Treatment of Hip Osteoarthritis (Coxarthrosis)

The hip is a ball-and-socket joint formed by the rounded end of the thigh bone (femoral head) and the socket in the pelvis (acetabulum). Both surfaces are covered with cartilage, which distributes body weight during walking and allows smooth movement. Osteoarthritis involves thinning and deterioration of this cartilage, with the bone surfaces gradually moving closer together.

Although commonly called "calcification" in Turkish, osteoarthritis does not involve lime accumulating in the joint; the name comes from the bony spurs seen on X-rays. Hip osteoarthritis usually develops slowly over years. Common contributing factors include excess weight, heavy lifting at work, previous hip fracture or dislocation, impaired femoral head blood supply and a shallow socket present from birth (dysplasia).

Not all hip pain is osteoarthritis. Hip impingement causing a pinching sensation in the groin, tendon or bursal problems causing outer hip pain, and nerve compression in the lower back can produce similar symptoms. Examination and X-rays distinguish them; an overview is available on the hip conditions page.

One surprising feature of hip osteoarthritis is that pain is often felt in the groin, not behind the hip. It may spread to the front-inner thigh or even the knee, so it can initially be mistaken for a knee problem.

• Pain in the groin, inner thigh or side of the hip that increases with walking
• Stiffness lasting 10–20 minutes after waking or prolonged sitting
• Difficulty tying shoelaces, putting on socks and getting into a car
• Reduced walking distance and limping
• Restricted movement when moving the leg to the side or rotating it inwards and outwards
• Night pain and a feeling of leg shortening in advanced disease

Diagnosis rests on examination and a standing pelvic X-ray. X-rays show narrowing of the joint space, bony spurs, hardening beneath the cartilage and cysts; socket depth and differences in leg length are also measured. Pain and restricted hip rotation during examination largely establish the diagnosis.

MRI is not needed for every patient. It is requested when pain persists despite near-normal X-rays, avascular necrosis is suspected or a labral or cartilage problem needs investigation. Blood tests do not diagnose osteoarthritis; they help distinguish inflammatory rheumatic disease. The lower back is also examined if pain may originate there.

Acetabular dysplasia means the hip socket has not developed sufficient depth. A shallow socket concentrates body weight on a narrow edge rather than a broad area. This focal loading wears the cartilage and rim tissue (labrum) prematurely over the years. Osteoarthritis may therefore develop younger in people with dysplasia than in the general population.

Symptoms often begin in the 20s–40s as groin pain after prolonged walking or standing. Diagnosis is made by measuring socket angles on a standing pelvic X-ray. Early management includes muscle strengthening, weight control and reducing load; when the socket is markedly shallow but cartilage is still preserved, bone surgery to reorient the socket (acetabular osteotomy) may be considered. If much of the cartilage has been lost, management follows the treatment pathway for osteoarthritis.

Screening and early treatment in infancy are the most important preventive steps. Developmental hip dysplasia in babies is a separate topic, explained on the developmental dysplasia of the hip in babies page.

In people treated for hip dislocation during infancy or childhood, the joint may not function exactly like a normal hip throughout life. Residual mismatch between the socket and femoral head distributes cartilage loading unevenly; early osteoarthritis, leg-length difference, limping and muscle fatigue may develop in adulthood. The effects are more pronounced when childhood dislocation was untreated.

Treatment is individualised: shoe lifts for leg-length difference, targeted exercises for muscle balance, non-surgical pain management and replacement in advanced cases are discussed. An abnormal socket makes replacement technically more complex to plan; this is explained clearly at examination. General information is available on the hip replacement surgery and recovery page.

Three foundations of non-surgical care apply at every stage: weight control, muscle strengthening and range-of-movement exercises, particularly for the muscles at the side of the hip, and activity modification. Painkillers, anti-inflammatory medicines, physiotherapy and a walking stick held opposite the painful side may be added. A stick substantially reduces hip loading and is nothing to be embarrassed about.

Because the hip joint lies deep within the body, intra-articular injections are less straightforward than in the knee and are usually performed with imaging guidance. The effects of hyaluronic acid, PRP and corticosteroid injections in hip osteoarthritis vary between patients. Claims that regenerative methods such as stem cells and exosomes renew cartilage remain under investigation, and these treatments are not suitable for every patient; the methods are compared on the regenerative and non-surgical treatments page.

Surgery is not decided from X-rays alone. Hip replacement is discussed when pain interrupts sleep despite non-surgical treatment, walking distance is substantially reduced, everyday tasks such as putting on shoes become difficult, and X-rays show severe joint-space narrowing.

In younger patients with dysplasia and largely preserved cartilage, bone surgery to reorient the socket may be discussed instead of joint replacement. The decision is made together, considering age, weight, occupation, expectations and coexisting conditions. The procedure, hospital stay, early walking and movements requiring care are explained on the hip replacement and recovery page.

Walking on level ground, cycling and especially swimming preserve muscle strength without overloading the hip. Prolonged squatting, sitting cross-legged and using low chairs or toilets increase hip loading; raising seat height may reduce pain. Dividing loads instead of lifting heavy objects and taking breaks during longer walks are helpful.

Weight management is one of the most effective measures for hip osteoarthritis. During walking, the hip bears several times body weight, so even modest weight loss can affect pain. Consistent exercise is part of treatment: it should be regarded as a daily habit rather than a programme lasting a few weeks. At AC CLINIC, programmes for patients from Ordu and the surrounding area are adapted to their work and walking habits.