Hip Pain & Hip Arthritis: Causes, Treatment and When to Consider Replacement

Quick answer
Where the pain is felt is the best clue to its cause. Pain in the groin usually comes from the hip joint itself, most often arthritis. Pain on the outside of the hip is usually from the tendons and bursa there. Pain in the buttock often comes from the lower back. Most hip pain is managed with exercise, weight management and pain relief. Hip replacement is a highly effective option when arthritis pain and stiffness keep limiting daily life despite these measures.
Last reviewed:
September 27, 2026

Overview

The hip is a deep ball-and-socket joint that carries several times your body weight when you walk or climb stairs. It is surrounded by strong muscles, especially the gluteal muscles on the outside, which keep the pelvis level with every step.

Groin, front of hipThe joint itselfOsteoarthritis, and in younger adults hip impingement or cartilage tears. Rarely, loss of blood supply to the bone.
Outside of hipTendons and bursaGluteal tendon pain (greater trochanteric pain syndrome): worse lying on that side and on stairs.
ButtockOften the backLower back and sacroiliac joint problems commonly send pain here.
Thigh or kneeReferred painHip problems can be felt in the thigh or knee, especially in older adults.

Where hip pain is felt, and what it most often means.

Symptoms & signs

  • Groin pain on walking, standing up or getting in and out of a car.
  • Stiffness, making it hard to put on socks and shoes or cut toenails.
  • A limp, or needing to hold a rail on stairs.
  • Pain lying on the outer hip at night, typical of gluteal tendon problems.
  • Pain felt in the thigh or knee rather than the hip.

Causes & risk factors

  • Osteoarthritis: the most common cause of hip pain from middle age onwards.
  • Gluteal tendinopathy and bursitis: common in women over 40, and after changes in activity.
  • Hip impingement and labral tears: in younger, active adults.
  • Avascular necrosis (loss of blood supply to the ball): linked to long-term steroid use and heavy alcohol use.
  • Back problems that refer pain to the buttock and hip.

When to see a doctor

  • A fall followed by hip or groin pain and difficulty standing or walking: this may be a fracture, even if you can take some steps.
  • Fever with a hot, very painful hip.
  • A child with a limp or hip pain, especially with fever: seek same-day assessment.
  • Sudden severe groin pain in someone taking long-term steroids or drinking heavily.
  • Unexplained weight loss, a history of cancer, or severe night pain.

How it’s diagnosed

Examination of how the hip moves, where it hurts and how you walk usually points to the cause, together with an examination of the back.

A standing X-ray of the pelvis shows arthritis clearly. MRI is used for suspected avascular necrosis, a hidden (occult) fracture, or tendon and cartilage problems when the diagnosis is unclear.

Treatment options

  • Exercise: strengthening the hip and thigh muscles is a core treatment for hip arthritis and for gluteal tendon pain.
  • Weight management: even modest weight loss reduces the load through the hip with every step.
  • Pain relief: simple painkillers or anti-inflammatories if suitable; a walking stick in the opposite hand can ease a painful hip.
  • Gluteal tendon pain: load management, specific strengthening, and avoiding crossing the legs or lying on the painful side. A steroid injection gives short-term relief for some.
  • Hip replacement: considered when arthritis pain, stiffness and reduced function keep affecting quality of life despite non-surgical treatment. It is one of the most successful operations in medicine.

How VinayakM helps

At VinayakM, hip pain starts with finding where it really comes from: the joint, the tendons or the back.

  • An orthopaedic assessment, with X-ray or MRI as needed, and an honest opinion on whether and when replacement makes sense.
  • A strengthening programme with our physiotherapist, and preparation before surgery if you are heading for a replacement.
  • Weight management with our dietitian where it will genuinely help the joint.

Prevention & self-care

  • Stay active with low-impact exercise: walking, cycling and swimming.
  • Keep the hip and thigh muscles strong.
  • Maintain a healthy weight.
  • Avoid long-term steroid tablets unless medically necessary, and limit alcohol.

Frequently asked questions

Is my pain from the hip or the back?

Groin pain usually comes from the hip joint; buttock pain often comes from the back. A careful examination of both is the best way to tell.

Can exercise really help hip arthritis?

Yes. Strengthening exercise is a core treatment in international guidelines. It reduces pain and improves function for many people, and it prepares the hip well if surgery is needed later.

When should I consider a hip replacement?

When pain, stiffness and reduced mobility keep limiting your daily life despite exercise, weight management and pain relief. The decision is yours, made with your surgeon, based on how the hip affects your life rather than a scan score.

How long does a hip replacement last?

Most modern hip replacements last many years, and a large majority are still working well 15 to 20 years later.

Why does my hip hurt when I lie on my side?

Pain on the outside of the hip at night is typical of gluteal tendon pain. Placing a pillow between the knees and avoiding lying on the painful side often helps.

Related reading

References

  1. National Health Service (NHS). Hip pain. — https://www.nhs.uk/symptoms/hip-pain/
  2. National Institute for Health and Care Excellence (NICE). Osteoarthritis in over 16s: diagnosis and management. NICE guideline NG226. — https://www.nice.org.uk/guidance/ng226
  3. National Institute for Health and Care Excellence (NICE). Joint replacement (primary): hip, knee and shoulder. NICE guideline NG157. — https://www.nice.org.uk/guidance/ng157
  4. Berry DJ, Lieberman JR (eds). Surgery of the Hip. 2nd ed. Elsevier; 2020. (textbook, consulted for background)
  5. Blom A, Warwick D, Whitehouse M (eds). Apley and Solomon’s System of Orthopaedics and Trauma. 10th ed. CRC Press; 2018. (textbook, consulted for background)
  6. Azar FM, Beaty JH, Canale ST (eds). Campbell’s Operative Orthopaedics. 13th ed. Elsevier; 2017. (textbook, consulted for background)

Written in our own words. Textbooks were used as background reading and are cited; no text, figures or tables have been reproduced from them.

This page is for general information and education only. It is not a substitute for a consultation, diagnosis or treatment from a qualified clinician. If you have any of the red-flag symptoms above, seek medical care promptly.

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