Hip Arthritis (Osteoarthritis)

The hip is a ball-and-socket joint formed by the femoral head (the top of the thigh bone) and the acetabulum (the socket in the pelvis). In a healthy hip, smooth articular cartilage coats both surfaces, allowing pain-free movement through a wide range of motion.

In hip osteoarthritis, this cartilage thins over years to decades. As it wears away, the joint capsule thickens, the body forms bone spurs called osteophytes, and the underlying bone reacts by becoming denser. The cumulative effect is pain, restricted motion, and progressive disability.

Hip arthritis is the most common reason for hip replacement surgery in the UK. The National Joint Registry recorded over 100,000 primary hip replacements in 2024, the majority for osteoarthritis.

For many years osteoarthritis was assumed to be a simple consequence of ageing. Modern imaging has shown that a large proportion of so-called primary osteoarthritis is actually secondary to subtle structural problems present from childhood or adolescence: mild hip dysplasia, where the socket is shallower than normal, or femoroacetabular impingement, where extra bone on the femoral neck pinches the socket rim and damages cartilage over years of normal activity.

The most important risk factors are:

• Age over 45. Cartilage repair declines with age and lifetime cumulative load adds up.
• Body Mass Index over 29. Each pound of body weight transmits roughly four pounds of force through the hip with every step.
• Previous hip injury. A prior fracture, dislocation, or significant sports injury changes joint mechanics permanently.
• Hip dysplasia. A shallow socket present from birth is responsible for up to 20 to 40 per cent of hip osteoarthritis cases.
• Femoroacetabular impingement (FAI). Cam or pincer deformities cause repetitive cartilage damage with normal activity.
• Family history. Both dysplasia and FAI can be inherited; first-degree relatives of patients with hip osteoarthritis have a measurably higher risk.
• Heavy-loading occupations. Years of farming, manual labour, or other repetitive heavy loading accelerate cartilage wear.

Non-surgical treatment is appropriate for most patients with mild to moderate hip arthritis. NICE published an updated osteoarthritis guideline (NG226) which made several significant changes to first-line care:

• Therapeutic exercise. Tailored physiotherapy combining strengthening, range-of-motion work, and aerobic exercise. The strongest evidence base of any intervention.
• Weight loss. Every pound of body weight lost reduces force through the hip by roughly four pounds per step. A reduction of at least 5 per cent of body weight is the minimum target.
• Topical NSAIDs. Preferred over oral NSAIDs because of fewer systemic side effects.
• Oral NSAIDs. Used at the lowest effective dose for the shortest duration, with attention to kidney function and stomach lining.
• Paracetamol. NICE 2026 no longer routinely recommends paracetamol for osteoarthritis pain (a notable change from earlier guidance), citing lack of effectiveness.
• Opioids. Not routinely recommended for osteoarthritis pain.
• Intra-articular injections. Image-guided corticosteroid gives short-term pain relief, typically up to three months. Hyaluronic acid offers modest four-to-six month benefit in selected patients. Platelet-rich plasma and combination injections continue to be studied.

Non-surgical treatment becomes futile when the hip has reached Kellgren-Lawrence grade 3 or 4, when night pain disrupts sleep, when walking distance falls below 100 metres, or when three to six months of structured care has failed to control symptoms. At that point, hip replacement becomes the right next step.

If you take prescribed medication, particularly blood-thinners, anti-inflammatories, or rheumatology drugs, please review Mr Hussain's patient guide on medications to pause before hip or knee surgery as you approach a surgical decision.

Both operations relieve the pain of hip arthritis and restore movement, but they differ in how much bone is removed and which patient group does best. Mr Hussain trained in both techniques and offers each based on what is right for the individual patient.

For a more detailed patient comparison covering recovery, return to sport, and implant choice, read Mr Hussain's patient guide on hip resurfacing versus total hip replacement. Active patients may also find returning to sport after hip resurfacing useful for setting realistic expectations.