Groin pain, stiff mornings and trouble putting on socks? How hip arthritis behaves, what helps most, and when a hip replacement is worth considering.
Hip arthritis often creeps up. First it is a stiff hip getting out of the car. Then an ache in the groin after a long walk or a day in the garden. Then putting on socks and shoes becomes a juggling act, and you notice you have started to limp. Sometimes the first symptom is not even in the hip at all — it is a pain in the knee.
Hip osteoarthritis is one of the most common reasons for hip pain in people over 50. A US study estimated that about one in four people may develop symptomatic hip osteoarthritis during their lifetime. It is a long-term condition, but it is not a straight line downhill, and there is a lot you can do. This guide explains how hip arthritis behaves, what the evidence says about exercise and other treatments, and how to know when a hip replacement is the right step.
At a glance
- What it is: a whole-joint condition of the ball-and-socket hip joint, involving cartilage, bone and surrounding tissues
- Typical symptoms: groin or front-of-hip pain, stiffness, difficulty with socks, shoes and getting in and out of cars
- Surprising sign: hip arthritis can cause pain felt mainly in the thigh or knee
- First-line care: education, exercise and, where relevant, weight management — recommended for everyone
- Helpful aids: a walking stick in the opposite hand reduces load on the hip
- Hip replacement: very effective for severe arthritis when pain and function are no longer acceptable despite good non-surgical care
What is hip osteoarthritis?
The hip is a ball-and-socket joint. The ball at the top of the thigh bone sits in a cup-shaped socket in the pelvis, and both surfaces are covered with smooth cartilage. In osteoarthritis, the cartilage thins and becomes rougher, the bone underneath changes and may form bony edges (osteophytes), and the joint lining can become irritated.
As a review in The Lancet describes, osteoarthritis is not simply "wear and tear". It is an active process involving the whole joint, influenced by age, genetics, joint shape, previous injury, body weight and general health. Some people have hip shapes from youth — such as hip dysplasia or femoroacetabular impingement — that make arthritis more likely later on.
Symptoms
- Pain in the groin or the front of the hip, sometimes in the buttock or down the front of the thigh
- Pain referred to the knee — occasionally the only symptom
- Stiffness in the morning or after sitting, usually easing within about half an hour
- Difficulty putting on socks and shoes, cutting toenails, or getting in and out of a car or bath
- Pain walking further, on uneven ground, or on stairs
- A limp, or the feeling the leg is shorter
- Pain at night in more advanced arthritis
Is it the hip joint, a tendon, or my back?
Three common causes of "hip pain" are easily confused:
- Hip joint arthritis — usually groin pain and stiffness turning the hip inwards.
- Gluteal tendinopathy — pain on the outside of the hip, worse lying on that side. See our guide to gluteal tendinopathy.
- Referred pain from the lower back — buttock pain, often with back pain and sometimes pins and needles.
They can also occur together. A physiotherapist will test the hip's movement, the tendons and the back to work out which is driving your pain.
Do I need an X-ray?
Hip osteoarthritis can usually be diagnosed from your symptoms and an examination, especially in people over 45 with typical symptoms. An X-ray is useful when the diagnosis is unclear, when symptoms change quickly, or when surgery is being considered. Remember that X-ray changes and pain levels often do not match closely.
What helps: the evidence
Two major guidelines — from the Osteoarthritis Research Society International (OARSI) and from the American College of Rheumatology — agree on the foundations of care for hip osteoarthritis: education, exercise and weight management, supported by aids and medicines where needed.
1. Exercise
A Cochrane review of exercise for hip osteoarthritis found that it reduces pain and improves physical function, with benefits lasting several months after a programme ends. Programmes usually combine:
- Strengthening of the hip and thigh muscles — especially the buttock (gluteal) muscles
- Movement exercises to maintain range in the hip
- Balance and control work
- Aerobic activity such as walking, cycling or water exercise
Structured programmes such as GLA:D, developed in Denmark for hip and knee osteoarthritis and now run by trained physiotherapists in Australia, combine education with supervised exercise and have reported meaningful improvements in pain across large numbers of people.
It is worth being honest that not every trial has been positive. An Australian trial in JAMA found that a 12-week physiotherapy package for hip osteoarthritis was no better than a convincing sham treatment. That result is a reminder that hip pain fluctuates, that expectations matter, and that passive treatments are not the answer on their own. Guidelines continue to recommend exercise as core treatment, based on the wider body of evidence and its broader health benefits.
2. Weight management
The hip carries several times your body weight with every step. If you are carrying extra weight, losing some reduces the load on the joint and often eases pain, as well as improving general health.
3. A walking stick
The American College of Rheumatology guideline strongly recommends a walking stick for hip osteoarthritis when walking is painful. Held in the hand opposite to the sore hip, it takes a surprising amount of load off the joint. A physio can set the height and show you how to use it.
4. Medicines
- Anti-inflammatory tablets can help many people, but have stomach, kidney and heart risks; discuss them with your GP or pharmacist.
- Topical anti-inflammatory gels are recommended mainly for the knee; the hip joint sits too deep for a gel to reach well.
- Image-guided steroid injections into the hip joint can give short-term relief during a significant flare-up.
- Strong opioids are not recommended for osteoarthritis.
5. Hydrotherapy
Warm water reduces load and pain, which makes it a comfortable place to start moving and strengthening, especially in a flare-up. See our hydrotherapy programme.
“Strong hip muscles, a good walking routine, a stick on bad days and a clear flare-up plan — that combination keeps many people with hip arthritis doing what they love for years.”
— UpPlus Physiotherapy team
Exercises to start with
Aim for mild discomfort at most, settling within 24 hours.
- Bridges: lying on your back, knees bent, squeeze your buttocks and lift your hips. 3 sets of 10.
- Sit to stand: stand up from a chair and sit down slowly. 3 sets of 10.
- Standing hip abduction: holding a bench, lift the leg out to the side and lower slowly, keeping your body upright. 3 sets of 10 each side.
- Hip flexor and quad stretch: in a half-kneeling or standing lunge position, gently push the hips forward. Hold 30 seconds each side.
- Step-ups: onto a low step, controlling the hip and knee. 3 sets of 8–10.
- Walking or cycling: build up towards 30 minutes on most days, in shorter bouts if needed.
Everyday tips
- Use a higher, firm chair and a raised toilet seat if low seats are hard.
- Use a long-handled shoe horn and a sock aid during flare-ups.
- Getting into a car: sit on the seat first, then swing both legs in together.
- Wear cushioned, supportive shoes.
- Break long walks or gardening sessions into shorter bouts.
Having a flare-up plan
Most people with hip arthritis have flare-ups — days or weeks when the hip is more painful, often after doing more than usual, a long car trip, or a change in the weather. A flare-up does not mean you have damaged the joint. Having a plan ready makes them less worrying:
- Reduce, do not stop: cut your exercise and walking back by about half, rather than stopping completely.
- Keep moving gently through the day so the hip does not stiffen.
- Use your stick for walks while it settles.
- Heat often helps a stiff hip; use whatever you find most comfortable.
- Talk to your GP or pharmacist about short-term pain relief if you need it.
- Build back up over one to two weeks once it settles, and contact your physio if it has not settled within two weeks.
Hip pain in younger adults
Hip arthritis is not only a condition of older age. People in their 20s, 30s and 40s can develop hip pain from femoroacetabular impingement (FAI) — a shape difference in the ball or socket that causes them to pinch at the extremes of movement — or from mild hip dysplasia, where the socket is shallow. Both can cause groin pain with sitting, squatting, twisting and sport, and both increase the chance of arthritis later.
Physiotherapy for these younger hips focuses on strengthening, movement control and modifying the positions that provoke pain, and some people are referred to a hip surgeon. If you are active and have groin pain that is not settling, it is worth getting it properly assessed. Read more about hip impingement.
When is a hip replacement worth considering?
Total hip replacement is one of the most successful operations in medicine for people with advanced hip arthritis. It is usually considered when:
- Pain is significant and persistent despite a good course of exercise, weight management, aids and medicines
- Pain is disturbing sleep most nights
- Walking distance, work, independence or quality of life are seriously limited
- X-rays show advanced arthritis that matches your symptoms
There is no prize for waiting until you cannot walk, and no benefit in rushing into surgery while non-surgical care is still working. The decision is personal and is made with your GP and an orthopaedic surgeon. If you are heading for surgery, being as strong and fit as possible beforehand helps recovery. Read about our hip replacement rehab.
Myths about hip arthritis
- "Exercise will wear the hip out faster." Appropriate exercise is one of the most effective treatments.
- "If it hurts, I should rest it." Short rest in a flare-up is fine; long-term rest weakens the muscles that protect the hip.
- "A walking stick means giving in." It reduces hip load and can let you walk further and more comfortably.
- "Knee pain can't be from my hip." Hip arthritis commonly refers pain to the thigh and knee.
- "Once it starts, it only gets worse." Many people's symptoms stay stable for long periods with good management.
When to see a physio
- Groin, hip or thigh pain lasting more than a few weeks
- Stiffness or pain limiting walking, work, sport or sleep
- You have been told you have hip arthritis and want a plan
- You are on a waiting list for a hip replacement and want to prepare
See a doctor promptly if you cannot bear weight after a fall, if the hip is hot and swollen with fever, or if pain is severe and constant, including at rest and at night, with weight loss or feeling unwell.
How UpPlus Physiotherapy helps
- Assessment of your hip, back, walking and goals
- A progressive strengthening and activity programme — in the clinic, our gym-based rehab, hydrotherapy or at home
- Walking aid assessment, pain management advice and flare-up planning
- Pre- and post-operative rehab for hip replacement
With a GP chronic condition management plan, physiotherapy sessions can be bulk billed, and we also see DVA clients. Read more about hip osteoarthritis, or our guide to knee osteoarthritis.
Finding a physio near me for hip arthritis
When searching for the best physio for hip arthritis, look for an assessment that separates joint, tendon and back pain, a programme built on strengthening and activity rather than passive treatment alone, and honest advice about when a surgical opinion makes sense.
Our clinic is at 177 Trimmer Parade, Seaton, a short drive from Woodville, Findon, Fulham Gardens, West Lakes and Semaphore Park. No referral is needed, and you can claim on the spot with private health cover.
Physio take-home message
- Hip arthritis often shows up as groin pain and stiffness — and sometimes as knee pain.
- Exercise and staying active are the foundations of treatment.
- A walking stick in the opposite hand is a simple, effective aid.
- Weight loss, if needed, reduces load on the hip.
- Hip replacement is excellent when non-surgical care is no longer enough — and prehab helps recovery.
If hip pain is limiting your day, our physiotherapists can assess it and build a plan around your goals. Book online or call 0403 907 587.
This article is general information, not a diagnosis or a substitute for an individual assessment. If you are unsure about your symptoms, see a health professional.
