Hip Osteoarthritis: Symptoms & Treatment

What hip osteoarthritis is

In a healthy hip, the head of the thigh bone and the socket are covered with smooth cartilage that allows movement without friction. In osteoarthritis the cartilage wears, the gap between the bones narrows and bony spurs form at the edges of the joint.

It usually moves slowly and differs a great deal from person to person. Some people stay stable for years, while others get worse faster.

The symptoms

Pain in the groin, the buttock or the front of the thigh. The pain often travels down to the knee.
Stiffness in the morning or after sitting for a while, which eases once you move.
Trouble putting on socks and shoes or getting into the car.
A limp and shorter walking distances.
Pain at night, in the later stages.

Note: knee pain with a normal knee examination can be coming from the hip.

Why it happens

Age plays a part, but it is not the only cause. There is often a reason behind the wear:

The shape of the joint, such as femoroacetabular impingement (FAI) or hip dysplasia.
Osteonecrosis of the femoral head.
An old fracture or injury.
Family history and extra body weight.
Inflammatory conditions such as rheumatoid arthritis.

How it is diagnosed

In most cases the history, a clinical examination and a plain pelvic X-ray are enough. On examination, the first movement to go is internal rotation of the hip. The X-ray shows the narrowed joint space and the bony spurs.

An MRI scan is needed only when the X-ray is normal and the pain persists, for example to rule out osteonecrosis. An important part of the examination is telling hip pain apart from pain that comes from the lower back.

Treatment without surgery

In the early and moderate stages, the aim is to reduce pain and keep you active.

Exercise. Swimming, cycling and walking keep the joint moving and the muscles strong. Movement does not wear the joint away.
Physiotherapy. Strengthening the gluteal muscles, and stretching.
Weight. Losing a few kilos clearly reduces the load.
Medication. Painkillers and anti-inflammatory drugs during flare-ups, under medical guidance.
A walking stick in the opposite hand, when distances get hard.
Injections. In selected patients, injection treatments such as PRP are discussed.

When surgery is needed

The decision does not come from the X-ray. It comes from your life. When pain wakes you at night, when your walking distance shrinks and when treatment without surgery is no longer enough, a total hip replacement is an operation with very good results.

There is no reason to rush, but no reason to wait for as long as you can bear it either. A very long wait weakens the muscles and makes recovery harder.

What you can do every day

Keep moving, with activities that do not cause sharp pain.
Choose higher seats. Low, soft ones strain the hip.
Spread your tasks through the day, with short breaks.
Wear shoes with a soft sole.
Keep a simple pain diary. It helps a lot at the appointment.

Myths and facts

Myth: “Exercise wears the joint out.” Fact: The right exercise is the main treatment.
Myth: “Arthritis always means surgery.” Fact: Many people will never need an operation.
Myth: “The X-ray shows how much I hurt.” Fact: The picture and the symptoms often do not match.

Common questions

How do I know whether the pain is from the hip or the back?

Hip pain is usually felt in the groin and gets worse when the leg is rotated. Back pain often runs down the back of the leg, below the knee. A clinical examination tells them apart.

Can osteoarthritis be stopped?

The wear cannot be reversed. Exercise, weight control and sensible loading reduce symptoms, though, and often slow things down.

Do joint supplements help?

The evidence for glucosamine and chondroitin is weak. Some people report relief. They do not replace exercise.