Hip Osteoarthritis

Hip arthritis produces deep groin pain that is often mistaken for a back problem. Remix Medical's Houston pain physicians use image-guided hip injections to find and treat the true source.

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By Raju Mantena, DO · Pain Medicine PhysicianReviewed Jul 31, 20262 min read

Key takeaways

Hip osteoarthritis is degeneration of the cartilage in the ball-and-socket joint, producing deep groin pain often mistaken for a back problem — because hip pain refers to the groin, buttock, thigh, and frequently the knee.
Reduced internal rotation is often the earliest objective sign. When hip and spine pain coexist, a diagnostic intra-articular hip injection confirms the source — substantial relief from local anesthetic in the joint means the hip is the culprit.
Core first-line treatment, agreed across ACR, OARSI, and VA/DoD guidelines, is education, weight management, and exercise (walking, strengthening, neuromuscular, or aquatic) — best when supervised.
NSAIDs and image-guided intra-articular corticosteroid injections manage pain, with medication calibrated to kidney and cardiovascular status. Guidelines generally recommend against routine opioid use.
Total hip replacement is highly effective for advanced arthritis that limits daily life and fails conservative care — while sudden inability to bear weight after a fall warrants urgent evaluation for fracture.

Hip arthritis is often mistaken for a back problem, because patients point to the groin and clinicians look at the spine. At Remix Medical in Houston, our pain management physicians locate the true source of hip and groin pain and treat it with image-guided intervention.

What is Hip Osteoarthritis?

Hip osteoarthritis is the degeneration of cartilage in the ball-and-socket joint formed by the femoral head and the acetabulum. As the cartilage thins, the joint space narrows, the bone thickens beneath it, and motion becomes painful and restricted.

The hip is a deep joint. Its pain does not stay put — it refers to the groin, the buttock, the lateral thigh, and frequently to the knee. A patient whose only complaint is knee pain sometimes has a hip that is the actual problem.

Common Causes of Hip Arthritis

1. Age and Cumulative Load

The most common contributor, and the least avoidable.

2. Femoroacetabular Impingement (FAI)

Subtle abnormalities in the shape of the femoral head or socket cause repeated abnormal contact, damaging cartilage and labrum over years.

3. Hip Dysplasia

A shallow socket concentrates force over a smaller cartilage surface.

4. Prior Fracture or Avascular Necrosis

Disruption of the blood supply to the femoral head causes bone collapse and secondary arthritis.

5. Inflammatory Arthritis

Rheumatoid and related conditions damage the joint directly.

How Remix Medical Can Help

Distinguishing hip pain from lumbar spine pain is the first job, and it is not always simple — the two commonly coexist. A careful examination of hip range of motion, combined with weight-bearing X-rays, usually settles it. Where it does not, a diagnostic intra-articular hip injection does: if local anesthetic in the joint substantially relieves the pain, the joint is the source.

Treatment then follows the guideline core — education, weight management, and supervised exercise — with interventional options layered on where pain limits participation.

Approach	What it involves
Weight management + supervised exercise	Walking, strengthening, neuromuscular, or aquatic programs with hip abductor work — the foundation across every major guideline
Medication management	NSAIDs and topical agents, calibrated to your kidney and cardiovascular status; routine opioids are not recommended
Image-guided hip joint injection	Corticosteroid under fluoroscopic or ultrasound guidance — both diagnostic and therapeutic
Radiofrequency ablation	Of the articular sensory branches, for selected patients
Coordinated multispecialty care	Our chiropractic and internal medicine teams where gait, weight, and spine are contributing
Arthroplasty referral	Total hip replacement for advanced arthritis that limits daily life and no longer responds to conservative care

Signs & symptoms

Signs and symptoms to watch for

Deep groin pain, often described as a C-shape gripped around the hip
Buttock or outer thigh pain
Referred pain to the knee, sometimes as the only symptom
Stiffness getting out of a car, putting on socks, or crossing the legs
Reduced internal rotation of the hip
Limping, or a shortened stride on the affected side
Groin pain with pivoting or turning

When to see a specialist

Should you see a specialist?

See a pain specialist for persistent groin or buttock pain, stiffness putting on shoes or socks, or a limp — particularly if back treatment has not helped. Sudden inability to bear weight after a fall requires emergency evaluation for fracture, and a hot, swollen joint with fever needs urgent evaluation.

Treatment options

Possible treatments

Frequently asked

Hip Osteoarthritis questions, answered

What are the first signs of hip arthritis?

Early on you may feel groin or outer-hip pain and stiffness, especially after sitting or first thing in the morning. Many people also notice trouble putting on socks or shoes.

Can hip osteoarthritis be treated without surgery?

Yes, for many people. Weight management, physical therapy, activity changes, and anti-inflammatory measures, sometimes with an image-guided injection, control symptoms for years.

Where is hip arthritis pain usually felt?

Most often in the groin, but it can radiate to the outer hip, buttock, thigh, or even the knee. That referred pattern sometimes makes it hard to pinpoint.

When is hip replacement necessary?

Replacement is considered when advanced arthritis causes pain that limits walking, sleep, and daily life despite non-surgical care. It's a quality-of-life decision, not an emergency.

What activities should I avoid with hip arthritis?

High-impact, repetitive pounding like running on hard surfaces tends to flare it, while swimming, cycling, and walking are usually well tolerated. The goal is to stay active without overloading the joint.

Why does hip arthritis get mistaken for a back problem?

Because hip pain refers to the groin, buttock, and thigh, and frequently to the knee — sometimes the knee is the only complaint. Patients point to the groin and clinicians examine the spine. A careful hip exam and weight-bearing X-rays usually sort it out.

How is the hip confirmed as the source of pain?

Reduced internal rotation on exam and joint-space narrowing on weight-bearing X-ray are the usual clues. When it's still unclear, a diagnostic intra-articular hip injection settles it — if local anesthetic in the joint substantially relieves the pain, the joint is the source.

What medications help hip arthritis?

NSAIDs (oral, and topical where applicable) and, for flares, image-guided intra-articular corticosteroid injections. Guidelines generally recommend against routine opioids. Medication choice is calibrated to your kidney and cardiovascular status.

When is hip pain urgent?

Sudden severe pain or inability to bear weight after a fall may signal a fracture, especially in older adults, and a hot, swollen joint with fever needs urgent evaluation.

Sources

References

Kolasinski SL, Neogi T, Hochberg MC, et al. 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee. Arthritis Care Res 2020;72(2):149–162 — https://doi.org/10.1002/acr.24131
Bannuru RR, Osani MC, Vaysbrot EE, et al. OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis. Osteoarthritis Cartilage 2019;27(11):1578–1589 — https://doi.org/10.1016/j.joca.2019.06.011
U.S. Department of Veterans Affairs/Department of Defense. VA/DoD Clinical Practice Guideline for the Non-Surgical Management of Hip and Knee Osteoarthritis (2020) — https://www.healthquality.va.gov/guidelines/CD/OA/
Sen R, Hurley JA. Osteoarthritis. StatPearls. NCBI Bookshelf — https://www.ncbi.nlm.nih.gov/books/NBK482326/
National Institute of Arthritis and Musculoskeletal and Skin Diseases: Osteoarthritis — https://www.niams.nih.gov/health-topics/osteoarthritis
American Academy of Orthopaedic Surgeons: Osteoarthritis of the Hip — https://orthoinfo.aaos.org/en/diseases--conditions/osteoarthritis-of-the-hip/

Your care team

Clinicians who treat this.

Every clinician at Remix Medical is board-certified and owns the practice — so the physician in your exam room is the one making decisions about your care.

Everald Manning, MD
Family Practice & Primary Care Physician
4.6 · 178 Google reviews
Accepting New Patients
Raju Mantena, DO
Pain Medicine Physician
4.8 · 118 Google reviews
Accepting New Patients

SpecialtyPain ManagementICD-10 codeM16.9Associated anatomyHip joint, femoral head, acetabulum, articular cartilage, labrum, groin

Also called Hip Arthritis, Coxarthrosis, Degenerative Hip Disease, Hip Joint Osteoarthritis

This page is for general education and is not a substitute for medical advice from your physician. Contact a Remix Medical clinician about your specific situation.

Updated July 31, 2026. Medically reviewed by Raju Mantena, DO.