Understanding Hip Osteoarthritis
Understanding causes, diagnosis and symptoms
Osteoarthritis is a disorder that can affect any moveable joint of the body, for example knees, hips, and hands. It can show itself as a breakdown of tissues and abnormal changes to cell structures of joints, which can be initiated by injury. As the joint tries to repair, it can lead to other problems.
We used to think that hip osteoarthritis was all about the bones and its coverings (articular cartilage). We now know that it also affects structures like ligaments, nerves and muscles, and there are overall changes to the inflammation process at the joint.
What are the different parts of the hip joint?
In a healthy joint, a coating of tough but smooth and slippery tissue, called cartilage, covers the surface of the bones and helps the bones to move freely against each other. When a joint develops osteoarthritis, part of the cartilage thins and the surface becomes rougher. This means the joint doesn’t move as smoothly as it should.
Hip Joint
The hip joint is a “ball and socket” joint where the top of the thigh bone or femoral head (ball) rests in a cup-like groove in the pelvis called the acetabulum (socket).
This allows the joint to support your body weight and allows your leg to move in different directions.
Want to know more about what happens the hip joint with osteoarthritis?
When cartilage covering the hip bones becomes worn or damaged, all the tissues (e.g., bone, synovium, ligaments, muscles) in the joint become more active than normal as the body tries to repair the damage. The repair processes may change the structure of the joint, but will often allow the joint to work normally and without any pain and stiffness. Almost all of us will have changes in some of our joints as we get older, though we may not even be aware of it.
However, the repair processes don’t always work so well and changes to the joint structure can sometimes cause or contribute to symptoms such as pain, swelling or difficulty in moving the joint normally.
For example:
- Extra bone may form at the edge of the joint. These bony growths are called osteophytes and can sometimes restrict movement or rub against other tissues. In some joints, especially the finger joints, these may be visible as firm, knobbly swellings.
- The lining of the joint capsule (called the synovium) may thicken and produce more fluid than normal, causing the joint to swell.
- Tissues that surround the joint and help to support it may stretch so that after a time the joint becomes less stable.
How common is osteoarthritis?
Approximately 9% of people globally have a diagnosis of hip osteoarthritis, with highest rates in Europe (13%). The percentage of people who have osteoarthritis increases with age.
However, younger and middle-aged people can also get osteoarthritis. Approximately 5% of people between 35 and 54 years of age have osteoarthritis. Many of these people have injured their joint earlier in life, or have another cause as listed below.
What causes hip osteoarthritis?
There is not one simple reason why you may have osteoarthritis – it is more likely a combination of things you can’t change e.g. genetics, and things you can potentially change e.g. activity levels.
Things you can’t change – hover over the items below to learn more.
AGE
Cartilage is a living tissue that can age and weaken over the years.
Anatomy (shape of your joints)
The shape of your ball and socket joint can influence the likelihood of hip osteoarthritis. The femoral head may not be perfectly round due to excess bone or the socket could be too shallow.
SEX
While overall, women get osteoarthritis more often than men, men are more likely to get osteoarthritis in the hips.
GENETICS
You are more likely to get osteoarthritis if someone in your family had it too.
Things you may be able to change – hover over the items below to learn more.
PHYSICAL INACTIVITY
The hip joints need activity and ‘loading’ to keep the joint healthy. Little or no activity is therefore unhealthy for your joints and surrounding muscles.
OBESITY
Being overweight or obese puts more load on the joints. Obesity is also associated with inflammation in the body that is linked to development of osteoarthritis.
Other factors to consider:
history of joint problems
History of joint problems – People who have had a traumatic injury to their hip joint (e.g., fracture, dislocation), a hip condition they were born with (e.g., hip dysplasia) or an existing painful hip condition (e.g., femoroacetabular impingement) are at a higher risk of developing hip osteoarthritis.
work or leisure time related injury
Lots of load over a long period of time without rest can cause osteoarthritis later in life. People who work in heavy labour jobs (farmers, firefighters, construction etc.) are more at risk of hip osteoarthritis.
muscle weakness
Weak muscles won’t provide proper support to your joint and may make it more likely that your hip osteoarthritis will get worse.
How is hip osteoarthritis diagnosed?
Hip osteoarthritis can be diagnosed by your doctor or another healthcare professional (e.g., a physiotherapist) clinically, by listening to your reported symptoms and with simple test of hip movement that check for pain and restriction.
Typically, osteoarthritis is diagnosed if you:
- Are aged 45 years or older,
- Have activity-related joint pain,
- Have either no morning stiffness or stiffness that lasts no longer than 30 minutes.
X-rays used to be a common way to diagnose osteoarthritis, but now that we understand that they are not needed, unless ruling out a different diagnosis (and can sometimes even be misleading!). An MRI scan is usually not helpful or recommended for the diagnosis of hip OA. See more information on this by clicking on “Read More” below.
What tests are there for hip osteoarthritis?
There’s no blood test for osteoarthritis, although your doctor may suggest you have them to help rule out other types of arthritis (e.g., rheumatoid arthritis).
X-rays are not necessary to diagnose osteoarthritis – this is a myth!
These are some reasons why X-rays are less commonly used to diagnose osteoarthritis and why the terms ‘bone on bone’ or ‘wear and tear’ are inaccurate and should not be used to describe the condition.
Should I see a specialist?
It’s unlikely that you’ll need to see a specialist to get a diagnosis of hip osteoarthritis, although your doctor may refer you if there’s some doubt about the diagnosis or if they think there might be additional problems.
Your doctor may refer you if specialist help is needed to manage your hip osteoarthritis – this might be for physiotherapy, podiatry for foot problems, or occupational therapy, which can help if you’re having difficulty with everyday activities.
If your hip osteoarthritis becomes severe and is causing long-term problems, your GP may refer you to an orthopaedic surgeon to consider joint surgery or to a pain management programme, if you have already tried the recommended treatment options (exercise and lifestyle and weight management).
Understanding Hip Osteoarthritis Symptoms
Will my hip osteoarthritis get much worse over time?
Hip osteoarthritis affects different people, and different joints, in different ways.
In the short-term symptoms can fluctuate up and down. For a large proportion of people however, the symptoms of osteoarthritis will not worsen over time. Some people will even improve. A minority will get progressively worse, which may lead to the need to undergo surgery or total hip replacement.
One research study that looked at people with early signs of hip osteoarthritis, showed that almost 50% no longer had hip pain after 10 years. Most had less pain or no change in pain after 10 years.
For people with early hip OA only 1 in 9 will need a total hip replacement within 10 years.
What are the most common symptoms of hip osteoarthritis?
The symptoms of osteoarthritis can significantly affect your function and quality of life. Symptoms may vary for no obvious reason. Or you may find that your symptoms vary depending on what you’re doing. The good thing is that it is possible to change and improve your symptoms.
pain / soreness
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The presence of pain can be worrying for people with osteoarthritis. We used to think that the pain was a direct reflection of ‘damage’ of tissues (for example the cartilage). But we now know that this isn’t true. We now appreciate that pain is a very complex and unique experience that often has little to do with any structural changes to the joint or the surrounding tissues. This is often very reassuring for people with osteoarthritis as this often acts as a barrier for some people engaging with physical activity or exercise. It’s important to note that things like stress, body weight, lack of sleep and environmental factors all play their part in someone’s pain experience. This is great news as it means there are many things that someone with osteoarthritis can try to influence to reduce the pain they are experiencing. |  |
stiffness
Usually, stiffness occurs when someone stays in a position for a long period of time. For example, people will often experience stiffness first thing in the morning or after sitting for an hour or so.
This should not cause concern and should ease when you start to move your leg/hip.
If you are performing activities like watching TV, try to move your legs regularly or stand up and sit down again, or split your time doing sedentary activities with more physically active tasks.
Restricted movement and difficultly with day-to-day activities
Restricted movement of the hip joint can cause difficulty with day-to day activities like getting in and out of a car, rising from a low chair, putting on socks or cutting toe-nails. Other daily activities that often become difficult are climbing stairs and walking longer distances.
crepitus
Many people with and without osteoarthritis complain of noisy joints. Noises can vary from grinding to clicking and cracking. The noises joints make are commonly referred to as ‘crepitus’ by healthcare professionals. We know from research that these noises are sometimes concerning for people with osteoarthritis, and they are fearful that they are causing damage. But generally, these sounds are completely normal and should not cause concern. |  |
pain / soreness
- For hip osteoarthritis, pain is usually felt in the outer side of the hip, groin (inner thigh), buttock and down the thigh. Occasionally this type of hip pain is felt in the knee and down the shin bone.
- People commonly report pain on the first few steps after sitting, pain climbing stairs or twisting movements of the leg. Typically, the pain is relieved by sitting. Sometimes pain can be accompanied by episodes of the leg ’giving way’.
- Research suggests that the pain associated with hip osteoarthritis can be more intense than knee osteoarthritis.
The presence of pain can be worrying for people with osteoarthritis. We used to think that the pain was a direct reflection of ‘damage’ of tissues (for example the cartilage). But we now know that this isn’t true. We now appreciate that pain is a very complex and unique experience that often has little to do with any structural changes to the joint or the surrounding tissues. This is often very reassuring for people with osteoarthritis as this often acts as a barrier for some people engaging with physical activity or exercise.
It’s important to note that things like stress, body weight, lack of sleep and environmental factors all play their part in someone’s pain experience. This is great news as it means there are many things that someone with osteoarthritis can try to influence to reduce the pain they are experiencing.
stiffness
Usually, stiffness occurs when someone stays in a position for a long period of time. For example, people will often experience stiffness first thing in the morning or after sitting for an hour or so.
This should not cause concern and should ease when you start to move your leg/hip.
If you are performing activities like watching TV, try to move your legs regularly or stand up and sit down again, or split your time doing sedentary activities with more physically active tasks.
Restricted movement and difficultly with day-to-day activities
Restricted movement of the hip joint can cause difficulty with day-to day activities like getting in and out of a car, rising from a low chair, putting on socks or cutting toe-nails. Other daily activities that often become difficult are climbing stairs and walking longer distances.
crepitus
Many people with and without osteoarthritis complain of noisy joints. Noises can vary from grinding to clicking and cracking. The noises joints make are commonly referred to as ‘crepitus’ by healthcare professionals.
We know from research that these noises are sometimes concerning for people with osteoarthritis, and they are fearful that they are causing damage.
But generally, these sounds are completely normal and should not cause concern.
Other Pain Resources
Clinical recommendations on how best to manage your pain can be found in the next section, Understanding Treatments.
For other helpful resources on pain management, please see Patient Resources and Supports.
Now you know more about your condition, let’s learn more about the different treatment options.
The information in this website page was informed by the following sources/references:
Scientific Publications
- Agricola, R., Waarsing, J. H., Arden, N. K., Carr, A. J., Bierma-Zeinstra, S. M., Thomas, G. E., … & Glyn-Jones, S. (2013). Cam impingement of the hip—a risk factor for hip osteoarthritis. Nature Reviews Rheumatology, 9(10), 630-634.
- Blackburn, S., Research User Group, Rhodes, C., Higginbottom, A., & Dziedzic, K. (2016). The OARSI standardised definition of osteoarthritis: A lay version. Osteoarthritis and Cartilage, 24(S1), S192 -S192. https://doi.org/10.1016/j.joca.2016.01.379.
- Cooper C, Inskip H, Croft P, Campbell L, Smith G, McLaren M, Coggon D. Individual risk factors for hip osteoarthritis: obesity, hip injury, and physical activity. Am J Epidemiol. 1998 Mar 15;147(6):516-22. doi: 10.1093/oxfordjournals.aje.a009482.
- Fan, Z., Yan, L., Liu, H. et al. The prevalence of hip osteoarthritis: a systematic review and meta-analysis. Arthritis Res Ther 25, 51 (2023). https://doi.org/10.1186/s13075-023-03033-7.
- French HP, Galvin R, Horgan NF, Kenny RA. Prevalence and burden of osteoarthritis amongst older people in Ireland: findings from The Irish LongituDinal Study on Ageing (TILDA). Eur J Public Health. 2016 Feb;26(1):192-8. doi: 10.1093/eurpub/ckv109.
- French SD, Bennell KL, Nicolson PJ, Hodges PW, Dobson FL, Hinman RS. What do people with knee or hip osteoarthritis need to know? An international consensus list of essential statements for osteoarthritis. Arthritis care & research. 2015;67(6):809-816.
- Kowalczuk, M., Yeung, M., Simunovic, N., & Ayeni, O. R. (2015). Does femoroacetabular impingement contribute to the development of hip osteoarthritis? A systematic review. Sports Medicine and Arthroscopy Review, 23(4), 174-179.
- Metcalfe D, Perry DC, Claireaux HA, Simel DL, Zogg CK, Costa ML. Does This Patient Have Hip Osteoarthritis?: The Rational Clinical Examination Systematic Review. JAMA. 2019 Dec 17;322(23):2323-2333. doi: 10.1001/jama.2019.19413.
- Mobasheri A, Batt M. An update on the pathophysiology of osteoarthritis. Annals of physical and rehabilitation medicine. 2016;59(5-6):333-339.
- van Berkel AC, Schiphof D, Waarsing JH, Runhaar J, van Ochten JM, Bindels PJE, Bierma-Zeinstra SMA. 10-Year natural course of early hip osteoarthritis in middle-aged persons with hip pain: a CHECK study. Ann Rheum Dis. 2021 Apr;80(4):487-493. doi: 10.1136/annrheumdis-2020-218625. Epub 2021 Jan 15.
- R. Juhakoski, M. Heliövaara, O. Impivaara, H. Kröger, P. Knekt, H. Lauren, J. P. A. Arokoski, Risk factors for the development of hip osteoarthritis: a population-based prospective study, Rheumatology, Volume 48, Issue 1, January 2009, Pages 83–87, https://doi.org/10.1093/rheumatology/ken427.
Patient Websites/Resources
- TREK ‘My Knee’ education and self-management toolkit. La Trobe University. https://myknee.trekeducation.org/
- Versus Arthritis. https://www.versusarthritis.org/about-arthritis/conditions/osteoarthritis/
Clinical Guidelines
- National Clinical Guideline Centre (UK). National Institute for Health and Clinical Excellence: Guidance. Osteoarthritis in over 16s: diagnosis and management. NICE guideline [NG226]. Published: 19 October 2022. https://www.nice.org.uk/guidance/ng226