Hip osteoarthritis is a common cause of ongoing hip pain, stiffness and reduced movement. It can gradually make everyday activities such as walking, climbing stairs, getting into a car or putting on shoes and socks more difficult.
For some people, symptoms remain manageable with exercise, weight management and other non-surgical treatments. For others, hip pain and loss of movement can eventually have a significant effect on everyday life and lead to discussions about hip replacement.
Understanding the hip osteoarthritis symptoms, how the condition can progress and the treatment options available can help you make informed decisions about your care.
What is hip osteoarthritis?
Osteoarthritis is a condition affecting the joints. In the hip, changes can occur in the cartilage and other structures within the joint, affecting how smoothly it moves.
The hip is a ball-and-socket joint. The rounded top of the thigh bone, called the femoral head, sits inside the socket in the pelvis. Cartilage normally helps the joint move smoothly. With osteoarthritis, changes to the cartilage, bone and surrounding tissues can contribute to pain, stiffness and reduced movement.
Hip osteoarthritis does not affect everyone in the same way. Some people have changes visible on an X-ray but relatively few symptoms, while others can have significant pain and difficulty with daily activities.
Osteoarthritis also does not necessarily become progressively worse simply because time passes. Symptoms and their impact can vary between individuals.
Hip osteoarthritis symptoms
The most common hip osteoarthritis symptoms are pain, stiffness and difficulty moving the hip.
Hip pain is often felt in the groin, although it can also occur around the outside of the hip, buttock or thigh. In some people, pain can extend towards the knee.
Common symptoms include:
- Pain when walking or standing for longer periods
- Hip stiffness, particularly after periods of inactivity
- Reduced range of movement
- Difficulty putting on shoes and socks
- Difficulty getting in and out of a car
- Pain when bending or squatting
- Difficulty walking or climbing stairs
- A limp or change in the way you walk
- Pain that may disturb sleep
- Tenderness around the hip
- Weakness around the muscles supporting the joint
Symptoms may initially be intermittent, appearing during or after activities that put more demand on the hip. As symptoms become more troublesome, pain may occur more frequently or during periods of rest.
The Royal National Orthopaedic Hospital also notes that hip osteoarthritis can cause deep pain in the groin, buttock or side of the hip, with stiffness affecting activities such as putting on shoes and socks.
What are the early signs of hip arthritis?
The early signs of hip arthritis can be subtle.
You may notice that your hip feels stiff after sitting for a while or when you first get moving. You might find certain movements more difficult than they used to be, such as putting on socks, getting into a car or walking longer distances.
Pain may initially be linked to activity rather than being present all the time. You may also notice that your usual activities take more effort or that you are unconsciously changing the way you move to avoid discomfort.
These symptoms do not automatically mean you have osteoarthritis. Hip pain can have many possible causes, so persistent or worsening symptoms should be assessed by an appropriate healthcare professional.
What causes hip osteoarthritis?
Osteoarthritis can develop for a number of reasons. Age is one factor, but it is not simply an inevitable part of getting older.
Factors associated with osteoarthritis include previous joint injury, certain conditions affecting the shape or development of the hip, family history and being overweight or obese. Previous surgery or other problems affecting the hip can also be relevant.
In some people, there may be no single identifiable cause.
Stages of hip arthritis
You may hear osteoarthritis described as being at an early, moderate or advanced stage. Imaging reports may also describe the severity of changes within the joint.
It is important to understand that there is not one universally used system that determines exactly how severe someone’s symptoms are. X-ray changes do not always correspond directly with the amount of pain or disability someone experiences.
Broadly, stages of hip arthritis may be described as follows:
Early hip osteoarthritis
In the early stages, changes within the joint may be relatively limited. Symptoms can include occasional pain, stiffness or reduced movement, particularly after activity.
You may still be able to carry out most everyday activities, although certain movements may become uncomfortable.
Treatment at this stage usually focuses on managing symptoms and maintaining strength and mobility.
Moderate hip osteoarthritis
As osteoarthritis progresses, pain and stiffness may become more frequent. Activities such as walking, climbing stairs, getting into a car or putting on footwear may become increasingly difficult.
Reduced movement can also affect the muscles around the hip, particularly if you become less active because of pain.
A structured exercise programme and other non-surgical treatments may still help manage symptoms.
Advanced hip osteoarthritis
Advanced osteoarthritis can cause persistent pain, significant stiffness and substantial loss of function.
Pain may occur during activity and, in some people, while resting or sleeping. Everyday activities may become increasingly difficult and mobility may be reduced.
At this stage, a healthcare professional may discuss whether hip replacement should be considered, particularly when symptoms are significantly affecting quality of life and non-surgical treatment has not provided sufficient relief.
NICE recommends considering referral for joint replacement when osteoarthritis symptoms such as pain, stiffness or reduced function substantially affect quality of life and non-surgical management is ineffective or unsuitable. The decision should be based on clinical assessment rather than an imaging score alone.
What does ‘bone on bone’ hip arthritis mean?
The phrase “bone on bone” is commonly used to describe severe joint changes where the normal space between the bones has become markedly reduced.
An X-ray may show narrowing of the joint space and other changes associated with osteoarthritis. However, the appearance of an X-ray does not necessarily tell you exactly how much pain you should be experiencing.
NICE advises that osteoarthritis should generally be diagnosed clinically in appropriate patients and that imaging is not routinely required for diagnosis unless there are atypical features or another diagnosis needs to be considered.
If imaging is clinically appropriate, an X-ray can provide useful information about the bones and joints. Transform Medical’s Private X-ray Service] can provide imaging for bone and joint problems, including arthritis, with appointments available at selected locations.
How is hip osteoarthritis diagnosed?
A healthcare professional will usually start by asking about your symptoms, how long you have had them and how they affect your daily activities. They may examine your hip and assess movement.
NICE states that osteoarthritis can often be diagnosed clinically in people aged 45 and over who have activity-related joint pain and either no morning stiffness or morning stiffness lasting no longer than 30 minutes. Routine imaging is not normally recommended unless symptoms are atypical or another condition needs to be considered.
An X-ray may sometimes be appropriate to investigate symptoms further or help assess the joint. Other types of imaging may be considered if a healthcare professional suspects a different problem.
Hip arthritis treatment UK: what are the options?
There is no single treatment that is right for everyone with hip osteoarthritis. The appropriate approach depends on your symptoms, mobility, general health and how much the condition is affecting your life.
Exercise and physiotherapy
Exercise is one of the main treatments recommended for osteoarthritis.
A physiotherapist can help develop an exercise programme that is appropriate for your symptoms and abilities. This may include exercises to strengthen the muscles around the hip and legs, maintain movement and improve general fitness.
NICE recommends therapeutic exercise tailored to the individual and notes that regular, consistent exercise can help reduce pain and improve physical function and quality of life.
Exercise does not mean you have to push through severe pain. Your programme should be adjusted according to your symptoms and carried out with appropriate professional advice where needed.
Weight management
If you are living with overweight or obesity, weight management may form part of your treatment plan.
NICE recommends discussing weight loss with people with osteoarthritis who are living with overweight or obesity. It states that any amount of weight loss is likely to be beneficial, with 10% weight loss likely to provide greater benefit than 5% for quality of life, physical function and pain.
Pain relief
Medication may be used alongside exercise and other non-surgical treatments.
Depending on your circumstances, a healthcare professional may discuss medicines such as non-steroidal anti-inflammatory drugs (NSAIDs). These are not suitable for everyone, so your medical history and other medicines need to be considered.
NICE recommends using medicines at the lowest effective dose for the shortest possible time and considering the potential risks of oral NSAIDs.
Steroid injections
A corticosteroid injection into the hip may sometimes be considered when other treatments have not provided sufficient relief or when short-term pain relief is needed to support therapeutic exercise.
The benefit is generally considered short term, and injections are not a permanent treatment for the underlying osteoarthritis.
Walking aids and activity changes
If hip osteoarthritis is affecting your mobility, a walking aid may sometimes help reduce the demands placed on the joint.
A physiotherapist or occupational therapist can advise whether an aid is appropriate and how to use it correctly. NICE recommends considering walking aids for people with lower-limb osteoarthritis.
Simple changes to activities may also help. This could include adjusting how long you walk for, taking regular breaks or choosing lower-impact activities that you can tolerate.
When is hip replacement considered?
Hip replacement is generally considered when hip pain and stiffness are having a substantial effect on everyday life and non-surgical treatments have not provided enough relief or are unsuitable.
This might mean persistent difficulty walking, sleeping, working or carrying out everyday activities.
A hip replacement replaces the damaged parts of the joint with artificial components. In a total hip replacement, the damaged ball of the hip is replaced and the socket is also replaced.
The decision to have surgery is individual. Your consultant will consider your symptoms, examination findings, medical history, mobility and the effect of your hip problem on your quality of life.
NICE specifically advises that people should not be excluded from consideration for joint replacement solely because of age, sex, smoking, other health conditions or being overweight or obese.
What happens during a hip replacement?
If you are considering private treatment, understanding the process can help you prepare.
At Transform Medical, the Private Hip Replacement pathway begins with a consultation with an orthopaedic consultant. Your symptoms, medical history and mobility are assessed, and imaging may be reviewed or arranged where appropriate.
If surgery is recommended and you decide to proceed, pre-operative assessment takes place before surgery. The procedure itself usually takes around one to two hours, followed by a period of recovery and physiotherapy in hospital.
You can also read the Hip Surgery Journey to understand the different stages from consultation and pre-assessment through to surgery and rehabilitation.
Recovering after hip replacement
Recovery varies between individuals and depends on factors including your general health, fitness, the type of surgery and your rehabilitation programme.
Physiotherapy and gradual increases in activity are important parts of recovery. You may initially use walking aids before progressing to greater independence.
Transform Medical’s hip replacement pathway states that many patients are walking short distances by around six to eight weeks, while recovery of muscle strength, flexibility and long-term comfort can continue for considerably longer.
Your surgeon and physiotherapy team will advise you about returning to work, driving, exercise and other activities.
When should you speak to a healthcare professional?
Consider seeking medical advice if hip pain or stiffness is persistent, worsening or beginning to affect your everyday activities.
You should also seek urgent medical attention after a significant injury if you have severe hip pain or are unable to walk or put weight on your leg.
Hip pain can have many causes, so getting an appropriate assessment is important before assuming that osteoarthritis is responsible.
Managing hip osteoarthritis over time
A diagnosis of hip osteoarthritis does not automatically mean that you will need surgery.
Many people manage their symptoms for years through a combination of exercise, physiotherapy, weight management where appropriate, medication and adjustments to daily activities. Others may eventually need surgery if symptoms become sufficiently disruptive.
The most appropriate treatment can change over time. What matters is understanding your symptoms, maintaining movement where possible and discussing your options with a qualified healthcare professional.
If your hip pain is significantly affecting your quality of life and you want to understand whether hip replacement could be an option, a specialist assessment can help you explore the next steps.
Book a consultation with Transform Medical to discuss your symptoms and treatment options.