Hip osteoarthritis

Why does hip osteoarthritis develop?

Osteoarthritis develops through a combination of cartilage wear, changes in the underlying bone and the way the joint responds over time. It is not simply an inevitable consequence of age, and no single cause is present in every patient.

• Increasing age and inherited susceptibility
• Previous injury or heavy physical loading
• Hip shape conditions such as dysplasia or impingement
• Earlier childhood hip conditions
• Muscle weakness and reduced conditioning
• Higher body weight, which can increase joint loading

What symptoms can it cause?

Pain is commonly felt in the groin, front of the thigh or buttock and can sometimes be felt around the knee. Symptoms may fluctuate, with better and worse periods.

• Pain when walking, standing or using stairs
• Stiffness after rest or difficulty putting on shoes and socks
• Reduced walking distance or a limp
• Night pain or disturbed sleep
• Difficulty with work, exercise and everyday activities

How is it assessed?

The diagnosis is usually made from the history, examination and plain X-rays. MRI is not routinely required when the clinical picture and radiographs already show osteoarthritis.

• Walking pattern and any limp
• Hip movement, particularly internal rotation, flexion and extension
• Leg length and the condition of the surrounding muscles
• X-ray features such as loss of joint space, osteophytes, sclerosis and bone cysts
• Other possible sources of pain, including the back, knee or soft tissues around the hip

Treatment without surgery

Treatment should be tailored to the person rather than the X-ray alone. Core management includes clear information, therapeutic exercise and support with weight management where appropriate.

• Activity modification and pacing
• Strength, mobility and aerobic exercise, often supported by physiotherapy
• Weight optimisation where relevant
• Simple pain relief or anti-inflammatory medication when medically suitable
• A walking stick or other aid when helpful
• A joint injection in selected circumstances for short-term symptom relief
• Continuing without surgery if symptoms remain manageable

When might hip replacement be considered?

Referral for joint replacement may be appropriate when pain, stiffness or reduced function substantially affects quality of life and non-surgical treatment is no longer providing acceptable relief.

The decision is shared. Age, sex, smoking, other health conditions or body weight should not by themselves prevent a referral, although health optimisation can reduce risk and improve recovery.

• The symptoms and their effect on your life
• Clinical examination and imaging
• Expected benefit and the limits of surgery
• Your health, priorities and willingness to undertake rehabilitation
• The risks, alternatives and option to delay or decline surgery