Hip Pain: Causes, Diagnosis & Treatment

Where does it hurt?

location points to the source

The hip is a ball-and-socket joint: the femoral head, the top of the thighbone, turns inside the acetabulum, a cup in the pelvis, on a layer of smooth cartilage. Where hip pain sits is a strong clue to its source.

Groin or front of thigh

Usually the joint itself: arthritis, a labral tear, or impingement. Hip-joint pain can also spread to the buttock or the knee.

Outer side of the hip

Usually the muscles, tendons, or bursa over the bony point there, rather than the joint itself.

Buttock or back of the hip

Often the lower back rather than the hip. A pinched nerve in the lower spine can send pain into the hip and down the leg.

Hip care at OSI

what is offered

Nonsurgical hip care

Activity changes, physical therapy, and steroid injections, the starting point for most hip pain.

Total hip replacement

The worn ball and socket are replaced with implants, through an anterior or posterior approach. Most patients are up walking the same day.

Revision hip replacement

Replacing an earlier hip replacement that has worn, loosened, or become painful for a definable mechanical reason.

Hip fracture surgery

Urgent surgical care for a broken hip; the fracture pattern determines whether the break is fixed or the ball is replaced.

Hip operations are performed at partner hospitals, with follow-up at any of the six clinic locations.

What causes hip pain?

common causes

Hip arthritis

The cartilage in the ball-and-socket gradually wears away, the joint space narrows, and the bones begin to rub. Groin pain with walking, stiffness that is worse in the morning, and a shrinking walking distance.

Bursitis on the side of the hip

The fluid-filled cushion over the bony point on the outer hip becomes inflamed. Pain there that is worse lying on that side at night. Common, and surgery is rarely needed.

Labral tears

The cartilage rim that seals the socket can tear. Deep groin pain and a catching sensation, often with twisting or pivoting.

Hip impingement (FAI)

Extra bone on the ball or socket gives it an irregular shape, so the joint pinches with deep bending and twisting. Athletes may notice the groin pain earlier.

Muscle and tendon strains

A hip-flexor or groin muscle stretched too far or torn, from a fall, a sudden effort, or overuse. Most heal with rest, ice, and rehabilitation.

Hip fracture

A broken hip, usually from a fall in an older adult with weakened bone. Pain in the groin and upper thigh and trouble bearing weight. Most hip fractures are treated with surgery.

How is hip pain diagnosed?

exam first, imaging second

Evaluation starts with your history and a physical examination, followed by X-rays, often taken while you stand so the images show the joint space under body weight. An MRI is reserved for questions an X-ray cannot answer, such as a suspected labral or soft-tissue tear.

How is hip pain treated?

nonsurgical care first

Most hip pain improves without an operation: activity changes, physical therapy, weight management, anti-inflammatory medication, and a steroid injection when inflammation is limiting progress. Surgery is considered when the joint is structurally worn or damaged, or when a full course of nonsurgical care has not restored comfort and function. The operations and what recovery involves are covered under hip surgery.

Frequently asked questions

common questions

What causes pain on the outside of the hip?

Pain over the bony point on the outer side of the hip usually comes from the soft tissue there rather than the joint, most often trochanteric bursitis, an irritation of the fluid-filled cushion over that bony point. It is often worse when lying on that side at night or getting up from a low chair, and it rarely needs surgery.

Does hip pain mean I need a hip replacement?

Usually not. Most hip pain improves without surgery, through activity changes, physical therapy, weight management, and anti-inflammatory or steroid injections. Surgery is considered when the joint is structurally worn or damaged, or when a full course of nonsurgical care has not restored comfort and function.

When should you see a doctor for hip pain?

It is reasonable to be seen when hip pain lasts more than a week or two, keeps returning, wakes you at night, or limits walking, stairs, or daily activities. Hip pain that follows a fall and leaves you unable to put weight on the leg should be evaluated promptly, because it can signal a fracture.

Hip Pain