Direct answer
The most common symptoms of hip arthritis are pain in the groin, stiffness in the morning or after sitting, reduced rotation (trouble with socks and shoes), a limp, and, as it progresses, pain at rest and at night. The usual pattern:
- Pain: deep in the groin, sometimes spreading to the front of the thigh, the buttock, or the knee. Worse with walking and standing, better with rest at first.
- Stiffness: worst first thing in the morning or after a long sit, easing within about an hour.
- Lost motion: turning the leg inward becomes limited and painful, which shows up when you cross your legs, put on socks, or get out of a car.
- Diagnosis: a physical exam plus a standing hip X-ray, graded for joint space narrowing and bone spurs.
- Next step: education, exercise, weight management, physiotherapy, and medication first; a surgical consultation when pain limits daily life or disturbs sleep despite that care.
This guide is for people with new or worsening hip pain who want to know whether it is arthritis, how a surgeon confirms it, and what to do before and after that point. The symptoms and treatment ranges below come from the American Academy of Orthopaedic Surgeons, OARSI, HealthLink BC, and published studies. Your surgeon decides what applies to you.
What are the symptoms of hip arthritis?
Osteoarthritis is the wearing away of the cartilage that cushions the ball-and-socket joint. As cartilage thins, bone rubs on bone, bone spurs form, and the joint lining becomes inflamed. The AAOS states that the most common symptom of hip osteoarthritis is pain, most often felt in the groin, and that it occurs most often in people 50 years of age and older.
| Symptom | What it feels like | Why it happens |
|---|---|---|
| Groin pain | A deep ache at the front of the hip, in the crease where the leg meets the body. It can radiate down the front of the thigh toward the knee or into the buttock. | The hip joint sits behind the groin, and the nerves that supply it also supply the thigh and knee, so pain is often felt away from the joint itself. |
| Stiffness | Worst in the morning or after sitting for a while. The AAOS notes that pain and stiffness “may be worse in the morning, or after sitting or resting awhile.” | Inflamed joint lining and thickened capsule tighten when the joint is still. |
| Reduced rotation | Difficulty crossing the legs, putting on socks and shoes, clipping toenails, or swinging the leg into a car. Turning the knee inward is often the first movement lost. | Bone spurs and a tight capsule block internal rotation before other movements. |
| Limp | A shortened stride on the painful side, or a lean over the hip with each step. Family often notice it first. | The AAOS describes reduced range of motion affecting the way you walk and causing a limp. |
| Grinding or catching | A grating sensation or sound with movement. | Crepitus from loose cartilage fragments and rough joint surfaces. |
| Night and rest pain | Pain that wakes you, or aches while sitting. Usually a later-stage sign. | The AAOS notes that over time symptoms “may occur more frequently, including during rest or at night.” |
The groin pain pattern
Location matters because several problems are mistaken for hip arthritis. Pain on the outside of the hip, over the bony point you feel when lying on your side, is more often bursitis or a gluteal tendon problem. Pain in the buttock or the back of the hip that travels below the knee often comes from the lower spine. True hip joint pain lives in the groin and the front of the thigh. In the Framingham Osteoarthritis Study, X-ray evidence of hip arthritis was highly specific for pain localised to the groin (specificity 90.5%), which is why surgeons start by asking you to point to the pain.
What the exam looks for
The American College of Rheumatology’s clinical classification criteria for hip osteoarthritis combine hip pain with findings such as pain on internal rotation, morning stiffness lasting 60 minutes or less, age over 50, and limited internal rotation (under 15 degrees) or limited flexion. The AAOS lists the same checks: tenderness, range of motion, crepitus, pain under pressure, gait, and signs of injury to the surrounding muscles and tendons.
How is hip arthritis diagnosed?
Diagnosis rests on three things: your history, the physical exam above, and a plain X-ray. The AAOS notes that X-rays of an arthritic hip may show narrowing of the joint space, bone changes, and bone spurs (osteophytes), and that MRI or CT is used occasionally to look at bone and soft tissue in more detail. In the ACR criteria, pain plus at least two of osteophytes, joint space narrowing, and a low sedimentation rate identified hip osteoarthritis with 89% sensitivity and 91% specificity.
X-ray grades
Radiologists and surgeons often grade the X-ray with the Kellgren-Lawrence scale, first proposed in 1957 and reviewed in Clinical Orthopaedics and Related Research in 2016. The grades run from 0 to 4:
| Grade | X-ray findings |
|---|---|
| 0 (none) | Definite absence of X-ray changes of osteoarthritis. |
| 1 (doubtful) | Doubtful joint space narrowing and possible osteophytic lipping. |
| 2 (minimal) | Definite osteophytes and possible joint space narrowing. |
| 3 (moderate) | Moderate multiple osteophytes, definite narrowing of joint space, some sclerosis, and possible deformity of bone ends. |
| 4 (severe) | Large osteophytes, marked narrowing of joint space, severe sclerosis, and definite deformity of bone ends. |
Why the X-ray and your pain can disagree
The grade describes the joint, and it is a poor stand-in for how you feel. A 2015 diagnostic study in the BMJ found that in the Framingham cohort only 15.6% of hips with frequent pain showed radiographic arthritis, and only 20.7% of hips with radiographic arthritis were frequently painful; the Osteoarthritis Initiative cohort showed a similar gap. The authors concluded that hip osteoarthritis might be missed if clinicians relied on the X-ray alone. The reverse is also true: a grade 3 or 4 hip in someone with mild symptoms is a reason to plan ahead, and on its own it is a weak reason to operate. Your surgeon weighs the image, the exam, and what you can and cannot do.
What helps hip arthritis early?
The AAOS states that, as with other arthritic conditions, early treatment of hip osteoarthritis is non-surgical. Two guideline bodies set the evidence-based order.
- Education and exercise. The 2019 OARSI guideline lists arthritis education and structured land-based exercise as the core treatments for hip osteoarthritis. The AAOS suggests switching high-impact activity for swimming or cycling. The NHS recommends at least 150 minutes of moderate aerobic activity a week plus strength work on two or more days, and a structured plan with a physiotherapist for more severe symptoms.
- Weight management. The AAOS lists weight loss among lifestyle changes that reduce stress on the joint, and the NHS notes that losing weight when overweight can improve mild symptoms.
- Physiotherapy. The 2023 AAOS hip osteoarthritis guideline gives a moderate recommendation for physical therapy in mild to moderate symptoms to improve function and reduce pain.
- Medication. The same guideline gives a strong recommendation that oral NSAIDs be used to reduce pain and improve function when they are safe for you. OARSI recommends against any oral NSAID in people with cardiovascular disease or frailty, and strongly recommends against opioids.
- Injections. The AAOS guideline says an intra-articular corticosteroid injection could be considered for short-term improvement in pain and function (moderate evidence). Its press release states that intra-articular hyaluronic acid received a strong recommendation against use because it does not improve function or reduce pain better than placebo.
- Walking aids. A cane in the opposite hand, and tools such as a long-handled reacher or sock aid, reduce strain on the joint.
Pathway’s guide to surgery versus non-surgical options for hip arthritis goes deeper on how long each of these tends to hold.
When should I see a surgeon?
HealthLink BC’s decision aid lists the point at which doctors consider hip replacement: very bad pain that other treatments have not helped, a large amount of cartilage lost, pain that limits the activity you need to maintain strength, flexibility, balance, or endurance, and no health problems that would make surgery dangerous. In practice, book a consultation when:
- groin pain limits walking distance, stairs, or standing time despite a real trial of exercise, weight management, medication, and physiotherapy;
- pain wakes you at night or is present at rest;
- stiffness has taken away socks, shoes, or getting in and out of a car;
- you have a limp that is changing how you move; or
- an X-ray already shows advanced change and you want to understand the options before symptoms force the decision.
Timing cuts both ways. The HealthLink BC aid notes that waiting too long can reduce strength and mobility and make recovery harder, and a Montreal and Boston cohort study found that patients with worse function before hip or knee replacement did not catch up to those who had surgery earlier. On the other side, a Lancet population study of 63,158 hip replacements found a lifetime revision risk of about 5% for patients over 70 and up to 35% for men in their early 50s, which is why surgeons weigh age and activity before recommending a joint replacement in a younger patient. A consultation is an assessment. It commits you to nothing, and it gives you a baseline and a plan.
Hip replacement vs. resurfacing vs. arthroscopy
Three operations come up in hip arthritis conversations. They suit different hips.
| Option | What it does | Who it suits |
|---|---|---|
| Total hip replacement | Removes the worn ball and socket surfaces and replaces them with metal, plastic, or ceramic components. CIHI reports that 99.6% of first hip replacements for osteoarthritis in Canada are total replacements, and that 94% of patients report a positive change in quality of life one year later. | Established arthritis with pain and function loss that has outlasted non-surgical care. Pathway’s surgeons perform it through the direct anterior approach. |
| Hip resurfacing | Caps the femoral head with a metal covering instead of removing it, and fits a metal shell in the socket. The AAOS notes it is performed less often than in the past because of metal ion release and the risk of femoral neck fracture. | Generally younger (under 60), larger-framed patients with strong bone. Older, female, or smaller-framed patients face higher complication risk. |
| Hip arthroscopy | Keyhole surgery that treats labral tears, impingement, and loose bodies. The AAOS does not list osteoarthritis among the conditions it treats. | Younger hips with a mechanical problem and little arthritis. A systematic review of 2,051 hips found that patients with a Tönnis grade of 1 or more, or joint space of 2 mm or less, were less likely to benefit and more likely to need conversion to a hip replacement. |
For most people with symptomatic hip arthritis, the realistic surgical option is a total hip replacement. Pathway’s pages on anterior hip replacement, resurfacing versus replacement, and hip arthroscopy cover each in detail, and the recovery guide sets out what the months after surgery look like.
Quick answers
Where does hip arthritis hurt?
Most often in the groin. The pain can spread to the front of the thigh, the buttock, or the knee. Pain on the outside of the hip is more often a tendon or bursa problem, and pain in the back of the hip can come from the spine. Your surgeon sorts this out with an exam and X-rays.
What are the first signs of hip arthritis?
Early hip osteoarthritis usually shows up as groin pain with activity, stiffness in the morning or after sitting that eases within about an hour, and trouble with movements that rotate the hip, such as putting on socks and shoes. The AAOS notes it occurs most often in people aged 50 and older.
Do I need an X-ray to diagnose hip arthritis?
An X-ray is the standard test and shows joint space narrowing, bone spurs, and bone changes. Symptoms and X-rays do not always match: a BMJ study found only 15.6% of hips with frequent pain showed radiographic arthritis in one cohort, so your surgeon weighs the exam and your symptoms alongside the image. An MRI or CT is used occasionally for more detail.
What helps hip arthritis without surgery?
OARSI lists arthritis education and structured land-based exercise as core treatments for hip osteoarthritis. Weight management, physiotherapy for mild to moderate symptoms, and oral NSAIDs when they are safe for you are supported by the AAOS hip guideline, and a corticosteroid injection can give short-term relief. Hyaluronic acid injections are recommended against, and OARSI strongly recommends against opioids.
When should I see a surgeon for hip arthritis?
When pain limits daily activities despite exercise, weight management, medication, and physiotherapy; when pain wakes you at night or is present at rest; or when stiffness and a limp are taking away the activity you need to stay strong. A consultation is an assessment; it commits you to nothing and gives you a baseline and a plan.
Questions to ask your surgeon
- Is my pain coming from the hip joint, or from the spine, the tendons, or the bursa?
- What grade is my X-ray, and how well does it match my symptoms?
- Which non-surgical treatments are still worth a proper trial, and for how long?
- Am I a candidate for a corticosteroid injection, and what would it tell us?
- Given my age and activity, when does a hip replacement make sense, and what happens if I wait?
- Which approach do you use, and how does it affect my recovery?
- What are the most common complications your patients experience, and how do you manage them?
If you are already thinking about timing, Pathway’s guides on how long a hip replacement lasts and hip replacement wait times in Canada cover the next questions most people ask.
References
- American Academy of Orthopaedic Surgeons (OrthoInfo). Osteoarthritis of the Hip. Accessed October 21, 2026.
- American Academy of Orthopaedic Surgeons (OrthoInfo). Hip Resurfacing. Accessed October 21, 2026.
- American Academy of Orthopaedic Surgeons (OrthoInfo). Hip Arthroscopy. Accessed October 21, 2026.
- American Academy of Orthopaedic Surgeons. Management of Osteoarthritis of the Hip: Clinical Practice Guideline summary (2023) and press release (January 23, 2024). Accessed October 21, 2026.
- 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.
- NHS. Osteoarthritis. Last reviewed March 20, 2023. Accessed October 21, 2026.
- HealthLink BC. Arthritis: Should I Have Hip Replacement Surgery? Current as of November 9, 2022. Accessed October 21, 2026.
- Altman R, Alarcón G, Appelrouth D, et al. The American College of Rheumatology criteria for the classification and reporting of osteoarthritis of the hip. Arthritis Rheum. 1991;34(5):505–514.
- Kim C, Nevitt MC, Niu J, et al. Association of hip pain with radiographic evidence of hip osteoarthritis: diagnostic test study. BMJ. 2015;351:h5983.
- Kohn MD, Sassoon AA, Fernando ND. Classifications in Brief: Kellgren-Lawrence Classification of Osteoarthritis. Clin Orthop Relat Res. 2016;474(8):1886–1893. Grade descriptions as summarised by Radiopaedia.
- Fortin PR, Clarke AE, Joseph L, et al. Outcomes of total hip and knee replacement: preoperative functional status predicts outcomes at six months after surgery. Arthritis Rheum. 1999;42(8):1722–1728.
- Bayliss LE, Culliford D, Monk AP, et al. The effect of patient age at intervention on risk of implant revision after total replacement of the hip or knee: a population-based cohort study. Lancet. 2017;389(10077):1424–1430.
- Domb BG, Gui C, Lodhia P. How much arthritis is too much for hip arthroscopy: a systematic review. Arthroscopy. 2015;31(3):520–529.
- Canadian Institute for Health Information. Hip replacements in Canada: osteoarthritis (information sheet, 2025; data from the Canadian Joint Replacement Registry, 2021–2022). Accessed October 21, 2026.
Health information notice: This article provides general information about hip arthritis symptoms and treatment ranges and cannot replace individual medical advice. Your surgeon and care team set your plan based on your health, your imaging, and your goals.