Walking Again After Hip Arthritis

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The Patient Profile

Let’s call her Evelyn — a 75-year-old retired schoolteacher living alone in a two-story home she’s owned for 35 years. She drove herself to the grocery store, attended her church group on Wednesdays, and walked her dog, a 10-year-old beagle named Scout, twice a day.

Then her right hip made all of that difficult.

The Slow Decline

Hip osteoarthritis often develops gradually. For Evelyn, it started as a dull ache in the groin after long walks. She attributed it to “getting older” and ignored it for nearly a year.

The ache became a limp. The limp became a shuffle. Within 18 months:

• Walking Scout went from 30 minutes to 10 minutes
• Climbing stairs to her bedroom required both hands on the railing
• Getting in and out of her car involved a painful sequence of careful movements
• She started declining invitations because getting there was too hard

The tipping point came when she nearly fell on the stairs. Her daughter insisted she see a doctor.

The Diagnosis

X-rays showed moderate to severe osteoarthritis of the right hip. The cartilage was significantly worn, with bone spur formation and narrowing of the joint space.

Her orthopedist discussed two main paths: hip replacement surgery or a trial of conservative treatments. Given Evelyn’s age, her preference for avoiding surgery, and the fact that she had never tried targeted treatment, they agreed to start conservative.

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The Treatment Journey

Phase 1: Physical Therapy (Weeks 1-8)

Evelyn began PT with a therapist experienced in hip OA. The focus was on:

Strengthening the hip stabilizers

• Gluteal exercises to improve hip support
• Core strengthening for balance and gait
• Hip abductor work to reduce the limp

Improving range of motion

• Gentle stretching to combat the stiffness
• Aquatic therapy for low-impact movement
• Joint mobilization techniques

Gait retraining

• Learning to walk without favoring the hip
• Stair-climbing techniques
• Safe movement patterns for daily activities

After eight weeks, Evelyn’s walking endurance improved. She could manage 15-minute walks with Scout and climb stairs more confidently. But the pain during and after activity was still significant — enough to limit her independence.

Her therapist reported good progress in strength but noted that the joint pain itself was the barrier to further improvement.

Phase 2: Hip Injection (Month 3)

Evelyn’s doctor recommended a hyaluronic acid injection for her hip. Hip injections are different from knee injections in an important way: the hip joint is deeper, which makes imaging guidance essential rather than optional.

Her injection was performed under fluoroscopic guidance, which allowed the doctor to confirm accurate placement within the hip joint.

Phase 3: Recovery and Response (Weeks 1-6 Post-Injection)

The first few days after the injection, Evelyn’s hip felt sore — more so than a knee injection typically does, due to the deeper access required. She rested and iced the area.

By week two, the soreness resolved and she noticed less stiffness in the morning. The hallmark groin pain that had accompanied every step was quieter.

Week four brought the clearest change. Evelyn walked Scout for 20 minutes without stopping. She climbed the stairs without gripping the railing with both hands. She drove to church without dreading the car entry and exit.

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What Independence Looked Like

Three months after the injection, combined with ongoing home exercises from her PT program, Evelyn described her daily life this way:

Before treatment:

• Pain with every step: 7/10
• Walking endurance: 10 minutes
• Stairs: painful, required railing, one step at a time
• Driving: limited to essential trips
• Dog walks: short, slow, often skipped
• Social activities: declining most invitations

After treatment:

• Pain with walking: 3/10
• Walking endurance: 25-30 minutes
• Stairs: manageable, one hand on railing
• Driving: comfortable for normal errands
• Dog walks: twice daily, 15-20 minutes each
• Social activities: attending church group, visiting friends

“I’m not running any marathons,” patients like Evelyn often say. “But I can live my life. That’s what I wanted.”

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Why This Matters at 75

Independence means something different at 75 than it does at 50. For Evelyn, the question wasn’t whether she could hike or play sports. It was whether she could:

• Stay in her home. Navigating stairs and daily tasks safely meant she didn’t need to consider assisted living or moving.
• Care for her dog. Scout needed walks. If Evelyn couldn’t walk him, she’d have to rehome him or hire help.
• Drive herself. In a suburban area without good public transit, not driving means depending on others for everything.
• Maintain social connections. Isolation is a serious health risk for seniors. Staying mobile meant staying connected.

These aren’t dramatic goals. But they represent the difference between independence and dependence, and that distinction matters deeply to patients like Evelyn.

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The Role of Each Treatment

What PT Contributed

Physical therapy built the muscular foundation that made the injection more effective. Stronger hip muscles meant:

• Better joint stability during walking
• More even weight distribution
• Improved balance to reduce fall risk
• Greater endurance for daily activities

Without PT, the injection alone would likely have provided less overall benefit.

What the Injection Contributed

The HA injection addressed what PT couldn’t — the joint-level pain from cartilage loss. By supplementing the hip’s natural lubrication, the injection reduced the bone-on-cartilage friction that caused pain with every step.

Without the injection, PT improvements were capped by pain. Evelyn could build strength but couldn’t use it comfortably.

The Combination Effect

Together, the treatments addressed both the structural weakness (PT) and the inflammatory pain (injection). This combination approach is supported by clinical evidence showing better outcomes than either treatment alone.

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Important Considerations for Hip Patients

Hip osteoarthritis treatment has some unique factors to understand:

The evidence for hip HA injections is less established than for knees. Most FDA-approved HA products are indicated for knee OA. Hip use may be off-label, and insurance coverage varies. Ask your doctor and insurer about coverage before proceeding.

Hip injections require imaging guidance. Unlike knee injections, which can sometimes be done accurately without imaging, hip injections should always use fluoroscopy or ultrasound to ensure the medication reaches the joint.

Hip replacement has very high success rates. If conservative treatment doesn’t provide adequate relief, hip replacement surgery is one of the most successful procedures in orthopedics. Don’t avoid surgery out of fear if your doctor recommends it and conservative options have failed.

Falls are a serious concern. Hip pain that causes an unstable gait increases fall risk, which can lead to hip fractures — a far more serious problem than the arthritis itself. If conservative treatment isn’t keeping you safe on your feet, that’s an important factor in the surgical decision.

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Frequently Asked Questions

Are gel injections FDA-approved for hip arthritis?

Most hyaluronic acid products are FDA-approved specifically for knee osteoarthritis. Their use in hips is considered off-label by some providers and insurers. Coverage varies. Always verify with your insurance provider before proceeding. Some providers have had success getting hip injections covered; others have not.

How is a hip injection different from a knee injection?

The hip joint is much deeper than the knee, surrounded by thick muscles. Hip injections require imaging guidance (fluoroscopy or ultrasound) for safe, accurate placement. The procedure takes slightly longer, and some patients experience more soreness in the first few days due to the deeper access.

Can physical therapy alone manage hip osteoarthritis?

For mild arthritis, PT alone may be sufficient. For moderate to severe OA, PT is most effective when combined with pain management (injections or medications) that allows the patient to exercise comfortably. Think of PT as building the infrastructure and pain management as removing the barrier.

How long do hip HA injections typically last?

Published data on hip viscosupplementation shows variable results, with responding patients typically reporting 3-6 months of benefit. This is generally shorter than knee injection duration. Your doctor can discuss whether repeat treatment is appropriate.

Is hip replacement ever the right first choice?

Yes. For patients with severe hip arthritis who have significant pain and functional limitation, proceeding directly to hip replacement may be the most appropriate option. The surgery has a 95%+ success rate at 10 years and can provide dramatic improvement in function and quality of life.

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This story is a composite narrative based on common patient experiences. It is not based on a single real patient. Individual results vary significantly, particularly for hip viscosupplementation where the evidence base is less established than for knee treatment. Always consult a qualified healthcare provider about your specific condition and treatment options. This article is for informational purposes only and does not constitute medical advice.

Last reviewed: March 2026