Kalça Ağrılarına Algoritmik Yaklaşım
Özet
Kalça ağrısı her yaş grubunda görülebilen, ancak özellikle yetişkin ve yaşlı popülasyonda yaygın olan önemli bir kas-iskelet sistemi yakınmasıdır. Pelvik kuşağın karmaşık anatomisi ve kalça çevresindeki çok sayıda yapı nedeniyle kalça ağrısının etiyolojisini belirlemek çoğu zaman zor olabilir. Hastalar kasık, lateral kalça, trokanterik bölge, bel veya uyluğa yayılan ağrı ile başvurabilir ve bu durum ayırıcı tanıyı genişletir. Bu bölümde kalça ağrısına algoritmik yaklaşım ele alınarak klinisyenlerin tanısal süreçte sistematik bir değerlendirme yapmasına yardımcı olacak temel prensipler sunulmuştur. Öncelikle kalça ekleminin anatomisi, biyomekaniği ve klinik değerlendirme yöntemleri özetlenmiştir. Ardından öykü, fizik muayene ve özel testlerin tanıdaki rolü açıklanmıştır. Kalça ağrısının değerlendirilmesinde travma varlığı, ağrının lokalizasyonu, eşlik eden sistemik bulgular ve hastanın yaşı gibi parametreler önemli belirleyicilerdir. Femoroasetabular sıkışma, labral yırtıklar, büyük trokanterik ağrı sendromu, avasküler nekroz, kalça osteoartriti, atletik pubalji ve snapping hip sendromu gibi sık görülen patolojiler ayrıntılı olarak incelenmiştir. Ayrıca pediatrik yaş grubunda görülen femur başı epifiz kayması, Legg-Calvé-Perthes hastalığı ve avulsiyon kırıkları gibi durumlara da değinilmiştir. Bu algoritmik yaklaşım, klinisyenlerin kalça ağrısının ayırıcı tanısını daha hızlı ve doğru şekilde yapmasına yardımcı olmayı amaçlamaktadır.
Hip pain is a common musculoskeletal complaint that can occur in individuals of all ages but is particularly prevalent among adults and the elderly. Due to the complex anatomy of the pelvic girdle and the large number of structures surrounding the hip joint, determining the exact etiology of hip pain can often be challenging. Patients may present with pain localized to the groin, lateral hip, trochanteric region, lower back, or thigh, which broadens the differential diagnosis. This chapter presents an algorithmic approach to hip pain to assist clinicians in performing a systematic diagnostic evaluation. First, the anatomy and biomechanics of the hip joint are summarized, followed by an overview of clinical assessment methods. The importance of patient history, physical examination, and specific clinical tests in the diagnostic process is emphasized. Key parameters such as the presence of trauma, localization of pain, accompanying systemic symptoms, and patient age play critical roles in narrowing the differential diagnosis. Common causes of hip pain including femoroacetabular impingement, acetabular labral tears, greater trochanteric pain syndrome, avascular necrosis, hip osteoarthritis, athletic pubalgia, and snapping hip syndrome are discussed in detail. In addition, pediatric hip conditions such as slipped capital femoral epiphysis, Legg–Calvé–Perthes disease, and avulsion fractures are also addressed. This algorithmic framework aims to facilitate a more efficient and accurate diagnostic approach to patients presenting with hip pain.
Referanslar
Ahuja V, Thapa D, Patial S, Chander A, Ahuja A. Chronic hip pain in adults: Current knowledge and future prospective. J Anaesthesiol Clin Pharmacol. 2020;36(4):450-457. doi:10.4103/joacp.JOACP_170_19
Bowman KF, Fox J, Sekiya JK. A Clinically Relevant Review of Hip Biomechanics. Arthroscopy. 2010;26(8):1118-1129. doi:10.1016/j.arthro.2010.01.027
Vleeming A, Schuenke MD, Masi AT, Carreiro JE, Danneels L, Willard FH. The sacroiliac joint: an overview of its anatomy, function and potential clinical implications. J Anat. 2012;221(6):537-567. doi:10.1111/j.1469-7580.2012.01564.x
Glenister R, Sharma S. Anatomy, Bony Pelvis and Lower Limb, Hip. İn: StatPearls [Internet]. StatPearls Publishing; 2023. Accessed December 13, 2025. https://www.ncbi.nlm.nih.gov/books/NBK526019/
Ganz R, Parvizi J, Beck M, Leunig M, Nötzli H, Siebenrock KA. Femoroacetabular Impingement: A Cause for Osteoarthritis of the Hip. Clin Orthop Relat Res. 2003;417:112. doi:10.1097/01.blo.0000096804.78689.c2
Pun S, Kumar D, Lane NE. Femoroacetabular Impingement. Arthritis Rheumatol Hoboken NJ. 2015;67(1):17-27. doi:10.1002/art.38887
Groh MM, Herrera J. A comprehensive review of hip labral tears. Curr Rev Musculoskelet Med. 2009;2(2):105-117. doi:10.1007/s12178-009-9052-9
Schmaranzer F, Kheterpal AB, Bredella MA. Best Practices: Hip Femoroacetabular Impingement. AJR Am J Roentgenol. 2021;216(3):585-598. doi:10.2214/AJR.20.22783
Frank JM, Harris JD, Erickson BJ, et al. Prevalence of Femoroacetabular Impingement Imaging Findings in Asymptomatic Volunteers: A Systematic Review. Arthroscopy. 2015;31(6):1199-1204. doi:10.1016/j.arthro.2014.11.042
Reid D. The management of greater trochanteric pain syndrome: A systematic literature review. J Orthop. 2016;13(1):15-28. doi:10.1016/j.jor.2015.12.006
Del Buono A, Papalia R, Khanduja V, Denaro V, Maffulli N. Management of the greater trochanteric pain syndrome: a systematic review. Br Med Bull. 2012;102(1):115-131. doi:10.1093/bmb/ldr038
Pumarejo Gomez L, Li D, Childress JM. Greater Trochanteric Pain Syndrome (Greater Trochanteric Bursitis). In: StatPearls. StatPearls Publishing; 2025. Accessed November 15, 2025. http://www.ncbi.nlm.nih.gov/books/NBK557433/
Silva F, Adams T, Feinstein J, Arroyo RA. Trochanteric bursitis: refuting the myth of inflammation. J Clin Rheumatol Pract Rep Rheum Musculoskelet Dis. 2008;14(2):82-86. doi:10.1097/RHU.0b013e31816b4471
Long SS, Surrey DE, Nazarian LN. Sonography of Greater Trochanteric Pain Syndrome and the Rarity of Primary Bursitis. Am J Roentgenol. 2013;201(5):1083-1086. doi:10.2214/AJR.12.10038
Williams BS, Cohen SP. Greater trochanteric pain syndrome: a review of anatomy, diagnosis and treatment. Anesth Analg. 2009;108(5):1662-1670. doi:10.1213/ane.0b013e31819d6562
Konarski W, Poboży T, Śliwczyński A, et al. Avascular Necrosis of Femoral Head—Overview and Current State of the Art. Int J Environ Res Public Health. 2022;19(12):7348. doi:10.3390/ijerph19127348
Powell C, Chang C, Naguwa SM, Cheema G, Gershwin ME. Steroid induced osteonecrosis: An analysis of steroid dosing risk. Autoimmun Rev. 2010;9(11):721-743. doi:10.1016/j.autrev.2010.06.007
Goncharov EN, Koval OA, Nikolaevich Bezuglov E, et al. Conservative Treatment in Avascular Necrosis of the Femoral Head: A Systematic Review. Med Sci. 2024;12(3):32. doi:10.3390/medsci12030032
Pritchett JW. Statin therapy decreases the risk of osteonecrosis in patients receiving steroids. Clin Orthop. 2001;(386):173-178. doi:10.1097/00003086-200105000-00022
Goes RA, Teles FDC, Figueiredo F, Noronha DR, Coelho ON, Peixoto LP. Epidemiological Analysis of 245 Patients with Athletic Pubalgia. Rev Bras Ortop. 2022;58(4):e563-e570. doi:10.1055/s-0042-1749431
Kraeutler MJ, Mei-Dan O, Dávila Castrodad IM, Talishinskiy T, Milman E, Scillia AJ. A proposed algorithm for the treatment of core muscle injuries. J Hip Preserv Surg. 2021;8(4):337-342. doi:10.1093/jhps/hnab084
Walker P, Ellis E, Scofield J, Kongchum T, Sherman WF, Kaye AD. Snapping Hip Syndrome: A Comprehensive Update. Orthop Rev. 13(2):25088. doi:10.52965/001c.25088
Lai PJ, Lai CY, Tseng IC, et al. A retrospective study of hip posterior fracture-dislocation: closed reduction at the emergency department or in the operation theater? J Orthop Traumatol. 2022;23(1):55. doi:10.1186/s10195-022-00677-0
Kolasinski SL, Neogi T, Hochberg MC, et al. 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee. Arthritis Care Res. 2020;72(2):149-162. doi:10.1002/acr.24131
Fan Z, Yan L, Liu H, et al. The prevalence of hip osteoarthritis: a systematic review and meta-analysis. Arthritis Res Ther. 2023;25(1):51. doi:10.1186/s13075-023-03033-7
Loder RT. The demographics of slipped capital femoral epiphysis. An international multicenter study. Clin Orthop. 1996;(322):8-27.
Aronsson DD, Loder RT, Breur GJ, Weinstein SL. Slipped Capital Femoral Epiphysis: Current Concepts. JAAOS - J Am Acad Orthop Surg. 2006;14(12):666. Accessed November 26, 2025. https://journals.lww.com/jaaos/abstract/2006/11000/slipped_capital_femoral_epiphysis__current.10.aspx
Herngren B, Stenmarker M, Vavruch L, Hagglund G. Slipped capital femoral epiphysis: a population-based study. BMC Musculoskelet Disord. 2017;18:304. doi:10.1186/s12891-017-1665-3
Livingstone JP, Opanova MI, Durkin RC, Burkhalter W. Management of Slipped Capital Femoral Epiphysis: The Hawai‘i Experience. Hawaii J Health Soc Welf. 2019;78(11 Suppl 2):21-25. Accessed November 28, 2025. https://pmc.ncbi.nlm.nih.gov/articles/PMC6874696/
Pediatrik Kalça Bozuklukları: Kaymış Baş Femoral Epifiz ve Legg-Calvé-Perthes Hastalığı | Pediatri Dergisi | Amerikan Pediatri Akademisi. Accessed November 28, 2025. https://publications.aap.org/pediatricsinreview/article-abstract/39/9/454/35194/Pediatric-Hip-Disorders-Slipped-Capital-Femoral?redirectedFrom=fulltext
Kessler JI, Cannamela PC. What are the Demographics and Epidemiology of Legg-Calvé-Perthes Disease in a Large Southern California Integrated Health System? Clin Orthop. 2018;476(12):2344-2350. doi:10.1097/CORR.0000000000000490
Rodríguez-Olivas AO, Hernández-Zamora E, Reyes-Maldonado E. Legg–Calvé–Perthes disease overview. Orphanet J Rare Dis. 2022;17(1):125. doi:10.1186/s13023-022-02275-z
Yeager KC, Silva SR, Richter DL. Pelvic Avulsion Injuries in the Adolescent Athlete. Clin Sports Med. 2021;40(2):375-384. doi:10.1016/j.csm.2020.12.002
Kocher MS, Tucker R. Pediatric Athlete Hip Disorders. Clin Sports Med. 2006;25(2):241-253. doi:10.1016/j.csm.2006.01.001
Referanslar
Ahuja V, Thapa D, Patial S, Chander A, Ahuja A. Chronic hip pain in adults: Current knowledge and future prospective. J Anaesthesiol Clin Pharmacol. 2020;36(4):450-457. doi:10.4103/joacp.JOACP_170_19
Bowman KF, Fox J, Sekiya JK. A Clinically Relevant Review of Hip Biomechanics. Arthroscopy. 2010;26(8):1118-1129. doi:10.1016/j.arthro.2010.01.027
Vleeming A, Schuenke MD, Masi AT, Carreiro JE, Danneels L, Willard FH. The sacroiliac joint: an overview of its anatomy, function and potential clinical implications. J Anat. 2012;221(6):537-567. doi:10.1111/j.1469-7580.2012.01564.x
Glenister R, Sharma S. Anatomy, Bony Pelvis and Lower Limb, Hip. İn: StatPearls [Internet]. StatPearls Publishing; 2023. Accessed December 13, 2025. https://www.ncbi.nlm.nih.gov/books/NBK526019/
Ganz R, Parvizi J, Beck M, Leunig M, Nötzli H, Siebenrock KA. Femoroacetabular Impingement: A Cause for Osteoarthritis of the Hip. Clin Orthop Relat Res. 2003;417:112. doi:10.1097/01.blo.0000096804.78689.c2
Pun S, Kumar D, Lane NE. Femoroacetabular Impingement. Arthritis Rheumatol Hoboken NJ. 2015;67(1):17-27. doi:10.1002/art.38887
Groh MM, Herrera J. A comprehensive review of hip labral tears. Curr Rev Musculoskelet Med. 2009;2(2):105-117. doi:10.1007/s12178-009-9052-9
Schmaranzer F, Kheterpal AB, Bredella MA. Best Practices: Hip Femoroacetabular Impingement. AJR Am J Roentgenol. 2021;216(3):585-598. doi:10.2214/AJR.20.22783
Frank JM, Harris JD, Erickson BJ, et al. Prevalence of Femoroacetabular Impingement Imaging Findings in Asymptomatic Volunteers: A Systematic Review. Arthroscopy. 2015;31(6):1199-1204. doi:10.1016/j.arthro.2014.11.042
Reid D. The management of greater trochanteric pain syndrome: A systematic literature review. J Orthop. 2016;13(1):15-28. doi:10.1016/j.jor.2015.12.006
Del Buono A, Papalia R, Khanduja V, Denaro V, Maffulli N. Management of the greater trochanteric pain syndrome: a systematic review. Br Med Bull. 2012;102(1):115-131. doi:10.1093/bmb/ldr038
Pumarejo Gomez L, Li D, Childress JM. Greater Trochanteric Pain Syndrome (Greater Trochanteric Bursitis). In: StatPearls. StatPearls Publishing; 2025. Accessed November 15, 2025. http://www.ncbi.nlm.nih.gov/books/NBK557433/
Silva F, Adams T, Feinstein J, Arroyo RA. Trochanteric bursitis: refuting the myth of inflammation. J Clin Rheumatol Pract Rep Rheum Musculoskelet Dis. 2008;14(2):82-86. doi:10.1097/RHU.0b013e31816b4471
Long SS, Surrey DE, Nazarian LN. Sonography of Greater Trochanteric Pain Syndrome and the Rarity of Primary Bursitis. Am J Roentgenol. 2013;201(5):1083-1086. doi:10.2214/AJR.12.10038
Williams BS, Cohen SP. Greater trochanteric pain syndrome: a review of anatomy, diagnosis and treatment. Anesth Analg. 2009;108(5):1662-1670. doi:10.1213/ane.0b013e31819d6562
Konarski W, Poboży T, Śliwczyński A, et al. Avascular Necrosis of Femoral Head—Overview and Current State of the Art. Int J Environ Res Public Health. 2022;19(12):7348. doi:10.3390/ijerph19127348
Powell C, Chang C, Naguwa SM, Cheema G, Gershwin ME. Steroid induced osteonecrosis: An analysis of steroid dosing risk. Autoimmun Rev. 2010;9(11):721-743. doi:10.1016/j.autrev.2010.06.007
Goncharov EN, Koval OA, Nikolaevich Bezuglov E, et al. Conservative Treatment in Avascular Necrosis of the Femoral Head: A Systematic Review. Med Sci. 2024;12(3):32. doi:10.3390/medsci12030032
Pritchett JW. Statin therapy decreases the risk of osteonecrosis in patients receiving steroids. Clin Orthop. 2001;(386):173-178. doi:10.1097/00003086-200105000-00022
Goes RA, Teles FDC, Figueiredo F, Noronha DR, Coelho ON, Peixoto LP. Epidemiological Analysis of 245 Patients with Athletic Pubalgia. Rev Bras Ortop. 2022;58(4):e563-e570. doi:10.1055/s-0042-1749431
Kraeutler MJ, Mei-Dan O, Dávila Castrodad IM, Talishinskiy T, Milman E, Scillia AJ. A proposed algorithm for the treatment of core muscle injuries. J Hip Preserv Surg. 2021;8(4):337-342. doi:10.1093/jhps/hnab084
Walker P, Ellis E, Scofield J, Kongchum T, Sherman WF, Kaye AD. Snapping Hip Syndrome: A Comprehensive Update. Orthop Rev. 13(2):25088. doi:10.52965/001c.25088
Lai PJ, Lai CY, Tseng IC, et al. A retrospective study of hip posterior fracture-dislocation: closed reduction at the emergency department or in the operation theater? J Orthop Traumatol. 2022;23(1):55. doi:10.1186/s10195-022-00677-0
Kolasinski SL, Neogi T, Hochberg MC, et al. 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee. Arthritis Care Res. 2020;72(2):149-162. doi:10.1002/acr.24131
Fan Z, Yan L, Liu H, et al. The prevalence of hip osteoarthritis: a systematic review and meta-analysis. Arthritis Res Ther. 2023;25(1):51. doi:10.1186/s13075-023-03033-7
Loder RT. The demographics of slipped capital femoral epiphysis. An international multicenter study. Clin Orthop. 1996;(322):8-27.
Aronsson DD, Loder RT, Breur GJ, Weinstein SL. Slipped Capital Femoral Epiphysis: Current Concepts. JAAOS - J Am Acad Orthop Surg. 2006;14(12):666. Accessed November 26, 2025. https://journals.lww.com/jaaos/abstract/2006/11000/slipped_capital_femoral_epiphysis__current.10.aspx
Herngren B, Stenmarker M, Vavruch L, Hagglund G. Slipped capital femoral epiphysis: a population-based study. BMC Musculoskelet Disord. 2017;18:304. doi:10.1186/s12891-017-1665-3
Livingstone JP, Opanova MI, Durkin RC, Burkhalter W. Management of Slipped Capital Femoral Epiphysis: The Hawai‘i Experience. Hawaii J Health Soc Welf. 2019;78(11 Suppl 2):21-25. Accessed November 28, 2025. https://pmc.ncbi.nlm.nih.gov/articles/PMC6874696/
Pediatrik Kalça Bozuklukları: Kaymış Baş Femoral Epifiz ve Legg-Calvé-Perthes Hastalığı | Pediatri Dergisi | Amerikan Pediatri Akademisi. Accessed November 28, 2025. https://publications.aap.org/pediatricsinreview/article-abstract/39/9/454/35194/Pediatric-Hip-Disorders-Slipped-Capital-Femoral?redirectedFrom=fulltext
Kessler JI, Cannamela PC. What are the Demographics and Epidemiology of Legg-Calvé-Perthes Disease in a Large Southern California Integrated Health System? Clin Orthop. 2018;476(12):2344-2350. doi:10.1097/CORR.0000000000000490
Rodríguez-Olivas AO, Hernández-Zamora E, Reyes-Maldonado E. Legg–Calvé–Perthes disease overview. Orphanet J Rare Dis. 2022;17(1):125. doi:10.1186/s13023-022-02275-z
Yeager KC, Silva SR, Richter DL. Pelvic Avulsion Injuries in the Adolescent Athlete. Clin Sports Med. 2021;40(2):375-384. doi:10.1016/j.csm.2020.12.002
Kocher MS, Tucker R. Pediatric Athlete Hip Disorders. Clin Sports Med. 2006;25(2):241-253. doi:10.1016/j.csm.2006.01.001
