommends knee replacement or hip replacement surgery, the pain still won’t go away for good without your help. You’ll still need to lose a substantial amount of weight in order to improve the outcome of the surgical procedures. If not, eventually, your weight will simply wear down your new hips and knees, causing them to be in pain again in the near future.

JAMA Study on Popular Weight Loss Diets

The Journal of the American Medical Association (JAMA) published an abstract paper in regards to popular diets. Its objective was to determine the outcomes of various popular weight loss diets. In this particular study, overweight adults with body mass indexes above 25 were randomly assigned to a specific popular weight loss diet. They all had to report their body mass indexes and weight at 3-month, 6-month and 12-month follow ups. The study which included 7,286 individual participants.

Results of the JAMA Popular Weight Loss Diets Study

Low Carb Diets Results

The highest weight loss amounts related to low-carbs diets:

  • 8.73 kg at 6-month follow up
  • 7.25 kg at 12-month follow up

Low Fat Diets Results

The highest weight loss amounts related to low-fat diets:

  • 7.99 kg at 6-month follow up
  • 7.27 kg at 12-month follow up

Results for Individual Diets

When it comes to the results for individual weight loss diets, the differences were minimal. Here are some examples:

  • At 6-month follow up, the Atkins Diet showed greater weight loss of 1.71 kg than the Zone Diet
  • Between the 6-month and 12-month follow up periods, the Atkins Diet combined with behavior support had a greater weight loss of 3.23 kg than the Zone Diet.

Weight Loss and Knee and Hip Pain

In other words, both low-carb and low-fat diets can help you achieve your goal of weight loss. The specific named diet doesn’t really seem to matter as long as you cut down on carbs and fat intake. So, what’s the bottom line for overweight and obese adults suffering from knee pain and/or hip pain? Your weight can be a major factor when it comes to sustaining relief from your hip and knee pain. When you combine maintaining a healthy weight with hip replacement or knee replacement surgeries, your long-term outcome is so much more successful.  Much lower risk of infection, blood clots, residual pain, and much longer lasting implant!! If you have been told that you would benefit from hip or knee replacement due to ongoing pain, call our award winning physicians at Orthopedic Surgery San Diego for an appointment.


Our hips are comprised of ball and socket joints which means a joint with a round head fits snugly into a cavity, allowing the joint to move more freely.  The hips are weight bearing joints and are used all day for standing, walking, running, sitting, and other activities.  It should be no surprise that the cartilage (the cushion in between the joints) in our hips wear down quicker than in other joints, mostly due to time, wear and tear, and repetitive motion.

When the cartilage wears down, muscles and tendons can become overused, and the hip pain begins.  Hip replacements are becoming common, especially in older patients. In the U.S. alone, there were 332,000 total hip replacements in 2010.  Science and medicine have made great strides in hip replacements. What used to be a 9 day hospital stay, 20 years ago, is now a 3-4 day stay. While most replacements occur in those between the ages of 50 and 80, there is no age limit for the surgery.

There are three kinds of hip replacement techniques: cemented, cementless and a hybrid. A total hip replacement requires an artificial hip, or prosthesis, to replace the damaged one. This implant is made with plastic and metal. Orthopedic surgeons use cement to secure the prosthesis into place.  Cemented hip replacements are usually reserved for older patients with weaker bones and who do not lead a very active lifestyle.

A cementless hip replacement uses a prosthesis that is porous, and allows the bone that is already there to grow into the microscopic areas. This allows the patient’s own bones to hold the replacement in place. This is usually a better choice for the younger patient who has stronger bones and leads a more active lifestyle. A hybrid replacement is a combination where only a part of the prosthesis is fixed with cement.

These replacements have similar end results, and the new hips can last from 15 to 20 years. Younger patients who move around may find their replacements wear down faster, however, and could be candidates for revision surgery.

Even though cementless hip replacements are usually for those with stronger bones, older patients can be eligible for the surgery. A study in Finland, however, showed that those between the ages of 80-89 have a high early failure rate with this type of surgery. Between 1998 and 2009 there were 4,509 octogenarian patients given a cementless hip replacement. Within one year, a revision was necessary, mostly for women, for more than twice the amount of patients receiving the cementless replacement as opposed to those having a cemented hip replacement. The main cause was a periprosthetic fracture, which is a break around the implant, and is a serious complication.

This study also showed that patient’s with a cementless replacement had a slightly lower 10 year survival rate compared with those that had a cement or hybrid replacement. Time and studies will show if this trend continues.

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