Hip osteoarthritis
The most common form of hip disease, causing progressive loss of cartilage in the hip joint, leading to pain, stiffness, and loss of mobility. Hip replacement is one of the most successful operations in modern surgery.
📊 Hip osteoarthritis affects approximately 8-10% of adults over 55 and is the leading indication for total hip replacement, with over 100,000 procedures performed annually in the UK.
What is hip osteoarthritis?
Hip osteoarthritis is a progressive degenerative condition characterised by loss of the articular cartilage lining the hip joint. The hip is a ball-and-socket joint formed by the femoral head (ball) articulating within the acetabulum (socket). As cartilage wears away, the underlying bone is exposed, causing pain, bony overgrowth (osteophytes), joint space narrowing, and progressive loss of movement and function.
Primary osteoarthritis occurs as a natural consequence of ageing without a specific cause. Secondary osteoarthritis develops as a result of a pre-existing condition - previous hip fracture, developmental dysplasia of the hip, Perthes disease in childhood, slipped capital femoral epiphysis (SCFE), or inflammatory arthritis. The distinction is important as it influences the age of onset, surgical planning, and the complexity of any joint replacement.
The severity of symptoms does not always correlate with X-ray findings. Some patients with severe radiological changes have minimal pain; others have severe pain with only moderate X-ray changes. Treatment decisions are based primarily on symptoms and functional impact rather than X-ray appearance alone.
Common causes
- Age-related cartilage degeneration (primary OA)
- Previous hip fracture or dislocation
- Developmental dysplasia of the hip (DDH)
- Perthes disease or slipped capital femoral epiphysis in childhood
- Femoroacetabular impingement (FAI) - abnormal bony contact in the hip
- Inflammatory arthritis (rheumatoid, ankylosing spondylitis)
- Avascular necrosis of the femoral head
- Obesity - increases mechanical load on the joint
Who is at risk? Age is the strongest risk factor. Obesity, female sex, a family history of osteoarthritis, and previous hip pathology in childhood significantly increase risk.
Symptoms
Symptoms vary depending on the severity and duration of the condition. Common symptoms include:
- Deep groin pain, sometimes felt in the buttock, thigh, or knee
- Stiffness, particularly in the morning and after sitting
- Reduced range of movement - difficulty putting on socks, cutting toenails, or getting in and out of a car
- A limp developing over time
- Aching at rest or at night in more severe disease
- Clicking, catching, or giving way of the hip
When to seek help: See your GP if hip pain is persistent, limiting your walking distance, disturbing your sleep, or not responding to simple analgesia. Referral to an orthopaedic specialist is appropriate when non-operative measures are no longer providing adequate relief.
How is it diagnosed?
Your surgeon will take a detailed history and examine the joint. The following investigations may be arranged to confirm the diagnosis:
- Clinical examination - assessment of range of movement, gait analysis, and provocative tests
- X-ray - AP pelvis and lateral hip views show joint space narrowing, osteophytes, subchondral sclerosis, and cyst formation
- MRI - used to assess cartilage damage, labral tears, and avascular necrosis in younger patients
- CT scan - used for pre-operative planning in complex cases with deformity
X-ray is the standard first-line investigation. The Kellgren-Lawrence grading system (0-4) classifies osteoarthritis severity radiologically. Grade 3-4 changes combined with significant symptoms are the typical threshold for joint replacement discussion.
Treatment pathway
Treatment is tailored to the severity of the condition, your age, activity level, and overall health. Most conditions are treated in a stepwise fashion, starting with the least invasive options.
Activity modification, analgesia, and physiotherapy
Simple analgesia (paracetamol, NSAIDs), activity modification to avoid high-impact activities, weight loss, and a targeted hip strengthening physiotherapy programme. Walking aids may improve comfort and safety.
Intra-articular injection
Corticosteroid injection into the hip joint provides short-term pain relief of several weeks to months. Hyaluronic acid (viscosupplementation) injections may provide longer-term benefit in some patients. Performed under ultrasound or fluoroscopic guidance.
Total hip replacement (THR)
Replacement of the femoral head and acetabulum with metal, ceramic, and polyethylene components. The most commonly performed and reliably successful orthopaedic procedure. Over 95% of patients report significant pain relief. Implant survival exceeds 90% at 20 years with modern uncemented designs in active patients.
Recovery
Recovery after total hip replacement is generally rapid. Most patients walk with a frame the day after surgery, with a stick within 4-6 weeks. Driving and low-impact activity resumes at 6-8 weeks. Precautions to prevent dislocation (avoiding crossing the legs, deep bending of the hip) are given by the surgical team and vary with the approach used.
- Non-operative management: 3-12 months trial
- After total hip replacement: mobilise day 1:
- Walking without aids: 4-6 weeks
- Return to driving: 6-8 weeks
- Full recovery: 6-12 months
What results can I expect?
Total hip replacement is one of the most successful operations in modern surgery with over 95% of patients reporting significant pain relief and improved function. Patient-reported outcomes (Oxford Hip Score) consistently show large, durable improvements. Revision surgery is required in approximately 10% of cases at 20 years.
Hip osteoarthritis - understanding your condition
In numbers
Typical activity timelines for this condition. These are approximate and vary considerably between patients. Always follow the specific guidance given by your surgeon and physiotherapist.
| Activity | Typical timeline | Notes |
|---|---|---|
| Stay active | Now | Exercise is one of the most effective treatments for hip OA. Low-impact activity (walking, swimming, cycling) is encouraged, not avoided.[1] |
| Lose weight if needed | Ongoing | Even modest weight loss (5-10%) reduces hip pain and slows progression in patients with overweight or obesity.[1] |
| Try paracetamol | As needed | Paracetamol and topical NSAIDs are recommended first-line analgesics. Oral NSAIDs at the lowest effective dose for the shortest time.[1] |
| Consider an injection | For flares | A corticosteroid injection can give short-term relief during a flare but is not for repeated long-term use.[1] |
| Discuss surgery | When function is limited | Hip replacement is considered when symptoms substantially affect daily life and non-surgical care is no longer enough.[4] |
| Drive after THR | 6-8 weeks after surgery | When you can react and brake safely. Inform your insurer. Earlier for left hip if driving an automatic.[6] |
| Return to sport | After THR: 3-6 months | Walking, cycling, swimming, and golf are usually fine. High-impact running and contact sport are typically discouraged.[5] |
Common concerns from patients with this condition or recovering from treatment, and whether they are expected or worth mentioning to your team.
Your questions, answered
Plain-English answers to the things people most often ask, grounded in UK clinical guidance. Tap a question to open it.
About thisWhat is hip osteoarthritis?
The hip is a ball-and-socket joint lined with smooth cartilage. In osteoarthritis that cartilage gradually wears and thins, the bone underneath reacts, and the joint becomes stiff and sore. It is the most common form of hip disease and tends to develop slowly over years.
SymptomsWhere will I feel the pain?
Hip arthritis is usually felt in the groin or the front of the thigh, and sometimes in the buttock. Pain referred down towards the knee is common and can be mistaken for a knee problem. Many people notice stiffness first thing in the morning that eases as they move about.
TreatmentWill I definitely need a replacement?
No. Most people are managed for a long time without surgery, using exercise, weight management and simple pain relief. A hip replacement is considered only when the pain and loss of function are affecting your daily life and non-surgical measures are no longer helping enough.
ExerciseIs exercise safe, or will it wear the joint out faster?
Keeping active is one of the most useful things you can do, and it does not wear the joint out. Strengthening the muscles around the hip and low-impact activity such as swimming, cycling or walking helps with pain and stiffness. Long periods of rest tend to make things stiffer and weaker.
InjectionsDo steroid injections work?
A steroid injection into the hip can settle a painful flare and give some people several weeks or months of relief, but it is not a cure and does not repair cartilage. It is usually used to help you stay active or to bridge a difficult patch, rather than as a long-term plan.
Daily lifeWhat can I do day to day to help?
Losing even a small amount of weight reduces the load through the hip. Supportive footwear, a walking stick held in the opposite hand, and pacing your activities can all make a real difference. Heat, gentle movement and keeping up your exercises usually help more than resting completely.
OutlookIs it certain to get worse over time?
Not necessarily. Osteoarthritis varies a great deal between people and many stay stable or improve their symptoms for years with the right exercise and self-care. It is not a relentless decline for everyone, and good management can keep you mobile and comfortable.
When to worryWhen should I seek urgent advice?
Seek help promptly if the hip becomes suddenly very painful, hot and swollen, you feel unwell or feverish, or you can no longer put weight on the leg. Severe pain after a fall, or new night pain that nothing relieves, should also be checked.
- 1.NICE NG226: Osteoarthritis in over 16s, diagnosis and management
- 2.Versus Arthritis: Hip pain and osteoarthritis
- 3.National Joint Registry annual report (NJR), hip and knee implant data
- 4.NICE NG157: Joint replacement (primary): hip, knee and shoulder
- 5.NHS: Hip replacement
- 6.Royal College of Surgeons of England: Recovering from surgery, driving guidance
- 7.Chartered Society of Physiotherapy: Patient information
- 8.NHS: Osteoarthritis
- 9.British Orthopaedic Association: Hip and knee osteoarthritis patient information
References are to UK clinical guidance and patient information from recognised organisations. This page is for general information and does not replace personalised advice from your own clinical team.
Preparing for surgery?
Read our step-by-step guide - what to expect before, during, and after your procedure.
How is it diagnosed?
- ✓Clinical examination - assessment of range of movement, gait analysis, and provocative tests
- ✓X-ray - AP pelvis and lateral hip views show joint space narrowing, osteophytes, subchondral sclerosis, and cyst formation
- ✓MRI - used to assess cartilage damage, labral tears, and avascular necrosis in younger patients
- ✓CT scan - used for pre-operative planning in complex cases with deformity
Recovery milestones
- ●Non-operative management: 3-12 months trial
- ●After total hip replacement: mobilise day 1:
- ●Walking without aids: 4-6 weeks
- ●Return to driving: 6-8 weeks
- ●Full recovery: 6-12 months