Prefer to watch? 4-minute lesson13 slides · same content, shorter

1 · SNAPSHOT

Hip Osteoarthritis body chart — Illustrative, not diagnostic. Canva body chart for Hip Osteoarthritis.

Who: Over about fifty, or post-traumatic.
What: Osteoarthritis of the hip joint.
How it behaves: Gradual groin, buttock or thigh ache. Stiffness in the morning or after inactivity. Pain with walking, stairs, and getting in and out of the car. Eased by rest and heat.

The one thing to take from this page:

Function, not X-ray, dictates management. Exercise and education are first-line in every guideline that exists — and for this pattern, unusually, one of those guidelines is Australian.

Where you actually are on the ladder

Stage	What it means
Mild–moderate	Exercise and education. First-line, everywhere
Not progressing	Review the dose, the adherence, the comorbidities — and what else is going on. Adjuncts sit here, added to exercise
Severe, function lost	The surgical conversation. A randomised trial found replacement produced greater improvement than resistance training at this end

✅ An Australian guideline exists — the RACGP knee and hip osteoarthritis guideline. We haven't read it — it is named so you use the local document, not as a source.

2 · SE — THE SUBJECTIVE PATTERN (the 70%)

Five stages, in your course's order. The subjective does most of the work, and the function questions are the ones that decide management.

MAIN PROBLEM

"My groin aches when I walk."
"Getting out of the car is the worst."
"It's stiff first thing, then it eases."

BODY CHART

Groin, buttock, or thigh. Anterior thigh referral is common and gets mistaken for a quad or hamstring problem.
Knee pain can be hip pain. Mark the knee, then examine the hip.
Lateral hip separately — gluteal tendinopathy coexists often.
Below the knee, or dermatomal? That opens the lumbar question.

BEHAVIOUR

	Fits hip OA	Points elsewhere
Aggs	Walking, stairs, in and out of the car, standing	Deep flexion pinch in a young hip → FAI syndrome
Stiffness	Morning, and after inactivity, easing with movement	Prolonged, with systemic symptoms → inflammatory
Eases	Rest, heat, movement in the middle	Nothing eases it → screen
Severity	VAS 0–10 at best / at worst / right now	—
Night	Sore after a big day	Constant night pain → screen
Course	Slow, over years	Fast decline over months → rapidly progressive OA, or something else

HISTORY — and this is where management is decided

What can't they do now that they could? This is the outcome you will track.
Walking distance, stairs, shoes and socks, getting in and out of the car.
Current activity — and what they've stopped.
Comorbidities: weight, sleep, systemic inflammation, diabetes, cardiovascular. They are part of the plan.
What have they been told about their X-ray? Usually the barrier.

SPECIAL / SCREENING QUESTIONS

Night pain, rest pain, weight loss, cancer history?
Any sudden change in function — a step off a kerb, a stumble, then unable to weight-bear? That is a fragility fracture question in an older pelvis.
Fever, unwell, a hot hip?
Any inflammatory features — prolonged morning stiffness, other joints, skin, eyes, bowel?

Assessing this region? Download the Hip & Groin assessment template →

3 · HYPOTHESIS RANKING

Competing pattern	The one discriminating feature
FAI syndrome	Younger, motion-related pinch with deep flexion, morphology on imaging. Same joint, not simply an earlier stage: in adults 55 and over, cam morphology was linked to new radiographic hip OA but not to new clinical hip OA [20].
Gluteal tendinopathy (GTPS)	Lateral hip pain over the greater trochanter, worse lying on that side. Coexists often.
Lumbar referral	Buttock and posterior thigh dominant, lumbar behaviour, and hip range is preserved.
Inflammatory arthritis	Prolonged morning stiffness, other joints, systemic features.

The two that outrank the table

Fragility fracture of the pelvis, in an older patient. A sudden change in function, weight-bearing pain, and a story that doesn't fit years of slow decline. It has been described as initially diagnosed as hip osteoarthritis.

Rapidly progressive hip osteoarthritis. Functional decline over months rather than years. If the trajectory is wrong, the label is wrong — or it isn't the whole story.

And the framing error that costs the most

Transferring knee osteoarthritis knowledge to the hip. There is a paper written specifically on how the two differ [1]. The location, the examination, the stiffness conventions and the surgical picture are all different — and the knee's morning-stiffness cut-off is not carried over here.

4 · RED FLAGS — DON'T MISS THIS

This section is free, on every pattern, forever. Safety is never gated.

Finding	What it suggests	What you do
Sudden functional change, unable to weight-bear, older patient	Fragility fracture of the pelvis or hip	Image
Night pain or rest pain, unrelieved	Malignancy, infection	Medical review
Cancer history with new hip pain	Metastatic disease	Medical review
Unexplained weight loss, fever, unwell	Infection, systemic disease	Medical review
Hot, swollen, exquisitely painful hip	Septic arthritis	Emergency
Rapid functional decline over months	Rapidly progressive OA, avascular necrosis, malignancy	Image and refer
Prolonged morning stiffness with other joints involved	Inflammatory arthritis	Medical review
Recent corticosteroid injection then rapid decline	Rapidly progressive OA	Medical review

The rule: slow, load-related groin and thigh pain with capsular restriction and a clean systemic screen is yours. A sudden change, a fast decline, night pain, systemic symptoms or an inflammatory pattern is not.

Cross-links: Femoroacetabular impingement · Gluteal tendinopathy · Hip labral tear · Knee osteoarthritis

Members

The 4-minute lesson is for members

Twelve slides on this pattern: what you'll hear, what to examine, what to do. Free with an account.

Guideline anchor

An Australian guideline exists for this one — the RACGP Guideline for the management of knee and hip osteoarthritis (2nd edn, 2018).

It is not indexed in our citation checker, so it is named as the local anchor and carried in citations_unverified rather than cited with a PMID. International anchors, all verified: OARSI non-surgical management (Bannuru et al. 2019, PMID 31278997), EULAR non-pharmacological core management (Moseng et al. 2024, PMID 38212040), AAOS clinical practice guideline (Hannon et al. 2024, PMID 38781351), and the JOSPT Hip Pain and Mobility Deficits revision (Koc TA et al. 2025, PMID 41165671).

PubMed Source

The Australian document is unsighted — it is named because it exists and should be the local reference, not because this page has read it. The ACSQHC Osteoarthritis of the Knee Clinical Care Standard covers the knee only and does not apply here. Everything cited with a PMID on this page is international.

Members

The evidence summary is for members

Verified diagnostic accuracy, where the evidence stands and what it doesn't settle. Free with an account.

Sources · 20

Show

Every source on this page resolves and title-verifies against PubMed. Newest first.

2022Hall et al. (2022). How does hip osteoarthritis differ from knee osteoarthritis?. Osteoarthritis and cartilage, 30(1), 32-41. https://doi.org/10.1016/j.joca.2021.09.010
2023Mourad & Vande Berg (2023). Osteoarthritis of the hip: is radiography still needed?. Skeletal radiology, 52(11), 2259-2270. https://doi.org/10.1007/s00256-022-04270-8
2026Hall et al. (2026). Exercise for osteoarthritis of the hip. The Cochrane database of systematic reviews, 7(7), CD007912. https://doi.org/10.1002/14651858.CD007912.pub3
2019Bannuru et al. (2019). OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis. Osteoarthritis and cartilage, 27(11), 1578-1589. https://doi.org/10.1016/j.joca.2019.06.011
2024Moseng et al. (2024). EULAR recommendations for the non-pharmacological core management of hip and knee osteoarthritis: 2023 update. Annals of the rheumatic diseases, 83(6), 730-740. https://doi.org/10.1136/ard-2023-225041
2024Hannon et al. (2024). American Academy of Orthopaedic Surgeons Clinical Practice Guideline Summary Management of Osteoarthritis of the Hip. The Journal of the American Academy of Orthopaedic Surgeons, 32(20), e1027-e1034. https://doi.org/10.5435/JAAOS-D-24-00420
2025Nandi et al. (2025). 2023 American Academy of Orthopaedic Surgeons Management of Osteoarthritis of the Hip Evidence-Based Clinical Practice Guideline: Case Studies. The Journal of the American Academy of Orthopaedic Surgeons, 33(4), e220-e223. https://doi.org/10.5435/JAAOS-D-24-00427
2025Koc TA et al. (2025). Hip Pain and Mobility Deficits-Hip Osteoarthritis: Revision 2025. The Journal of orthopaedic and sports physical therapy, 55(11), CPG1-CPG31. https://doi.org/10.2519/jospt.2025.0301
2024Kjeldsen et al. (2024). Progressive Resistance Training or Neuromuscular Exercise for Hip Osteoarthritis : A Multicenter Cluster Randomized Controlled Trial. Annals of internal medicine, 177(5), 573-582. https://doi.org/10.7326/M23-3225
2023Teirlinck et al. (2023). Effect of exercise therapy in patients with hip osteoarthritis: A systematic review and cumulative meta-analysis. Osteoarthritis and cartilage open, 5(1), 100338. https://doi.org/10.1016/j.ocarto.2023.100338
2016Bartels et al. (2016). Aquatic exercise for the treatment of knee and hip osteoarthritis. The Cochrane database of systematic reviews, 3(3), CD005523. https://doi.org/10.1002/14651858.CD005523.pub3
2022Runge et al. (2022). The Benefits of Adding Manual Therapy to Exercise Therapy for Improving Pain and Function in Patients With Knee or Hip Osteoarthritis: A Systematic Review With Meta-analysis. The Journal of orthopaedic and sports physical therapy, 52(10), 675-A13. https://doi.org/10.2519/jospt.2022.11062
2022French et al. (2022). Adjunctive therapies in addition to land-based exercise therapy for osteoarthritis of the hip or knee. The Cochrane database of systematic reviews, 10(10), CD011915. https://doi.org/10.1002/14651858.CD011915.pub2
2023Weng et al. (2023). Comparative efficacy of exercise therapy and oral non-steroidal anti-inflammatory drugs and paracetamol for knee or hip osteoarthritis: a network meta-analysis of randomised controlled trials. British journal of sports medicine, 57(15), 990-996. https://doi.org/10.1136/bjsports-2022-105898
2025Pereira et al. (2025). Effectiveness and safety of intra-articular interventions for knee and hip osteoarthritis based on large randomized trials: A systematic review and network meta-analysis. Osteoarthritis and cartilage, 33(2), 207-217. https://doi.org/10.1016/j.joca.2024.08.014
2024Marriott et al. (2024). Are the Effects of Resistance Exercise on Pain and Function in Knee and Hip Osteoarthritis Dependent on Exercise Volume, Duration, and Adherence? A Systematic Review and Meta-Analysis. Arthritis care & research, 76(6), 821-830. https://doi.org/10.1002/acr.25313
2023Holden et al. (2023). Moderators of the effect of therapeutic exercise for knee and hip osteoarthritis: a systematic review and individual participant data meta-analysis. The Lancet. Rheumatology, 5(7), e386-e400. https://doi.org/10.1016/S2665-9913(23)00122-4
2024Frydendal et al. (2024). Total Hip Replacement or Resistance Training for Severe Hip Osteoarthritis. The New England journal of medicine, 391(17), 1610-1620. https://doi.org/10.1056/NEJMoa2400141
2023Fan et al. (2023). The prevalence of hip osteoarthritis: a systematic review and meta-analysis. Arthritis research & therapy, 25(1), 51. https://doi.org/10.1186/s13075-023-03033-7
2023Runhaar et al. (2023). Risk Factors and Population-Attributable Fractions for Incident Hip Osteoarthritis. HSS journal : the musculoskeletal journal of Hospital for Special Surgery, 19(4), 407-412. https://doi.org/10.1177/15563316231192461

Mapped to this pattern

Generic measures that also apply

Did this page do its job?

CliniStudy is in beta. One tap is enough — it decides what gets fixed first.