Yes, osteoarthritis absolutely causes groin and hip pain—this is the classic presentation.
Groin pain is the hallmark symptom of hip osteoarthritis, occurring in the majority of patients, though pain can also radiate to the lateral hip, buttock, thigh, and even below the knee. 1
Typical Pain Patterns in Hip OA
The most common pain locations in hip OA patients are:
- Groin area (53% of patients) - This is the most specific location for hip OA 2
- Greater trochanter/lateral hip (77% of patients) 2
- Anterior/lateral thigh (42% of patients) 2
- Buttock (38% of patients) 2
Groin pain has 84.3% sensitivity and 70.3% specificity for hip dysfunction, making it a reliable indicator 3. When examining patients, internal rotation of the hip that reproduces groin or hip pain is highly suggestive of hip OA 1, 4.
Important Clinical Pitfall: Pain Below the Knee
Hip OA commonly causes pain radiating below the knee (47% of cases), following the saphenous nerve distribution 3. This is frequently misunderstood—88.5% of orthopaedic trainees incorrectly believe hip pain does not radiate below the knee 3. This misconception leads to misdiagnosis, with patients sometimes undergoing unnecessary knee interventions (including total knee arthroplasty) when the actual problem is hip OA 5.
Physical Examination Findings
The most useful findings for identifying hip OA include:
- Decreased passive hip adduction (sensitivity 80%, specificity 81%, LR 4.2) 4
- Decreased internal rotation (sensitivity 66%, specificity 79%, LR 3.2) 4
- Groin pain on passive abduction or adduction (sensitivity 33%, specificity 94%, LR 5.7) 4
- Abductor weakness (sensitivity 44%, specificity 90%, LR 4.5) 4
Normal passive hip adduction is most useful for ruling out OA (negative LR 0.25) 4.
Critical Caveat: Radiographic-Clinical Discordance
Only 15-21% of hips with frequent pain show radiographic hip OA, and conversely, only 21-24% of hips with radiographic OA are frequently painful 6. This means you cannot rely solely on radiographs to diagnose or exclude symptomatic hip OA. The clinical presentation (groin pain, limited internal rotation, pain with activity) should guide diagnosis even when radiographs appear normal or only mildly abnormal 6.
Pain intensity, radiographic severity, and functional scores (Oxford Hip Score) do not correlate well with pain distribution patterns 3.