What are the characteristic symptoms and pain descriptions for hip osteoarthritis?

Characteristic Symptoms and Pain Descriptions for Hip Osteoarthritis

Hip osteoarthritis typically presents with groin pain that radiates to the buttock or thigh, worsens with activity, and improves with rest, accompanied by only brief morning stiffness (less than 30 minutes). 1, 2

Primary Pain Location and Distribution

The most common pain locations in hip OA patients are:

• Greater trochanter area (77% of patients) - the most frequently affected site 3
• Groin area (53% of patients) - often considered the hallmark location for hip OA 1, 3
• Anterior/lateral thigh (42% of patients) - pain commonly radiates down the front or side of the thigh 3
• Buttock area (38% of patients) - posterior radiation is common 3
• Knee (17% of patients) and lower leg (15%) - referred pain can extend distally, though no patients have pain exclusively in these areas 3

Pain Characteristics

The pain is mechanical in nature, meaning it follows a predictable pattern:

• Activity-related pain - worsens with weight-bearing activities like walking, climbing stairs, or squatting 1, 2, 4
• Rest provides relief - pain typically improves with rest, distinguishing it from inflammatory arthritis 1, 2
• Progressive worsening over time - symptoms begin gradually and increase slowly but progressively 4
• Variable severity - pain intensity fluctuates and may initially present as self-limiting episodes before becoming more constant 4

Stiffness Pattern (Critical Distinguishing Feature)

• Brief morning stiffness - typically lasts less than 30 minutes, which is a key feature distinguishing OA from inflammatory arthritis 2, 4
• Inactivity stiffness - patients experience stiffness after prolonged sitting that resolves quickly with movement 4

Physical Examination Findings That Reproduce Pain

Pain with internal rotation of the hip is the most characteristic examination finding, often reproducing the patient's symptoms:

• Internal rotation restriction and pain - sensitivity 66%, specificity 79%, positive likelihood ratio 3.2 1, 5
• Decreased passive hip adduction - sensitivity 80%, specificity 81%, positive likelihood ratio 4.2 5
• Groin pain on passive abduction or adduction - sensitivity 33%, specificity 94%, positive likelihood ratio 5.7 5
• Squat causing posterior pain - sensitivity 24%, specificity 96%, positive likelihood ratio 6.1 5
• Abductor weakness - sensitivity 44%, specificity 90%, positive likelihood ratio 4.5 5

Associated Symptoms

• Functional limitations - difficulty with activities of daily living, reduced walking distance, and impaired capacity for valued activities like exercise or dancing 2, 4
• Joint crepitus - grinding or clicking sensations with movement 4
• Progressive loss of range of motion - particularly internal rotation and adduction 2, 5
• Bony enlargement - may be palpable on examination 2

Important Clinical Pitfalls

Poor correlation exists between radiographic severity and pain intensity - patients with severe radiographic changes may have minimal symptoms and vice versa 4. This means imaging alone should never determine the diagnosis or treatment plan 6.

Differential diagnosis is essential because several conditions mimic hip OA:

• Lumbar spine pathology - can refer pain to the hip region and must be systematically screened 6, 7
• Sacroiliac joint dysfunction - may present with similar pain patterns 7
• Femoroacetabular impingement (FAI) syndrome - typically affects younger, more active patients with groin pain 6, 1
• Labral tears - present with similar groin pain radiating to the buttock 1

Age and Risk Factor Context

• Typical age of presentation is over 40 years, with 33% of individuals older than 75 years having symptomatic and radiographic knee OA (similar prevalence for hip) 2, 4
• Female sex, obesity, genetics, and prior major joint injury are significant risk factors 2
• No pain exclusively in the knee or lower leg - if pain is isolated to these areas without proximal hip symptoms, consider alternative diagnoses 3

Diagnostic Approach

Imaging is not required for diagnosis when typical clinical features are present - the combination of characteristic pain pattern, age over 40, brief morning stiffness, and positive examination findings allows confident clinical diagnosis 6. However, when imaging is indicated, anteroposterior pelvis and lateral femoral head-neck radiographs are the first-line studies 6, 1.