Osteoarthritis of the hip joint
Osteoarthritis of the hip joint, also called coxarthrosis, is the gradual wearing away of the joint cartilage. The cartilage that lets the bone surfaces glide smoothly over each other thins and roughens. The result is pain in the groin, morning stiffness and a shrinking walking distance. Osteoarthritis is a chronic and progressive disease, but its course can be managed.
What arthritis is and how cartilage wears away
The hip joint works on a ball and socket principle. The round head of the femur sits in a socket in the pelvis called the acetabulum. Both surfaces are covered with cartilage, a smooth and flexible tissue that cushions impact and carries movement quietly and without pain.
In osteoarthritis this cartilage gradually thins. First it loses its smoothness and elasticity, then cracks appear on it, and finally it disappears in places and bone touches bone. From that moment on the pain becomes constant.
In parallel the joint tries to compensate for the damage: osteophytes, that is bony outgrowths, appear at the edges of the bone, the joint space narrows and the range of movement decreases. These changes are clearly visible on an X-ray.
Cartilage has no blood vessels and no nerves of its own. That is why, on the one hand, it barely regenerates, and on the other hand there may be no pain at all in the early stage of damage. This explains why a large share of patients come to a doctor when the changes are already significant.
Osteoarthritis or arthritis, what is the difference
Osteoarthritis is wear of the cartilage, that is a mechanical, degenerative process. Arthritis is inflammation of the joint. They can exist at the same time, but the logic of treatment is different.
Osteoarthritis
The pain increases with loading and eases with rest. Morning stiffness is usually under 30 minutes. It normally affects one or two large joints. It develops over years.
Arthritis
The pain may also come at night and may not ease with rest. Morning stiffness often lasts more than an hour. Several joints can be affected at once, with swelling, redness or heat. Inflammatory markers appear in blood tests.
The exact distinction is made by a doctor, based on examination, an X-ray and, where needed, blood tests. This page cannot replace a consultation.
How hip osteoarthritis is recognised
The most common mistake is when a patient reads hip joint pain as pain in the side of the hip. Pain from this joint typically appears in the groin, not on the outside.
Pain in the groin
It often spreads down the front of the thigh and reaches the knee. Sometimes a patient comes in with knee pain while the problem is in the hip joint.
Morning stiffness
The first steps after sleep or after sitting for a long time are hard. It takes a few minutes to loosen up.
Shorter walking distance
You used to walk a kilometre easily, and now you need to stop after two hundred metres. This is one of the most objective signs we assess at a consultation.
Trouble putting on socks and cutting toenails
The range of movement in the joint decreases. Bending the leg and moving it out to the side becomes difficult. This often appears before the pain.
Limping and a changed gait
The body protects the affected joint and shifts loading onto the other leg. Over time this damages the back and the other joint as well.
Night pain
This is already a sign of an advanced stage. If pain wakes you at night and it is hard to find a comfortable position, that is a separate conversation to have with a doctor.
Why the pain should not be ignored
Pain is not just discomfort. It sets off a chain of changes, some of which are then irreversible. Waiting does not stop the disease.
When a person spares the affected leg for months or years, the way they walk changes. Loading shifts to the healthy leg, the lower back and the knees. As a result we often meet a patient who, instead of one joint, already has several problems.
Long-term pain damages sleep, reduces physical activity and often leads to weight gain, which increases the load on the joint even further. This is a closed circle.
The psychological and emotional side deserves separate mention. Constant pain lowers quality of life, limits social activity and often leads to low mood. This is not a secondary matter, and we talk about it at the consultation too.
At the same time, and this is no less important, seeing a surgeon does not mean surgery. A patient who comes early often does not need an operation precisely because they came in time.
Can osteoarthritis be cured
The honest answer: damaged cartilage does not fully restore itself, and today there is no medicine that restores it. But that does not mean nothing can be done.
The course of osteoarthritis can be managed. Correctly chosen treatment reduces pain, preserves the range of movement and slows progression. Many patients live a full life for years without surgery.
The promises circulating online about cartilage regeneration, miracle supplements or procedures that "cure" arthritis do not match reality. Anyone who gives you such a guarantee is either mistaken or not telling you the truth.
When the cartilage is worn out and the pain becomes constant, a joint replacement becomes a reasonable decision. This is not a defeat. It is a stage of treatment with its own, very well studied indications.
The outcome is individual and depends on the stage of the disease, age, other conditions and the patient’s activity level. No treatment can guarantee a result.
X-ray or MRI, which investigation do I need
The main and in most cases sufficient investigation for diagnosing hip osteoarthritis is a plain X-ray. MRI is ordered to clarify particular questions, not routinely.
A practical tip: bring the original X-ray image to the consultation, not only the written report. The image carries far more information than a written description.
If you want a preliminary assessment before travelling to Batumi, send a photo of the X-ray on WhatsApp. File upload on the site is deliberately not offered, because a medical image is a special category of personal data.
What each investigation shows
| Investigation | What it shows | When it is ordered |
|---|---|---|
| X-ray | Width of the joint space, osteophytes, bone structure, joint geometry | Always, and first. Both hip joints on one image, taken standing |
| MRI | Cartilage, soft tissue, early avascular necrosis of the femoral head, labral damage | When the X-ray shows no change but the pain is severe, or necrosis is suspected |
| CT scan | A detailed three-dimensional image of the bone | In complex cases, when planning surgery, in dysplasia or deformity |
Questions and answers
Do I have to put up with arthritis because of my age?
No. Osteoarthritis is indeed more common with age, but there is no need to live with the pain. There are several steps of treatment, and most of them have nothing to do with surgery. Age in itself is neither an indication for surgery nor a reason against it.
Are hyaluronic acid injections effective?
In some patients injection therapy reduces pain and improves movement, especially in the early and middle stages. It is not cartilage regeneration and the effect is temporary. In the advanced stage, when the joint space has almost gone, the benefit drops sharply. The question is decided case by case.
Can I do sport with hip arthritis?
Movement is necessary and not harmful. On the contrary, inactivity makes the joint worse. What matters is the type of activity: swimming, cycling and walking on level ground are usually well tolerated, while jumping, running on hard surfaces and heavy weights increase the load. The specific regime is set after an examination.
Why does my knee hurt if the problem is in the hip?
This is referred pain. The nerve supply of the hip joint is arranged so that pain often spreads down the front of the thigh and is felt in the knee. That is exactly why an orthopaedic surgeon also examines the hip joint when a patient reports knee pain.
How quickly does osteoarthritis progress?
This is very individual. In some patients the changes barely increase over years, in others they worsen sharply within a few months. The speed is influenced by the cause, weight, the type of loading, the original geometry of the joint and other conditions. That is exactly why follow-up X-rays are scheduled at intervals.
Do both hips need to be X-rayed?
Yes. As standard, both hip joints are captured on one image, taken standing. This allows the sides to be compared and the pelvic tilt and any leg length difference to be assessed. For planning surgery this is critical.
Have a question about your own case?
At the consultation we look at your X-ray together and I tell you what stage the joint is at and what the next step is. Seeing a surgeon does not mean surgery.
Updated: · Author: Mikheil Mikeladze, MD