Author: DokterSingapura Editorial Team
Clinical review: Dr Terence Tan, licensed medical doctor in Singapore
Founder, The Pain Relief Clinic
Reviewed: May 2026

Hip arthritis can be confusing because the pain is not always felt directly at the side of the hip.

Many people with hip arthritis describe:

“My groin hurts when I walk.”
“It is harder to put on socks.”
“I feel stiff getting out of a chair.”
“My thigh aches after walking.”
“I am starting to limp.”

Some assume it is a groin strain.

Some think it is sciatica.

Others suspect ageing but are unsure what to do next.

The practical question is:

How do you recognise hip arthritis, and what are the sensible treatment pathways before assuming surgery is inevitable?

What Is Hip Arthritis?

Hip arthritis usually refers to wear-and-change processes affecting the hip joint.

The most common type is osteoarthritis.

In osteoarthritis, the joint may develop changes involving:

• cartilage
• underlying bone
• joint lining
• joint fluid environment
• surrounding muscles
• movement mechanics

It is often described as “wear and tear,” but that phrase is too simplistic.

Hip osteoarthritis is not just cartilage disappearing.

It is a whole-joint condition that affects pain, stiffness, strength, mobility, and walking ability.

Why Hip Arthritis Often Causes Groin Pain

Hip joint pain is commonly felt deep in the groin.

This surprises many patients because they expect hip pain to be felt only on the side of the hip.

Hip arthritis may also refer pain to the:

• front of the thigh
• outer hip
• buttock
• knee

AAOS notes that hip osteoarthritis commonly causes pain in the groin or thigh, sometimes spreading to the buttocks or knee, with stiffness and reduced range of motion affecting walking. (OrthoInfo)

This is why knee or thigh pain should not always be assumed to come from the knee itself.

Sometimes the hip is the source.

Common Symptoms Of Hip Arthritis

Hip arthritis may cause:

• deep groin ache
• stiffness after rest
• pain with walking
• reduced walking distance
• difficulty putting on socks or shoes
• difficulty getting into or out of a car
• trouble crossing the legs
• limp
• reduced hip rotation
• pain climbing stairs
• grinding or catching sensations
• thigh or knee referral pain

Symptoms often develop gradually.

However, flare-ups may occur.

Why Walking Becomes Difficult

Walking requires repeated hip movement and weight-bearing.

If the joint is stiff or irritated, walking can become painful because the hip must manage:

• body weight
• rotation
• stride length
• balance
• impact
• muscle control

As the hip becomes stiffer, the body may compensate by changing gait.

This can contribute to:

• limping
• back discomfort
• knee strain
• reduced walking confidence
• lower activity levels

According to Dr Terence Tan, hip arthritis is often missed when patients focus only on the painful area, especially when pain is felt in the groin, thigh, or knee rather than clearly at the hip.

Hip Arthritis vs Back Pain

Hip arthritis and lower back problems can overlap.

This is why careful assessment matters.

More Suggestive Of Hip Arthritis

• deep groin pain
• reduced hip rotation
• difficulty putting on socks
• pain getting in and out of a car
• limp
• stiffness with walking
• pain reproduced by hip movement

More Suggestive Of Back Or Nerve Involvement

• back pain with leg symptoms
• numbness or tingling
• pain below the knee
• weakness
• walking-limited leg heaviness relieved by sitting
• symptoms affected strongly by spine position

Some people have both hip and back problems.

The diagnosis is not always either-or.

Does Hip Arthritis Always Show On X-Ray?

X-ray is often useful for suspected hip arthritis because it can show:

• joint space narrowing
• bony changes
• osteophytes
• alignment changes
• advanced degenerative features

However, symptoms and X-ray findings do not always match perfectly.

Some people have visible arthritis but manageable symptoms.

Others have meaningful pain with less dramatic imaging.

Clinical assessment still matters.

Does Hip Arthritis Need MRI?

Not always.

MRI may be useful when:

• X-ray does not explain symptoms
• early arthritis or other pathology is suspected
• avascular necrosis is a concern
• stress injury is possible
• labral pathology is being considered
• pain persists despite care
• diagnosis remains unclear

But for many typical hip arthritis presentations, X-ray may be the more practical first imaging test.

Is Exercise Still Recommended?

In many appropriate cases, yes.

Exercise does not mean forcing painful movement aggressively.

It means therapeutic movement tailored to the person’s condition and tolerance.

NICE recommends therapeutic exercise tailored to the person’s needs for all people with osteoarthritis, including local muscle strengthening and general aerobic fitness; supervised exercise may also be considered. (NICE)

Exercise may help with:

• strength
• walking tolerance
• balance
• confidence
• general conditioning
• function

The correct exercise plan depends on pain level, mobility, and overall health.

Does Weight Matter?

Weight may matter because the hip is a load-bearing joint.

Weight management may be relevant for some patients, especially when symptoms affect walking and daily mobility.

OARSI guidelines for non-surgical management include patient-centred recommendations for hip, knee, and polyarticular osteoarthritis, supporting the broader role of education, exercise, and weight-related strategies where suitable. (PubMed)

However, weight is not the only factor.

Hip shape, prior injury, joint mechanics, muscle strength, age, and activity history may all contribute.

Does Hip Arthritis Always Lead To Hip Replacement?

No.

Hip replacement can be highly relevant for selected people with advanced arthritis and major disability.

But hip arthritis does not automatically mean surgery.

Treatment decisions depend on:

• pain severity
• walking limitation
• stiffness
• sleep disturbance
• X-ray findings
• response to conservative care
• overall health
• personal goals

Many people begin with conservative care.

Surgery becomes more relevant when symptoms are severe, persistent, and meaningfully limit quality of life despite appropriate management.

Conservative Care For Hip Arthritis

Conservative care may include:

• education
• activity modification
• therapeutic exercise
• strengthening
• walking tolerance planning
• weight management where relevant
• medication where appropriate
• mobility aids in selected cases
• reassessment if symptoms progress

Conservative care should not mean passive waiting.

It should be structured and reviewed.

Common Patient Mistakes

Mistake 1: Assuming Groin Pain Is A Muscle Strain

Persistent groin pain with stiffness may suggest hip joint involvement.

Mistake 2: Ignoring Limping

A persistent limp often reflects functional limitation and should be assessed.

Mistake 3: Avoiding All Activity

Too much avoidance may worsen strength, conditioning, and confidence.

Mistake 4: Assuming Surgery Is The Only Option

Many people can start with conservative care, depending on severity.

Mistake 5: Treating Knee Pain Without Checking The Hip

Hip arthritis may refer pain toward the knee.

When To Seek Assessment

Consider assessment if you have:

• persistent groin pain
• worsening walking tolerance
• limp
• reduced hip rotation
• difficulty putting on socks
• pain getting into or out of a car
• pain that affects daily life
• symptoms not improving with reasonable care

Seek more urgent assessment if pain follows trauma, weight-bearing becomes impossible, or there are systemic symptoms such as fever or unexplained illness.

Practical Questions To Ask

If hip arthritis is suspected, useful questions include:

• Is the pain deep in the groin?
• Is hip rotation stiff?
• Is walking distance reducing?
• Am I limping?
• Is putting on socks difficult?
• Does pain spread to the thigh or knee?
• Does the back also hurt?
• Is numbness or tingling present?
• Would X-ray clarify the situation?
• Has conservative care been structured and reviewed?

These questions help guide the next step.

The Main Takeaway

Hip arthritis often causes groin pain, stiffness, walking difficulty, and reduced hip movement.

It can also refer pain to the thigh, buttock, or knee.

The diagnosis should not be based on pain location alone.

X-ray may often be useful when hip arthritis is suspected, while MRI is usually reserved for selected cases where deeper clarification is needed.

Hip arthritis does not automatically mean hip replacement.

Many patients begin with education, exercise, activity modification, weight management where appropriate, and structured conservative care.

The right pathway depends on symptoms, function, imaging, and personal goals.

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FAQ

Where is hip arthritis pain usually felt?

Hip arthritis commonly causes groin pain, but pain may also spread to the thigh, buttock, outer hip, or knee.

Does hip arthritis always need surgery?

No. Many people start with conservative care. Surgery is usually considered when symptoms are severe, persistent, and function-limiting despite appropriate management.

Is X-ray or MRI better for hip arthritis?

X-ray is often a useful first imaging test for suspected hip arthritis. MRI may be considered when diagnosis is unclear or other conditions need assessment.

Can exercise help hip arthritis?

Yes, when appropriately tailored. Exercise may support strength, mobility, walking tolerance, and function.

Can hip arthritis feel like knee pain?

Yes. Hip joint pain can sometimes refer toward the thigh or knee, so persistent knee pain may sometimes require hip assessment.

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About The Medical Reviewer

Dr Terence Tan is a licensed medical doctor in Singapore and founder of The Pain Relief Clinic. He has over 20 years of clinical experience in musculoskeletal assessment and practical non-surgical care pathways.

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Medical Disclaimer

This article is for general educational purposes only and does not replace personalised medical assessment, diagnosis, or treatment by a licensed healthcare professional.