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Health condition · Clinically reviewed

Hip osteoarthritis, from first groin ache to modern hip replacement.

Common, treatable and often transformable with surgery. A stepped plan - weight, movement, medication, injection and, when needed, joint replacement - keeps you moving.

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Why trust this guide

  • 01

    Clinically reviewed

    Written by our editorial team and reviewed by a registered UK clinician before publication.

  • 02

    Sourced from guidance

    Checked against NICE NG226, the British Orthopaedic Association and peer-reviewed sources you can see at the end.

  • 03

    Current for 2026

    Reflects modern UK practice including robotic-assisted total hip replacement, contemporary bearings and hip resurfacing.

Key facts

Hip osteoarthritis at a glance.

The essentials, in plain English - what it is, who it affects, and the shape of modern UK care from physio through to a robotic-assisted hip replacement.

  • What it is

    A degenerative joint disease of the hip - cartilage loss with subchondral sclerosis and osteophyte formation at the femoral head and acetabulum.

  • How common

    Very common - symptomatic hip osteoarthritis affects up to a quarter of adults over 50 in the UK.

  • Types

    Primary (idiopathic, age and genetics) and secondary (FAI, dysplasia, AVN, Perthes, SUFE, trauma, inflammatory arthritis).

  • Classic pattern

    Insidious groin pain, activity-related ache, morning stiffness under 30 minutes, reduced range and a subtle limp.

  • First-line care

    Weight optimisation, structured exercise and specialist musculoskeletal physiotherapy - the foundation of NICE NG226.

  • Definitive option

    Total hip replacement is the definitive treatment - transformative for pain, function and quality of life.

Why this guide matters

A stepped ladder, not a straight line to surgery.

Hip osteoarthritis has one of the strongest evidence bases in orthopaedics. The three points below shape everything else on this page.

  • Conservative care is real medicine

    Weight, exercise and physiotherapy come first for a reason - they change symptoms, function and even how much surgery you ultimately need.

  • Imaging supports, it does not decide

    A weight-bearing X-ray graded on Kellgren-Lawrence sets a baseline. The person in front of the surgeon - not the film - guides the plan.

  • Modern hip replacement is transformative

    When surgery is right, it is one of the most effective operations in medicine. Robotic-assisted and contemporary bearings improve accuracy and longevity.

How the diagnosis is made

From first groin ache to a clear plan.

The steps a UK GP, physiotherapist or orthopaedic surgeon will normally follow, in order - so you know what to expect and why.

  1. 01

    Assessing

    History and red flags

    Onset, groin versus lateral pain, night pain, stiffness pattern, functional limits and any red flags for infection, malignancy or fracture.

  2. 02

    Assessing

    Focused hip examination

    FADIR and FABER provocation tests, log-roll, Trendelenburg sign and a gait assessment for antalgic or short-leg patterns.

  3. 03

    Assessing

    Range and functional score

    Internal rotation is typically lost first. A quick Oxford Hip Score gives a reproducible baseline for later comparison.

  4. 04

    Confirming

    Weight-bearing X-ray

    AP pelvis and lateral views graded on Kellgren-Lawrence - joint space, sclerosis, osteophytes and subchondral cysts.

  5. 05

    Confirming

    MRI where indicated

    Reserved for suspected AVN, labral tears, occult fracture or when symptoms outpace the X-ray findings.

  6. 06

    Preparing

    Specialist orthopaedic review

    For advancing disease, failed conservative care, or when surgery is on the table - a hip surgeon shapes the next step.

  7. 07

    Preparing

    Pre-operative optimisation

    Weight, smoking, diabetes and cardiovascular fitness are worked on before surgery to improve outcomes and recovery.

Typical timeline: clinical diagnosis on day one, imaging within weeks, specialist plan shortly after.

Symptoms

What hip osteoarthritis actually feels like.

The classic mix of groin pain, stiffness, lost internal rotation and a subtle limp - and the features that mean it is time to escalate.

  • Groin pain

    The classic location - a deep ache in the groin, sometimes radiating to the front of the thigh or the knee.

  • Activity-related pain

    Worse with walking, stairs and pivoting - eased by rest early on, but progressive over months and years.

  • Morning stiffness

    Usually lasts less than 30 minutes - longer stiffness raises suspicion of an inflammatory arthritis.

  • Reduced range

    Internal rotation goes first - putting on socks, shoes and getting in and out of a car become telling difficulties.

  • Limp and gait change

    An antalgic gait or Trendelenburg lurch as abductor weakness sets in - often subtle before it is obvious.

  • Sleep disturbance

    Night pain and difficulty finding a comfortable position - a strong signal that conservative care is no longer enough.

  • Functional decline

    Walking distance shrinks, hills and stairs get harder and daily tasks - shoes, socks, driving - start to be limited.

  • Red flag - rest and night pain

    Constant rest pain, fevers or unexplained weight loss need urgent review to exclude infection, fracture or tumour.

Treatment

How hip osteoarthritis is treated in the UK.

NICE NG226 and BOA standards frame the ladder - lifestyle and physio, medication, injection and, for the right person, total hip replacement or resurfacing.

  • Weight and exercise

    Even modest weight loss meaningfully reduces hip load. Structured strength and mobility work is the single most evidence-based intervention.

  • Specialist physiotherapy

    A musculoskeletal physio builds a hip-specific programme - abductor strength, range, gait retraining and pacing strategies.

  • Simple analgesia and NSAIDs

    Paracetamol, topical or oral NSAIDs with gastric protection where appropriate - short courses at the lowest effective dose.

  • Intra-articular steroid

    A fluoroscopy or ultrasound-guided steroid injection can settle a flare and buy time for prehabilitation.

  • Hyaluronic acid and PRP

    Selective options in some UK centres - evidence is mixed and use is individualised rather than routine.

  • Total hip replacement

    The definitive treatment. Total hip replacement - open, minimally invasive or robotic-assisted (Mako) - transforms pain and function.

  • Hip resurfacing

    Hip resurfacing is a specialist commissioned option for younger, active patients with good bone stock.

  • Specialist MDT

    Orthopaedic surgeon, physiotherapy, pain and rheumatology input where needed - supported by Versus Arthritis and BOA standards.

What this guide is based on

The sources behind every claim on this page.

UK national guidance, specialist society standards and the National Joint Registry - current at the time of last review.

Key references

Guidelines and standards we relied on.

A quiet reminder

This guide is for information, not medical advice.

Your GP or orthopaedic surgeon knows your hip and history and can tell you which parts apply to you. If in doubt, get seen.

  • NICE. Osteoarthritis in over 16s: diagnosis and management (NG226).

  • British Orthopaedic Association (BOA). Standards for primary hip replacement.

  • National Joint Registry (NJR). Annual report on hip arthroplasty outcomes in the UK.

  • Versus Arthritis. Patient information on hip osteoarthritis and joint replacement.

Red flags

When hip pain needs urgent attention.

Most hip osteoarthritis is manageable through primary care and outpatient orthopaedics. These are the situations that are not - and where prompt review is essential.

  • Constant rest and night pain

    Unremitting pain that is not eased by rest deserves urgent review to exclude infection, fracture or malignancy.

  • Fever with hip pain

    A hot, painful hip with fever - especially after surgery or in someone immunosuppressed - needs same-day orthopaedic assessment.

  • Sudden severe pain after a fall

    Groin pain with an inability to weight bear after a fall is a fractured neck of femur until proven otherwise.

  • Unexplained weight loss

    Weight loss with new hip pain warrants prompt imaging to exclude a secondary cause.

  • Locking or giving way

    Mechanical locking can point to a labral tear or loose body - see hip labral tear for related detail.

  • Rapidly progressive collapse

    Rapid loss of joint space over months can indicate osteonecrosis (AVN) and needs specialist MRI and orthopaedic review.

  • Children and adolescents

    Consider Perthes, SUFE or dysplasia - a very different pathway from adult osteoarthritis.

  • Bilateral inflammatory pattern

    Prolonged morning stiffness, systemic features or small joint involvement raises inflammatory arthritis and needs rheumatology input.

  • Infected joint replacement

    Any wound issue, fever or new pain in a replaced hip is a surgical emergency until proven otherwise.

Living with it

A manageable condition, with a clear ladder.

Four habits that make the biggest difference day to day - keep moving, manage weight, pace activity and speak up when the pain starts to steal your sleep.

A quiet reminder

Consistency beats intensity, every time.

Small, steady habits kept up for months do more than a heroic fortnight that never lasts.

  1. 01 Move

    Motion is medicine

    Consistent low-impact activity - walking, cycling, swimming and strength work - protects the joint and the muscles around it.

  2. 02 Weight

    Every kilogram counts

    The hip carries multiples of body weight with each step. Small, sustained weight loss quietens symptoms.

  3. 03 Pace

    Pace, don’t push

    Break longer activities into shorter bouts, plan rest and use walking aids without shame if they keep you active.

  4. 04 Escalate

    Don’t suffer in silence

    When sleep, work or independence are affected, ask for a specialist opinion - modern hip replacement outcomes are excellent.

Frequently asked

Everything we get asked about hip osteoarthritis.

Quick answers on symptoms, diagnosis, conservative care and when to consider a hip replacement.

  • What is hip osteoarthritis?

    It is a degenerative joint disease of the hip in which the cartilage lining the femoral head and acetabulum wears away, the underlying bone hardens (subchondral sclerosis) and osteophytes form at the joint margins. It is the most common cause of chronic hip pain in adults over 50.

  • What are the earliest symptoms?

    Most people notice groin pain that is worse with walking or pivoting, morning stiffness lasting less than 30 minutes, and a loss of internal rotation - typically felt as difficulty putting on socks, shoes or getting in and out of a car.

  • How is it diagnosed?

    The diagnosis is largely clinical, supported by a weight-bearing X-ray graded on the Kellgren-Lawrence scale. MRI is reserved for suspected AVN, labral pathology or occult fracture, or when symptoms are out of proportion to the plain films.

  • Does exercise make it worse?

    No. Structured low-impact exercise and specialist musculoskeletal physiotherapy are the single most evidence-based interventions in NICE NG226. Strengthening the hip abductors and maintaining range protects function and reduces pain.

  • When is a hip replacement the right decision?

    When pain, stiffness and functional limitation persist despite optimised conservative care - and when sleep, work or independence are affected. Modern total hip replacement, including robotic-assisted (Mako) approaches, delivers reliable, durable relief.

  • Are steroid injections a long-term answer?

    No, but a targeted intra-articular steroid injection can settle a flare, reduce inflammation and buy time for prehabilitation or scheduling of surgery. They are used selectively rather than repeatedly.

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