Hip Osteoarthritis
Arthritis in the ball-and-socket hip joint, usually felt as groin or thigh pain and stiffness. Exercise is the foundation, even though its effect is more modest for hips than knees. When pain becomes severe, hip replacement works well for most people.
Symptoms. Pain in the groin, buttock or front of the thigh, sometimes felt in the knee. Stiffness after sitting, trouble putting on socks and shoes or getting in and out of a car, and sometimes a limp.
Not the outer hip. Pain on the outside of the hip that’s worse lying on that side is usually from irritated buttock tendons, a different problem with a different fix: see outer hip pain.
Who gets it. More likely with age, when it runs in the family, after a hip injury, and in people who had hip problems as a child (such as a shallow hip socket).
How it’s diagnosed. Usually from your story and an examination: hip arthritis typically limits turning the leg inwards. An X-ray may help if the picture is unclear or surgery is being considered.
The hip osteoarthritis ladder
Start at the bottom, climb only if you need to. Steps 1 and 2 stay part of the plan even if you end up having surgery.
- Step 1 · Self-careExercise and strengtheningButtock and thigh strengthening, plus walking, cycling or water exercise, most days.
- Works
- Pain down about 7 points out of 100 on average vs no exercise (2026 review, 18 trials). Modest, but cheap, safe and good for the rest of you
- Cost
- Free, or about $5–20 a session for a pool or gym
- How long
- 6–12 weeks to feel it; keep going for life
- Watch for
- Some soreness is normal. Fine if it settles within 24 hours.
Smaller effect than for knees. Still the best-value treatment going.
- Step 2 · Self-careWeight loss, if above a healthy weightLess load through the hip with every step and stair.
- Works
- Any weight loss is likely to help, and 10% likely beats 5%. Evidence is stronger for knees than hips
- Cost
- Free; weight-loss medicines are private scripts, often several hundred dollars a month
- How long
- Months
- Watch for
- Weight-loss medicines: nausea, constipation; not in pregnancy.
Also makes recovery from any future surgery easier.
- Step 3 · PharmacyAnti-inflammatory tablets, short termIbuprofen or naproxen, or celecoxib on prescription, at the lowest dose for the shortest time.
- Works
- Modest short-term relief in hip and knee arthritis trials; useful for flares
- Cost
- Pharmacy about $5–15; celecoxib under the $25 PBS co-payment
- How long
- Days to a couple of weeks
- Watch for
- Stomach bleeds, kidney and heart risks. Not safe for many people: check with your GP or pharmacist.
Gels are great for knees and hands. The hip is buried too deep to count on them.
- Step 4 · Allied healthPhysio, exercise physiology or a GLA:D programA tailored strengthening plan, or a 6-week group program (2 sessions a week) run by trained physios.
- Works
- GLA:D registry: hip pain about a quarter lower at 3 and 12 months; people taking painkillers fell from about 58 in 100 to 45 in 100 (no comparison group)
- Cost
- About $90–130 a session; Medicare rebates for up to 5 allied health visits a year with a GP care plan. GLA:D about $400–700 for the program
- How long
- 6–8 weeks of sessions, then keep going at home
- Watch for
- Choose someone who gets you moving, not just massaged.
Squats in a group: weirdly fun, genuinely useful.
- Step 5 · ProcedureSteroid injectionAn injection into the hip, usually with ultrasound or X-ray guidance, for a bad flare.
- Works
- Modest relief compared with a saltwater injection, lasting about 2–4 weeks on average in arthritis trials
- Cost
- From bulk-billed to a few hundred dollars, depending on the clinic and whether ultrasound is used
- How long
- Weeks
- Watch for
- Not a long-term fix. Rare infection. Many surgeons prefer a gap of a few months before a hip replacement.
A pause button, not a fix.
- Step 6 · SpecialistHip replacementFor severe pain and disability despite at least 3 months of good non-surgical care.
- Works
- Most people have much less pain and walk better. Long term, about 1 in 10 still have troublesome pain; in Australian registry data about 1 in 10 hip and knee patients were unhappy with the result at 6 months
- Cost
- Free in the public system (expect a wait); private out-of-pocket costs vary from hundreds to several thousand dollars
- How long
- Most people walk the next day; full recovery takes months
- Watch for
- Clots, infection, dislocation, leg-length difference. Being fitter beforehand helps recovery.
One of medicine’s great operations. Still not a reason to skip rung 1.
Save your money
Popular, heavily marketed or often asked about, but the evidence is weak or says no.
- GlucosamineA 2-year trial in 222 people with hip arthritis found no benefit over a dummy tablet for pain, function or joint narrowing. NICE advises against it.
- Hyaluronic acid (“gel”) injectionsNICE advises against them for osteoarthritis. Pricey, and no good evidence for hips.
- PRP and stem cell injectionsNo good-quality evidence for hip arthritis. Stem cell treatments can cost thousands.
- MRI scansRarely needed. The diagnosis is usually clear from an examination, with an X-ray if anything.
- AcupunctureNICE advises against it for osteoarthritis because the benefit is too small or uncertain.
What you can do
- Aim for 150 minutes of activity a week. On bad days, do less rather than stopping.
- Use a walking stick in the hand opposite the sore hip to take load off it.
- A higher chair, a raised toilet seat and a long-handled shoehorn make daily life easier.
- Ask a physio which moves from our knee exercise handout suit your hip: many of the leg-strengthening exercises overlap.
See your GP if
- Pain stops you sleeping, working or doing what you enjoy
- You need anti-inflammatory tablets most days
- Walking distance keeps shrinking despite 3 months of exercise and weight management
- You’re under 45 with hip pain, or the pain is mainly on the outside of the hip
See a doctor the same day for a hot, very painful hip with fever, or if you suddenly can’t put weight on your leg, especially after a fall: a broken hip can follow even a small fall in older people.
Common questions
Is groin pain really from my hip?
Often, yes. Hip arthritis is usually felt in the groin or front of the thigh, and sometimes only in the knee. Pain on the outside of the hip is more often a tendon problem.
Does exercise work for hip arthritis?
Yes, but modestly: on average pain improves by about 7 points out of 100. It’s safe, cheap and helps your heart, weight and balance too, so it’s still the first step for everyone.
Should I rest my hip?
Short breaks in a flare are fine, but long rest makes the joint stiffer and the muscles weaker. Keep moving at a level that settles within 24 hours.
When should I think about a hip replacement?
When pain and stiffness are severe and limit your life despite at least 3 months of good non-surgical care. Your age or X-ray alone don’t decide it.
Helpful resources
- GLA:D AustraliaStructured 6-week education and exercise program for hip and knee arthritis, run by trained physios. Paid; check your health fund. Australia.
- MyOA (Arthritis Australia)Trusted osteoarthritis information, plus symptom tracking and goal-setting tools. Free, Australia.
- Knee osteoarthritis exercise handoutPrintable, one page. Many of the leg-strengthening moves suit hips too. Free, from us.
- Arthritis AustraliaInformation sheets and the free Arthritis Infoline (1800 011 041) for questions and local support. Free, Australia.
Evidence and more information
- Cochrane: Exercise for osteoarthritis of the hip (2026)
- University of Sydney: Summary of the 2026 Cochrane hip exercise review
- NICE: Osteoarthritis diagnosis and management (2022)
- BMC Musculoskeletal Disorders: GLA:D registry results for hip and knee (2017)
- AAFP summary: Glucosamine for hip osteoarthritis, 2-year trial (2008)
- BMJ Open: Long-term pain after hip and knee replacement (2012)
- AusDoc: First national patient-reported results after hip and knee replacement
maladywise.com/hip-oa/