Hip Arthritis

Hip osteoarthritis is the gradual wearing away of the smooth cartilage that covers the ball and socket. As the cartilage thins, the joint becomes painful and stiff. Treatment ranges from simple exercise to hip replacement, depending on how much the arthritis affects your life.

Symptoms of hip arthritis

• Pain in the groin or front of the thigh, sometimes felt in the buttock or knee
• Morning stiffness, or stiffness after sitting
• Difficulty putting on shoes and socks, or getting in and out of a car
• A limp, or needing a cane on longer walks
• Pain at night in more advanced stages

Causes and risk factors

Age, genetics, prior injury, hip impingement (FAI), hip dysplasia and avascular necrosis can all lead to arthritis. Other forms include inflammatory arthritis (such as rheumatoid arthritis) and post-traumatic arthritis after a fracture.

Diagnosis

Standing X-rays show joint-space narrowing, bone spurs and changes in the bone. Dr. Dold also checks your range of motion and gait, and rules out pain from the spine, which can feel similar.

Non-surgical treatment

• Exercise and physical therapy: strengthening and low-impact activity such as cycling and swimming
• Weight management: even modest weight loss reduces load on the hip
• Medicine: anti-inflammatories or acetaminophen, when safe for you
• Injections: an image-guided cortisone injection can relieve flare-ups for weeks to months
• Biologic injections: some patients ask about platelet-rich plasma (PRP). Evidence for PRP in hip arthritis is still limited and mixed. It is not FDA-approved specifically for this use and usually isn’t covered by insurance. Dr. Dold, who published a 2014 systematic review of PRP for cartilage disease, will give you a candid view.
• Walking aids: a cane in the opposite hand can meaningfully reduce hip load

Is hip arthroscopy an option for arthritis?

Generally, no. Arthroscopy works well for hips with healthy cartilage, such as labral tears and impingement. In a hip with moderate or advanced arthritis it tends to give poor results, and Dr. Dold will usually recommend against it. Because he performs both procedures, you’ll get a straight answer about which one fits your hip.

When is it time for hip replacement?

Consider replacement when hip pain limits your walking, work, sleep or activities despite good non-surgical care, and X-rays confirm significant arthritis. There is no single “right” age. The decision is based on your symptoms and goals.

Dr. Dold performs anterior hip replacement, a muscle-sparing approach, with OrthoGrid Hip AI® guidance during surgery. Many patients go home the same day.

What the research shows

Hip arthritis is one of the most studied conditions in orthopedics. Here is what the research shows about each step of treatment.

Exercise and weight

Exercise is the foundation. Randomized trials show it reduces pain and improves function, and in a large analysis it relieved pain about as well as pain medicine, with fewer side effects. Weight loss helps overall health and mobility, though one recent trial found that adding an intensive diet to exercise did not reduce hip pain further.

Injections

Cortisone injections can give short-term relief, and some analyses rank them highest for pain relief in the first weeks. However, results are mixed: some meta-analyses found no injection, including cortisone, PRP and hyaluronic acid, clearly outperformed a saline placebo. Injections can still be useful to calm a flare-up or to confirm that pain is coming from the hip joint.

Arthroscopy is for hips without significant arthritis

Studies consistently show that moderate arthritis on X-rays predicts poor results after hip arthroscopy. In carefully selected patients over 40 with little arthritis, arthroscopy has outperformed therapy alone.

Hip replacement

For severe arthritis, a 2024 randomized trial found that hip replacement reduced pain and improved function substantially more than a supervised strength program. Modern hip replacements are durable, with registry data suggesting most last 20 years or more. The anterior approach is associated with faster early recovery and a similar complication rate to the posterior approach, though it carries a higher chance of numbness on the outer thigh from irritation of a skin nerve.

Why see Dr. Dold

• Board certified by the American Board of Orthopaedic Surgery, with subspecialty certification in Sports Medicine
• Fellow of the American Orthopaedic Association (FAOA), the American Academy of Orthopaedic Surgeons (FAAOS), the American College of Surgeons (FACS) and the Royal College of Surgeons of Canada (FRCSC)
• Sports medicine and arthroscopy fellowship at NYU Langone / Hospital for Joint Diseases; orthopedic residency at the University of Toronto
• Member of the International Society for Hip Arthroscopy (ISHA)
• D Magazine Best Doctors (Collin County), 2019–2026 · Rated 4.9 on Google

Frequently asked questions

Research cited on this page

1. Fransen M, McConnell S, Hernandez-Molina G, Reichenbach S. Exercise for osteoarthritis of the hip. Cochrane Database Syst Rev. 2014;(4):CD007912. PubMed
   Pooled results of 10 randomized trials: land-based exercise reduces pain and improves function in hip arthritis, with benefits lasting 3 to 6 months after the program ends.
2. Kolasinski SL, Neogi T, Hochberg MC, et al. 2019 American College of Rheumatology/Arthritis Foundation guideline for the management of osteoarthritis of the hand, hip, and knee. Arthritis Rheumatol. 2020;72(2):220-233. PubMed
   Strongly recommends exercise, weight loss for people who are overweight, self-management programs, tai chi, cane use and oral anti-inflammatory medicines for hip and knee arthritis.
3. Belk JW, Houck DA, Littlefield CP, et al. Platelet-rich plasma versus hyaluronic acid for hip osteoarthritis yields similarly beneficial short-term clinical outcomes: a systematic review and meta-analysis of level I and II randomized controlled trials. Arthroscopy. 2022;38(6):2035-2046. PubMed
   In six studies of hip arthritis, PRP and gel (hyaluronic acid) injections produced similar short-term improvement.
4. Andronic O, Claydon-Mueller LS, Cubberley R, et al. Inconclusive and contradictory evidence for outcomes after hip arthroscopy in patients with femoroacetabular impingement and osteoarthritis of Tönnis grade 2 or greater: a systematic review. Arthroscopy. 2022;38(7):2307-2318. PubMed
   For hips with moderate or advanced arthritis, results of hip arthroscopy were inconsistent, and some studies reported 35% to 70% of patients going on to hip replacement.
5. Dold AP, Zywiel MG, Taylor DW, et al. Platelet-rich plasma in the management of articular cartilage pathology: a systematic review. Clin J Sport Med. 2014;24(1):31-43. PubMed
   Dr. Dold’s review: limited, mostly low-quality evidence suggested short-term benefit of PRP for knee arthritis, and more high-quality studies were needed.
6. Gibbs AJ, Gray B, Wallis JA, et al. Recommendations for the management of hip and knee osteoarthritis: A systematic review of clinical practice guidelines. Osteoarthritis Cartilage. 2023;31(10):1280-1292. PubMed
   A review of clinical guidelines found higher-quality guidelines consistently recommend education, exercise and weight management for hip arthritis, with anti-inflammatory medicine and cortisone injections as options.
7. Weng Q, Goh SL, Wu J, et al. Comparative efficacy of exercise therapy and oral non-steroidal anti-inflammatory drugs and paracetamol for knee or hip osteoarthritis: a network meta-analysis of randomised controlled trials. Br J Sports Med. 2023;57(15):990-996. PubMed
   A network meta-analysis of 152 trials found exercise relieved arthritis pain about as well as anti-inflammatory medicine or acetaminophen, with a better safety profile.
8. Bartels EM, Juhl CB, Christensen R, et al. Aquatic exercise for the treatment of knee and hip osteoarthritis. Cochrane Database Syst Rev. 2016;3(3):CD005523. PubMed
   A Cochrane review found aquatic exercise gives small, short-term improvements in pain and function in hip and knee arthritis.
9. French HP, Cusack T, Brennan A, et al. Exercise and manual physiotherapy arthritis research trial (EMPART) for osteoarthritis of the hip: a multicenter randomized controlled trial. Arch Phys Med Rehabil. 2013;94(2):302-14. PubMed
   In a randomized trial, exercise therapy improved hip function, and adding manual therapy did not improve results further.
10. Abbott JH, Robertson MC, Chapple C, et al. Manual therapy, exercise therapy, or both, in addition to usual care, for osteoarthritis of the hip or knee: a randomized controlled trial. 1: clinical effectiveness. Osteoarthritis Cartilage. 2013;21(4):525-34. PubMed
    A randomized trial found manual physiotherapy and exercise physiotherapy each gave benefits over usual care in hip and knee arthritis.
11. French HP, Abbott JH, Galvin R. Adjunctive therapies in addition to land-based exercise therapy for osteoarthritis of the hip or knee. Cochrane Database Syst Rev. 2022;10(10):CD011915. PubMed
    A review found that adding other therapies to exercise for hip arthritis did not clearly improve pain or function.
12. Hall M, Hinman RS, Knox G, et al. Efficacy of a Very-Low-Calorie Weight Loss Diet Plus Exercise Compared With Exercise Alone on Hip Osteoarthritis Pain : A Randomized Controlled Trial. Ann Intern Med. 2025;178(9):1227-1237. PubMed
    In a 2025 randomized trial, adding a very-low-calorie diet to exercise led to more weight loss but did not reduce hip pain more than exercise alone, though most other outcomes improved.
13. da Costa BR, Pereira TV, Saadat P, et al. Effectiveness and safety of non-steroidal anti-inflammatory drugs and opioid treatment for knee and hip osteoarthritis: network meta-analysis. BMJ. 2021;375:n2321. PubMed
    A network meta-analysis of 192 trials found some oral anti-inflammatory medicines reduce arthritis pain meaningfully, but they may not be appropriate for people with other medical conditions.
14. Zhao Z, Ma JX, Ma XL. Different Intra-articular Injections as Therapy for Hip Osteoarthritis: A Systematic Review and Network Meta-analysis. Arthroscopy. 2020;36(5):1452-1464.e2. PubMed
    A network meta-analysis of hip arthritis injections found cortisone gave the greatest short-term pain relief.
15. Brookes PA, Stynes S. In Patients With Painful Hip Osteoarthritis, Is It More Beneficial to Offer Them an Ultrasound-Guided or a Fluoroscopic-Guided Intra-Articular Corticosteroid Injection to Relieve Their Symptoms? A Systematic Review and Network Meta-Analysis. Musculoskeletal Care. 2024;22(4):e70005. PubMed
    Ultrasound- and X-ray-guided cortisone injections both reduced hip arthritis pain at 1 month.
16. Kelly E, Heron N. Pain management of hip osteoarthritis with corticosteroids vs injection therapies: a systematic review and meta-analysis. BMC Musculoskelet Disord. 2025;26(1):473. PubMed
    A 2025 meta-analysis found cortisone injections for hip arthritis did not reach a statistically significant benefit over placebo.
17. Gazendam A, Ekhtiari S, Bozzo A, et al. Intra-articular saline injection is as effective as corticosteroids, platelet-rich plasma and hyaluronic acid for hip osteoarthritis pain: a systematic review and network meta-analysis of randomised controlled trials. Br J Sports Med. 2021;55(5):256-261. PubMed
    A meta-analysis of 11 randomized trials found no hip injection significantly outperformed a saline placebo injection at 2–6 months.
18. Nouri F, Babaee M, Peydayesh P, et al. Comparison between the effects of ultrasound guided intra-articular injections of platelet-rich plasma (PRP), high molecular weight hyaluronic acid, and their combination in hip osteoarthritis: a randomized clinical trial. BMC Musculoskelet Disord. 2022;23(1):856. PubMed
    A randomized trial found PRP, hyaluronic acid and the combination all improved hip arthritis symptoms, with longer-lasting effects in the PRP groups.
19. Degen RM, Nawabi DH, Bedi A, et al. Radiographic predictors of femoroacetabular impingement treatment outcomes. Knee Surg Sports Traumatol Arthrosc. 2017;25(1):36-44. PubMed
    A review found that moderate arthritis on X-ray (Tönnis grade 2 or more, or joint space under 2 mm) predicts worse results after hip preservation surgery.
20. Horner NS, Ekhtiari S, Simunovic N, et al. Hip Arthroscopy in Patients Age 40 or Older: A Systematic Review. Arthroscopy. 2017;33(2):464-475.e3. PubMed
    In patients 40 or older, hip arthroscopy with labral repair or bone reshaping gave meaningful improvement, but labral debridement alone did not.
21. Martin SD, Dean MC, Gillinov SM, et al. Hip Arthroscopy Versus Physical Therapy for the Treatment of Symptomatic Acetabular Labral Tears in Patients Older Than 40 Years: 24-Month Results From a Randomized Controlled Trial. Am J Sports Med. 2024;52(10):2574-2585. PubMed
    A randomized trial in patients 40 or older with limited arthritis found arthroscopy plus therapy gave better 2-year results than therapy alone.
22. Frydendal T, Christensen R, Mechlenburg I, et al. Total Hip Replacement or Resistance Training for Severe Hip Osteoarthritis. N Engl J Med. 2024;391(17):1610-1620. PubMed
    A 2024 randomized trial in adults 50 and older with severe hip arthritis found hip replacement gave a clinically important greater reduction in pain and better function than resistance training.
23. Pentland V, Thompson Z, Dayimu A, et al. Survivorship of modern total hip replacement to 30 years: systematic review, meta-analysis, and extrapolation of global joint registry data. Lancet. 2026;407(10531):855-866. PubMed
    A 2026 analysis of nearly 1.9 million hip replacements estimated about 94% survival at 20 years and about 92% at 30 years.
24. Ang JJM, Onggo JR, Stokes CM, et al. Comparing direct anterior approach versus posterior approach or lateral approach in total hip arthroplasty: a systematic review and meta-analysis. Eur J Orthop Surg Traumatol. 2023;33(7):2773-2792. PubMed
    A meta-analysis of 24 studies found the direct anterior approach gave better early function and a shorter hospital stay than the posterior approach, with similar dislocation and complication rates.
25. Moerenhout K, Derome P, Laflamme GY, et al. Direct anterior versus posterior approach for total hip arthroplasty: a multicentre, prospective, randomized clinical trial. Can J Surg. 2020;63(5):E412-E417. PubMed
    A randomized trial found anterior and posterior approaches had similar hospital stays and outcomes, with a trend toward faster early recovery after the anterior approach.
26. Yang XT, Huang HF, Sun L, et al. Direct Anterior Approach Versus Posterolateral Approach in Total Hip Arthroplasty: A Systematic Review and Meta-analysis of Randomized Controlled Studies. Orthop Surg. 2020;12(4):1065-1073. PubMed
    A meta-analysis found the anterior approach gave earlier recovery and less pain, with a higher rate of numbness on the outer thigh from irritation of a skin nerve.

Medically reviewed by Andrew P. Dold, MD, FAOA, FAAOS, FACS, FRCSC. Last reviewed September 30, 2026. This page is general information, not medical advice.