What Are the Symptoms and Stages of Hip Osteoarthritis?
Hip osteoarthritis is the gradual wearing of the cartilage inside your hip joint. The earliest signs are usually a deep ache in the groin or front of the thigh, stiffness first thing in the morning, and difficulty with movements like putting on shoes. It progresses through mild, moderate and severe stages, and a standing X-ray can show joint changes that a lying-down scan may miss.
Key takeaways
- Groin or thigh ache, morning stiffness and reduced range of movement are the hallmark early signs of hip arthritis.
- The condition moves through mild, moderate and severe stages, each with different impacts on daily life.
- Lying-down imaging relaxes the joint and can understate how much space has been lost. Standing imaging shows your hip under real load.
- ScanAlign is a diagnostic clinic. It provides the imaging your specialist needs, not treatment itself.
- If you have sudden severe hip pain, leg weakness, or loss of bladder or bowel control, seek urgent medical attention (GP, 111 or A&E).
Hip osteoarthritis is the most common form of arthritis in the hip. The smooth cartilage that cushions the ball (femoral head) and socket (acetabulum) wears down over time. Bone may rub on bone, small bony growths called osteophytes can form, and the joint space narrows.
The condition is not the same as a sudden injury. It develops slowly, often over years, and many people put up with it long before seeking an answer. Understanding the symptoms and stages helps you have a clearer conversation with your clinician, and clearer imaging helps your clinician plan the right next step.
What does arthritis in the hip feel like?
Hip arthritis symptoms usually start with a dull, deep ache rather than a sharp pain. The discomfort is most often felt in the groin, front of the thigh or buttock, though it can also refer to the knee. Many people notice it after sitting for a long time or when getting out of a car.
A deep, nagging ache in the groin or front of the thigh, often worse after activity.
The joint feels stiff when you wake or after sitting. It usually eases within 30 minutes of moving.
Trouble rotating the leg inwards, crossing your legs, or reaching down to tie a shoe.
You may start to limp, lean to one side, or shorten your stride without realising it.
Some people also hear or feel a grinding sensation in the joint. Pain at night, especially when lying on the affected side, is common in later stages. If your hip pain is affecting how you walk, it may be changing the load on your knee, pelvis and lower back too. This idea of hip pain and alignment is important, because your body compensates as a whole chain.
What are the stages of hip osteoarthritis?
Hip osteoarthritis is generally described in three broad stages: mild, moderate and severe. These are based on the amount of cartilage loss, the size of bony changes, and the impact on daily life.
Mild (early) stage
Cartilage begins to thin, but the joint space is only slightly reduced. You might notice stiffness in the morning or a dull ache after a long walk. Standard X-rays taken lying down may look almost normal at this point, because the joint is unloaded and the gap appears wider than it truly is under your body weight.
Moderate stage
The cartilage is noticeably thinner. Osteophytes (small bony spurs) start to form around the rim of the joint. Pain becomes more frequent and predictable, appearing during everyday tasks like climbing stairs or getting out of a chair. You may notice your hip cannot rotate as far as it used to.
Severe (advanced) stage
Little or no cartilage remains and the joint is described as "bone on bone." Pain can be constant, including at rest and at night. Walking distance drops significantly and limping is common. This is the stage where a surgeon may discuss hip replacement explained as an option.
What causes hip osteoarthritis?
There is rarely a single cause. Hip osteoarthritis usually develops from a mix of factors over many years.
Cartilage naturally thins as you get older, especially after 50.
A family history of osteoarthritis raises your risk.
Conditions like hip impingement (FAI) or hip dysplasia in adults change how forces pass through the joint.
A fracture or significant soft-tissue injury can accelerate cartilage loss in that hip.
Excess body weight increases the load through the hip with every step, and physically demanding occupations or high-impact sports over many years can add to the cumulative stress. Importantly, a hip joint that is slightly out of alignment may wear unevenly for decades before symptoms appear.
How does a standing X-ray help assess hip arthritis?
A standing X-ray shows your hip joint under your actual body weight, which is exactly how it works in real life. When you lie down for a standard X-ray, CT or MRI, gravity is removed, the muscles relax, and the joint space can appear wider than it truly is. This means early or moderate narrowing may be understated.
When you stand, your full body weight compresses the hip joint. The image captures the true joint space, any tilt in the pelvis, and how the hip relates to the knee and spine above and below. This gives your clinician a realistic picture of the wear pattern.
Lying flat removes gravity. The femoral head settles differently in the socket, muscles relax, and the pelvis may level out. The resulting image can make the joint gap look larger than it is when you are on your feet, potentially understating the stage of arthritis.
EOS is a low-dose standing imaging system that captures your full skeleton from head to feet in a single scan. It uses about 90% less radiation than a standard X-ray, around ten times less. Because it sees the whole chain, it can show whether a pelvic tilt, a leg-length difference, or spinal alignment is placing extra stress on one hip. ScanAlign standing EOS imaging at 19 Harley Street provides this type of assessment for self-referred adults.
Wondering whether a standing scan could give you a clearer picture? Talk to our radiographer at no cost.
Book a free video consultationWhat can be done about hip osteoarthritis?
Management depends on the stage and how it affects your daily life. ScanAlign is a diagnostic imaging clinic, so it provides the imaging your clinician needs to plan the right approach. It does not offer treatment itself. Common approaches recommended by clinicians include:
- Staying active. Low-impact exercise like swimming, cycling and walking helps keep the joint mobile and the surrounding muscles strong.
- Physiotherapy. A structured programme can improve strength, flexibility and reduce pain.
- Weight management. Reducing load on the joint slows progression and eases discomfort.
- Pain management. Your GP or specialist may recommend medication or injections to manage symptoms.
- Surgery. When the joint is severely worn and other approaches have not helped enough, hip replacement is a well-established option.
The key is knowing exactly where you stand. A clear image that shows the true stage of wear, alongside the alignment of your whole lower limb and pelvis, helps your clinician recommend the right step at the right time. You can book a standing hip scan without a GP referral.
When is MRI more useful? EOS shows bones, joints and alignment brilliantly. For soft tissue, discs, the labrum inside the hip, or nerves, MRI is usually the better tool. If your clinician suspects a labral tear or soft-tissue problem alongside arthritis, they may recommend MRI as well.
- Have ongoing hip or groin pain with no clear diagnosis
- Want to understand the stage of known arthritis before deciding on next steps
- Need pre-surgical imaging showing your hip under load
- Have been told you have a leg-length difference or pelvic tilt
- Have sudden, severe hip pain after a fall or injury
- Notice numbness, weakness or loss of bladder or bowel control
- Have a fever alongside joint pain and swelling
- Cannot weight-bear at all
Frequently asked questions about hip osteoarthritis
The earliest signs are usually a dull ache in the groin or front of the thigh, stiffness in the morning that eases within about 30 minutes, and difficulty with movements like rotating your leg inward or putting on socks and shoes.
Yes. The hip and knee share nerve pathways, so hip arthritis can refer pain to the knee. A change in how you walk because of hip pain can also put extra stress on the knee joint. A full standing image helps show whether the knee pain is linked to the hip.
Diagnosis is usually based on your symptoms, a physical examination, and imaging. X-rays show joint space narrowing, osteophytes and bone changes. A standing X-ray shows these features under real body weight, giving a more accurate picture of the wear.
When you lie down, gravity is removed and the hip joint is unloaded. The joint space can look wider than it really is. A standing image captures the joint under your actual body weight, showing the true gap and any pelvic tilt or leg-length difference affecting the hip.
No. ScanAlign accepts self-referrals. You can book a free video consultation with our radiographer directly, with no GP letter needed.
EOS uses about 90% less radiation than a standard X-ray, around ten times less. It captures a full standing image from head to feet in one low-dose pass.
Cartilage that has worn away cannot regrow. However, symptoms can be managed well with exercise, physiotherapy and weight management. Knowing the true stage of wear helps your clinician recommend the right approach at the right time.
Hip impingement (femoroacetabular impingement, or FAI) is a shape issue where extra bone on the ball or socket causes pinching. Over time, impingement can damage the cartilage and lead to arthritis. They are related but not the same condition.
Pricing depends on the scan package. You can find current costs on the ScanAlign FAQs page. The initial video consultation is free.
Hip replacement is generally considered when pain significantly limits your daily activities and other approaches have not provided enough relief. There is no single threshold. Your surgeon will use clinical assessment and clear imaging to help you decide.
See your hip under real load
A free video consultation with our specialist radiographer can help you decide whether a standing scan is the right next step.
Book a free video consultationSources
- National Institute for Health and Care Excellence (NICE). Osteoarthritis: care and management. Clinical guideline CG177, updated 2022.
- Arthritis Research UK (now Versus Arthritis). Osteoarthritis of the hip information booklet.
- Illés T, Somoskeöy S. The EOS imaging system and its uses in daily orthopaedic practice. International Orthopaedics. 2012;36(7):1405-1411.
Written by Abbas Dhami (Specialist Diagnostic Radiographer)
This page is general information and not a diagnosis.
ScanAlign is the trading name of CoreMed Solutions Ltd and operates under The Harley Street Hospital's CQC licence.