Hip Osteoarthritis: Treatment Without Surgery

Sources

1. American Academy of Orthopaedic Surgeons, OrthoInfo. Osteoarthritis of the hip. Checked October 29, 2026.
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   The hip is “a ball-and-socket joint”; its surfaces are covered with articular cartilage; osteoarthritis “occurs most often in people 50 years of age and older”; the cartilage “gradually wears away over time,” the joint space decreases and bone spurs (osteophytes) can form; risk factors: increasing age, family history, previous hip injury, obesity and developmental dysplasia of the hip; “The most common symptom of hip osteoarthritis is pain”; “Pain and stiffness may be worse in the morning, or after sitting or resting awhile”; “Over time, painful symptoms may occur more frequently, including during rest or at night”; “Pain in your groin (most common) or thigh that radiates (spreads out) to your buttocks or your knee”; pain that flares with vigorous activity, locking or sticking, crepitus, decreased range of motion that “may cause a limp”; the examination (tenderness, passive and active motion, crepitus, gait); X-rays may show “a narrowing of the joint space, changes in the bone, and the formation of bone spurs”; “Occasionally” MRI or CT; “early treatment of osteoarthritis of the hip is nonsurgical”: minimizing aggravating activities “such as climbing stairs,” switching from high-impact activities (jogging, tennis) to lower impact ones (swimming, cycling), losing weight, physical therapy, walking supports and a long-handled reacher, acetaminophen, NSAIDs and corticosteroids; surgery “if your pain from arthritis causes disability and is not relieved with nonsurgical treatment”; osteotomy “is used only rarely.”
2. Murphy LB, Helmick CG, Schwartz TA, et al. One in four people may develop symptomatic hip osteoarthritis in his or her lifetime. Osteoarthritis and Cartilage. 2010;18(11):1372–1379. doi:10.1016/j.joca.2010.08.005 (PMID 20713163).
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   The Johnston County Osteoarthritis Project, a population-based study of 3,068 people aged 45 to 93 in North Carolina: “Lifetime risk of symptomatic hip OA was 25.3%,” similar by sex, race, education and hip injury history; “we found no association between BMI and lifetime risk.”
3. Bannuru RR, Osani MC, Vaysbrot EE, et al. OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis. Osteoarthritis and Cartilage. 2019;27(11):1578–1589. doi:10.1016/j.joca.2019.06.011 (PMID 31278997).
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   Guideline from meta-analyses graded with GRADE and a panel vote: “Core Treatments for Hip and Polyarticular OA included arthritis education and structured land-based exercise programs,” while knee OA’s core treatments added “dietary weight management”; intraarticular corticosteroids, intraarticular hyaluronic acid and aquatic exercise were knee treatments “but were not recommended for individuals with Hip or Polyarticular OA”; acetaminophen “conditionally not recommended”; oral and transdermal opioids “strongly not recommended.”
4. 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 & Research. 2020;72(2):149–162. doi:10.1002/acr.24131 (PMID 31908149).
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   Read in full at PubMed Central (PMC11488261). “Exercise is strongly recommended for patients with knee, hip, and/or hand OA”; evidence “is insufficient to recommend specific exercise prescriptions”; exercise for hip OA “could include walking, strengthening, neuromuscular training, and aquatic exercise, with no hierarchy of one over another”; “Exercise is associated with better outcomes when supervised”; walking “was the most common form of exercise evaluated”; “There is no uniformly accepted level of pain at which a patient should or should not exercise”; strong: weight loss for knee and/or hip OA with overweight or obesity (“A loss of ≥5% of body weight can be associated with changes in clinical and mechanistic outcomes”), self-efficacy and self-management programs, tai chi for knee and/or hip OA, and “Cane use” when OA has “a sufficiently large impact on ambulation, joint stability, or pain”; conditional: balance exercises, cognitive behavioral therapy, acupuncture and thermal interventions (heat or cold); conditionally against: massage, and manual therapy with exercise over exercise alone; strong: oral NSAIDs; topical NSAIDs strong for knee OA and conditional for hand OA, with the hip not included; conditional: acetaminophen (“the effect sizes … are very small”), duloxetine and tramadol; conditionally against: non-tramadol opioids; strong: intraarticular glucocorticoid injections for knee and/or hip OA, and “imaging guidance for injection into hip joints is strongly recommended”; strongly against for hip OA: hyaluronic acid injections, glucosamine, platelet-rich plasma and stem cell injections; conditionally against: prolotherapy.
5. National Institute for Health and Care Excellence. Osteoarthritis in over 16s: diagnosis and management (NG226). Published October 19, 2022. Checked October 29, 2026.
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   1.1.1 diagnose clinically without imaging in people who “are 45 or over and have activity-related joint pain and have either no morning joint-related stiffness or morning stiffness that lasts no longer than 30 minutes”; 1.1.2 “Do not routinely use imaging” unless features are atypical; 1.2.2 “the core treatments for the condition are therapeutic exercise and weight management (if appropriate), along with information and support”; 1.3.1 offer therapeutic exercise to all; 1.3.2 consider supervised sessions; 1.3.3 “joint pain may increase when they start therapeutic exercise,” and regular, consistent exercise “will be beneficial for their joints”; long-term adherence increases its benefits; 1.3.4 combine exercise with education or behavior change; 1.3.5 weight loss “will improve their quality of life and physical function, and reduce pain,” and “losing 10% of their body weight is likely to be better than 5%”; 1.3.6–1.3.7 manual therapy only alongside exercise, “not enough evidence to support its use alone”; 1.3.8 do not offer acupuncture or dry needling; 1.3.9 do not offer TENS, ultrasound, interferential, laser, pulsed short-wave therapy or NMES; 1.3.10 “Consider walking aids (such as walking sticks) for people with lower limb osteoarthritis”; 1.4.1 medicines alongside exercise, “at the lowest effective dose for the shortest possible time”; 1.4.3 consider a topical NSAID for joints other than the knee; 1.4.4 an oral NSAID if topical medicines are ineffective or unsuitable, with a gastroprotective treatment; 1.4.5 do not routinely offer paracetamol (acetaminophen) or weak opioids, “there is no strong evidence of benefit for paracetamol”; 1.4.6 “Do not offer glucosamine or strong opioids”; 1.4.9 “Do not offer intra-articular hyaluronan injections”; 1.4.10 consider corticosteroid injections, which “only provide short-term relief (2 to 10 weeks)”; 1.5.3 seek follow-up if management is not working; 1.5.4 no routine imaging for follow-up; 1.6.1 consider referral for joint replacement if symptoms “are substantially impacting their quality of life” and non-surgical management “is ineffective or unsuitable”; 1.6.2 clinical assessment “instead of systems that numerically score severity”; 1.6.3 do not exclude people because of age, sex or gender, smoking, comorbidities, overweight or obesity.
6. Fransen M, McConnell S, Hernandez-Molina G, Reichenbach S. Exercise for osteoarthritis of the hip. Cochrane Database of Systematic Reviews. 2014;(4):CD007912. doi:10.1002/14651858.CD007912.pub2 (PMID 24756895).
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   Ten trials of land-based exercise: “High-quality evidence from nine trials (549 participants) indicated that exercise reduced pain … and improved physical function” immediately after treatment, by about 8 and 7 points on a 0 to 100 scale (number needed to treat 6); the pain reduction “was sustained at least three to six months after ceasing monitored treatment”; no benefit on quality of life (low-quality evidence from three small studies); adverse events were few and “all were related to increased pain attributed to the exercise programme.”
7. MedlinePlus, US National Library of Medicine. Hip pain. Review date June 4, 2025. Checked October 29, 2026.
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   “You may not feel pain from your hip directly over the hip area. You may feel it in your groin, thigh, or knee”; arthritis is “often felt in the front part of the thigh or groin”; “Pain you feel in the hip may reflect a problem in your back”; “Pain due to problems in the hip joint itself is often felt most in the groin”; home care: avoid activities that make pain worse, “Sleep on the side of your body that does not have pain. Put a pillow between your legs,” lose weight if overweight, avoid standing for long periods, stand on a soft, cushioned surface “with an equal amount of weight on each leg,” wear flat cushioned shoes, “Avoid running straight down hills. Walk down instead”; the provider examines “your hips, thighs, back, and the way you walk”; get emergency help for acute pain after a serious fall or injury, a deformed, badly bruised or bleeding leg, being “unable to move your hip or bear any weight on your leg,” or worsening pain with difficulty urinating or having a bowel movement; contact your provider if the hip is painful after 1 week of home treatment, with fever or rash, sudden pain with sickle cell anemia or long-term steroid use, pain in both hips and other joints, or limping with difficulty on stairs.
8. American Academy of Orthopaedic Surgeons, OrthoInfo. How to use crutches, canes, and walkers. Checked October 29, 2026.
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   A cane “can be helpful if you have minor problems with balance or stability, some weakness in your leg or trunk, an injury, or a pain”; a quad cane gives more stability; “the top of your cane should reach to the crease in your wrist” with the elbow slightly bent; “Hold the cane in the hand opposite the side that needs support. For example, if your right leg is injured, hold the cane in your left hand”; on stairs, grasp the handrail, step up with the good leg first, and coming down put the cane on the step first, then the injured leg.
9. MedlinePlus, US National Library of Medicine. Using a cane. Review date April 1, 2025. Checked October 29, 2026.
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   “The most common question about using a cane is, ‘Which hand should I hold it in?’ The answer is the hand opposite the leg that you had surgery on, or that is the weakest”; the handle at the level of your wrist; step forward with the weaker leg as the cane moves the same distance; take some pressure off the weaker leg by placing pressure on the cane; turn by pivoting on the strong leg; “up with the good, down with the bad”; “Use a chair with armrests when you can to make sitting and standing easier.”
10. American Academy of Orthopaedic Surgeons, OrthoInfo. Total hip replacement. Checked October 29, 2026.
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    “more than 450,000 total hip replacements are performed each year in the U.S.”; people who benefit often have “Hip pain that limits everyday activities, such as walking or bending,” “Hip pain that continues while resting, either during the day or at night,” stiffness that limits moving or lifting the leg, and “Inadequate pain relief from anti-inflammatory drugs, physical therapy, or walking supports”; “There are no absolute age or weight restrictions”; “Recommendations for surgery are based on a patient’s pain and disability, not age. Most patients who undergo total hip replacement are 50 to 80 years old”; serious complications such as joint infection “occur in less than 2% of patients”; the implant can wear or loosen over the years.
11. American Physical Therapy Association, ChoosePT. Physical therapy guide to osteoarthritis. Expert review September 12, 2023; revised March 1, 2024. Checked October 29, 2026.
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    “You can contact a physical therapist directly for an evaluation”; “Warmth with swelling or redness around the joint is not typical with OA”; the therapist performs a thorough exam, designs an exercise program, uses manual therapy, suggests changes to the work area, teaches aerobic and strengthening exercise and a home program, recommends “a cane, walker, or knee brace if needed,” and helps with safe weight loss; OA not helped by physical therapy alone is referred to an orthopedist; “All physical therapists are prepared through education and experience to treat OA,” and you may consider a board-certified clinical specialist or one with a residency or fellowship in orthopedic or geriatric physical therapy; ask about experience with osteoarthritis and describe what makes symptoms better or worse.
12. National Institute of Arthritis and Musculoskeletal and Skin Diseases. Osteoarthritis. Last reviewed September 2023. Checked October 29, 2026.
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    Osteoarthritis “is the most common type of arthritis and is more common in older people”; “Women are more likely than men to have osteoarthritis, especially after age 50”; joint pain and, after rest, stiffness “usually lasting less than 30 minutes”; “in the later stages of the disease, the pain may be worse at night”; at the hip, “pain and stiffness in the hip joint or in the groin, inner thigh, or buttocks. Sometimes, the pain from arthritis in the hip can radiate (spread) to the knees”; osteoarthritis “can damage all the areas of the joint,” including cartilage, tendons and ligaments, the synovium (lining) and bone; “If you have joint pain, you may be less active, and this can lead to muscle weakness, which may cause more stress on the joint”; for some people it is mild, for others it causes significant pain and disability.
13. MedlinePlus, US National Library of Medicine. Osteoarthritis. Review date April 9, 2026. Checked October 29, 2026.
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    Morning stiffness “often lasts for 30 minutes or less”; “As OA gets worse, you may have pain even when you are resting. And it may wake you up at night”; “Some people might not have symptoms, even though x-rays or physical exam show the physical changes of OA”; “Blood tests are not helpful in diagnosing OA” but can look for alternatives such as rheumatoid arthritis or gout; treatments “can often delay surgery”; physical therapy can improve strength, motion and balance, and “If therapy does not make you feel better after 6 to 12 weeks, then it likely will not be helpful”; water exercises “are often helpful”; adjust your work area or tasks if work stresses certain joints; “you should not take more than 4 grams (4,000 milligrams) of acetaminophen a day” from all medicines; “Talk with your provider before taking an NSAID on a regular basis.”
14. American Academy of Orthopaedic Surgeons, OrthoInfo. Hip bursitis. Checked October 29, 2026.
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    Trochanteric bursitis is inflammation of the bursa over the bony point of the hip (the greater trochanter); iliopsoas bursitis causes pain “in the groin area” and is less common; “The main symptom of trochanteric bursitis is pain at the point of the hip. The pain usually extends to the outside of the thigh area”; “Typically, the pain is worse at night, when lying on the affected hip, and when getting up from a chair after being seated for a while”; more common in women and middle-aged or elderly people; the doctor checks for tenderness over the point of the hip, and X-rays, bone scans or MRI may rule out other conditions.
15. American Physical Therapy Association. Direct access advocacy. “As of July 1, 2025, all 50 states, the District of Columbia, and the U.S. Virgin Islands have either provisional or unrestricted direct access to physical therapist services for evaluation and treatment”; “some provisions tied to treatment absent a referral still persist in a number of states.” Checked October 29, 2026.
16. National Institute of Arthritis and Musculoskeletal and Skin Diseases. Osteoarthritis: diagnosis, treatment, and steps to take. Last reviewed September 2023. Checked October 29, 2026.
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    “There is no single test for osteoarthritis”; X-rays show joint space loss and bone spurs, but “Early joint damage does not usually appear on x-rays”; MRI “helps health care providers evaluate a joint that is locking or giving out”; blood tests and joint fluid rule out other causes; exercise “can reduce joint pain and stiffness and increase flexibility, muscle strength, and endurance”; “start any exercise program slowly”; a program may include range-of-motion and stretching, strengthening “with weights or exercise bands,” water exercise, balance and agility, and low-impact activities “such as walking, cycling, swimming, tai chi, water aerobics”; losing weight “can be especially helpful for weight-bearing joints such as your knees or hips”; corticosteroid injections “temporarily relieve pain”; the team includes primary care doctors, rheumatologists, orthopaedic surgeons, physical therapists, and occupational therapists “who teach ways to protect joints, minimize pain, perform activities of daily living, and conserve energy”; heat and cold therapies “can reduce joint pain”; “a cane or walker can help you move around safely, provide stability, and lower pain.”
17. Bennell KL, Egerton T, Martin J, et al. Effect of physical therapy on pain and function in patients with hip osteoarthritis: a randomized clinical trial. JAMA. 2014;311(19):1987–1997. doi:10.1001/jama.2014.4591 (PMID 24846036).
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    A placebo-controlled, participant- and assessor-blinded trial of 102 people with painful hip osteoarthritis in Australia: 10 sessions over 12 weeks of education and advice, manual therapy, home exercise and a gait aid if appropriate, against inactive ultrasound and inert gel; “physical therapy did not result in greater improvement in pain or function compared with sham treatment”; 41% of the active group reported mild adverse effects, against 14% with sham.
18. American Academy of Orthopaedic Surgeons, OrthoInfo. Hip conditioning program. Checked October 29, 2026.
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    A general program, “performed under your doctor’s supervision”; strengthening the muscles that support the hip “will help keep your hip joint stable” and “can relieve pain”; continued “for 4 to 6 weeks, unless otherwise specified,” then 2 to 3 days a week as maintenance; warm up with 5 to 10 minutes of walking or a stationary bicycle; “You should not feel pain during an exercise”; for the strengthening exercises, “Begin with a weight that allows 8 repetitions and progress to 12 repetitions … add weight in 1-pound increments”; the knee to chest, supine hamstring stretch, hip abduction, hip adduction, prone hip extension and clamshell with their repetitions and step-by-step directions, as quoted in the exercise cards.
19. Office of Disease Prevention and Health Promotion, US Department of Health and Human Services. Top 10 things to know about the second edition of the Physical Activity Guidelines for Americans. Checked October 29, 2026.
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    Adults need “at least 150 to 300 minutes of moderate-intensity aerobic activity, like brisk walking or fast dancing, each week” and muscle-strengthening activity “at least 2 days each week”; “any amount of physical activity has some health benefits”; “physical activity can decrease pain for those with osteoarthritis.”
20. Frydendal T, Christensen R, Mechlenburg I, et al. Total hip replacement or resistance training for severe hip osteoarthritis. New England Journal of Medicine. 2024;391(17):1610–1620. doi:10.1056/NEJMoa2400141 (PMID 39476341).
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    A multicenter randomized trial in Denmark of 109 people aged 50 or older (mean 67.6) with severe hip osteoarthritis and an indication for surgery: at 6 months the Oxford Hip Score improved by 15.9 points with total hip replacement and 4.5 with resistance training (difference 11.4 on a 0 to 48 scale); “12 patients (21%) who had been assigned to resistance training had undergone total hip replacement”; serious adverse events were similar, mostly known complications of replacement.
21. Centers for Medicare & Medicaid Services. Physical therapy services (Medicare.gov). Checked October 29, 2026.
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    “After the Part B deductible, you pay 20% of the Medicare-approved amount”; a doctor or other provider (including a nurse practitioner, clinical nurse specialist or physician assistant) “must certify that you need it”; “There’s no limit on how much Medicare pays for your medically necessary outpatient therapy services in one calendar year.”
22. Centers for Medicare & Medicaid Services. Therapy services. The 2026 KX modifier thresholds: “$2,480 for PT and SLP services combined, and $2,480 for OT services”; claims above them without the KX modifier “are denied”; targeted medical review at “a lower threshold amount of $3,000.” Checked October 29, 2026.
23. Centers for Medicare & Medicaid Services. Compare Original Medicare & Medicare Advantage (Medicare.gov). Medicare Advantage plans “must cover all medically necessary services that Original Medicare covers”; you may need approval (prior authorization) from the plan before it covers certain services. Checked October 29, 2026.

Medical disclaimer. This page is for general educational purposes and does not constitute medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider about your individual situation. Seek urgent medical attention for any of the symptoms listed above.