Pain in the groin, and often deep in the buttock — not usually on the outer side of the hip.
Pain referred to the front of the thigh, sometimes as far as the knee. Hip arthritis presenting as knee pain is common and frequently confuses the diagnosis.
Stiffness, particularly first thing in the morning or after sitting, easing after moving about.
Difficulty putting on socks and shoes or cutting your toenails — often the first thing patients actually notice.
A limp, which may develop so gradually that family members comment on it before you do.
Shrinking walking distance and a growing reluctance to plan outings.
Grinding or catching from the joint.
Later, pain at rest and at night, which is usually the point at which people seek help.
The leg feeling shorter, as the joint space is lost and the hip stiffens.
Why it happens
Age-related wear of the cartilage, the commonest cause.
Avascular necrosis, where the blood supply to the ball fails and it collapses — associated with steroid use, alcohol, sickle cell disease and sometimes no identifiable cause.
Untreated hip impingement or a labral tear, causing wear at the socket rim over decades.
Hip dysplasia, where a shallow socket concentrates load over a small area.
Childhood hip conditions such as Perthes disease or a slipped upper femoral epiphysis.
A previous fracture involving the hip joint or the socket.
Inflammatory arthritis such as rheumatoid disease or ankylosing spondylitis.
Previous infection in the joint.
See someone sooner if…
Pain is waking you at night regularly.
You cannot put on your own socks and shoes.
You are under 50 with significant hip pain, since avascular necrosis and dysplasia both have time-sensitive treatment options.
The hip suddenly becomes much more painful and you cannot bear weight, which may indicate a fracture or collapse.
The hip is hot, you have a fever and feel unwell — this needs assessment today.
Where hip pain is actually felt
This causes more diagnostic confusion than almost anything else in orthopaedics. Hip arthritis is felt in the groin and deep in the buttock, and it often refers down the front of the thigh to the knee. Pain on the outer side of the hip, over the bony point you can feel with your hand, is usually not the joint at all — that is typically the tendons and bursa on the outside, which is a different problem with a different treatment.
If you are under fifty, the cause matters
In an older patient, hip arthritis is usually straightforward wear. In someone younger, there is nearly always an underlying reason, and identifying it can open treatment options that would otherwise be missed.
Avascular necrosis
The blood supply to the ball of the hip fails, and the bone dies and then collapses. Caught before the ball loses its shape, there are procedures that can preserve the joint. Once it has collapsed, replacement is usually the answer. Early diagnosis genuinely changes what is possible, and it needs an MRI — X-rays are normal in the early stages.
Hip dysplasia
The socket is too shallow, so body weight is concentrated on a small area of cartilage. In a young adult with preserved cartilage, an operation to reorient the socket can redistribute the load and preserve the joint for decades.
Untreated impingement
Years of the ball pinching the socket rim wears the cartilage at the edge. If the cartilage is still healthy, arthroscopy may be appropriate. If it is not, that window has closed.
Post-traumatic arthritis
A fracture through the joint surface that healed with a step or a gap wears out early. Sometimes correctable; often eventually needing replacement.
What helps before surgery
Hip arthritis responds less dramatically to non-surgical treatment than knee arthritis does, largely because the hip is a deeper joint that is harder to unload and harder to compensate for with muscle. That said, these are worth doing properly, and they improve your result when you do have surgery.
Strengthening the gluteal and thigh muscles, which improves gait and reduces limping.
Weight reduction where relevant, which lowers the load through the joint with every step.
Low-impact activity that maintains movement: cycling, swimming, walking on level ground.
Simple analgesia and anti-inflammatories for flares, with a clear plan rather than open-ended daily use.
A walking stick in the opposite hand, which removes a real proportion of load and often extends walking distance considerably.
Practical adaptations: a long-handled shoehorn, a sock aid, a raised toilet seat, a higher chair.
An image-guided injection into the joint, useful both for temporary relief and for confirming the hip as the source of pain.
How to know when it is time
There is no X-ray appearance that says now. The decision belongs to you, and the most reliable signals are these.
Signals it is time
Signals to wait
Pain wakes you at night
Simple painkillers still control it
You cannot put on your own socks and shoes
You are still doing everything you want to
You have stopped planning things because of the hip
You have not yet tried a proper strengthening programme
You need painkillers every day
Weight loss is likely to make a real difference first
You are becoming less independent
You are young with preserved cartilage — a joint-preserving option may exist
First, without surgery
What to try before an operation
This list comes first on purpose. For most people reading this page, it is the whole treatment — and where it is not, having genuinely worked through it makes the decision to operate a much clearer one.
Strengthening the gluteal, hip and thigh muscles to improve gait and reduce limping.
Weight reduction where relevant, which directly reduces joint load.
Low-impact conditioning: static cycling, swimming, pool walking.
Anti-inflammatory medication for flares, used with a defined plan.
A walking stick held in the opposite hand, which genuinely extends comfortable walking distance.
An image-guided intra-articular injection for relief and for diagnostic confirmation.
Aids for daily living: long-handled shoehorn, sock aid, raised toilet seat, firm high chair.
Regular review, so that a hip deteriorating faster than expected is investigated rather than accepted.
If surgery is needed
And when it genuinely is
Each option below says when it applies, not just what it is. If your situation does not match, that is a good reason to ask more questions.
Walking to the temple again, three weeks after surgery
“I had stopped going out. I could not put on my own shoes and I had not slept properly in a year. I walked with the physiotherapist on the day of the operation, which I did not believe would be possible. Three weeks later I walked to the temple without my stick.”
Savitaben P., 71 · Retired teacher
Athwa · 13 months after treatment
Outcome. Total hip replacement. Walking with a frame on day zero, stick discarded at three weeks, precautions lifted at three months, independent and pain-free.
A consultation means your imaging on the screen, a plain explanation of what is actually wrong, and an honest opinion on whether you need surgery — including when the answer is no.