Hip Arthritis: Causes, Symptoms & Treatment

Dr. Leo Zalikha is a Stanford fellowship-trained orthopedic surgeon in Long Beach, CA, specializing in hip and knee arthritis, from early conservative management through total hip replacement.

• Stanford Fellowship
• 30+ Peer-Reviewed Publications
• Full Spectrum of Arthritis Care
• Long Beach · Greater LA · Orange County

The hip is a ball-and-socket joint. The ball (femoral head) sits within the socket (acetabulum) of the pelvis, and both surfaces are covered by a layer of articular cartilage, a smooth, nearly frictionless tissue that allows the hip to move freely and absorb load with each step.

In osteoarthritis, this cartilage gradually deteriorates. As the protective layer thins and eventually wears away, the underlying bone is exposed, leading to inflammation, pain, stiffness, and the formation of bone spurs (osteophytes). Over time, the joint space narrows, and the hip becomes increasingly difficult to move without discomfort.

Cartilage has a very limited ability to repair itself. Once damaged, whether from age, prior injury, abnormal joint mechanics, or genetic predisposition, the wear process tends to progress over time. The rate varies significantly from person to person.

Hip arthritis symptoms tend to develop gradually, though their severity can vary significantly from patient to patient. X-ray findings do not always match symptom level, some patients with mild imaging changes have significant pain, while others with advanced arthritis manage with modest discomfort. What matters most is how your symptoms affect your life.

• A deep, aching pain in the groin or front of the hip is the most characteristic location
• Morning stiffness or stiffness after sitting for extended periods
• Pain that worsens with activity and initially improves with rest
• Difficulty with stairs, getting in and out of a car, or bending to tie shoes
• A gradual decrease in how far you can walk comfortably before pain sets in
• A limp or feeling of instability in the hip
• Hip arthritis pain at night that disrupts sleep is often a sign of more advanced disease
• A sense of grinding, catching, or clicking within the joint
• Reduced range of motion, particularly when rotating the leg inward

Note: These symptoms usually develop over months to years. If pain is sudden, severe, or accompanied by fever, redness, or inability to bear weight, seek urgent medical evaluation, these may indicate a different or more urgent condition.

Hip arthritis care is not all-or-nothing. There is a wide spectrum of options, and the right approach depends on your stage of disease, symptom severity, activity level, and personal goals. For most patients, particularly those with mild to moderate arthritis, the starting point is nonoperative management.

Step 1 – Nonoperative Care

Conservative Management Options

Structured strengthening of the muscles around the hip, flexibility training, and gait retraining are among the most effective strategies for arthritis symptom management. Learn about Physical Therapy for Arthritis.

Weight Optimization

The hip bears multiple times body weight with each step. Even modest weight reduction significantly lowers joint stress and improves symptoms. Learn about Weight Optimization & Prehab.

Medications

Over-the-counter NSAIDs, acetaminophen, and topical anti-inflammatories help manage pain. Prescription options are available when appropriate and discussed individually.

Activity Modification

Switching from high-impact to lower-impact activities, such as swimming, cycling, and elliptical, preserves fitness and reduces joint stress without requiring you to stop moving entirely.

Assistive Devices

A cane or walker used on the opposite side of the affected hip can meaningfully reduce load across the joint and improve walking confidence.

Step 2 – Injections

When Therapy Alone Is Not Enough

Corticosteroid Injections

Reduce inflammation and provide temporary pain relief. Not a cure for arthritis, but can be an effective part of a longer-term management plan. There are limits to the frequency of administration.

Hyaluronic Acid Injections

Supplement the joint fluid to reduce friction and improve comfort. Evidence and appropriateness vary by patient and are discussed individually.

PRP & Biologic Injections

Platelet-rich plasma and other biologic options may offer benefit in select patients, particularly those with earlier-stage arthritis seeking alternatives before surgery.

There is no single X-ray threshold or pain score that determines surgical timing. The right time is when arthritis has meaningfully eroded your quality of life, and conservative care is no longer adequate. You may be a candidate for total hip replacement if:

• Pain consistently limits daily activities such as walking, sleeping, or working
• Nonoperative treatments have been given a reasonable trial without adequate relief
• You are avoiding activities you value because of hip pain
• Hip pain is affecting your mental health, relationships, or independence

Dr. Zalikha will never pressure you toward surgery. His role is to give you the information and honest assessment you need to make the right decision for your life.

Total Hip Replacement

Direct Anterior Approach

Robotic-Assisted Surgery

Outpatient Hip Replacement