Hip pain (Osteoarthritis)

Hip pain is common and there are several possible causes.

Osteoarthritis (OA) is the most common cause of hip pain in people aged over 45. The pain from hip OA is usually felt in the groin area. The joint may feel stiff, particularly first thing in the morning or on getting up after sitting for a while. The pain may come and go, but over time the joint usually becomes increasingly stiff.

Pain which is due to a hip problem is sometimes only felt in the knee. This is because of the way that the same nerve picks up pain sensation from different sites.

Pain which people think is in their hip can be from a problem in the spine or abdomen and nothing to do with the hip at all.

Lateral hip pain is felt in the outer hip or outer buttock area and is usually due to irritation of the soft tissues (muscles/tendons/bursa). This is a common problem. The pain is often worse with prolonged sitting, climbing stairs or lying on the affected side. It is sometimes called Greater Trochanteric Pain Syndrome. An older term is Trochanteric Bursitis.

Hip pain in young adults can be due to hip dysplasia (a problem with normal development of the hip joint in early life). Femoro-acetabular impingement (FAI) is a form of hip dysplasia which can give rise to hip pain and stiffness in young adults.

Osteoarthritis

As part of normal life, joints are exposed to a constant low level of damage. In most cases, the body repairs the damage itself and there are few or no symptoms. In osteoarthritis, the protective cartilage on the ends of the affected bones breaks down, causing pain, swelling and problems moving the joint. The effect on a person’s function and quality of life with osteoarthritis is extremely variable but tends to be progressive.

Although OA develops in previously healthy joints, normally in people over 45, it can also develop in younger people after a fracture or similar injury or when a joint has been damaged by other conditions such as rheumatoid arthritis or gout. It is twice as common in women as men, and most likely in people who are overweight or who suffer from high blood pressure. Exercise appears to be protective.

Selfcare and more information

Managing my condition

The aims of any treatment for any hip pain are to reduce your pain and improve movement.

Many people find that self-help measures are enough to help them manage their symptoms. These include:

  • Rest
  • Activity modification
  • Painkillers
  • Strengthening your core muscles

You can click here for a list of exercises that may help your hip pain.

A physiotherapist can suggest further measures for you if self-help is not enough.

You should seek early medical advice if:

  • The pain is severe or getting worse or you are unable to bear weight on the affected leg
  • Your hip pain came on suddenly following significant injury
  • There is redness +/- swelling over the joint
  • You also have a fever or feel unwell
  • Unexplained, increasing or sudden onset severe pain in a previously replaced joint The pain is also in other joints

 

Advice for specific conditions

Femoro-acetabular Impingement

Where FAI is suspected in a younger adult (18 – 50yrs) and the above measures have not improved symptoms, then a specialist review is usually recommended to avoid disease progression and to consider the role of corrective surgery.

Please be aware that there are local commissioning policies in place for this condition. Please click here for more information.

Trochanteric Pain Syndrome

The majority of trochanteric (lateral) hip pain will settle with conservative measures within 12 months. If you are not able to manage your symptoms through the self-help techniques outlined previously then you should seek referral to a local physiotherapist.

Local steroid injections are no longer considered appropriate in the routine management of trochanteric pain although may be considered in cases of severe or intractable trochanteric pain.

Osteoarthritis of the hip

Osteoarthritis of the hip tends to be a progressive condition and therefore the symptoms may worsen with time. The aims of any treatment for osteoarthritis of the hip are to reduce your pain and improve movement with a view to improving quality of life.

Deciding what to do about Osteoarthritis of the hip

Lifestyle changes

Being overweight puts extra strain on weight-bearing joints like the hip and can lead to more severe OA.

If you are overweight, then losing weight through dietary changes can be very helpful to reduce further damage to your knee joint and improve your pain.

Exercising can also aid weight loss. If you exercise regularly and gradually increase your exercise then you may be able to walk further and faster, climb stairs more easily and move your joint more freely.

These changes can help you feel more in control of your arthritis and benefit your overall health including other medical conditions such as diabetes and heart disease and psychological disorders such as anxiety and depression. They will also help your recovery if you do eventually have surgery as obesity is linked to an increased risk of surgical complications.

Specific mobility and strengthening exercises for the affected joint are also helpful.

Generally, doing enough exercise and eating a healthy diet is safe. Lifestyle changes do require daily commitment, but you won’t need to spend time in hospital.

Click here to find out more information about health, lifestyle and wellbeing.

Physiotherapy

In Devon, there are different ways of accessing physiotherapy.

Physiotherapists often recommend specific exercises which you will be taught during your session. Even if you are normally quite active, it is worth committing to these exercises as they are designed to strengthen and stretch specific muscles. It may include using walking aids including walking sticks and crutches, using special insoles. Sometimes physiotherapists use massage or manipulation.

Physiotherapy can be uncomfortable at first, but this should ease. It can improve your mobility and quality of life as well as helping you to remain independent.

You will probably need to attend several sessions. It is important that you spend time continuing the exercises in between your therapy sessions so that you can progress to further exercises at your next appointment. It is also beneficial to continue the exercises after you have been discharged from physiotherapy.

In Devon, anyone who needs an orthopaedic referral for knee osteoarthritis will usually need to have undergone a course of physiotherapy.

The reasons are:

  • You may benefit sufficiently from physiotherapy, so a referral is no longer needed
  • The physiotherapist can make a detailed assessment of the severity of your condition and discuss with you how much you are likely to benefit from surgery
  • If surgery is needed, then physiotherapy helps to improve the outcome by ensuring that the muscles surrounding the joint are working well prior to the operation

However, it is recognised that NHS physiotherapy may not be available in some areas, and this will be considered when referrals are assessed.

In Torbay and South Devon, the physiotherapy service will assess your condition, arrange X-rays or scans and refer you to an orthopaedic specialist if needed without involving your GP.

In other areas, your GP or First Contact Physiotherapist at the surgery will make the referral if needed, following a course of physiotherapy. An X-ray is required prior to referral.

Pain management

Pain is a complex problem and how we experience pain can be affected by our feelings and emotions. Further information on understanding pain and how to manage it can be found via the following links:

You can buy simple painkillers such as paracetamol and ibuprofen. Your GP can prescribe painkillers. It is usually best to avoid opioid painkillers such as codeine and tramadol for ongoing pain because they tend to be addictive. There is a risk of getting used to them and needing increasing doses (tolerance). They can cause drowsiness which will affect ability to drive as well as other activities and can contribute to a higher risk of falls.

Your GP or physiotherapist may suggest a programme such as cognitive behavioural therapy (CBT) to help you manage your pain. Programmes vary in length, but all require a commitment by you both during and between the sessions. They are often delivered through a specialist pain clinic.

Easing your pain can help you move around more easily including walking further and faster as well as climbing stairs more easily. Changing the way in which you think about your pain can help you to keep more active.

Complementary therapies

Some people say that they find complementary therapies help their pain and mobility. These include TENS, acupuncture and the nutritional supplements chondroitin and glucosamine.

Complementary treatments are not likely to slow or stop arthritis from getting worse. You need to access these treatments privately as the lack of evidence of effectiveness means they are not available on the NHS.

Herbal medicines may interact adversely with other medication. There is a risk of infection from acupuncture.

Surgery

Surgery is reserved for people who have severe symptoms and have tried other treatments without success. Surgery replaces the damaged joint or its surface – hip replacement or hip joint resurfacing. Hip replacement usually helps reduce pain. However, not everyone is satisfied with the results and some people suffer complications of surgery. Individual risks and benefits need to be considered before surgery.

To help you decide if surgery would be a good option for you, please click here.

An NHS Devon commissioned pathway is in place for hip surgery and can be found here:

You will be expected to have had a course of physiotherapy and an X-ray before referral.

Complications of surgery include blood clots, infections and bleeding, which can slow down your recovery.

If you are overweight or you smoke, you are more likely to develop complications. You may want to discuss with your health professional getting support to lose weight or to stop smoking prior to considering surgery.

Most people go home about three to five days after the operation. For the first four to six weeks after the operation you will need a walking aid such as crutches, to help support you. You will need about six weeks off work, depending on your job. Most people can get back to their normal activities within two to three months. You will need to do various exercises to help you to recover well.

For more information on hip replacement surgery, please follow this link:

Hip replacement surgery | Treatment options | Arthritis UK

Useful information about hip pain

Waiting for a specialist opinion

If you have been referred for a specialist opinion your details will be reviewed and it may be recommended that you are seen by a hospital clinician. Information to support you in choosing your preferred hospital, including waiting times can be found using the links below.

How long will I wait?

If a hospital assessment and/or treatment is clinically recommended your information will be sent to a specialist. Click below to find out more about waiting times for routine hospital assessment and/or treatment.