What is Hip Arthritis?
Hip arthritis is a degenerative condition where the cartilage covering the ball-and-socket hip joint gradually wears away. As the protective cartilage deteriorates, the bones of the joint rub together, causing pain, inflammation, and reduced mobility.
The hip joint is one of the body’s largest weight-bearing joints, making it particularly susceptible to wear and tear. Hip osteoarthritis affects approximately 10 million Americans and is a leading cause of disability in older adults.
Anatomy of the Hip Joint
Understanding hip anatomy helps explain why arthritis causes specific symptoms:
- Femoral head (ball): The rounded top of the thigh bone
- Acetabulum (socket): The cup-shaped cavity in the pelvis
- Articular cartilage: Smooth tissue covering both surfaces
- Synovial fluid: Natural lubricant within the joint
- Labrum: Ring of cartilage around the socket edge
When arthritis develops, the cartilage thins, synovial fluid decreases, and bone spurs may form—all contributing to pain and stiffness.
Recognizing Hip Arthritis Symptoms
Hip arthritis symptoms often develop gradually and may initially be mistaken for other conditions.
Primary Symptoms
- Groin pain: The most common location, often deep and aching
- Thigh pain: Can radiate down the front or inside of the thigh
- Buttock pain: May be confused with back problems
- Knee pain: Referred pain from the hip is common
Functional Limitations
- Difficulty rising from chairs or getting out of a car
- Trouble climbing stairs
- Limping or altered walking pattern
- Reduced ability to bend or rotate the hip
- Difficulty with daily activities like putting on shoes
Warning Signs to Watch
Seek evaluation if you experience:
- Pain that doesn’t improve after 2-3 weeks of rest
- Stiffness lasting more than 30 minutes
- Night pain that disrupts sleep
- Increasing reliance on pain medications
- Noticeable changes in walking ability
Stages of Hip Osteoarthritis
Stage 1: Early
- Minimal cartilage changes
- Occasional discomfort after activity
- Full range of motion maintained
- Management: Exercise, weight control, activity modification
Stage 2: Mild
- Visible cartilage wear on imaging
- More frequent pain after walking or standing
- Some morning stiffness
- Management: Physical therapy, NSAIDs, lifestyle modifications
Stage 3: Moderate
- Significant cartilage loss
- Daily pain affecting activities
- Noticeable stiffness and reduced motion
- Management: Injection therapies, advanced PT, assistive devices
Stage 4: Severe
- Bone-on-bone contact in portions of joint
- Constant pain affecting quality of life
- Significant functional limitation
- Management: Advanced injections, surgical evaluation
Causes and Risk Factors
Primary (Idiopathic) Hip Arthritis
Develops without a clear underlying cause, typically related to:
- Natural aging and wear over time
- Genetic predisposition
- Cumulative stress on the joint
Secondary Hip Arthritis
Results from identifiable factors:
- Developmental conditions: Hip dysplasia, Legg-Calve-Perthes disease
- Trauma: Previous fractures or dislocations
- Avascular necrosis: Loss of blood supply to the femoral head
- Inflammatory conditions: Rheumatoid arthritis, lupus
- Femoroacetabular impingement (FAI): Abnormal bone shape causing friction
Diagnosis
Accurate diagnosis guides appropriate treatment selection.
Clinical Evaluation
- Detailed symptom history
- Physical examination of hip motion and strength
- Gait analysis
- Assessment of other potential pain sources
Imaging Studies
- X-rays: Show joint space narrowing, bone spurs, and cysts
- MRI: Reveals cartilage damage and soft tissue conditions
- CT scan: Detailed bone structure evaluation when needed
- Fluoroscopy: Used for guided injection procedures
Differential Diagnosis
Other conditions that mimic hip arthritis:
- Lumbar spine problems
- Trochanteric bursitis
- Hip labral tears
- Stress fractures
- Sacroiliac joint dysfunction
Non-Surgical Treatment Options
Most patients benefit from conservative treatments, especially in earlier stages.
Lifestyle Modifications
- Weight management: Reducing pressure on the hip joint
- Activity modification: Avoiding high-impact activities
- Assistive devices: Canes, walkers, grab bars as needed
- Ergonomic adjustments: Proper seating, raised toilet seats
Physical Therapy
Structured PT programs improve:
- Hip strength and stability
- Range of motion and flexibility
- Walking mechanics
- Core strength to support the hip
- Balance to prevent falls
Medications
- Acetaminophen: First-line pain relief
- NSAIDs: Anti-inflammatory medications (oral or topical)
- Prescription options: For moderate to severe pain
Injection Therapies
When conservative measures aren’t enough:
- Corticosteroid injections: Quick anti-inflammatory relief lasting weeks to months
- Hyaluronic acid injections: Restore joint lubrication for longer-term relief
- PRP injections: Use your body’s healing factors (emerging treatment)
Why Imaging Guidance Matters for Hip Injections
The hip joint is deep within the body and cannot be accurately injected without imaging guidance. Studies show:
- Blind hip injections frequently miss the joint entirely
- Fluoroscopic guidance provides real-time visualization
- Precise placement ensures medication reaches the joint space
- Better outcomes with image-guided techniques
Always confirm that your provider uses fluoroscopic or ultrasound guidance for hip injections.
When to Consider Surgery
Surgery may be appropriate when:
- Conservative treatments no longer provide adequate relief
- Pain significantly impacts quality of life
- Functional limitations affect independence
- Imaging shows severe joint damage
Surgical Options
- Hip arthroscopy: Minimally invasive for specific conditions
- Hip resurfacing: Preserves more bone (select patients)
- Total hip replacement: Highly successful for advanced arthritis
Living Well with Hip Arthritis
Many patients effectively manage hip arthritis for years through:
- Consistent low-impact exercise (swimming, cycling, walking)
- Maintaining a healthy weight
- Appropriate use of medications and injections
- Physical therapy maintenance programs
- Pacing activities to avoid overexertion
Questions to Ask Your Provider
- What stage is my hip arthritis?
- Am I a candidate for injection treatments?
- Do you use imaging guidance for hip injections?
- What physical therapy approach do you recommend?
- When should I consider surgical options?
- What can I do to slow the progression?