Osteoarthritis of the Hip
What is hip osteoarthritis?
Osteoarthritis (OA) of the hip is a degenerative joint condition in which the articular cartilage covering the femoral head (the ball) and acetabulum (the socket) gradually breaks down, reducing the joint's ability to absorb load and move smoothly. As the cartilage thins and deteriorates, the underlying bone is exposed, bony spurs (osteophytes) form around the joint margins, and the surrounding soft tissues become inflamed and thickened. The result is pain, stiffness, reduced range of motion, and progressive difficulty with walking, stairs, and daily activities.
Hip OA is one of the most common musculoskeletal conditions in Australia, affecting approximately one in ten adults over 45 and becoming increasingly prevalent with age. It is the leading cause of total hip replacement surgery in Australia, with over 50,000 procedures performed annually.
What causes hip osteoarthritis?
Hip OA develops from a combination of factors rather than a single cause. Age is the most significant risk factor — cartilage naturally loses its capacity to repair and regenerate over time. Genetics plays a meaningful role — family history of OA substantially increases individual risk. Being overweight increases the mechanical load on hip cartilage and accelerates breakdown. Previous hip injuries, including labral tears and femoroacetabular impingement (FAI), can predispose the joint to earlier degeneration. Developmental conditions such as childhood hip dysplasia are associated with significantly increased OA risk in adulthood.
The common misconception that OA is simply "wear and tear from too much exercise" is not well supported by evidence. Regular, appropriate exercise is actually protective of joint cartilage — it's the combination of abnormal joint mechanics, loading asymmetries and metabolic factors that drives pathological cartilage breakdown rather than activity itself.
What are the symptoms?
Hip OA typically produces a gradual onset of pain in the groin or front of the thigh — a location that surprises many people who expect hip pain to be felt on the outer hip. Buttock and referred thigh pain are also common. Stiffness is characteristic, particularly in the morning or after sitting for a prolonged period. Range of motion progressively reduces — internal rotation is usually the first movement affected — and activities like putting on shoes and socks, getting in and out of a car, and walking become increasingly difficult as the condition progresses.
Many people with hip OA experience a pattern of episodic flare-ups interspersed with more comfortable periods. Understanding what drives flare-ups — typically overactivity, prolonged inactivity, or changes in load — is as clinically useful as understanding the structural changes in the joint.
How is it diagnosed?
Hip OA is typically diagnosed on clinical examination combined with plain X-ray. X-ray features include joint space narrowing, osteophyte formation, subchondral sclerosis (bony hardening beneath the cartilage) and subchondral cysts. It is worth noting — as with cervical spondylosis — that imaging findings don't always correlate with symptoms. Significant X-ray changes can be present with minimal pain, and meaningful pain can exist before obvious imaging changes appear. The clinical assessment of how the hip moves, what provokes symptoms, and what the functional limitations are is as important as the imaging.
How can physiotherapy and exercise physiology help?
This is where an honest and important point needs to be made: exercise and physiotherapy are among the most evidence-based treatments for hip OA, recommended as first-line management by Arthritis Australia and international clinical guidelines. Exercise does not damage an arthritic hip — it helps maintain cartilage nutrition, builds the muscular support around the joint, reduces pain through neurological mechanisms, and maintains the functional capacity that determines quality of life.
The research is unambiguous: people with hip OA who participate in structured exercise programs have significantly less pain, better function and higher quality of life than those who don't — and this benefit is achieved without accelerating joint degeneration.
Physiotherapy for hip OA focuses on targeted strengthening of the hip abductors, extensors and external rotators — the muscles that control femoral head position in the acetabulum and reduce abnormal joint loading. Gait retraining addresses movement pattern compensations that develop in response to pain and that worsen joint mechanics if left unchecked. Manual therapy to the hip and lumbar spine can improve range of motion and reduce pain in the short term, particularly in earlier-stage OA.
Exercise physiology is increasingly recognised as central to hip OA management — structured, progressive exercise programs that systematically build hip and lower limb strength and aerobic capacity produce durable benefits that outlast any passive treatment. For patients with co-occurring conditions such as obesity, diabetes or cardiovascular disease — which are common in the hip OA population — exercise physiology addresses these simultaneously. Eligible patients may access exercise physiology through a Chronic Disease Management Plan with a GP referral.
Clinical Pilates is particularly well suited to hip OA management — the low-impact, load-controlled environment of reformer-based exercise allows meaningful strengthening without the high joint loads of conventional gym training, and the emphasis on movement quality addresses the compensation patterns that worsen symptoms.
What about hip replacement?
For patients whose hip OA has progressed to the point where conservative management is no longer providing adequate relief — significant rest pain, severe functional limitation, or quality of life substantially affected — total hip replacement surgery is a highly effective option. Physiotherapy plays an important pre-operative role (prehabilitation — building strength and function before surgery improves post-operative outcomes) and a central post-operative rehabilitation role.
Our Exercise Physiologist Ash O'Regan and physiotherapists Eliane Machado and Emma Cameron all have experience in hip OA management.
To book or find out more, call us on 07 3706 3407 or book online below. We see patients from across Brisbane's southside including Tarragindi, Coorparoo, Holland Park, Greenslopes and Mt Gravatt.
Osteoarthritis (OA) of the hip is a degenerative joint condition in which the articular cartilage covering the femoral head (the ball) and acetabulum (the socket) gradually breaks down, reducing the joint's ability to absorb load and move smoothly. As the cartilage thins and deteriorates, the underlying bone is exposed, bony spurs (osteophytes) form around the joint margins, and the surrounding soft tissues become inflamed and thickened. The result is pain, stiffness, reduced range of motion, and progressive difficulty with walking, stairs, and daily activities.
Hip OA is one of the most common musculoskeletal conditions in Australia, affecting approximately one in ten adults over 45 and becoming increasingly prevalent with age. It is the leading cause of total hip replacement surgery in Australia, with over 50,000 procedures performed annually.
What causes hip osteoarthritis?
Hip OA develops from a combination of factors rather than a single cause. Age is the most significant risk factor — cartilage naturally loses its capacity to repair and regenerate over time. Genetics plays a meaningful role — family history of OA substantially increases individual risk. Being overweight increases the mechanical load on hip cartilage and accelerates breakdown. Previous hip injuries, including labral tears and femoroacetabular impingement (FAI), can predispose the joint to earlier degeneration. Developmental conditions such as childhood hip dysplasia are associated with significantly increased OA risk in adulthood.
The common misconception that OA is simply "wear and tear from too much exercise" is not well supported by evidence. Regular, appropriate exercise is actually protective of joint cartilage — it's the combination of abnormal joint mechanics, loading asymmetries and metabolic factors that drives pathological cartilage breakdown rather than activity itself.
What are the symptoms?
Hip OA typically produces a gradual onset of pain in the groin or front of the thigh — a location that surprises many people who expect hip pain to be felt on the outer hip. Buttock and referred thigh pain are also common. Stiffness is characteristic, particularly in the morning or after sitting for a prolonged period. Range of motion progressively reduces — internal rotation is usually the first movement affected — and activities like putting on shoes and socks, getting in and out of a car, and walking become increasingly difficult as the condition progresses.
Many people with hip OA experience a pattern of episodic flare-ups interspersed with more comfortable periods. Understanding what drives flare-ups — typically overactivity, prolonged inactivity, or changes in load — is as clinically useful as understanding the structural changes in the joint.
How is it diagnosed?
Hip OA is typically diagnosed on clinical examination combined with plain X-ray. X-ray features include joint space narrowing, osteophyte formation, subchondral sclerosis (bony hardening beneath the cartilage) and subchondral cysts. It is worth noting — as with cervical spondylosis — that imaging findings don't always correlate with symptoms. Significant X-ray changes can be present with minimal pain, and meaningful pain can exist before obvious imaging changes appear. The clinical assessment of how the hip moves, what provokes symptoms, and what the functional limitations are is as important as the imaging.
How can physiotherapy and exercise physiology help?
This is where an honest and important point needs to be made: exercise and physiotherapy are among the most evidence-based treatments for hip OA, recommended as first-line management by Arthritis Australia and international clinical guidelines. Exercise does not damage an arthritic hip — it helps maintain cartilage nutrition, builds the muscular support around the joint, reduces pain through neurological mechanisms, and maintains the functional capacity that determines quality of life.
The research is unambiguous: people with hip OA who participate in structured exercise programs have significantly less pain, better function and higher quality of life than those who don't — and this benefit is achieved without accelerating joint degeneration.
Physiotherapy for hip OA focuses on targeted strengthening of the hip abductors, extensors and external rotators — the muscles that control femoral head position in the acetabulum and reduce abnormal joint loading. Gait retraining addresses movement pattern compensations that develop in response to pain and that worsen joint mechanics if left unchecked. Manual therapy to the hip and lumbar spine can improve range of motion and reduce pain in the short term, particularly in earlier-stage OA.
Exercise physiology is increasingly recognised as central to hip OA management — structured, progressive exercise programs that systematically build hip and lower limb strength and aerobic capacity produce durable benefits that outlast any passive treatment. For patients with co-occurring conditions such as obesity, diabetes or cardiovascular disease — which are common in the hip OA population — exercise physiology addresses these simultaneously. Eligible patients may access exercise physiology through a Chronic Disease Management Plan with a GP referral.
Clinical Pilates is particularly well suited to hip OA management — the low-impact, load-controlled environment of reformer-based exercise allows meaningful strengthening without the high joint loads of conventional gym training, and the emphasis on movement quality addresses the compensation patterns that worsen symptoms.
What about hip replacement?
For patients whose hip OA has progressed to the point where conservative management is no longer providing adequate relief — significant rest pain, severe functional limitation, or quality of life substantially affected — total hip replacement surgery is a highly effective option. Physiotherapy plays an important pre-operative role (prehabilitation — building strength and function before surgery improves post-operative outcomes) and a central post-operative rehabilitation role.
Our Exercise Physiologist Ash O'Regan and physiotherapists Eliane Machado and Emma Cameron all have experience in hip OA management.
To book or find out more, call us on 07 3706 3407 or book online below. We see patients from across Brisbane's southside including Tarragindi, Coorparoo, Holland Park, Greenslopes and Mt Gravatt.
