Hip Osteoarthritis
Hip osteoarthritis is the most common cause of chronic hip pain in adults over 50 — and one of the leading reasons people in the Washington, D.C. metro area seek orthopedic care. At Maryland Orthopedic Specialists, our adult reconstruction team treats every stage of hip arthritis, from early cartilage loss managed with physical therapy and injections to end-stage disease requiring total hip arthroplasty. Our goal is to relieve pain, restore function, and keep you active as long as possible with the least invasive approach that works for you.
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What is hip osteoarthritis?
Hip osteoarthritis (OA) is a degenerative joint disease characterized by the progressive breakdown of articular cartilage — the smooth, low-friction lining that covers the femoral head and acetabulum. As cartilage thins and erodes, bone rubs on bone, triggering pain, inflammation, reactive bone spur (osteophyte) formation, and eventual joint-space narrowing visible on X-ray.
Hip osteoarthritis (OA) is a degenerative joint disease characterized by the progressive breakdown of articular cartilage — the smooth, low-friction lining that covers the femoral head and acetabulum. As cartilage thins and erodes, bone rubs on bone, triggering pain, inflammation, reactive bone spur (osteophyte) formation, and eventual joint-space narrowing visible on X-ray.
Key facts:
- Affects an estimated 10–25% of adults over age 60
- Primary OA develops without a clear underlying cause; secondary OA results from prior hip conditions such as femoroacetabular impingement (FAI), hip dysplasia, childhood Legg-Calvé-Perthes disease, avascular necrosis, or prior trauma
- Both hips may be affected, though often asymmetrically
The C-Sign: Patients frequently describe groin pain by cupping their hand in a "C" shape over the front of the hip, with fingers toward the groin and thumb toward the buttock. This is a classic clinical indicator of intra-articular hip pathology, including OA.
Gait changes: Advanced OA commonly produces an antalgic gait — a shortened stance phase on the affected side to minimize pain — or a Trendelenburg gait if abductor muscles weaken secondarily.
Treatment options
Treatment follows a structured ladder based on symptom severity, functional limitation, and radiographic stage.
Non-Operative Treatments
Physical therapy is first-line and among the most effective interventions for mild-to-moderate hip OA. A targeted program addresses hip flexor and external rotator flexibility, hip abductor and core strengthening, and gait retraining. Aquatic therapy reduces joint load while maintaining cardiovascular conditioning. Activity modification — reducing high-impact activities (running, jumping) in favor of low-impact alternatives (cycling, swimming, elliptical) — decreases mechanical joint stress and slows symptom progression. Weight management: Each pound of body weight lost reduces hip joint loading by 3–6 pounds per step. Even a 10% reduction in body weight produces measurable symptom improvement. Oral medications: NSAIDs (ibuprofen, naproxen, celecoxib) are effective for pain and inflammation. Acetaminophen and topical diclofenac are alternatives for patients who cannot tolerate oral NSAIDs. Corticosteroid injection: Ultrasound- or fluoroscopy-guided intra-articular corticosteroid injection provides short-term pain relief (typically 4–12 weeks) and is most useful as a bridge to physical therapy or surgery. Platelet-Rich Plasma (PRP): PRP injections concentrate autologous growth factors that may modulate inflammation and support cartilage health. Emerging evidence supports their use in mild-to-moderate hip OA, with effects that may outlast corticosteroid. Viscosupplementation: Hyaluronic acid injections aim to restore joint lubrication and reduce friction; evidence in the hip is more limited than in the knee, and insurance coverage varies.
Total Hip Arthroplasty (Hip Replacement)
Complete hip joint replacement removing the arthritic femoral head and acetabulum and replacing them with metal, ceramic, and polyethylene components. Anterior approach technique is available for eligible patients, preserving more muscle tissue.
Click for moreFrequently Asked Questions
Can hip arthritis be reversed?
How do I know if it's my hip or my lower back causing my groin pain?
Is there a best age for hip replacement?
What is the difference between PRP and a cortisone shot?
How long after total hip replacement can I expect to be back to normal daily activities?
Meet the specialists
John J. Christoforetti, MD
Orthopedic Surgery · Sports Medicine · Hip Preservation Surgery
Meet Dr. Christoforetti →References
- Glyn-Jones S, Palmer AJ, Agricola R, et al. Osteoarthritis. Lancet. 2015;386(9991):376–387. https://doi.org/10.1016/S0140-6736(14)60802-3
- Arden NK, Perry TA, Bannuru RR, et al. Non-surgical management of hip osteoarthritis. BMJ. 2021;374:n1682. https://doi.org/10.1136/bmj.n1682
- Mow VC, Huiskes R. Basic Orthopaedic Biomechanics and Mechano-Biology. 3rd ed. Lippincott Williams & Wilkins; 2005. [Foundational reference for cartilage biomechanics]
- Haddad FS, Konan S, Tahmassebi J. A prospective randomised controlled trial of total hip arthroplasty versus resurfacing arthroplasty in the treatment of young patients with arthritis of the hip joint. Bone Joint J. 2015;97-B(11):1440–1450. https://doi.org/10.1302/0301-620X.97B11.36515
- Bannuru RR, Osani MC, Vaysbrot EE, et al. OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis. Osteoarthritis Cartilage. 2019;27(11):1578–1589. https://doi.org/10.1016/j.joca.2019.06.011
- American Academy of Orthopaedic Surgeons. Hip Osteoarthritis. OrthoInfo. https://orthoinfo.aaos.org/en/diseases--conditions/arthritis-of-the-hip/