Hip osteoarthritis
By The Treatment Registry editors
Degenerative joint disease of the hip, characterised by progressive cartilage loss, joint-space narrowing, osteophyte formation, and pain. Symptoms typically include groin pain on weight-bearing, stiffness after rest, and progressive functional limitation. Treatment is staged from lifestyle and medical management through intra-articular injection and finally hip replacement for end-stage disease.
Clinical overview
Signs and symptoms
In the hip, as in other large weight-bearing joints, the main symptom of osteoarthritis is pain, which causes loss of function and is often accompanied by stiffness. The pain is typically made worse by prolonged activity and relieved by rest, while stiffness is most common in the morning, usually lasting less than thirty minutes after activity begins but returning after periods of inactivity such as prolonged sitting. Movement of the affected joint may produce a crackling noise known as crepitus, and a person may report joint locking or instability. The hip and knee are among the large weight-bearing joints most commonly involved, and as osteoarthritis progresses gait and other movement patterns are typically affected.
Causes and risk factors
Osteoarthritis of the hip is believed to result primarily from mechanical stress on the joint with insufficient self-repair, together with low-grade inflammation. Contributing sources of stress include congenital or pathological bone misalignment, mechanical injury, excess body weight, loss of strength in the supporting muscles, and impaired peripheral nerves. Risk rises with age, previous joint injury, and family history, and hip osteoarthritis is about twice as common in people with obesity. It is more prevalent among post-menopausal women, who tend to have more severe hip symptoms and imaging findings than men, and occupational risk is increased by manual handling, physically demanding work, and, for the hip in particular, working in bent or twisted positions. Pathologically there is progressive cartilage loss, a disorganised collagen matrix with reduced proteoglycan content, osteophyte formation at the joint margins, and changes in the subchondral bone.
How it is diagnosed
Hip osteoarthritis is diagnosed with reasonable certainty from the history and clinical examination. X-rays may confirm the diagnosis, with typical changes including joint-space narrowing, subchondral sclerosis, subchondral cyst formation, and osteophytes; the combination of hip pain and osteophytes on X-ray has good sensitivity and specificity for the diagnosis. Radiographs may not correlate with the physical examination or the degree of pain, particularly early in the disease when imaging findings can be relatively normal. The Tönnis classification is used to grade osteoarthritis of the hip joint using projectional radiography features.
Who it affects
Hip osteoarthritis affects about 0.85 per cent of the population. Osteoarthritis overall is the most common form of arthritis, affecting about 237 million people, or 3.3 per cent of the world's population as of 2015, and becomes more common with age. More than 90 per cent of hip and knee joint replacements are performed because of osteoarthritis. In the Middle East and North Africa the prevalence of hip osteoarthritis increased roughly three-fold between 1990 and 2019, to about 1.28 million cases.
Clinical overview sourced from encyclopaedic medical reference; see sources below. General information only — not a substitute for individual clinical assessment.
Treatment ladder
Conservative options are first-line where appropriate; surgical options are typically reserved for cases where lower-tier options are unsuitable or have failed. Decisions are individual and depend on clinical assessment.
Conservative
- Weight management and physiotherapy
First-line for all symptomatic patients. Each kilogram lost reduces hip load substantially; supervised exercise improves pain and function in early-to-moderate disease.
- Analgesia (paracetamol, NSAIDs)
Topical NSAIDs preferred for localised symptoms; systemic NSAIDs effective but with cardiovascular and gastrointestinal risk profiles to consider in older patients.
- Walking aid (cane, walker)
A cane held in the contralateral hand reduces hip load by approximately 25%. Often deferred by patients but a meaningful intervention.
Procedural
- Intra-articular corticosteroid injection
Short-term symptomatic relief (weeks to months). Repeated injections may accelerate joint deterioration and are not a long-term solution.
- Hyaluronic acid (viscosupplementation) injection
Less established evidence for hip than for knee; some patients report symptomatic improvement.
Surgical
- Total hip replacement · View procedure page
Definitive surgical treatment for end-stage hip osteoarthritis. Modern implant survivorship at 15 years exceeds 90% in registry data.
- Hip resurfacing arthroplasty
Bone-conserving alternative to total hip replacement; metal-on-metal bearings limit current usage to selected younger male patients due to historical concerns about metal-ion debris.
- Hip arthroscopy (for early labral pathology)
Minimally invasive treatment of femoroacetabular impingement and labral tears in earlier disease; not appropriate for advanced osteoarthritis.
Related procedures
Sources
- [1]AAOS — Surgical Management of Osteoarthritis of the Knee Clinical Practice Guideline — aaos.org(accessed 2026-05-09)
- [2]Wikipedia — Osteoarthritis — en.wikipedia.org(accessed 2026-07-24)
- [3]National Joint Registry for England, Wales, Northern Ireland and the Isle of Man — Annual Report — njrcentre.org.uk(accessed 2026-05-09)
Sources marked “on file” are held by The Treatment Registry but are not publicly accessible.