Hip arthritis in Adelaide — recognising the symptoms and knowing when to act

Hip pain is common. But not all hip pain is the same, and not all of it improves on its own. For many people, pain that started as a mild ache — easily explained away after a long day on their feet — gradually becomes something that affects sleep, limits walking distance, and makes putting on shoes in the morning a genuine effort.

Hip osteoarthritis is one of the most common causes of this pattern of symptoms in adults over 50. Understanding what it is, how to recognise it, and when to seek specialist input can save months or years of unnecessary limitation.

What is hip osteoarthritis?

The hip is a ball-and-socket joint. The ball (the head of the femur, or thigh bone) sits inside a socket (the acetabulum, part of the pelvis). Both surfaces are covered by articular cartilage — a smooth, resilient tissue that allows the joint to move with minimal friction.

Osteoarthritis occurs when that cartilage gradually breaks down. As the surface wears, the joint loses its smooth gliding motion. Bone may begin to rub on bone. The body’s response — inflammation, the formation of bone spurs (osteophytes), and thickening of the joint capsule — adds to pain and stiffness.

This process happens slowly, typically over years or decades. It is not caused by one specific injury in most people, though previous hip trauma can accelerate it.

Recognising the symptoms

Hip osteoarthritis has a characteristic pattern of symptoms. Recognising it early gives more time to manage it well.

Groin pain

The most telling symptom of hip arthritis is pain felt in the groin — deep inside, roughly where the crease of the hip meets the thigh. Many patients are surprised by this location; they expect hip pain to be felt on the outer side of the hip or in the buttock. While pain can radiate to those areas, true hip joint pain typically starts in the groin. Pain that is purely on the outer hip or running down the side of the thigh is more likely coming from structures around the hip (such as bursae or tendons) than from the joint itself.

Stiffness, especially in the morning

A feeling of tightness or restricted movement when first getting out of bed is a hallmark of inflammatory joint disease, and is also present in osteoarthritis. The stiffness typically eases within 20 to 30 minutes of movement. If stiffness persists for longer than this, it may suggest a different type of arthritis and is worth discussing with a doctor.

Loss of rotation and range of movement

Early hip arthritis often affects internal rotation before other movements. Practically, this shows up in everyday tasks: difficulty crossing legs, trouble getting in and out of low cars, awkwardness putting on socks and shoes, and reduced stride length when walking. Patients often adapt without realising — sitting with one leg turned out, for instance — and are surprised when examined how much range of motion has been lost.

Pain that worsens with activity and eases with rest

In mild to moderate arthritis, pain is typically worse during or after activity and settles with rest. As the condition progresses, pain can start occurring at rest and at night — a sign that the joint has reached a more advanced stage.

A limp or altered gait

The hip abductor muscles on the outer hip work hard to stabilise the pelvis during walking. When the hip is painful, these muscles are inhibited, which produces a characteristic lurch or lean toward the affected side with each step (a Trendelenburg gait). Many patients are unaware they have developed a limp until someone else points it out.

The classic presentation is someone who can’t put their socks on in the morning, gets groin pain on a long walk, and sleeps on their side with a pillow between their knees to get comfortable. By the time they reach the rooms, the pain has often been building for two or three years.

Risk factors

Hip osteoarthritis is not caused by any single factor. Several things increase the likelihood of developing it:

• Age. The incidence rises significantly after 50, though osteoarthritis is not inevitable with ageing — it reflects cumulative wear and individual biology rather than age alone.
• Genetics. Family history plays a meaningful role. If a parent or sibling has had a hip replacement, the risk of developing hip arthritis is higher.
• Previous hip conditions. Developmental dysplasia of the hip, Perthes disease in childhood, and slipped capital femoral epiphysis (SCFE) in adolescence all alter the shape of the joint in ways that accelerate cartilage wear in adulthood.
• Previous hip injury. A fracture around the hip, or significant ligamentous injury, increases long-term arthritis risk.
• Femoroacetabular impingement (FAI). An abnormal shape of the ball, socket, or both can cause abnormal contact during movement, which over time damages the cartilage and labrum and may lead to early arthritis.
• Body weight. Excess weight increases load on the hip joint with every step. It is a modifiable risk factor, and weight reduction can meaningfully reduce symptoms in people with early-to-moderate arthritis.
• Occupation and activity. Prolonged heavy physical work involving repetitive hip loading is associated with earlier arthritis onset.

Non-surgical management

For most people with mild to moderate hip osteoarthritis, the first approach is non-surgical. These treatments do not reverse the arthritis, but they can reduce symptoms, improve function, and slow progression in some cases.

Physiotherapy and exercise

Strengthening the muscles around the hip — particularly the abductors and the hip flexors — reduces the load passing through the joint during walking. A well-designed physiotherapy programme is one of the most evidence-backed interventions for hip arthritis. Low-impact activities such as swimming, cycling, and walking are generally better tolerated than high-impact exercise such as running.

Weight management

For people who are overweight, even modest weight reduction can produce a meaningful reduction in symptoms. The hip joint carries roughly three times body weight during normal walking, so a reduction of 10 kg reduces the load on the joint by approximately 30 kg with each step.

Anti-inflammatory medications

Over-the-counter anti-inflammatory medications (such as ibuprofen or naproxen) can help manage pain and swelling. These should be used at the lowest effective dose and for the shortest time necessary, particularly in older patients or those with kidney, gut, or cardiovascular health concerns. A GP can advise on what is appropriate for an individual’s circumstances.

Corticosteroid injections

An injection of corticosteroid (anti-inflammatory) into the hip joint can provide significant pain relief for weeks to months in some patients. The response varies between individuals, and injections are typically not repeated more than two or three times per year. They are useful as a bridging measure — to manage symptoms while pursuing weight loss or physiotherapy, or while waiting for surgery when the timing is not yet right.

Walking aids

A walking stick, used on the opposite side to the painful hip, reduces load through the joint and can significantly improve walking comfort and distance. Many people are reluctant to use one but find it genuinely helpful when they do.

When conservative treatment stops working

Non-surgical treatment is the right starting point for most people, but it has limits. There are clear signs that a hip has progressed beyond what conservative management can meaningfully address:

• Pain occurring at rest and through the night, consistently disrupting sleep
• Significant reduction in walking distance — unable to manage a supermarket trip or a short block without stopping
• Dependence on opioid analgesia to manage daily pain
• Inability to perform normal daily activities (dressing, driving, working) without significant limitation
• Radiological evidence of advanced joint space narrowing or bone-on-bone contact

At this point, continuing to defer surgical intervention often means accepting unnecessary limitation for months or years. The outcomes of hip replacement surgery are generally better when the patient’s surrounding musculature and bone quality are still in good condition — both of which can deteriorate with prolonged pain and inactivity.

Specialist consultation — what to expect

A GP referral to an orthopaedic surgeon is appropriate when hip pain is significantly affecting daily life and is not responding adequately to non-surgical management. A GP referral is required for Medicare rebate purposes.

At a first specialist consultation for hip arthritis, Dr Mooney will typically:

• Take a detailed history of symptoms — location, onset, pattern, what makes it better or worse
• Examine the hip — range of movement, strength, gait, and relevant provocation tests
• Review X-rays (a standing AP pelvis X-ray is the standard starting point; further imaging may be requested)
• Discuss the findings — what is seen on imaging, what stage the arthritis has reached, and what the options are
• Formulate a plan — this may be to continue non-surgical management with specific modifications, to arrange further imaging or investigations, or to discuss surgical options if the joint has reached an appropriate stage

There is no obligation to proceed with surgery at or after a consultation. Many people find value in understanding the state of their hip even if surgery is not the right option for them at that time.

Surgical options for hip arthritis

When conservative management is no longer providing adequate relief and the joint has reached an advanced stage, hip replacement surgery (total hip arthroplasty) is the most effective and durable treatment for hip osteoarthritis. It is one of the most studied surgical procedures in medicine, with extensive long-term outcome data.

The procedure involves removing the worn ball and socket and replacing them with prosthetic components — typically a metal shell and ceramic or polyethylene liner in the socket, and a metal stem with a ceramic or metal ball in the femur. Modern implants are designed to last 20–25 years based on data from the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR).

Two aspects of surgical planning that significantly influence outcomes are:

• Surgical approach. The direct anterior approach (DAA) accesses the hip from the front without cutting through the gluteal muscles. This is associated with faster early recovery, less post-operative discomfort, and a reduced risk of dislocation compared with traditional posterior or lateral approaches. Dr Mooney uses the direct anterior approach as his standard technique for hip replacement.
• Implant positioning. Precise positioning of the cup and stem is critical to long-term function, durability, and dislocation risk. Robotic-assisted surgery using the MAKO system uses a pre-operative CT scan to build a 3D model of the patient’s individual anatomy and allows real-time verification of implant position during surgery. This technology is available at both Eastwood Private Hospital and Calvary Adelaide Hospital.

Recovery from hip replacement is gradual. Most patients are walking with a frame on the day of surgery and progress to independent walking over the following weeks. Full recovery — including return to recreational activity — typically takes three to six months, though many daily activities are resumed much earlier.

Taking the next step

Hip arthritis is common and manageable. The most important thing is to understand what is happening in the joint and to have an accurate picture of what stage it has reached — because the right treatment at the right time produces significantly better outcomes than waiting until function is severely compromised.

If hip pain is affecting sleep, daily activity, or walking distance, a GP referral for specialist assessment is a reasonable next step. The consultation is informational — it provides clarity on what is happening and what the options are, so that any decision about treatment is made from a position of accurate knowledge rather than uncertainty.