Arthritis in Hips

When Lois W.’s hip pain from osteoarthritis started a few years ago, she could manage it with cortisone injections a few times a year. But it didn’t stay that way. Over time, “I started walking with a limp and had very limited mobility in my hip,” she says, noting that she became unable to sit in a cross-legged position. Eventually, things worsened to the point that she was in “severe daily pain” for almost two years before she decided to have a hip replacement surgery.

The hip is a ball-and-socket joint. The “ball” is the top of your thigh bone; it sits in a “socket” that is formed by part of your pelvic bone. Slippery tissue called cartilage covers the bone surface and helps cushion the joint, creating a low-friction environment so you can move easily and without pain.

When you have arthritis in the hip, you can start to lose that cartilage in the joint that cushions the bones. You can experience inflammation and pain in reaction to that degeneration. “Arthritis is a wear-and-tear or immune response that makes this cartilage get thinner or wear away,” says Jonathan M. Vigdorchik, MD, hip and knee surgeon at the Hospital for Special Surgery in New York City. “It’s like the treads on a tire. As you wear out the treads, they get thinner and thinner.”

Everyday tasks like bending over to tie a shoe, getting up from a chair, or going for a walk become more challenging and downright painful.

With rheumatoid arthritis (RA) and other forms of inflammatory arthritis, the immune system mistakenly attacks the protective lining in your joint called the synovium and destroys cartilage. Though RA tends to affect smaller joints first (such as those in your hands and feet), symptoms can spread to one or both your hips as the disease progresses. In osteoarthritis (OA), the cartilage in the hip joint gradually wears down, which over time leads to pain, stiffness, swelling, and lack of mobility.

Learn more about what causes hip arthritis and how it is treated.

Symptoms of Arthritis in the Hip

Common symptoms of hip arthritis may include:

  • Pain in the hip joint, which may include pain in the groin, buttock, or outer thigh
  • Pain that radiates down the inside of the leg
  • Occasional knee pain, usually on the inside of the knee
  • “Locking” or “sticking” of the hip joint
  • Grinding noise (called crepitus) when you move; it’s caused by loose fragments of cartilage and other tissue that interfere with the motion of the joint
  • Difficulty walking or decreasing distance that you can walk
  • Walking with a limp (loved ones and friends may notice the limp)
  • Difficulty walking up or down stairs
  • Difficulty getting in and out of a car
  • Difficulty bending over, such as to put on socks and shoes
  • Difficulty sleeping or pain that wakes you up at night
  • Pain that worsens with vigorous or extended activity
  • Stiffness in the hip or limited/decreased range of motion (ex: can’t sit cross-legged)
  • Limited ability to do everyday activities
  • Pain comes and goes; as it progresses, good days decrease and bad days increase
  • Leg on the affected side may become shorter

“It aches all the time especially when I move my hip left or right, of if I bend down for something,” CreakyJoints member Joyce F., who has rheumatoid arthritis, shared on Facebook. The hip pain affected her ability to walk far or lift her foot to use stairs. “Sleeping at night is a painful agony as I cannot stay in one position for very long without pain waking me up,” she added.

Mary Y., who has osteoarthritis and sacroiliac joint pain, agreed that sleeping with hip pain is hard because she can’t sleep on her side. In addition, “standing for any length of time is torture,” she says. “There is never a moment when I don’t have deep aching pain in my hip.”

Types of Arthritis that Affect the Hips

If you have arthritis in your hips, it’s important to understand the type of arthritis that might be causing it. That’s because each type can have its own specific medications and treatments. Here are some of the more common types of arthritis that strike in hips.

Osteoarthritis

Osteoarthritis is the most common type of hip arthritis. Osteoarthritis (OA) is a degenerative joint disease where the cartilage that cushions the ends of a joint wears away gradually. Osteoarthritis often occurs because of typical wear and tear on a joint that happens with age; it can also occur as a result of injury to the joint. The lifetime risk of developing osteoarthritis of the hip is about 25 percent, although many people will have only mild symptoms, says rheumatologist Neal Birnbaum, MD, former president of the American College of Rheumatology and founder of Pacific Rheumatology Associates Medical Group in San Francisco.

Osteoarthritis may occur in one hip but not the other. Those who develop OA of the hip at an earlier age are often born with a congenital deformity of the hip joint called hip dysplasia, says Dr. Birnbaum.

Axial spondyloarthritis and ankylosing spondylitis

Axial spondyloarthritis (axSpA) is a type of inflammatory arthritis that primarily affects the back and sacroiliac joints (where the spine connects with the pelvis), though it can affect other joints too.

AxSpA is an umbrella for a spectrum of disease that includes non-radiographic axial spondyloarthritis (nr-axSpA) — in which there is inflammation in the spine and sacroiliac joints but no visible changes to the joints on X-ray — and ankylosing spondylitis (AS), which is when joint damage is visible on X-rays.

Hip involvement is common in axSpA; studies suggest it can affect up to 20 to 30 percent of patients and can often be disabling. Hip symptoms in axSpA may, in fact, be an indicator of having more severe disease and be associated with a likelihood of having more bone damage over time, research shows.

Post-traumatic arthritis

This common type of hip arthritis develops as a result of injury, even one that happened a long time ago. For example, a sprain, fracture, or dislocation may damage cartilage after you’ve been injured in a fall, car accident, or sport. That can lead to premature deterioration of the joint. Symptoms may appear within a few years, or it can take decades for joint damage from an injury to cause pain. It happens in 5 to 10 percent of patients with arthritis of the hip, says Dr. Vigdorchik.

Post-traumatic arthritis generally affects younger adults; according to 2016 research in the journal RMD Open, “patients with disabling OA who had had an articular injury are more than 10 years younger than those who did not have joint trauma.”

Rheumatoid arthritis

Rheumatoid arthritis (RA) is a chronic inflammatory disease in which the body’s immune system attacks itself, causing inflammation, swelling, stiffness, and pain in various joints. RA often first occurs in the small joints of the hands and feet, though it can affect other joints, such as the knees, elbows, hip, and neck.

RA is often considered symmetrical, typically affecting both hips at the same time, but it can involve both sides at different times.

Arthritis in the hips due to RA used to be more significant, says Matt Miller, MD, an arthritis and joint replacement surgeon at Stanford Medicine in California. Thanks to advances in medicine, such as disease-modifying drugs (DMARDS, including biologics) and in joint replacement surgery, debilitation from arthritis in the hips with RA is less common now, he says.

A study published in The American Journal of Pharmacy Benefits showed that while rates of hip and knee replacement surgery almost tripled in the general population over the 15-year study period, they decreased for people with a primary diagnosis of RA.

“The introduction of biologics for the treatment of RA was associated with a reduction in the proportion of patients with a primary diagnosis of RA among all RA patients receiving TKR [total knee replacement] and THR [total hip replacement] surgeries,” the study authors concluded.

Systemic lupus erythematosus

Lupus is an autoimmune disease that occurs when your immune system attacks your own tissues and organs. The inflammation from lupus can affect different parts of the body, including the joints, kidneys, brain and central nervous system, heart, lungs, and blood vessels. There are different types of lupus; the most common type is systemic lupus erythematosus (SLE), which accounts for approximately 70 percent of all cases of lupus, according to the Lupus Foundation of America.

Lupus may affect both hips at the same time. Hip disease in SLE is usually related to avascular necrosis, where the hip loses blood supply abruptly, causing pain and reduced range of motion, says Brett Smith, DO, a rheumatologist with Blount Memorial Physicians Group in Alcoa, Tennessee. (It’s akin to a stroke or heart attack in your bones.) Research suggests this complication occurs in about 10 percent of lupus patients.

If avascular necrosis of the hip progresses, the femoral head (top of your thigh) can fracture and require a total hip replacement. This can happen spontaneously in lupus, but it’s more commonly associated with patients who are taking prolonged high doses of steroids, he says.

How Arthritis in the Hips Is Diagnosed

The diagnosis of arthritis in the hips begins with taking your medical history and doing a physical exam of your hip. The doctor will look at where you’re in pain and how well you can move the hip (how range of motion is impacted). Dr. Vigdorchik says he watches patients walk to assess their gait. “If they’re tilting their body over the hip that hurts, that’s the body’s response to making it hurt less,” he says.

Your doctor will ask questions that can help make sure your pain is indeed coming from the hip and not due to a different problem. Other conditions like a hernia or a pinched nerve in the back can mimic pain from arthritis in the hip.

X-rays of the hips and spine can determine if the joint has any abnormalities and assess where your pain is coming from. They can reveal such changes indicative of arthritis, including:

  • Thinning or erosion in the bones
  • Loss of joint space
  • Excess fluid in the joint

You may need other imaging, such as an MRI or a CT scan, to get a clearer picture if an X-ray doesn’t show enough, says Dr. Vigdorchik.

If your doctor suspects that inflammatory arthritis could be responsible for your hip pain, they will order additional blood tests to check for levels of inflammation and the presence of antibodies that may indicate autoimmune disease (in lupus or rheumatoid arthritis, for example).

How Arthritis in the Hips Is Treated

Treatment for arthritis of the hips depends on the type of arthritis that you have. Treatment typically starts with conservative, non-surgical measures.

Medication

Non-steroidal anti-inflammatory drugs (NSAIDs)

Over-the-counter medications like ibuprofen (Advil) and naproxen (Aleve), as well as prescription NSAIDs, can help relieve pain and swelling in the hip joints. However, even though many NSAIDs are available over the counter, they can have side effects (such as causing stomach ulcers, increased heart attack risk, and kidney problems), especially when taken for the long term and/or in high doses. NSAIDs are a first-line of treatment in osteoarthritis to reduce pain and stiffness. They are also commonly a first-line treatment for axial spondyloarthritis.

In many cases of inflammatory arthritis, NSAIDs are used along with other kinds of medication to treat inflammation, pain, and swelling.

Analgesics

Analgesics (such as acetaminophen) can help with mild to moderate pain. While NSAIDs target both pain and inflammation, analgesics are used just for pain relief. They may be recommended for people who can’t take NSAIDs due to their medical history. When used as directed, they’re also a good choice for people whose arthritis causes pain but not inflammation.

Steroid injections

Injections of steroid medication can help treat and relieve inflammation. They require either ultrasound or X-ray guidance. An occasional shot can be given in the hip (both hips can be done at the same time, says Dr. Smith) and offer temporary pain relief and reduce inflammation. Injections shouldn’t be done into the same joint more a few times a year; more frequent injections can damage cartilage.

CreakyJoints member Elizabeth F., who says her pain feels like her “hips are screaming,” says cortisone shots are the only thing so far that work for a couple of months.

Disease-modifying anti-rheumatic drugs (DMARDs)

If you have an inflammatory arthritis like rheumatoid arthritis, disease-modifying anti-rheumatic drugs (DMARDs) such as methotrexate are used as a first-line therapy to help reduce the immune system activity that triggers inflammation and pain. DMARDs are not used for osteoarthritis.

Biologics

Biologics are a newer class of DMARDs that target specific immune system pathways to reduce immune system activity that is causing inflammation and pain. They’re used to treat inflammatory types of arthritis, such as rheumatoid arthritis, axial spondyloarthritis, and psoriatic arthritis, and are typically offered after patients haven’t responded to conventional DMARDs or other medications.

Lifestyle Changes

Physical therapy

Your doctor may send you for physical therapy to help improve your range of motion and strengthen the muscles that surround the hip. Hip exercises relieve stiffness, improve flexibility, build strength, and increase your ability to move your joints through their full range of motion.

Assistive devices

A cane or walker can help reduce stress on the affected hip joint and help improve mobility and stability. Holding a cane in the hand opposite the painful hip can help and is usually recommended. Both walkers and canes can help prevent falls, says Dr. Vigdorchik.

“A cane is essential to keep me from falling,” says Mary Y., who has also found that swimming provides an opportunity for movement and relief and alternates applying ice and heat to her hip.

Learn more here about using a cane with arthritis.

Exercise

Done correctly, working out should not exacerbate your hip pain or make your arthritis worse. But *not* exercising can make your arthritis worse, which is why doctors recommend that exercise be an important part of your hip arthritis treatment plan, regardless of what type of arthritis you have.

Exercise helps strengthen the muscles that support your hip, which takes some of the load off the worn-out, weakened joint. That shift can help decrease pain and stiffness, promote motion, and improve flexibility. Stretching the muscles and tendons surrounding the joint can help ease pain from some hip problems. Exercise also help enhance balance, boost energy, improve sleep, and control weight. In people with mild to moderate hip OA, a study published in Annals of the Rheumatic Diseases found those who exercised for one hour at least twice a week for 12 weeks were 44 percent less likely to need hip replacement surgery six years later, compared with those who did not exercise.

Types of exercise that can help ease hip arthritis pain may include:

  • Range-of-motion and stretching exercises (to help maintain and improve flexibility)
  • Strengthening exercises (to work your muscles)
  • Aerobic exercises, like swimming or biking (to improve cardiovascular health and control your weight)

CreakyJoints member Rachel M., who says she has constant hip pain that varies from a dull ache to a sharp, stabbing feeling with clicking and cracking, counts on walking and a few gentle yoga moves to help, including child’s pose, side twists, and happy baby.

Heat and ice therapy

Many CreakJoints members use different ice and heat therapy techniques for pain relief. Pamela S., who has ankylosing spondylitis, osteoarthritis in the hip, as well as bursitis and disc issues in her lower back, says she swears by “hot showers — lots of them.”

“Heat packs and scalding Epsom salt baths are also helpful!” Rachel M. says.

Read more here about ice therapy and heat therapy (including lots of ideas beyond heating pads and ice packs).

Lose weight or maintain healthy weight

Maintaining a healthy weight helps reduce stress on the hip joints. Losing excess pounds can lead to less pain and more mobility and function. Being at a healthy weight can make biologic medications used to treat inflammatory arthritis work more effectively and, if you need hip surgery, help ensure a better recovery. People with a high body mass index (BMI) have a  greater risk for complications after joint replacement surgery, Dr. Vigdorchik says.

Consider a new mattress

It is common for hip arthritis to cause difficulty sleeping and finding a comfortable sleep position. Of course, the kind of mattress that feels right to you is highly individual, but multiple CreakyJoints members with arthritis hip pain said on Facebook that switching to a foam mattress helped them sleep better. Melissa W. was having trouble sleeping on her side but found that her new foam mattress has really improved her ability to sleep at night.

There’s no set rule for when you should replace your current mattress, but if it’s been more than a decade and you think your mattress may be contributing to your hip pain and trouble sleeping, consider shopping for a replacement.

Quit smoking

Add these to the many reasons to stub out cigarettes for good: Smoking decreases the effectiveness of some drugs used to treat arthritis and increases pain sensitivity. And smoking can make it harder for you to participate in activities that relieve arthritis symptoms, like exercise.

Surgical Treatments for Hip Arthritis

Total hip replacement surgery

“When you reach the end of the road, this surgery can give you a new lease on life. The pain goes away. This surgery can get you back normal function,” says Dr. Miller. Initially, he says, hip replacement aimed to help with basic functions like walking. Now, he says the surgery can help patients regain the ability to do many of the activities and hobbies that became limited by their arthritis pain, including low-impact sports like hiking, biking, and swimming. This procedure —called hip arthroplasty — once involved significant hospital stays and recovery time. Advances have improved the experience, with about some patients even going home the same day as the procedure, says Dr. Vigdorchik. “It’s one of the greatest operations of all time in terms of patient satisfaction and lack of complications,” he says. And these hips can last 25 to 30 years.

Many factors impact how quickly and smoothly your hip replacement surgery recovery may go. One of the biggest factors is how active you were before surgery. Also, taking measures before surgery to minimize infection risk will help prevent complications from developing later.

Hip resurfacing surgery

According to the American Academy of Orthopaedic Surgeons, in a traditional total hip replacement, the head of the thighbone (femoral head) and the damaged socket (acetabulum) are both removed and replaced with metal, plastic, or ceramic components. By contrast, in a hip resurfacing procedure, the femoral head is not removed. Instead, it is trimmed and capped with a smooth metal covering. The damaged bone and cartilage within the socket is removed and replaced with a metal shell, just as in a traditional total hip replacement.

Unlike hip replacement, hip resurfacing is not suitable for all patients. “It’s a great operation, but we have found that a particular group does well with the surgery,” says Dr. Vigdorchik. The best candidates for hip resurfacing are young (under age 60), active males who “use and abuse their hips,” he says. Patients who are older, female, smaller-framed with weak or damaged bone are at higher risk of complications, such as femoral neck fracture.

Hip osteotomy surgery

This operation — which isn’t commonly performed, says Dr. Birnbaum — is done to prevent arthritis around the hip. It’s meant for people who do not yet have advanced arthritis but are starting to get pain in the hips due to wear and tear or cartilage degeneration. Here, damaged portions of the hip are removed. The joint is reshaped or repositioned in a way that lets the healthy part of the hip bear most of the weight. This surgery is a good option if you’re younger than 40.

Hip arthroscopy

This procedure is also done to prevent arthritis around the hip. Hip arthroscopy is a minimally invasive procedure. Your surgeon inserts a small camera, or an arthroscope, into your hip joint. The camera displays pictures on a video monitor, and your surgeon uses these images to guide the surgical instruments. Because the arthroscope and surgical instruments are thin, your surgeon can use very small incisions, rather than the larger ones needed for open surgery. The procedure is used to treat a range of hip issues related to the cartilage or other soft tissues around the hip joint, such as bone spurs, synovitis, tendon damage, or infection in the hip.

Hip arthroscopy has been performed for many years but is not as common as knee or shoulder arthroscopy. “Results of hip arthroscopy aren’t always successful and many patients eventually come to hip replacement,” says Dr. Birnbaum.

While CreakyJoints members who ultimately chose to have hip surgery did not make the decision lightly — and tried many non-invasive techniques first — those who were very debilitated reported significant relief afterward. “Almost immediately after my hip replacement, I felt no pain when walking and no longer limped,” says Lois W. “It was life-changing for me.”

Not Sure What’s Causing Your Hip Pain?

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Keep Reading

Arthritis of the Hip. Washington University Physicians. https://www.ortho.wustl.edu/content/Patient-Care/3207/Services/Hip-Knee/Adult-Reconstruction-and-Hip-Preservation-Overview/Arthritis-of-the-Hip.aspx.

Baraliakos X, et al. Hip involvement in ankylosing spondylitis: what is the verdict? Rheumatology. September 2009. doi: https://doi.org/10.1093/rheumatology/kep298.

Cruyssen BV, et al. Hip disease in ankylosing spondylitis. Current Opinion in Rheumatology. July 2013. doi: http://dx.doi.org/10.1097/BOR.0b013e3283620e04.

David G, et al. Rheumatoid Arthritis and Joint Replacement: Impact of Biologics. The American Journal of Pharmacy Benefits. November/December 2014. https://www.pharmacytimes.com/publications/ajpb/2014/AJPB_NovemberDecember2014/Rheumatoid-Arthritis-and-Joint-Replacement-Impact-of-Biologics.

Hip Arthroscopy. OrthoInfo. American Academy of Orthopaedic Surgeons. https://orthoinfo.aaos.org/en/treatment/hip-arthroscopy.

Hip Osteotomy. Hospital for Special Surgery. https://www.hss.edu/condition-list_hip-osteotomy.asp.

Hip Resurfacing. OrthoInfo. American Academy of Orthopaedic Surgeons. https://orthoinfo.aaos.org/en/treatment/hip-resurfacing.

Inflammatory Arthritis of the Hip. OrthoInfo. American Academy of Orthopaedic Surgeons. https://orthoinfo.aaos.org/en/diseases–conditions/inflammatory-arthritis-of-the-hip.

Interview with Brett Smith, DO, a rheumatologist with Blount Memorial Physicians Group in Alcoa, Tennessee

Interview with David Geier, MD, an orthopedic surgeon, sports medicine specialist, and author of That’s Gotta Hurt: The Injuries That Changed Sports Forever

Interview with Jonathan M. Vigdorchik, MD, hip and knee surgeon at the Hospital for Special Surgery in New York City

Interview with Matt Miller, MD, an arthritis and joint replacement surgeon at Stanford Medicine in California

Interview with Neal Birnbaum, MD, former president of the American College of Rheumatology and founder of Pacific Rheumatology Associates Medical Group in San Francisco

Jeong H, et al. Characteristics of hip involvement in patients with ankylosing spondylitis in Korea. Korean Journal of Internal Medicine. January 2017. doi: http://dx.doi.org/10.3904/kjim.2015.229.

Kennedy JW, et al. Total Hip Arthroplasty in Systemic Lupus Erythematosus: A Systematic Review. International Journal of Rheumatology. Volume 2015. doi: http://dx.doi.org/10.1155/2015/475489.

Michet CJ, et al. Hip joint disease in psoriatic arthritis: risk factors and natural history. Annals of the Rheumatic Diseases. July 2005. doi: http://dx.doi.org/10.1136/ard.2004.022228.

Murphy LB, et al. One in four people may develop symptomatic hip osteoarthritis in his or her lifetime. Osteoarthritis Cartilage. November 2010. doi: http://dx.doi.org/10.1016/j.joca.2010.08.005.

Osteoarthritis of the Hip. OrthoInfo. American Academy of Orthopaedic Surgeons. https://orthoinfo.aaos.org/en/diseases–conditions/osteoarthritis-of-the-hip.

Svege I, et al. Exercise therapy may postpone total hip replacement surgery in patients with hip osteoarthritis: a long-term follow-up of a randomised trial. Annals of the Rheumatic Diseases. January 2015. doi: http://dx.doi.org/10.1136/annrheumdis-2013-203628.

Total Hip Replacement. OrthoInfo. American Academy of Orthopaedic Surgeons. https://orthoinfo.aaos.org/en/treatment/total-hip-replacement.

Why Smoking Will Worsen Your Chronic Pain. Cleveland Clinic. https://health.clevelandclinic.org/why-smoking-will-worsen-your-chronic-pain.