Hip Osteoarthritis
Hip osteoarthritis is the most common cause of chronic hip pain in adults over 50. It is also 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.
Symptoms — do you recognize these?
- Deep groin pain, often described as aching or throbbing
- Pain with weight-bearing activities: walking, stair climbing, rising from a chair
- Morning stiffness lasting less than 30 minutes (longer stiffness suggests inflammatory arthritis)
- Reduced hip range of motion — difficulty putting on shoes and socks, getting in and out of a car
- Grinding or catching sensation (crepitus) in the joint
- Referred pain to the thigh, buttock, or knee
- Positive FABER test (Flexion, ABduction, External Rotation) and FADIR test (Flexion, ADduction, Internal Rotation) on physical examination — internal rotation is typically the first motion lost in hip OA
Call us at (301) 515-0900. Same-day appointments available at our Bethesda and Germantown locations.
How we diagnose it
Physical examination remains central. Your provider will assess range of motion, perform provocative tests (FABER, FADIR, log roll), evaluate gait, and screen for referred pain from the lumbar spine.
Weight-bearing X-rays are the primary imaging tool. Standing AP pelvis and lateral hip views reveal:
- Joint-space narrowing (normal joint space: 3–5 mm; concerning if < 2 mm)
- Subchondral sclerosis and cysts
- Osteophyte formation at joint margins
MRI may be ordered when symptoms are disproportionate to X-ray findings, when a labral tear or chondral defect is suspected alongside early arthritis, or to evaluate AVN.
Diagnostic injection: An image-guided intra-articular injection of local anesthetic can confirm the hip as the pain generator, particularly when lumbar spine pathology co-exists.
Laboratory tests (ESR, CRP, CBC, uric acid) help rule out inflammatory or crystalline arthritis if the clinical presentation warrants.
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 moreRecovery & rehabilitation
Recovery depends on treatment stage:
- Physical therapy program: 6–12 weeks to functional improvement; ongoing home program
- Corticosteroid/PRP injection: Relief typically within 1–2 weeks; activity may resume immediately
- Total hip arthroplasty: Walking with a cane or walker within 1–2 days; most patients return to light activity in 4–6 weeks; full recovery and return to sport at 3–6 months
Frequently 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, Knee & Shoulder Arthroscopy · Shoulder Replacement
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/