Hip osteoarthritis is the most common form of arthritis in adults, with the hip being the second most affected joint.
Your hip joint consists of a ball (femoral head) at the top of the thigh bone (femur), which fits into a socket (acetabulum) in your pelvis. The bones of both the femoral head and the acetabulum are covered by a smooth slippery surface, known as cartilage. This cartilage allows the bones to move against each other without friction.
The basic anatomy of the hip joint is shown below:
Osteoarthritis causes the cartilage in your hip joint to become thinner and the smoothness of the cartilage reduces. The exact cause of osteoarthritis is unknown but there are a number of factors that increase the chances of developing hip osteoarthritis:
• Age - likelihood of developing osteoarthritis increases with age
• Genetics
• Obesity
• Gender- hip osteoarthritis is more common in women
• Conditions that affect the shape of the hip bones ie hip dysplasia, Perthes disease, slipped capital femoral epiphysis and femoroacetabular impingement syndrome
• Previous hip injury or surgery
Many people who have hip osteoarthritis won’t have any symptoms. In those who do have symptoms, these could include:
• Deep pain in the groin and/or buttock and side of the hip. It can sometimes cause pain down the thigh to the knee
• Hip stiffness- this can cause difficulty putting on socks and shoes and cutting your toe-nails
• Pain on walking- sometimes causing a limp
• Pain on sitting, bending forwards or squatting
• Hip pain and stiffness first thing in the morning Sometimes the symptoms of osteoarthritis can affect mood and sleeping patterns.
In most cases your doctor or physiotherapist will diagnose hip osteoarthritis from your symptoms and also from a number of tests on the physical examination of your hip. In some cases, imaging with an x-ray may be used to gain more information on the stage of osteoarthritis.
Recent evidence suggests that the first line management for hip osteoarthritis is:
Education, Exercise and Weight Management
Education This involves learning more about your hip osteoarthritis and how it affects you. Gaining a greater understanding of what movements and positions aggravate your symptoms and modifying these can help in managing your symptoms. Your therapist can discuss activity modifications that are specific to your functional level.
Exercise A key component of the treatment for hip osteoarthritis is exercise and joints need to be exercised regularly to keep them healthy. Exercise has shown to:
• Reduce pain
• Improve function
• Improve muscle strength
• Help to manage your weight It is important that exercises for osteoarthritis help to:
• Strengthen the muscles around the hip joints, leg muscles and the trunk.
• Maintain the movement in your joints and keep them supple
• Work on aerobic fitness for your cardiovascular health through increasing your heart rate and making you short of breath. Your therapist can you give you specific advice and exercises tailored to your needs.
Weight Management Increased weight can place more load through your hip joint and aggravate your symptoms. Losing weight could reduce your pain and other symptoms. Following a balanced, healthy diet together with regular exercise is a great start to losing weight.
The Association of UK dieticians provide some useful information on diet and weight loss and diet with osteoarthritis.
The NHS website has a weight loss plan to help you manage your weight.
The NHS website also provides support on smoking cessation and lifestyle changes to support your health on the ‘Live well’ pages.
As well as managing your weight there are other ways you can try to reduce the strain through your hip joint.
Pacing your activities
Try to break your activities into smaller, more manageable chunks and take regular rest breaks in between as needed.
Walking aids
Using a walking aid, such as a stick or crutch, can be helpful to reduce the load through your sore hip. Use it in the opposite hand to the sore hip. Your therapist can advise you on the most appropriate walking aid for your needs and functional level.
Stairs
Use a handrail for support when going up and down stairs. Using the stronger leg first to lead the movement going up the stairs and the sore hip leading when going down to reduce the strain on the sore hip. Your therapist can advise you on this technique.
Sitting position
Try to sit with the hips slightly higher than the knees, using a wedge shaped cushion or sitting in a higher chair can help this. Try to avoid sitting for long periods, so getting up and moving around regularly will help.
Special equipment
There can be special equipment and aids that can make doing your daily jobs easier and keep you as independent as possible. For example, there are devices that can assist with putting on your shoes and socks if you have difficulty bending the hip. Your therapist can discuss special equipment options with you tailored to your needs.
Sleeping
If you prefer to sleep on your side, a pillow between your knees can support the hips. If you prefer lying on your back, you could try a pillow under the knees to support the hips.
Mood
In some people, living with osteoarthritis can affect mood, making them feel depressed, low or anxious. It is important to discuss these feelings with GP who may be able to offer advice and support or refer you to other services that can help. Resources that may be helpful to support yourself are:
Versus Arthritis is a charity whose website has a lot of helpful information about what it means to have arthritis, the treatments and exercises. There is a helpline to call, and an online community with whom you can register, hosting forums to share experiences with other people who might be in a similar situation.
As well as your physical health, it is also important to look after your mental wellbeing – the mental health charity Mind have a webpage on managing mental health
There are other options that can help in the management of your symptoms:
Painkillers
Paracetamol can be used to help with pain but your doctor may prescribe a stronger pain medication or creams if needed. Please speak to your doctor about all the medication that you are taking.
Injections
Corticosteroid injection (CSI) can be used to help with symptoms with evidence showing short-term effect on symptoms.
Manual therapy
Techniques by a therapist can be used to improve the movement of your hip. This will not improve symptoms on its own and should be done alongside an exercise programme as advised by your therapist.
Surgery
If you feel that your symptoms are not well managed with physiotherapy and other treatment options, your surgeon may discuss if surgery is a potential treatment option for you. The main surgical option is a total hip replacement (THR) which involves replacing the head of the femur and relining the socket. Your surgeon will discuss the risks and benefits of surgery specific to your situation.
For further information please contact: Physiotherapy Department: 020 8909 5820
Gibbs et al. Recommendations for the management of hip and knee osteoarthritis: A systematic review of clinical practice guidelines. Osteoarthritis Cartilage. 2023 Oct;31(10):1280-1292
GBD 2021. Osteoarthritis collaborators. Global, regional, and national burden of osteoarthritis, 1990–2020 and projections to 2050: a systematic analysis for the Global Burden of Disease Study 2021. Lancet Rheumatology 2023; 5: e508–22
NICE guidance: Obesity, identification, assessment and management
NICE guidance: Osteoarthritis in over 16s: diagnosis and management
Rostron et al. Effects of a targeted resistance intervention compared to a sham intervention on gluteal muscle hypertrophy, fatty infiltration and strength in people with hip osteoarthritis: analysis of secondary outcomes from a randomised clinical trial. BMC Musculoskeletal Disorders (2022) 23:944
Teirlink et al. Effect of exercise therapy in patients with hip osteoarthritis: A systematic review and cumulative meta-analysis. Osteoarthritis & Cartilage Open. 2023 Jan 19;5(1):100338.
Varsus Arthritis: Osteoarthritis of the hip
Page last updated: 24 June 2025