Bones in hip & pelvis

Anatomy: Bones of the hip and pelvis – the supporting base

The pelvis connects the spine to the legs. It consists of a bony ring that absorbs high forces when walking, running and lifting. The hip is the ball joint between the thigh bone (femur) and the socket (acetabulum) of the pelvis.

• Pelvic ring: ilium (os ilium), ischium (os ischii) and pubic bone (os pubis) form the hip bone on the right and left; connected at the front via the pubic symphysis (symphysis), at the back via the sacrum (os sacrum) and sacroiliac joints.
• Hip joint: socket (acetabulum) in the pelvis, head of the thigh bone (caput femoris). Important region: femoral neck (collum femoris) and the bony prominences of the greater/minor trochanter.
• Sacrum & Coccyx: Transition from spine to pelvis, relevant for load transfer and pelvic stability.
• Vascular supply: The femoral head is supplied by fine vessels (including the medial circumflex femoral artery). Disorders can damage bone tissue.

Bones respond to stress: They become stronger with training, but can develop microtrauma, edema or fractures when overloaded. Misalignments change the lines of force and increase local stress.

Typical bone diseases of the hip and pelvis

The following selection shows common and relevant bone causes in the hip/pelvis area. We offer in-depth subpages on the most important topics:

• Femoral head necrosis: Circulatory disorder of the femoral head with risk of collapse and osteoarthritis - early detection is crucial.
• Stress fractures of the hip: Overstress fractures of the femoral neck or pelvis - typical when running increases, bone weakness or training errors.
• Osteitis pubis: Painful irritation of the pubic symphysis – often during sports that involve changing direction or after pelvic floor strain.
• Pelvic instability: Particularly at the pelvic ring or symphysis pubis; can occur after injury, pregnancy or weak connective tissue.
• Misalignments of the femur or pelvis: Changed statics with increased stress on certain bone areas.
• Nonunion after fracture: Failure of bone healing with persistent pain and instability.

Other relevant categories: acute injuries (fractures) see trauma/injuries; Systemic influences such as osteoporosis or inflammatory diseases can be found under systemic causes.

Causes and risk factors

• Overload: Rapid training build-up, high running volumes, hard surfaces – microtraumas with a risk of stress fractures.
• Reduced bone density: osteopenia/osteoporosis, hormone deficiency, malnutrition, vitamin D deficiency.
• Circulatory disorders: E.g. long-term cortisone medication, alcohol abuse, metabolic diseases - promote femoral head necrosis.
• Misalignments & axial deviations: Increase local bone stress.
• Posttraumatic: After fractures or operations – risk of delayed healing or nonunion.
• Infection/Tumor (rare): Inflammatory or neoplastic processes may affect bone structures.
• Special stress: pregnancy/peripartum phase (symphysis), sport-specific changes of direction, long-distance running.

Symptoms: How do I recognize bony causes?

Bone problems often occur depending on the load, but - depending on the cause - can also occur at rest or at night. The exact location of pain provides important information.

• Groin pain: Typical in femoral head/femoral neck problems.
• Lateral hip pain: Often in soft tissue, but in stress fractures it is deep local tenderness.
• Pubic bone pain/symphysis pubis: pain when walking, climbing stairs, changing direction; often pressure sensitive.
• Near the buttocks/SIJ area: When the pelvic ring is involved, sometimes radiating into the back.
• Pain on exertion/start-up, pain later at rest or pain at night (warning signs).
• Restricted movement, limping, subjective feeling of instability.
• Swelling/overheating (rare, especially with inflammation).

Red Flags: Severe pain after a fall, visible misalignment, inability to bear weight, fever/night sweats, increasing pain at rest - please seek medical advice promptly.

Diagnostics: step by step to the cause

Structured diagnostics avoid delays in therapy. We combine history, physical examination and targeted imaging.

Important: MRI can detect early changes when the X-ray image is still normal - crucial, for example, in the case of stress fractures or femoral head necrosis.

Treatment: Conservative first

The aim of conservative therapy is to relieve pain, protect the structure and enable a resilient return to everyday life and sport. The plan depends on the diagnosis, severity and life situation.

• Load control: Temporary relief up to forearm crutches; then gradually increase the load according to symptoms and findings.
• Physiotherapy: Strengthening the hip and pelvic stabilizers (especially gluteal muscles), improving mobility and gait, coordination and pelvic ring stability.
• Training & Return-to-Activity: Progression with clear criteria (pain-adapted distances/intensity, no increase in subsequent day pain).
• Pain therapy: Short-term NSAIDs or paracetamol as indicated; local cold/heat depending on tolerance.
• Aids: insoles for axis or length problems, if necessary bandages/pelvic straps to relieve the symphysis pubis.
• Metabolism & bones: Vitamin D optimization, calcium intake, lifestyle (exercise, sun), osteoporosis management in cooperation.
• Everyday adjustments: load management, footwear, running technique, training planning and recovery times.

Injections or so-called regenerative bone procedures (e.g. PRP) only have a place in selected situations and beyond acute stress fractures and are used individually and cautiously based on the current evidence. Cortisone injections directly into the bone are not indicated in the event of healing disorders or necrosis.

Surgical options – only if there is a clear indication

If conservative measures are not sufficient or structural damage progresses, surgery may make sense. The decision is made after weighing up the benefits and risks, imaging and individual objectives.

• Fracture stabilization: Screws/plates/intramedullary nails for stabilizing femoral neck or pelvic fractures.
• Treatment of femoral head necrosis: In early stages, if necessary, relief drilling (core decompression), bony support (spongiosplasty) - depending on the stage.
• Corrective osteotomies: For misalignments to correct the axis and redistribute the load.
• Pseudarthrosis therapy: revision, stabilization and bony filling to promote healing.
• Endoprosthetics: Only when joint destruction and pain persist despite conservative treatment.

We discuss options in an understandable and open-ended manner. Operational steps take place in designated centers/with experienced partners in Hamburg – with careful preparation and aftercare.

Prevention: Strengthen bones, reduce risks

• Training control: Slow increase in volume and intensity, cross-training instead of monotonous stress.
• Strength & technique: hip and core stability, running technique, good shoes/insoles if necessary.
• Regeneration: Adequate rest, sleep, periodization.
• Nutrition & Bone Health: Sufficient protein, calcium, vitamin D; Avoid being underweight.
• Lifestyle: Quit smoking, moderate alcohol consumption.
• Check medications: Long-term cortisone or other bone-relevant therapies should be followed by a doctor.
• Special phases: Peripartum symphysis care, postnatal and pelvic floor training under supervision.
• Fall prevention: Especially with osteoporosis – balance, vision, living space adjustments.

Course and prognosis

Healing processes depend on the cause, location, bone quality and adherence to therapy. In general, the earlier the diagnosis is made, the easier it is to limit stress-related damage.

• Stress fractures: Often 6-12 weeks until pain-free loading, or longer depending on the location (e.g. high-risk femoral neck).
• Femoral head necrosis: course depends on the stage; Early stages can be stabilized, advanced stages risk joint consequences.
• Nonunions: Require patience and consistent follow-up treatment; Healing times vary significantly.
• Instabilities & misalignments: With targeted therapy, often good suitability for everyday use; sporty return according to clear criteria.

A structured, symptom-guided build-up of stress and regular follow-up checks are crucial for a good prognosis.

Special patient groups

• Athletes: Often overload, training errors or technical issues; Return to sport according to a step-by-step plan.
• Pregnant woman/newborn phase: loosening of the symphysis and pelvic ring problems possible; gentle stabilization and pelvic floor work.
• Older people: focus on osteoporosis and risk of falls; safe mobility is a priority.
• Active young people/adolescents: apophyseal stimuli or growth plate issues – stress dosage and technique training are important.

Our subpages: Bone topics in detail

For more in-depth information on selected diagnoses, you can find separate advice pages. These explain symptoms, diagnostics, conservative and - if necessary - surgical options in detail:

• Femoral head necrosis – causes, stages, treatment options.
• Stress fractures of the hip – risk profiles, MRI diagnosis, stress build-up.
• Osteitis pubis – sports and everyday life management, stabilization.
• Pelvic instability – symphysis and pelvic ring stability, training.
• Misalignments of the femur or pelvis – axis analysis, correction options.
• Nonunion after fracture – promoting healing and stabilization.

Additionally recommended: Overview of joints/cartilage, bursa and muscles/tendons/ligaments, as complaints often occur in combination.

When should I seek medical advice?

• Acute severe pain after a fall or twisting trauma.
• Inability to bear weight, visible misalignment, leg shortening.
• Increasing nighttime/quiet pain with no clear cause.
• Fever, severe swelling or redness.
• Groin pain for several weeks despite rest.
• Known osteoporosis with new hip/pelvic pain.

In our practice at Dorotheenstraße 48, 22301 Hamburg, we assess your situation in a structured manner and discuss the next steps transparently.

Your appointment in Hamburg

Would you like a well-founded assessment of bone problems in the hip or pelvis? We take time for anamnesis, physical examination and – if necessary – targeted imaging. Our focus is on conservative solutions, complemented by interdisciplinary collaboration when it makes sense.

Location: Dorotheenstraße 48, 22301 Hamburg. Make an appointment conveniently online via Doctolib or contact us by email. We advise you individually and based on evidence – without blanket promises of healing.