Start here
Hip arthritis is not one thing - and it does not always end in a new hip
Arthritis is one of the most common reasons a hip starts to hurt. The word just means inflammation of the joint. It usually begins quietly and builds slowly, over years.
But arthritis in the hip is not a single condition. Several kinds can settle there, and the kind you have shapes what happens next. This page is about the most common one.
The kinds of arthritis that reach the hip
This page
Osteoarthritis
The wear-and-tear kind, and by far the most common. The smooth cartilage lining the joint slowly thins, and the hip works with less and less cushion. Age, weight and old injuries all play a part.
The other kinds are inflammatory or autoimmune - a different mechanism, and a different plan:
Rheumatoid arthritis
The immune system attacks the joint lining
Ankylosing spondylitis
Inflammatory, often starting in the spine and pelvis
Psoriatic arthritis
Linked to psoriasis of the skin
Lupus
An autoimmune condition that can involve the joints
Arthritis is progressive, which means it tends to move in one direction over time. But progressive is not the same as unstoppable.
In a lot of people the hip settles into something they can live with, and does not march straight to a replacement. The earlier we understand what is going on, the more of that road we can work with.
The signs
Where you feel it - and why the hip can fool you
Hip arthritis rarely announces itself where you would expect. The pain often sits some distance from the joint itself, which is one reason it gets missed for so long.
Where the pain usually shows up
Where hip arthritis is felt - groin, thigh and buttock, and sometimes referred down to the knee.
Groin
most telling
Deep pain in the front crease of the hip. Groin pain usually points straight at the joint.
Thigh
An ache down the front or outside of the thigh, sometimes reaching towards the knee.
Buttock
A dull, deep ache behind the hip, easy to mistake for the back.
The one that catches people out
Sometimes it shows up as knee pain
Some people arrive certain the problem is their knee - and the knee is perfectly fine. The pain is coming from the hip and travelling down. The giveaway is simple: when we turn the hip, the pain answers back. If your knee hurts but nothing seems wrong with it, the hip is worth a look.
How it tends to behave
1
Worse after you use it
A long walk or a day on your feet sets it off; it eases with rest. Early on, it comes and goes.
2
Stiff when you start
Tight for the first few steps after sitting or first thing, then it loosens as you move.
3
A limp you may not notice
You quietly start favouring the side, shortening your stride to keep weight off it.
4
Harder to reach your foot
Socks, shoes and nail-cutting get awkward as the hip loses some of its range.
Further along, the pain can start showing up at rest, or wake you at night. That is a sign the arthritis has moved on, not a sign you have run out of options.
Wherever you are feeling it, the next question is the useful one: why did this happen to your hip?
Why it happens
Why it happened to your hip - and why some wear out early
Osteoarthritis is wear outrunning repair. The hip is built to last decades, and for most people it does. When it wears down, it happens slowly, in a way you can usually picture.
What is happening inside the joint
How the joint wears - a smooth cushion thins until bone meets bone and the ball rides higher.
01
The cushion
Smooth cartilage caps the ball and the socket, so the hip glides without friction.
02
It thins
Over years the cartilage wears faster than the body can rebuild it, and the cushion gets thinner.
03
The gap closes
The space in the joint narrows, and the ball can slowly ride higher in the socket. This is what an X-ray shows.
Why it happens to one hip and not another
The ordinary route
Wear that adds up over time
Age - decades of use eventually tell on any joint.
Weight - every extra kilo is extra load through the hip, every step.
Years of hard load - heavy, repetitive work or high-impact activity done without a break.
A head start on wear
Why some hips wear out a decade or two early
An old injury - a past fracture or serious knock to the hip.
A hip shaped a little differently - a shallow socket, or a ball and socket that pinch instead of glide, sometimes from childhood.
Another kind of arthritis - inflammation from a condition like rheumatoid can wear the joint down too.
This is why two people the same age can have very different hips. The cause matters, because it changes what we can do about it.
A hip that is wearing out because of its shape may have room for repair that protects the joint. So the next step is working out exactly what is going on inside yours.
Getting it right
How we work out it is the hip
Most of the diagnosis happens before any scan. Hip osteoarthritis is worked out in the conversation and the examination first. The X-ray comes in to confirm what the hip is already telling us.
In the room
Where it hurts, and what sets it off
The pattern of pain - groin, thigh, buttock, sometimes the knee - already points us at the hip.
How the hip moves
We check its range. Losing a little turning-in movement is often the first thing to go.
Watching you walk
A limp, or how steadily the hip holds you on one leg, tells us how much it is affecting you.
On the X-ray
Taken standing
Your weight goes through the hip, so the true gap between the bones shows up honestly.
What we look for
A narrowed joint space, small bony spurs, and areas where the bone has hardened or formed cysts.
It confirms, it does not decide
Early on an X-ray can look almost normal even when the hip hurts. We go by the hip, not only the picture.
The test that settles it
If turning the hip reproduces your pain - even when the ache you came in with was in the knee - that is the clearest sign the hip is the source. It is one of the most useful things we do in the room.
Blood tests
Not to prove it is arthritis. They help us tell the wear-and-tear kind apart from the inflammatory kinds.
A scan is rarely needed
Only when the picture is unclear, or we are checking the shape of a younger hip. Most hips do not need one.
None of this takes long, and very little of it is high-tech. A careful history, a hands-on examination and one standing X-ray answer most of the question.
Once we know it is osteoarthritis and roughly how far along it is, the useful conversation begins: what we can do about it, starting with the simplest things.
What we do
What we do, simplest first
There is a lot of ground between a hip that has started to ache and a hip that needs replacing. Almost everything we do happens on that ground. We start with the most basic steps and only move up if the hip asks us to.
Not every treatment suits every patient. Where you start depends on how far the hip has gone, and what you need from it.
Start here
What helps most people, and costs the hip nothing
Take the load off
Losing weight is often the single biggest lever. Every kilo you carry is extra force through the hip on every step.
Adjust how you move
Swapping the activities that flare it for ones the hip tolerates, without giving up on staying active.
Physiotherapy
Building the muscles around the hip so they carry more of the load and the joint carries less.
A walking stick when you need it
Used on the right side, it takes real pressure off the hip. It is a sensible tool, not a defeat.
Add when you need more
Settling the pain so you can keep moving
Simple pain relief
Paracetamol, used sensibly, takes the edge off so the rest of the plan is easier to stick to.
Anti-inflammatory medicines
Used in short courses when the hip flares, with an eye on the usual precautions.
If it comes to surgery
Two very different operations, for two different situations
Joint-preserving surgery
For a younger hip whose wear comes from its shape, reshaping the joint can protect what is left of the cartilage and help slow the wear. It keeps your own hip.
Hip replacement
When the joint is genuinely worn out and the pain is running your day, a replacement is the step that gives the hip back. It is a decision we reach together, not a foregone conclusion.
Most people never climb the whole ladder. The earlier we start, the longer the simple steps tend to hold.
And if surgery does come, it comes as a considered choice at the right time, not because a hip was left too long.
Straight answers
What patients actually ask
The questions that come up most in the room, answered plainly.
Q1
Will it affect my other hip too?
Sometimes. Hip arthritis can settle in both hips, though usually one is further along than the other. We keep an eye on both and treat each on its own timing - one hip needing attention does not mean the other is on the same clock.
Q2
Am I too young for this?
A younger hip with arthritis usually has a reason behind it - an old injury, or a hip that was shaped a little differently. That is exactly where joint-preserving options matter most. Being younger is a reason to come in sooner, not to wait.
Q3
Am I going to be left with a limp?
The limp usually comes from the arthritis itself and the muscles weakening around the hip. Taking the load off and building those muscles back often improves the walk on its own. After a replacement, most people walk without a limp once their strength returns.
Q4
If I do need a replacement, how long will it last?
Modern hip replacements commonly last 15 to 20 years, and often longer. How long yours lasts depends on your age, weight and how hard you use it. If one ever does wear out, it can be revised - so a replacement is not a one-shot decision.
Q5
Will I be able to sit on the floor again?
With arthritis, floor-sitting and cross-legged positions get harder as the hip stiffens. After a replacement, deep positions like sitting cross-legged or on the floor may need to be limited, and how much depends on the type of replacement and your surgeon’s guidance. Many people do return to floor-sitting in time - but it is a judgement made for your hip, not a blanket rule.
If your question is not here, it is worth asking in person. The honest answer usually depends on your hip, not hip arthritis in general.
Next step
When to come in
You do not need to be struggling to walk to justify an appointment. The most useful time to see us is earlier than most people come - while more of the hip, and more of your choices, are still intact.
Worth getting checked if
You have groin, thigh or buttock pain that keeps coming back
You have started to walk with a limp, or someone has pointed one out
The hip is stiffening up - socks, shoes and stairs are getting awkward
Your knee hurts but the knee itself checks out fine
You are reaching for painkillers more often than you used to
The pain has started showing up at rest or at night
Why sooner genuinely matters here
For an older hip, coming in early means more of the simple, hip-sparing steps are still working in your favour.
For a younger hip, it matters even more. If the wear is coming from the shape of the joint, there is a window where the hip can still be reshaped and protected. Once the cartilage is gone, that window has closed. Being seen early is what keeps it open.
