Hip osteoarthritis (hip OA) is a common degenerative joint condition characterised by changes to the cartilage, bone, and surrounding structures of the hip joint. The hip is a ball-and-socket joint, formed by the head of the femur (thigh bone) and the acetabulum of the pelvis. Its design allows both stability and a wide range of movement, but it also means the joint is exposed to high loads during daily activities such as walking, stair climbing, and running.
Hip osteoarthritis develops when the joint is no longer able to tolerate the mechanical loads placed upon it. Over time, this can lead to cartilage thinning, changes in the underlying bone, joint stiffness, pain, and reduced function. Importantly, hip OA is not simply a result of “wear and tear” or ageing alone. It is a complex condition influenced by biomechanics, muscle strength, activity levels, previous injury, and general health.
Hip osteoarthritis is one of the leading causes of pain and disability worldwide and is highly prevalent in Australia, particularly in older adults. However, younger and more active individuals can also develop hip OA, especially if they have a history of hip injury, structural hip conditions, or heavy occupational or sporting loads.
Physiotherapy for hip osteoarthritis is at the forefront of evidence-based management. Physiotherapists play a key role in reducing pain, improving joint function, maintaining mobility, and delaying or even avoiding the need for surgery. Targeted exercise, education, and load management form the foundation of hip osteoarthritis rehabilitation.
Key Facts
- Hip osteoarthritis is one of the most common forms of osteoarthritis and a leading cause of pain and disability in older adults. 🔗
- Radiographic changes of hip osteoarthritis are common, but symptoms do not always correlate with imaging severity.
- Physiotherapy interventions can reduce pain and improve function in people with hip osteoarthritis, regardless of disease severity.
Risk Factors
- Increasing age.
- Previous hip injury or surgery.
- Structural hip conditions such as hip dysplasia or femoroacetabular impingement.
- Reduced hip muscle strength.
- Obesity or higher body weight increasing joint load.
- Occupations or sports involving repetitive or heavy hip loading.
Symptoms
- Pain in the groin, front of the thigh, buttock, or outer hip.
- Stiffness in the hip, particularly in the morning or after sitting.
- Pain that worsens with walking, standing, or weight-bearing activity.
- Reduced hip range of motion, especially rotation.
- Difficulty with functional tasks such as putting on socks, getting in and out of a car, or climbing stairs.
- Limping or altered walking pattern.
Aggravating Factors
- Prolonged walking or standing.
- Stair climbing or walking on hills.
- Getting up from low chairs or cars.
- High-impact activities such as running or jumping.
- Sustained positions such as sitting with hips flexed.
Causes
Hip osteoarthritis develops when the balance between joint loading and the joint’s capacity to tolerate that load is disrupted. This can occur due to a combination of mechanical, biological, and lifestyle factors.
Cartilage changes are a feature of hip OA, but they are only one part of the picture. Changes also occur in the underlying bone, joint capsule, ligaments, muscles, and even the way the nervous system processes pain. This helps explain why pain severity does not always match what is seen on imaging.
Structural factors such as femoroacetabular impingement (FAI), hip dysplasia, or previous trauma can alter how forces are distributed through the hip joint, increasing the risk of osteoarthritis. Muscle weakness, particularly in the hip abductors and extensors, can further increase joint load during walking and daily activities.
From a physiotherapy perspective, hip osteoarthritis is best managed by improving joint load tolerance through strength, movement optimisation, and education, rather than attempting to eliminate all joint loading.
How Is It Diagnosed?
Hip osteoarthritis is diagnosed using a combination of clinical assessment and, when appropriate, imaging. A physiotherapist will assess symptom history, functional limitations, hip movement, strength, gait, and how symptoms respond to load.
Clinical features such as groin pain, reduced hip rotation, and pain with weight-bearing tasks strongly suggest hip OA. Importantly, diagnosis should not rely on imaging alone, as many people have imaging changes without pain.
Physiotherapists play a key role in identifying hip osteoarthritis early and guiding conservative management, even before imaging changes become pronounced.
Investigations & Imaging
- X-ray
- May show joint space narrowing, osteophytes, and bony changes. Findings do not always correlate with pain severity.
- MRI
- Occasionally used to assess early joint changes or rule out other causes of hip pain.
Grading / Classification
- Mild hip osteoarthritis
- Minimal pain and stiffness with mild functional limitation. Symptoms often fluctuate.
- Moderate hip osteoarthritis
- More persistent pain, reduced range of motion, and increasing difficulty with daily activities.
- Severe hip osteoarthritis
- Significant pain, marked stiffness, and major functional limitations, often affecting quality of life.
Physiotherapy Management
Physiotherapy for hip osteoarthritis focuses on reducing pain, improving movement, and increasing the hip’s ability to tolerate load. Exercise therapy and education are the most effective long-term treatments.
Physiotherapists tailor management to symptom severity, activity goals, and overall health, aiming to keep people active and independent.
Exercise
Hip osteoarthritis physiotherapy exercises typically target the hip abductors, extensors, and deep stabilising muscles. Strengthening these muscles reduces joint load during walking and daily activities.
Programs also include mobility exercises to maintain hip range of motion and functional exercises such as sit-to-stand, step-ups, and gait retraining.
Activity Modification
Activity modification focuses on pacing, load management, and finding ways to stay active without provoking excessive symptoms. This may include breaking tasks into shorter bouts or alternating high and low load activities.
Manual Therapy
Manual therapy may be used to address hip and lumbar spine stiffness and improve movement comfort.
A randomised controlled trial of hip osteoarthritis rehabilitation found “convincing evidence” that the inclusion of manual therapy resulted in better outcomes for both pain and hip function. Crucially, these benefits lasted for at least 6 months after completion of the rehabilitation program.
Heat & Ice
Heat may assist with stiffness, while ice can help manage pain flares after activity.
Education
Education is central to hip osteoarthritis management. Understanding that movement is safe and beneficial helps reduce fear and improve outcomes.
Other
Other strategies may include gait aids, footwear advice, and coordination with GPs or other health professionals.
Other Treatments
Other treatments may include medication prescribed by a doctor. Injections may be considered in some cases but are not a long-term solution.
Surgery
Surgery, such as total hip replacement, may be considered when symptoms are severe and no longer respond to conservative management. Physiotherapy remains important both before and after surgery.
Prognosis & Return to Activity
Hip osteoarthritis is a long-term condition, but symptoms can be effectively managed. Many people maintain a high quality of life with appropriate physiotherapy, exercise, and load management.
Progression varies between individuals and is influenced by activity levels, strength, and overall health rather than imaging findings alone.
Complications
- Progressive loss of hip mobility.
- Reduced walking tolerance and physical activity levels.
- Secondary pain in the knee or lower back due to altered movement.
Preventing Recurrence
- Maintain regular hip strengthening and aerobic exercise.
- Manage body weight to reduce joint load.
- Address hip pain early with physiotherapy.
When to See a Physio
- You have persistent hip or groin pain affecting daily activities.
- Your hip stiffness is worsening or limiting movement.
- You want to manage hip osteoarthritis without surgery.