Hip Osteoarthritis: Symptoms, Signs and Diagnosis

Part of The Joint Replacement Guide — Phase 1: Understanding Your Condition · Article 2 of 44 · Hip

Key Points

Hip osteoarthritis often causes pain in the groin, but pain may also be felt around the outer hip, buttock, thigh or knee.
Some people mainly notice pain in the thigh or knee, which can make the source of the pain less obvious.
Examination may show reduced hip movement, particularly when the leg is turned inwards. However, no single symptom or examination finding proves the diagnosis.
Hip osteoarthritis can often be diagnosed clinically without an X-ray during the initial assessment.
If you are referred for specialist assessment and hip replacement may be considered, X-rays will routinely be obtained to assess the joint, support confirmation of the diagnosis and help with surgical planning.
Treatment decisions take account of your pain, mobility, daily activities, quality of life, examination findings and X-rays—not the X-ray appearance alone.

Typical Symptoms of Hip Osteoarthritis

Hip osteoarthritis commonly causes an ache or pain in the groin. However, symptoms vary, and pain may also be felt around the outer hip, buttock, front of the thigh or knee.

Pain felt away from its original source is called referred pain. Because the hip and nearby parts of the leg share nerve pathways, some people with hip osteoarthritis mainly notice thigh or knee pain. If knee pain is not explained by an examination of the knee, a clinician may also examine the hip.

Other possible symptoms include:

pain that is worse during or after walking and other activity
stiffness after resting, often improving within about 30 minutes of movement
difficulty putting on socks or shoes, cutting toenails, or getting in and out of a car
reduced walking distance or a limp
pain when resting or sleeping
clicking, catching or a feeling that the hip may give way

These symptoms are not unique to osteoarthritis. Similar symptoms can arise from the muscles and tendons around the hip, the lower back, or other medical conditions. An assessment by an appropriately qualified healthcare professional is therefore important if symptoms persist or interfere with everyday life.

What Happens During a Hip Examination?

The clinician will usually ask:

where you feel the pain
when it started
what makes it better or worse
whether it affects walking, sleep or daily activities
whether you have had an injury or previous hip problem
whether you have symptoms that could suggest another condition

They may watch you walk and assess how comfortably you place weight through each leg. They will usually examine the movement of both hips. Hip osteoarthritis often limits movement, particularly when the leg is turned inwards, but this finding is not present in everyone and is not enough to establish the diagnosis by itself.

The clinician may also assess muscle strength, leg length and the lower back, knee and surrounding soft tissues. Other examination manoeuvres may help identify signs suggesting a different or additional cause of pain. No physical examination test can exclude every alternative diagnosis with complete certainty.

X-rays and Other Imaging

Hip osteoarthritis can often be diagnosed from your symptoms and a clinical examination. NICE advises that routine imaging is not usually needed for the initial diagnosis in people aged 45 or over who have typical symptoms.

The position is different when someone is referred for specialist assessment and hip replacement may be considered. As part of this pathway, X-rays will routinely be obtained to assess the joint, support confirmation of the diagnosis, establish the pattern and extent of structural change, identify features that may affect treatment, and help plan any potential surgery.

The standard X-rays commonly include a view of the pelvis from the front and an additional view of the affected hip. The precise views requested may vary according to the clinical situation and local imaging protocol.

Changes associated with hip osteoarthritis may include:

Joint-space narrowing: a reduction in the space visible between the bones, usually associated with loss of cartilage.
Osteophytes: areas of additional bone that develop around the edge of the joint.
Subchondral sclerosis: increased density of the bone beneath the joint surface.
Subchondral cyst-like changes: rounded changes that may develop in the bone next to the joint.

The amount of change visible on an X-ray does not always match the severity of a person’s symptoms. Some people have marked X-ray changes with relatively little pain, while others have substantial symptoms despite less pronounced structural change.

A decision about hip replacement is therefore not based on an X-ray alone. It takes account of the person’s pain, mobility, ability to manage everyday activities, quality of life, response to non-surgical treatment, general health, examination findings, preferences and imaging results.

MRI is not routinely required for typical hip osteoarthritis or standard joint-replacement planning. It may occasionally be considered when the diagnosis remains uncertain or when another condition is suspected.

Could the Symptoms Have Another Cause?

Groin, hip, thigh and knee pain can have several causes. Depending on your symptoms and circumstances, a clinician may consider:

pain arising from tendons or other soft tissues around the hip
pain referred from the lower back
femoroacetabular impingement, in which the shape of the hip bones affects movement
damage to the labrum, the ring of cartilage around the hip socket
an inguinal hernia
an earlier hip condition, including hip dysplasia
inflammatory arthritis
a fracture, infection or, much less commonly, another bone condition

Some abnormalities seen on scans are also found in people without pain. A scan result must therefore be interpreted alongside your symptoms and examination.

MRI is not routinely needed to diagnose typical hip osteoarthritis. It may be considered when the diagnosis remains uncertain or when a clinician suspects a different condition that would affect treatment. The most appropriate investigation depends on the individual situation.

When to Seek Medical Advice

Arrange a routine assessment if hip pain:

persists or keeps returning
is getting worse
affects sleep, walking or normal daily activities
is accompanied by prolonged morning stiffness
has not improved with reasonable self-care

Seek urgent medical advice through NHS 111 or an urgent GP service if:

severe hip pain starts suddenly without an obvious injury
the hip or surrounding area becomes hot or markedly swollen
the skin changes colour
you have hip pain together with fever, shivering or feeling generally unwell

Call 999 or attend an emergency department after a significant injury if you have severe hip pain and cannot stand or put weight through the leg.

Important Information

This article provides general educational information. It cannot diagnose the cause of an individual’s symptoms and does not replace assessment or advice from an appropriately qualified healthcare professional. Recommendations may differ according to your symptoms, medical history, examination findings and local healthcare arrangements.

References

Versus Arthritis. Osteoarthritis (OA): causes, symptoms and treatments. Available from: https://www.versusarthritis.org/about-arthritis/conditions/osteoarthritis/ [Accessed 14 August 2026].

National Institute for Health and Care Excellence. Osteoarthritis in over 16s: diagnosis and management. NICE guideline NG226. Published 19 October 2022. Available from: https://www.nice.org.uk/guidance/ng226 [Accessed 14 August 2026].

National Institute for Health and Care Excellence. Osteoarthritis in over 16s: Quality statement 1—Diagnosis. NICE quality standard QS87. Updated 19 October 2022. Available from: https://www.nice.org.uk/guidance/qs87/chapter/quality-statement-1-diagnosis [Accessed 14 August 2026].

NHS. Hip pain in adults. Available from: https://www.nhs.uk/symptoms/hip-pain/ [Accessed 14 August 2026].

NHS. Osteoarthritis: symptoms. Available from: https://www.nhs.uk/conditions/osteoarthritis/symptoms/ [Accessed 14 August 2026].

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