What coxarthrosis is and why it hurts
Hip osteoarthritis, or coxarthrosis, is a process in which the whole joint changes – the cartilage, the bone beneath it, the joint capsule and the surrounding muscles. It is not simply the hip “wearing out” like a tyre. The joint responds to load throughout life, and whether it hurts depends not only on how the cartilage looks, but also on muscle strength, activity level, body weight and sleep.
The typical picture is pain in the groin, stiffness after the night and after sitting for a long time, and a gradual loss of mobility – first of internal rotation, later of flexion. The symptoms usually come in waves: better weeks alternate with worse ones, often after a sudden increase in activity.
A common response to pain is to cut down on movement – shorter walks, giving up cycling, avoiding stairs. In the short term this brings relief, but in the longer run the muscles weaken, the range of motion shrinks and the hip copes less well with everyday loads. That is why the aim of treatment is not to spare the joint, but to restore its tolerance to movement.
Assessment and what an X-ray tells you
In a person over 45 with typical symptoms, the diagnosis is based mainly on the history and examination. An X-ray can be useful, but the degree of change on the image says little about how much the hip will hurt and what it will be able to cope with. So we check the range of motion, strength, gait and the everyday activities that give you difficulty.
An important part of the assessment is ruling out other sources of pain. Pain on the outer side of the hip comes more often from the gluteal tendons than from the joint – we describe this in more detail on the hip pain page. Pain in the buttock and thigh, on the other hand, can be referred from the lumbar spine.
Exercise, education and body weight – first-line treatment
Current guidelines on osteoarthritis agree: the first step is education and exercise and, if you are overweight, weight loss. Only when that is not enough are further methods considered. In practice this means a medical training programme carried out regularly for at least several weeks and then continued on your own: strengthening the glutes and thighs, balance exercises, work on range of motion and aerobic activity that you enjoy.
There is no need to avoid pain at all costs. Moderate discomfort during exercise is acceptable as long as you are no worse than usual the next day. Manual therapy can bring relief and make movement easier, but without exercise its effect is short-lived. Most people notice the first improvement after a few weeks of regular work.
If you are overweight, losing weight reduces the forces acting on the joint with every step and makes exercise easier. For the hip its effect on pain is less pronounced than for the knee, but combined with training it helps improve function and fitness. Walking, a stationary bike and exercise in water are good additions.
When to see an orthopaedic surgeon and how to keep the results
If, despite consistent conservative treatment, the pain wakes you at night and walking and everyday activities are clearly limited, it is worth consulting an orthopaedic surgeon, who will assess whether surgery is indicated. That is a decision for the doctor and the patient – our role is to give an honest assessment of what treatment through movement has achieved.
For most people the goal is a hip that works well day to day: strength exercises two or three times a week, walking, cycling or swimming, and sensible dosing of load in the worse weeks. It is worth checking your progress every few months and increasing the exercise load – muscles that stop getting a stimulus lose strength quickly. We set out the details at the visit.