Hip Osteoarthritis: Symptoms, Causes & Treatment

What Causes Hip Osteoarthritis?

Hip osteoarthritis develops when the cartilage that cushions the hip joint gradually breaks down over years, causing the bones to rub together and leading to pain, stiffness, and reduced mobility. Risk factors include age over 45, obesity, previous joint injury, family history, and repetitive joint stress from certain occupations or sports activities.

The exact cause of hip osteoarthritis is not completely understood, but scientists know that it develops slowly over many years as the joint's protective cartilage deteriorates. While aging itself does not directly cause osteoarthritis, the longer you have been exposed to factors that stress the joint, the greater your risk becomes. This is why hip osteoarthritis becomes more common with increasing age.

Healthy cartilage is a firm, rubbery tissue that covers the ends of bones in joints, providing a smooth, friction-free surface for movement while absorbing shock. In osteoarthritis, this cartilage gradually thins, becomes less elastic, and develops small cracks and fissures. As the cartilage breaks down, the underlying bone can also change, developing bony spurs called osteophytes. The joint space narrows, and movement becomes increasingly difficult and painful.

Understanding the risk factors that contribute to hip osteoarthritis can help you make informed decisions about prevention and management. Some risk factors cannot be changed, such as age and genetics, while others like weight and activity levels are modifiable. By addressing the factors within your control, you can potentially slow the progression of the disease and reduce symptoms.

Risk Factors You Can Control

Several lifestyle factors increase the risk of developing hip osteoarthritis and can accelerate its progression. The good news is that modifying these factors can help protect your joints and reduce symptoms if you already have the condition.

• Excess weight: Being overweight or obese significantly increases the mechanical load on your hip joints. Research shows that for every pound of body weight, your hip experiences several pounds of force during walking and other activities. Losing even a small amount of weight can substantially reduce joint stress and pain.
• Repetitive joint stress: Occupations or sports that involve repeated heavy lifting, prolonged standing, or high-impact activities can accelerate cartilage wear. Farmers, construction workers, and athletes in high-impact sports face higher risks.
• Muscle weakness: Weak muscles around the hip cannot properly support and stabilize the joint, leading to increased cartilage stress. Strength training helps protect the joint.
• Sedentary lifestyle: Paradoxically, too little movement is also harmful. Regular moderate exercise helps maintain cartilage health by promoting nutrient delivery to the joint tissue.

Risk Factors That Cannot Be Changed

While some risk factors for hip osteoarthritis are beyond your control, understanding them helps you and your healthcare provider assess your overall risk and plan appropriate monitoring and treatment strategies.

• Age over 45 years: The risk of hip osteoarthritis increases substantially after age 45, with the condition becoming increasingly common with each decade of life.
• Previous joint injury: A prior hip injury, fracture near the joint, or hip surgery can damage cartilage and increase the risk of osteoarthritis developing years later.
• Family history: Genetics play a significant role. If your parents or siblings have osteoarthritis, you have a higher risk of developing the condition.
• Joint abnormalities: Congenital hip conditions like hip dysplasia or structural abnormalities can lead to uneven wear on the cartilage and early osteoarthritis.
• Sex: Women develop hip osteoarthritis more frequently than men, particularly after menopause, suggesting hormonal factors may play a role.

What Are the Symptoms of Hip Osteoarthritis?

The primary symptom of hip osteoarthritis is pain in the groin area that worsens with physical activity. As the condition progresses, you may experience morning stiffness, reduced range of motion, pain radiating to the knee or thigh, start-up pain after sitting, and eventually pain at rest or during sleep. Symptoms typically develop gradually over months to years and often fluctuate in severity.

Hip osteoarthritis symptoms develop gradually and often progress in a characteristic pattern. In the early stages, you may notice mild discomfort only during or after certain activities. Over time, symptoms typically become more persistent and can significantly impact your daily life. Understanding this progression helps you recognize the condition early when treatment is most effective.

One distinctive feature of osteoarthritis is that symptoms tend to wax and wane in what doctors call "flares" or "episodes." You may experience periods of significant pain and limitation followed by weeks or months when symptoms are much milder. This variability is normal and does not necessarily indicate that the underlying condition is getting worse during a flare or better during a calm period.

The location and quality of pain in hip osteoarthritis is often quite specific and can help distinguish it from other conditions. Recognizing these patterns helps ensure accurate diagnosis and appropriate treatment.

Early Symptoms

In the initial stages of hip osteoarthritis, symptoms are often subtle and may be dismissed as normal aging or minor strain. However, recognizing these early signs allows for earlier intervention, which can slow progression and preserve function.

• Groin pain during activity: Pain typically starts in the front of the hip and groin area during physical exertion like walking, climbing stairs, or getting in and out of a car.
• Pain in the upper thigh: Many people feel discomfort along the upper part of the thigh, from the groin extending downward.
• Pain around the knee: Because nerves from the hip also supply the knee area, hip osteoarthritis frequently causes pain that seems to come from the knee. This referred pain can be confusing and sometimes leads to misdiagnosis.
• Mild stiffness after rest: You may notice your hip feels stiff after sitting for a while or upon waking, but this stiffness improves within a few minutes of movement.

Progressive Symptoms

As hip osteoarthritis advances, symptoms become more noticeable and begin to affect daily activities. Many people at this stage have trouble with tasks they previously took for granted.

• Pain with walking and standing: Discomfort occurs not just with strenuous activity but with ordinary walking and prolonged standing.
• Increased stiffness: The hip joint becomes noticeably stiffer, making it harder to rotate the leg, put on socks and shoes, or cross your legs.
• Start-up pain: A characteristic symptom is pain when you first stand up after sitting or lying down. This "start-up" or "gelling" phenomenon typically improves after a few steps as the joint warms up.
• Reduced range of motion: You may notice you cannot move your hip as far as before, particularly when rotating the leg inward or outward.
• Altered walking pattern: As pain and stiffness increase, you may unconsciously change how you walk, taking shorter steps or limping to avoid discomfort.

Advanced Symptoms

In advanced hip osteoarthritis, symptoms can significantly impact quality of life. However, even at this stage, many treatment options remain available, including the highly successful option of hip replacement surgery.

• Pain at rest: Discomfort occurs even when you are not moving, often described as a dull ache that is difficult to ignore.
• Night pain: Many people with advanced hip osteoarthritis experience pain that disturbs sleep, often waking multiple times per night.
• Significant functional limitation: Activities like walking, getting dressed, and personal care become challenging. Many people cannot walk more than short distances without stopping due to pain.
• Secondary back pain: Changes in posture and gait due to hip pain often lead to lower back problems.

When Should You See a Doctor for Hip Pain?

Consult a healthcare provider if you have persistent hip or groin pain that affects your daily activities, pain that does not improve with rest, or progressive stiffness that limits your movement. Early evaluation and treatment can slow disease progression and maintain your quality of life. Most people can initially see a physical therapist or primary care provider without needing a specialist referral.

Many people with hip osteoarthritis delay seeking medical attention, either because they believe pain is just a normal part of aging or because they fear being told they need surgery. However, early intervention with conservative treatments like exercise therapy and physical therapy is highly effective at managing symptoms and may delay or even prevent the need for surgery. The sooner you start appropriate treatment, the better your outcomes are likely to be.

In most healthcare systems, you do not need a referral to see a physical therapist for hip pain. Physical therapists are trained to assess musculoskeletal conditions and can often diagnose hip osteoarthritis based on your symptoms and a physical examination. If they suspect a different condition or your symptoms are complex, they will refer you to a physician for further evaluation.

Signs You Should Seek Care

While hip osteoarthritis itself is not dangerous and develops slowly, certain signs indicate you would benefit from professional evaluation and treatment:

• Persistent groin or hip pain: Pain that continues for more than a few weeks and does not improve with rest and over-the-counter pain relievers.
• Pain affecting daily activities: When hip discomfort makes it difficult to walk, climb stairs, get in or out of a car, or perform your usual activities.
• Progressive stiffness: Increasing difficulty moving your hip through its normal range of motion.
• Morning stiffness lasting more than 30 minutes: While some morning stiffness is common, stiffness lasting over 30 minutes may suggest inflammatory arthritis, which requires different treatment.
• Limping or altered gait: If you notice you are walking differently or favoring one leg.

How Is Hip Osteoarthritis Diagnosed?

Hip osteoarthritis is typically diagnosed through a combination of your symptom history and a physical examination assessing range of motion, pain patterns, and gait. X-rays are not always necessary for initial diagnosis and treatment, as clinical findings are usually sufficient. Imaging may be recommended if symptoms are severe, atypical, or if surgery is being considered.

When you visit a healthcare provider for hip pain, they will begin by asking detailed questions about your symptoms: where exactly you feel pain, what makes it better or worse, how long you have had it, and how it affects your daily life. This symptom history provides crucial information that helps distinguish hip osteoarthritis from other conditions that can cause similar symptoms.

The physical examination is a key component of diagnosis. Your provider will observe how you walk, assess the range of motion in your hips and spine, and perform specific tests that help identify whether the hip joint is the source of your pain. They will check for tenderness, evaluate muscle strength, and note any clicking or grinding sensations when the hip moves.

Interestingly, early-stage hip osteoarthritis often does not show up on X-rays. The clinical diagnosis based on symptoms and physical examination is therefore more reliable than imaging in the early stages. Additionally, many people have arthritis changes visible on X-rays but no symptoms, making the clinical picture more important than imaging findings alone.

Diagnostic Tests

While clinical examination is the primary diagnostic tool, imaging studies may be ordered in certain situations to confirm the diagnosis, rule out other conditions, or plan treatment.

• X-rays: Standard X-rays can show narrowing of the joint space, bone spurs (osteophytes), and changes to the bone beneath the cartilage. However, X-ray findings often lag behind symptoms, and normal X-rays do not rule out early osteoarthritis.
• MRI: Magnetic resonance imaging provides detailed images of soft tissues including cartilage, labrum, and muscles. MRI is not routinely needed but may be ordered if other conditions need to be ruled out or if surgery is being planned.
• Blood tests: While not used to diagnose osteoarthritis, blood tests may be ordered if inflammatory arthritis like rheumatoid arthritis is suspected. Osteoarthritis does not cause elevated inflammatory markers in the blood.

How Is Hip Osteoarthritis Treated?

The most effective treatment for hip osteoarthritis combines exercise therapy, education about the condition, and weight management if needed. Regular strengthening and flexibility exercises are proven to reduce pain and improve function as effectively as medication but without side effects. Pain medications can be used as needed, and hip replacement surgery is an excellent option for people who do not respond adequately to conservative treatment.

Treatment for hip osteoarthritis focuses on reducing pain, improving function, and maintaining your quality of life. The good news is that effective treatments exist at every stage of the condition. International guidelines consistently recommend exercise therapy and patient education as the first-line treatment, with medications used as needed and surgery reserved for cases where conservative measures are insufficient.

A common misconception is that resting a painful joint is the best approach. In fact, appropriate exercise and movement are crucial for joint health. The cartilage in your hip requires regular loading to receive nutrients and stay healthy. Avoiding activity leads to muscle weakness, increased stiffness, and actually makes symptoms worse over time.

Exercise Therapy: The Foundation of Treatment

Exercise is the single most important treatment for hip osteoarthritis, recommended by every major medical guideline worldwide. Multiple high-quality studies have shown that regular exercise reduces pain and improves function as effectively as anti-inflammatory medications, but with additional benefits like improved cardiovascular health, better mood, and no side effects.

It is normal to experience some discomfort when you first start exercising with hip osteoarthritis. This does not mean you are damaging your joint. In fact, research confirms that appropriate exercise does not accelerate cartilage breakdown and actually helps protect the joint. Starting slowly and gradually increasing intensity allows your body to adapt.

A well-designed exercise program for hip osteoarthritis includes three main components: strengthening exercises to build the muscles that support the hip, flexibility exercises to maintain range of motion, and aerobic exercise for overall fitness and weight management.

• Strengthening exercises: Focus on the muscles around the hip, including the gluteal muscles, quadriceps, and hip flexors. Strong muscles take stress off the joint and improve stability. Examples include hip bridges, standing hip abduction, mini-squats, and step-ups.
• Flexibility exercises: Gentle stretching helps maintain range of motion and reduces stiffness. Hip flexor stretches, piriformis stretches, and gentle hip circles are commonly recommended.
• Aerobic exercise: Low-impact activities like swimming, water aerobics, cycling, and walking improve cardiovascular fitness, help with weight management, and release endorphins that naturally reduce pain. Aim for 150 minutes per week of moderate-intensity activity.

Medication Options

While exercise is the foundation of treatment, medications can help manage pain and allow you to participate more fully in exercise and daily activities. The goal is to use the lowest effective dose for the shortest time needed.

Paracetamol (acetaminophen) is often recommended as a first-choice pain reliever for osteoarthritis. It is generally safe when used as directed but has modest pain-relieving effects. It is particularly suitable for older adults or those with conditions that make other medications risky.

Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and naproxen provide more substantial pain relief and also reduce inflammation. They can be taken orally or applied as gels or creams directly to the skin (topical NSAIDs). However, long-term use of oral NSAIDs can cause stomach problems, and they should be used cautiously in people with heart disease, kidney problems, or a history of stomach ulcers.

People over 75 years old, those with cardiovascular disease, or those with a history of stomach ulcers should generally use paracetamol instead of NSAIDs, or use topical NSAIDs which have fewer systemic side effects. Always discuss medication choices with your healthcare provider.

Osteoarthritis symptoms typically fluctuate over time. During flare-ups when pain is more severe, taking pain medications regularly on a schedule (for example, morning and evening) is often more effective than waiting until pain becomes severe.

Assistive Devices and Aids

Various aids and devices can help reduce stress on your hip joint and make daily activities easier:

• Walking aids: A cane or walking stick used in the opposite hand from your affected hip can significantly reduce joint loading and pain during walking. Nordic walking poles are another option that many people find helpful.
• Supportive footwear: Shoes with good cushioning and arch support absorb impact and reduce stress on the hip. Avoid high heels and worn-out shoes.
• Home modifications: Raised toilet seats, grab bars in the bathroom, and long-handled shoe horns can make daily tasks easier when hip mobility is limited.

Weight Management

If you are overweight, losing weight is one of the most effective things you can do for your hip osteoarthritis. The hip joint bears significant forces during walking and other activities, and every pound of body weight translates to several pounds of force on the joint. Even modest weight loss of 5-10% of body weight can meaningfully reduce pain and improve function.

Combining a healthy diet with regular exercise is the most effective approach to sustainable weight loss. A dietitian can provide personalized guidance if you need help creating an eating plan that works for you.

Hip Replacement Surgery

When conservative treatments no longer provide adequate relief and hip osteoarthritis significantly impacts your quality of life, hip replacement surgery (total hip arthroplasty) is an excellent option. This surgery involves replacing the damaged hip joint surfaces with artificial components made of metal, plastic, or ceramic.

Hip replacement is one of the most successful surgical procedures in modern medicine. Over 95% of patients experience significant pain relief and improved function. Modern hip replacements typically last 20-25 years or longer, meaning most people will never need a revision surgery.

Surgery is typically considered when you have tried conservative treatments including exercise, physical therapy, and medications for at least 3-6 months without adequate improvement, and your symptoms significantly affect your ability to work, care for yourself, or enjoy life. The decision to have surgery is personal and should be made in partnership with your orthopedic surgeon after understanding the benefits, risks, and what to expect during recovery.

If you are well-conditioned physically before surgery, you will recover faster and have better outcomes. This is another reason to engage in regular exercise even if you know surgery is in your future.

How Can You Prevent or Slow Hip Osteoarthritis?

While you cannot completely prevent hip osteoarthritis, you can reduce your risk and slow its progression by maintaining a healthy weight, staying physically active with regular exercise that includes strength training, avoiding excessive repetitive joint stress, and addressing injuries promptly. If osteoarthritis runs in your family, these preventive measures are especially important to start early.

Prevention strategies focus on protecting your joint cartilage and keeping the supporting structures around your hip strong and healthy. Even if you already have some degree of hip osteoarthritis, these same strategies can help slow progression and reduce symptoms.

Regular physical activity is arguably the most important preventive measure. Exercise maintains muscle strength, flexibility, and helps with weight control. Strong muscles support the hip joint and reduce abnormal stresses on the cartilage. Cartilage itself benefits from regular moderate loading, which helps deliver nutrients to this tissue that has no direct blood supply.

• Stay active: Engage in regular moderate exercise including both strengthening and aerobic activities. Avoid long periods of inactivity.
• Maintain a healthy weight: Keep your body mass index (BMI) in a healthy range. Even modest weight loss can significantly reduce joint stress if you are overweight.
• Avoid extreme joint stress: If your job or hobbies involve heavy lifting, prolonged squatting, or high-impact activities, use proper techniques and take breaks to protect your joints.
• Treat injuries properly: If you injure your hip, seek appropriate treatment and complete any recommended rehabilitation. Properly healed injuries are less likely to lead to future arthritis.
• Wear supportive footwear: Good shoes with cushioning absorb impact and protect all your lower extremity joints including the hip.
• Listen to your body: Some discomfort with activity is normal, but persistent or worsening pain is a signal to modify your activities and possibly seek evaluation.

What Happens in the Body with Hip Osteoarthritis?

In hip osteoarthritis, the cartilage that normally covers the ends of bones in the hip joint gradually breaks down, losing its smooth surface and shock-absorbing properties. The underlying bone responds by forming bony spurs (osteophytes), and the joint space narrows. This process develops over many years and is influenced by mechanical stress, inflammation, and genetic factors.

The hip is a ball-and-socket joint where the round head of the femur (thigh bone) fits into a cup-shaped socket in the pelvis called the acetabulum. Both surfaces are covered with articular cartilage, a specialized tissue that is firm yet flexible, providing a nearly frictionless surface for movement while absorbing shock from activities like walking and jumping.

In a healthy joint, cartilage is constantly being maintained through a balance of breakdown and repair. Cells within the cartilage called chondrocytes produce new cartilage matrix while old or damaged material is broken down. In osteoarthritis, this balance shifts toward breakdown, and the repair process cannot keep up with the damage.

As cartilage deteriorates, it becomes thinner, softer, and develops cracks and fissures. The smooth surface becomes rough, increasing friction during movement. The body attempts to compensate by forming new bone at the joint margins (osteophytes or bone spurs), but these do not restore normal function and can actually limit movement. The joint space narrows as cartilage is lost, and in advanced cases, bone may rub against bone.

Inflammation plays a role in this process, even though osteoarthritis is not primarily an inflammatory disease. The breakdown products of cartilage trigger inflammatory responses in the joint lining (synovium), which can contribute to pain and further cartilage damage. Understanding these mechanisms has led to research into new treatments that might slow or even reverse the process, though currently there is no medication proven to regenerate cartilage.

Living Well with Hip Osteoarthritis

Most people with hip osteoarthritis can maintain an active, fulfilling life by combining regular exercise, appropriate pain management, and sensible activity modifications. Education about the condition empowers you to make informed decisions about your care and maintain a positive outlook. Support from healthcare providers, family, and sometimes peer support groups can help you navigate challenges.

Receiving a diagnosis of hip osteoarthritis can be concerning, but it is important to know that this condition is highly manageable. Many people with hip osteoarthritis remain active, continue working, and enjoy their hobbies with appropriate treatment and self-management strategies.

Knowledge is power when it comes to managing osteoarthritis. Understanding your condition helps you make informed decisions about treatment, recognize when symptoms need attention, and feel more confident in your ability to influence your outcomes. This is why patient education is considered a core component of treatment alongside exercise.

Finding the right balance between activity and rest is important. While exercise is beneficial, it is also wise to pace yourself, alternate demanding activities with lighter ones, and listen to your body. This does not mean avoiding activity when symptoms flare, but rather modifying intensity temporarily while staying as active as possible.