Hip Osteoarthritis
Overview
Hip osteoarthritis can cause groin pain, stiffness and reduced mobility, but symptoms do not always match the changes seen on an X-ray. Assessment focuses on how the hip affects your life, not the scan alone. Exercise, education, activity adjustment and selected medicines help many people. Hip replacement may be considered when pain and loss of function remain unacceptable despite appropriate non-surgical care.
What is hip osteoarthritis?
The hip is a ball-and-socket joint. Smooth cartilage normally allows the ball at the top of the thigh bone to move within the socket with little friction. Osteoarthritis involves changes throughout the joint, including cartilage loss, altered bone, inflammation and reduced movement.
Osteoarthritis is not simply an inevitable result of ageing. Previous injury, developmental hip shape, family history, inflammatory disease and other factors may contribute. Symptoms may improve, worsen or flare over time rather than progressing at a constant rate.
Common symptoms
- Pain in the groin, front of the thigh or buttock; pain may sometimes be felt at the knee.
- Stiffness after rest, difficulty putting on shoes or socks, and reduced hip rotation.
- Pain with walking, stairs, getting in or out of a car, sport or prolonged standing.
- Reduced walking distance, disturbed sleep or increasing reliance on a walking aid.
- Intermittent catching or a sense that the leg is less reliable.
How is it assessed?
Assessment considers where the pain is felt, how long it has been present, its effect on sleep and daily activity, general health, gait and hip movement. The back and knee are also examined because pain can be referred to or from these areas. A typical diagnosis can often be made clinically. Weight-bearing X-rays are useful when symptoms are atypical, the diagnosis is uncertain, progress is not as expected or surgery is being considered.
MRI is not routinely required for established hip osteoarthritis and may show abnormalities that are not causing pain. Blood tests or other imaging are used selectively when infection, inflammatory disease, stress injury, avascular necrosis or another diagnosis is possible.
Non-surgical treatment
- Education, pacing and activity modification while remaining as active as symptoms allow.
- A tailored exercise program to maintain strength, mobility, balance and general fitness.
- Choose exercise you can sustain. Walking, cycling, water exercise and strengthening can all be useful when matched to your symptoms and goals.
- Weight management where relevant, with practical and non-judgemental support.
- A walking stick or other aid when this improves comfort and confidence.
- Pain-relieving medicines may help you remain active. Anti-inflammatory medicines require review of stomach, kidney, heart, bleeding and medication risks before use.
- An image-guided corticosteroid (cortisone) injection into the hip may provide temporary relief for selected people. Response varies, and an injection does not restore cartilage or cure arthritis.
When may hip replacement be considered?
Hip replacement may be discussed when pain, stiffness and loss of function have a major effect on quality of life and appropriate non-surgical care has not provided acceptable relief. The decision is not based on age, body weight or X-ray appearance alone.
Suitability depends on symptoms, health, expectations, surgical risk and the likelihood that the hip joint is the main pain source. The benefits, limitations, alternatives and possible complications should be considered through shared decision-making.
When should hip pain be reviewed promptly?
- Inability to bear weight after a fall or injury.
- A hot, markedly swollen joint, fever or feeling generally unwell.
- Rapidly progressive pain, unexplained weight loss or persistent night pain.
- New leg weakness, numbness, loss of bladder or bowel control, or severe back pain.
Frequently asked questions
Does a severe X-ray mean I need surgery?
No. Treatment is guided by pain, function, health and personal goals. Some people have marked X-ray changes with manageable symptoms, while others are significantly limited by less dramatic changes.
Will exercise wear the hip out faster?
Appropriate exercise is a core part of osteoarthritis care and does not ‘wear out’ the joint. Some temporary discomfort can occur as activity builds, so the type and dose may need adjustment during a flare.
Can an injection cure hip arthritis?
No. An injection may reduce symptoms for a period in selected people, but it does not restore lost cartilage or prevent all progression.
Is arthroscopy used for established hip osteoarthritis?
Hip arthroscopy is not usually helpful when pain is primarily due to established osteoarthritis. Other hip conditions require separate assessment.
General information
This page provides general information only. It cannot diagnose your condition or replace advice from a clinician who has assessed you. Your treatment and recovery plan may differ from the examples described here. Follow the instructions from your treating team. In an emergency, call 000 or attend the nearest emergency department.