Symptoms of Hip Osteoarthritis
Primary Pain Location
The hallmark symptom of hip osteoarthritis is groin pain that is exacerbated by activity and relieved by rest, with progressive worsening over time. 1, 2
- Groin pain is the most common presenting symptom, occurring in 89-95% of patients with hip OA 3, 4
- Pain with internal rotation of the hip during physical examination is highly characteristic and often reproduces the patient's symptoms 1, 5
- The pain typically follows a mechanical pattern: worse with weight-bearing activities, climbing stairs, or walking up slopes, and better with rest 1, 2
Pain Distribution Patterns
Hip OA pain frequently radiates beyond the groin to multiple locations:
- Greater trochanter area: 77% of patients 4
- Buttock: 38-53% of patients 3, 4
- Anterior/lateral thigh: 33-42% of patients 3, 4
- Knee: 17-29% of patients (referred pain) 3, 4
- Lower leg: 8-15% of patients 3, 4
- Low back: 17% of patients 3
Importantly, no patients with hip OA present with pain exclusively in the knee or lower leg—groin or hip region pain is always present. 4 This is a critical diagnostic point to avoid missing hip pathology when patients complain of knee or thigh pain.
Associated Symptoms
Beyond pain location, patients experience:
- Stiffness: Brief morning stiffness or inactivity stiffness (typically less severe than inflammatory arthritis) 6, 2
- Functional limitations: Difficulty with activities like putting on shoes/socks, getting in/out of cars, walking distances 6, 2
- Joint dysfunction: Reduced range of motion, particularly internal rotation and adduction 5
- Bony enlargement: May be palpable on examination 2
Physical Examination Findings
Key examination findings that support the diagnosis:
- Pain with passive internal rotation: Sensitivity 66%, specificity 79%, positive LR 3.2 5
- Decreased passive hip adduction: Sensitivity 80%, specificity 81%, positive LR 4.2 5
- Groin pain on passive abduction or adduction: Sensitivity 33%, specificity 94%, positive LR 5.7 5
- Abductor weakness: Sensitivity 44%, specificity 90%, positive LR 4.5 5
- Squat causing posterior pain: Sensitivity 24%, specificity 96%, positive LR 6.1 5
Normal passive hip adduction is the most useful finding to rule out hip OA (negative LR 0.25). 5
Important Clinical Caveats
- Poor correlation exists between radiographic severity and symptom intensity—patients with severe X-ray changes may have minimal symptoms and vice versa 1
- Hip OA symptoms can mimic or coexist with lumbar spine pathology, sacroiliac joint dysfunction, or femoroacetabular impingement syndrome 1
- Patients with polyarticular hip OA are at increased risk for knee OA and generalized OA at other sites 6
- The disease course is progressive, with patients becoming more sedentary, leading to increased comorbidities and 20% higher age-adjusted mortality 2