Hip Osteoarthritis: Treatment, Wear and Tear and Hip Replacement Recovery

Hip osteoarthritis is a common cause of the hip and pelvic pain, it is also often misunderstood. Patients book in with me believing that “wear and tear” means that their hip is worn out and that nothing but a hip replacement will cure it. The evidence says otherwise. Most people with hip osteoarthritis can stay active, manage their pain well and delay or even avoid surgery and the things that help most are quite ordinary and achievable: movement, strength and sensible load management.[1]

One surprise for many patients is the area where the pain is felt, where it presents itself. True hip joint pain is usually felt in the groin, sometimes spreading to the front of the thigh or the knee, rather than on the outside of the hip. If you have been puzzled by groin pain that worsens with walking, this page about arthritis in your hip should be helpful for you.

“His understanding and knowledge of the human body and how it functions is very impressive”

“Leslie has been treating to control pain and build muscle strength as I have severe arthritis in both hips. His understanding and knowledge of the human body and how it functions is very impressive. He is able to locate sources of pain and treat them quickly and effectively. He has a very sympathetic and understanding approach to his patients. I cannot recommend Leslie too highly.”

David H

what is hip osteoarthritis?

Osteoarthritis is a gradual change in a joint that takes place over time. It can present in most articulating joints of your body including the spine, shoulder, knees or the thumb and hand.

In the hip, the cartilage that cushions the ball and socket of your hip becomes thinner and less smooth, the bone beneath it remodels and the joint can become stiff, achey and sometimes inflamed. You may hear it called degenerative hip disease, degenerative joint disease or wear and tear. They all describe the same process.

What that phrase misses is that osteoarthritis is not a passive wearing out of the joint. Joints are living tissue that respond to how they are used. That is precisely why exercise is the best supported treatment for hip osteoarthritis which sounds counterintuitive when a joint hurts but movement can help.[2] An osteoarthritic hip that is kept moving and kept strong usually behaves far better than one that is rested and cautiously gaurded.

what causes it arthritis in the hip

Age is one of the biggest factors and most people over the age of 50 years old will have some osteoarthritic change show on an X-ray whether they feel it or not. Genetics also play a part in the cause as does a history of a physically heavy working life. Previous hip problems account for causes too: a childhood hip condition, an old fracture or the shape variations that I describe on my hip pain in young adults page can all bring the onset of osteoarthritis forward by years. Body weight is relevant because each extra kilogram multiplies the load through the hip and is why weight management sits alongside exercise in the NICE guidance as a core treatment[1]

Importantly, the amount of change on an X-ray often does not correlate to the amount of pain felt by a person. I see patients with dramatic looking films and the patient has mild symptoms and then the reverse of this too.

common causes list of hip osteoarthritis

Explore our hip and pelvic guides

Hip and pelvic pain: the main guide

Hip and groin

Hip osteoarthritis, wear and tear, and hip replacement care (you are here)
Hip pain in younger and sporting adults: impingement, labral tears and clicking hips
Hip pain and the symptoms people mistake for a bad back

Side of the hip and buttock

Pelvis and tailbone

Related guides

When hip or buttock pain starts in the back

When the problem shows up further down the leg

Wear and tear, bones and staying active

When sport or training is behind it

Symptoms of hip osteoarthritis

Patients usually describe to me a deep ache in the groin or the front of the thigh, it can get worse after walking or gardening and is often stiff first thing in the morning or after sitting. Putting on socks and shoes becomes awkward. Getting out of a low car seat is more difficult. Some people feel the pain of a hip in their buttock or the knee which is one reason hip osteoarthritis is regularly mistaken for a back problem, something I have written about in my blog post about differentiating between hip and back pain

The location of the pain matters for telling conditions apart. Pain on the outside of the hip, especially pain that stops you lying on that side at night is more likely to be gluteal tendinopathy than osteoarthritis and I cover that separately on the lateral hip pain page. Groin pain with stiffness and a reduced walking range points to the joint itself.

How chiropractic care may help hip pain

NICE recommends therapeutic exercise and weight management as the core treatments for hip osteoarthritis with manual therapy considered as an addition alongside exercise.[1] That is what I endorse.

Chiropractic treatment typically combines gentle mobilisation of the hip and surrounding joints, soft tissue work through the hip flexors, gluteals and adductors and a progressive strengthening programme you do between visits. A trial combining manual therapy with exercise for hip and knee osteoarthritis found meaningful improvements in pain and function.[3] The research is occasionally mixed, one hip study found little added benefit over treatment, [4] which is why the exercise component of your plan is an imperative part of your treatment plan.

Most patients notice change within four to six visits. Osteoarthritis is a long-term condition so the realistic aim is confident, comfortable movement and fewer flare-ups rather than a cure and your chiropractic plan is built around your hip and it’s response, your activities and your personal goals.

If arthritis in your hip is getting in the way of your lifestyle and affecting things you want to be doing, come and talk it through. I offer a free 15-minute consultation, you can come in for a short no-obligation chat with no examination or treatment.

Book a free consultation

Or call for a chat on 01202 937568

Before and after hip replacement

If a hip does eventually need replacing, outcomes of surgery are generally excellent and there is still a useful role for conservative chiropractic care on either side of surgery, before and after. Beforehand, keeping the joint mobile and the muscles strong helps you go into the operation in the best possible shape. Afterwards, once your surgical team has cleared you, gentle treatment of the muscles and joints around the new hip, alongside graded rehabilitation exercises may support your recovery and confidence and this is the stage where patients tell me their treatment made a real noticeable difference. I always work within and alongside your surgeon’s and physiotherapist’s guidance.

Anteroposterior X-ray of a right total hip replacement.

possible red flags

The great majority of hip pain is mechanical and not a sign of anything serious. A few situations do need a doctor: hip pain following a fall or accident where you cannot put weight through the leg, pain accompanied by fever or feeling unwell, constant night pain that does not ease in any position, unexplained weight loss or a hot, swollen, rapidly worsening joint. If any of those apply, please see your GP or call 111 or A&E.

Everything else other than these situations would benefit from a chiropractic assessment and this is precisly why I offer my free chats

your first visit to Bournemouth Chiropractic

Your first full chiropractic visit starts with a full medical history, then a physical assessment of your hip’s range of movement, strength and your gait, with specific orthopaedic tests to separate joint pain from tendon, back and pelvic causes. I explain what I find and we agree a plan together, which will include a referral onwards if that is the right course. I also offer a free consultation or a chat on the phone first, what ever helps you most to decide whats the best way to move forward.

Frequently Asked Questions

Can a chiropractor help with hip osteoarthritis?

Yes, a chiropractor can help with hip osteoarthritis as part of the approach NICE recommends. Manual therapy is used as an adjunct alongside exercise and weight management, the core treatments. In my clinic that means hands on treatment to ease pain and stiffness combined with a strengthening programme with advice and discussion about what chiropractic treatment can and cannot change.

Why does my hip osteoarthritis hurt in my groin?

Your hip osteoarthritis hurts in your groin because that is where the hip joint refers pain to. The hip joint sits deep at the front of the pelvis, so groin and front-of-thigh ache is the classic pattern. Pain on the outer side of the hip usually comes from the tendons instead.

Should I walk or rest with hip osteoarthritis?

Walk, within comfortable limits. Resting an osteoarthritic hip usually will make it stiffer and weaker, regular movement is the best supported treatment there is. If walking currently flares your pain, shorten the distance, adjust the load and rebuild gradually rather than stopping altogether. I give advice on the stepped personalised plan.

Will my hip osteoarthritis definitely need a replacement?

No, hip osteoarthritis does not definitely lead to a hip replacement. Many people manage well for years and some indefinitely, with exercise, weight management and periodic hands-on care and they never need surgery. Surgery is there if pain and function deteriorate despite good conservative care and surgery works well when it is needed.

Can I see a chiropractor after a hip replacement?

Yes, you can see a chiropractor after a hip replacement once your surgical team has cleared you for rehabilitation. Care at that stage is gentle, focused on the muscles and joints around the new hip and always coordinated with your surgeon’s and physiotherapist’s advice.

Whatever is behind your hip pain, come and find out

Hip osteoarthritis usually builds up gradually through wear and tear in the joint, though the stiffness and aching can seem to come and go. However it began, a proper assessment is nearly always the right place to start. I'd happily see you for a full assessment or first for a free 15 minute consultation, a short, no-obligation chat to talk through what's going on, not an examination or treatment at that stage. I'll answer your questions and be honest about whether chiropractic may help and you can then choose whether to book a full visit for examination and treatment from there.

Hip pain from osteoarthritis is a very common reason people often book in to see me at my clinic in Bournemouth.

In many of the cases that I see, chiropractic care is a very well-tolerated option worth considering and where there's wear and tear involved I'll focus on helping you keep the joint moving and manage the load alongside the exercise that makes the biggest difference. I'll explain clearly what I think may help you in your particular case. If I think you'd be better served by your GP, a specialist or another practitioner, I'll help point you in the right direction.

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