Hip arthritis: symptoms, causes and treatment

Hip arthritis is a general term for arthritis affecting the hip joint. The NHS says there are lots of types of arthritis and not to self-diagnose. The most common is osteoarthritis, in which the protective cartilage on the ends of the bones breaks down, causing pain, swelling and problems moving the joint, and bony growths can develop. Inflammatory types such as rheumatoid arthritis, an autoimmune disease in which the immune system attacks the cells lining the joints, can also affect the hips.

The NHS says the main symptoms of osteoarthritis are pain and stiffness in the joints, which can make it difficult to move the joints and do certain activities. For the hip specifically it says osteoarthritis often causes difficulty moving the hip joints. For example, you may find it difficult to put your shoes and socks on or to get in and out of a car. You will usually have pain in the groin or outside the hip. This is often worse when you move the hip joints, although it can also affect you when you are resting or sleeping.

Other symptoms the NHS lists include tenderness, increased pain and stiffness when you have not moved your joints for a while, a grating or crackling sound or sensation, limited range of movement, and weakness and muscle wasting. Symptoms may come and go in episodes, related to activity levels and even the weather, and in more severe cases can be continuous.

The NHS hip pain page gives clues to type: over 45, pain worse when walking and stiffness after moving suggests osteoarthritis, while pain and stiffness that are worse after not moving, for example on waking, suggest rheumatoid arthritis.

The NHS hip pain and arthritis pages describe these patterns. A GP or specialist decides which applies.

The NHS says osteoarthritis is a long-term condition that cannot be cured, but a number of treatments reduce symptoms. The main ones are lifestyle measures such as maintaining a healthy weight and exercising regularly, medication to relieve pain, and supportive therapies that make everyday activities easier.

Exercise: the NHS says exercise is one of the most important treatments for people with osteoarthritis, whatever your age or level of fitness, and that regular exercise that keeps you active and builds muscle usually helps improve symptoms. A GP or physiotherapist can give you an exercise plan, because doing too much too quickly, or the wrong sort, may damage your joints.

Painkillers: your GP might suggest paracetamol for short-term relief, although many people find it does not work very well. A GP may prescribe an anti-inflammatory (NSAID); tablets are usually prescribed with a stomach-protecting medicine. Opioids such as codeine may be used for severe pain on a short-term basis. Steroid injections may be offered when other treatments have not worked and can ease pain for several weeks or months.

Supportive treatments: hot or cold packs, shock-absorbing footwear, a walking stick held on the opposite side to the affected hip, and occupational therapy for everyday tasks (NHS). For hip pain generally the NHS also suggests losing weight if overweight, gentle hip stretching exercises and avoiding sitting in low chairs.

The NHS says that in a small number of cases, where other treatments have not helped or the damage to the joints is particularly severe, surgery may be done to repair, strengthen or replace a damaged joint. On its hip pain page it adds that some people with pain from a damaged hip joint may eventually need a hip replacement if other treatments do not help, and that a referral to a specialist may lead to a scan and discussion of surgery.

Hip replacement is described in more detail on the hip replacement pages of this library.

For osteoarthritis the NHS says the exact cause is not known, but several things are thought to increase the risk: joint injury, other conditions that damage a joint (such as rheumatoid arthritis or gout), age, family history, obesity and being a woman. The NHS says rheumatoid arthritis is an autoimmune disease, with higher risk if you are a woman, have a family history or smoke.

The NHS says it is not possible to prevent osteoarthritis altogether but you may be able to minimise the risk by avoiding injury and living a healthy lifestyle, including at least 150 minutes of moderate aerobic activity a week plus strength exercises on 2 or more days, and keeping to a healthy weight.

The NHS says a GP will first ask about your symptoms and examine your joints. They may suspect osteoarthritis if you are 45 or older, have joint pain that gets worse the more you use the joint, and morning stiffness that is absent or lasts less than 30 minutes. Further tests such as X-rays or blood tests are not usually necessary, but may be used to rule out other causes such as rheumatoid arthritis or a fractured bone. For arthritis generally, the NHS lists blood tests, X-ray or ultrasound scans and, for gout, a sample of joint fluid, and says you may be referred to a rheumatologist if rheumatoid arthritis or gout is suspected.

The NHS says osteoarthritis does not necessarily get worse over time and can sometimes gradually improve, although it cannot be cured. For arthritis in general it says your symptoms may sometimes suddenly get worse, known as a flare-up, which can last several days. Rheumatoid arthritis can flare, but the NHS says early diagnosis and appropriate treatment enables many people to have periods of months or even years between flares and to lead full lives.

The NHS says to see a GP if hip pain is stopping you doing normal activities or affecting your sleep, is getting worse or keeps coming back, has not improved after treating it at home for 2 weeks, or if you have hip stiffness for more than 30 minutes after waking.

Ask for an urgent GP appointment or call NHS 111 if you have severe hip pain that started suddenly without a fall or injury, a swollen hip that feels hot, skin around the hip that has changed colour, or hip pain with feeling generally unwell and a high temperature or feeling hot, cold or shivery. Call 999 or go to A&E if you have severe hip pain after a fall or injury, cannot walk or put weight on your leg, or have tingling or loss of feeling in your hip or leg after an injury. Do not drive yourself to A&E.

The NHS says that in many areas you may be able to refer yourself to NHS community musculoskeletal (MSK) services for physiotherapy without a GP referral. A GP can arrange tests and refer you to orthopaedics or rheumatology.

Some people choose a private orthopaedic or rheumatology opinion for faster scans or surgery. Ask for scan reports to be shared with your GP, and for non-surgical options (exercise, weight management, physiotherapy, injections) to be discussed as well as surgery.