Differential Diagnosis for Hip Pain while Walking/Standing
Single Most Likely Diagnosis
- Osteoarthritis (OA) of the Hip: This is the most common cause of hip pain in adults, especially in those over 50 years old. OA leads to cartilage breakdown, causing pain and stiffness, particularly with weight-bearing activities like walking or standing.
Other Likely Diagnoses
- Trochanteric Bursitis: Inflammation of the bursa over the trochanter, often caused by repetitive friction or direct trauma, leading to pain on the outer aspect of the hip, which can worsen with walking or standing.
- Piriformis Syndrome: Compression of the sciatic nerve by the piriformis muscle, leading to pain in the hip and buttock area that can radiate down the leg, often exacerbated by activities like walking.
- Hip Labral Tear: A tear in the labrum, the cartilage that surrounds the socket of the hip joint, can cause pain, especially with weight-bearing activities, and may be associated with a history of trauma or repetitive hip movement.
Do Not Miss Diagnoses
- Avascular Necrosis (AVN) of the Femoral Head: A condition where the blood supply to the femoral head is disrupted, leading to bone death. It can be caused by trauma, steroid use, or excessive alcohol consumption. Early diagnosis is crucial to prevent collapse of the femoral head.
- Septic Arthritis of the Hip: A bacterial infection within the hip joint, which is a medical emergency requiring prompt antibiotic treatment and possibly surgical drainage to prevent joint destruction.
- Stress Fracture: A small crack in the bone, often due to overuse or repetitive stress, which can be painful and may not be immediately visible on X-rays. It's critical to diagnose and treat stress fractures to prevent them from becoming complete fractures.
Rare Diagnoses
- Synovial Chondromatosis: A rare condition where cartilage grows within the synovium of the joint, leading to joint pain and swelling. It can cause mechanical symptoms like locking or catching.
- Paget's Disease of Bone: A chronic condition that can result in enlarged and misshapen bones due to abnormal bone destruction and regrowth. It can cause pain and deformity in the affected bones, including the hip.
- Bone Tumors: Both benign (like osteoid osteoma) and malignant (like osteosarcoma) tumors can cause hip pain. While rare, they are important to consider in the differential diagnosis, especially in younger patients or those with night pain.