Back Pain Doctor
Hip Osteoarthritis
Written by Dr Joshua Hatch, Musculoskeletal GP, RACGP Fellow, Diploma in Musculoskeletal Medicine (FSEM UK).
Osteoarthritis of the hip — sometimes called “wear-and-tear” arthritis — is common as we age, and the hip is one of the weight-bearing joints most often affected. Over time the smooth articular cartilage that lines the ball-and-socket joint gradually wears and roughens, the space between the bones narrows, and the bone may form spurs (osteophytes). The result is pain and stiffness that tends to build slowly and can make everyday tasks — putting on shoes, rising from a chair, walking a short distance — harder.
Pain is typically felt in the groin or thigh and can spread to the buttock or knee, often worse in the morning or after rest and flaring with activity. There is no cure, but a great deal can be done to manage it: staying active with lower-impact exercise, maintaining a healthy weight to reduce load on the joint, physiotherapy to preserve strength and range of motion, and simple pain relief such as paracetamol or anti-inflammatories where appropriate.
Our role is to confirm the diagnosis, assess how much the hip is affecting your daily life, and build a practical plan focused on keeping you mobile and comfortable. Where symptoms are more advanced, we are honest about the point at which a surgical opinion — usually about hip replacement — becomes worthwhile, and we make sure good rehabilitation remains part of the picture either way.
Common symptoms
- Groin or thigh pain, sometimes radiating to the buttock or knee
- Stiffness that is worse in the morning or after sitting or resting
- Pain that flares with activity and, over time, may occur at rest or at night
- Reduced hip movement, difficulty walking or bending, sometimes with a limp
Commonly seen in
Evidence for twelve treatment options in hip osteoarthritis
This is not a fixed ladder or a package of treatments. Every option is assessed independently against this diagnosis, including treatments with limited direct research that may still be reasonable for a clearly defined tissue target. The evidence level, likely benefit, risks, cost and alternatives are weighed at consultation.
Foundation — diagnosis, education and rehabilitation
The part of care with the broadest relevance. For many people it is enough on its own; other options are judged against it, not automatically added after it.
Diagnosis, education and progressive rehabilitation Working out what is driving the pain, explaining what your imaging does and does not mean, and building a graded loading plan you can actually follow. Core care
What it involves
Assessment to identify the likely pain source, an explanation of what the diagnosis means, adjustment of the loads that aggravate it, and a progressive strength and conditioning plan — with weight management where that is clinically relevant.
What the evidence shows
Exercise is the core treatment, and it performs as well as the tablets. A network meta-analysis of 152 randomised trials and 17,431 patients found exercise gave the same pain relief and functional improvement as oral anti-inflammatories and paracetamol, with a far better safety profile (Weng, Br J Sports Med 2023). EULAR (Moseng, Ann Rheum Dis 2024) and the American College of Rheumatology (Kolasinski, Arthritis Rheumatol 2020) both make exercise, education and weight management the core of non-pharmacological care. An individual-participant meta-analysis of 31 trials and 4,241 patients is honest about the size of it: the average effect is small and of questionable clinical importance, and those with more pain and worse function at the start benefit most (Holden, Lancet Rheumatol 2023).
Pairing reviewed 2026-09-02.
Where it fits for you
Worth being straight about: the average effect is modest, and it is larger for people who are struggling more to begin with. What it does have over the alternatives is that it is safe to keep doing, and it works on the things a joint injection cannot — strength, capacity and weight.
Muscle and symptom-modifying options
Useful only when the examination identifies the tissue they target or when short-term pain control creates a useful rehabilitation window.
Wet needling and trigger point injection (trigger point injection) A fine needle into a tender band of muscle, with a small volume of dilute glucose solution injected through it. Dry needling evidence
What it involves
The needle is placed into the tender muscle band and a small volume of 5% glucose with 0.02-0.08% lignocaine is injected. Often done in the same visit as your assessment, and usable where the tender area sits deeper. Dry needling — the same technique with nothing injected — is not offered here.
What the evidence shows
The needling evidence at this joint comes from one research group, and all of it is dry needling rather than the injected form this row describes. In a double-blind trial of 30 people with hip osteoarthritis, three sessions of dry needling to tender bands in the iliopsoas, rectus femoris, tensor fasciae latae and gluteus minimus reduced pain and improved range and physical function, while sham needling did not (Ceballos-Laita, Musculoskelet Sci Pract 2019). A second double-blind trial of 45 people, against both sham needling and no treatment, found less pain and better WOMAC function and hip strength with real needling (Ceballos-Laita, Arch Phys Med Rehabil 2021), and a third trial of 38 found three needling sessions improved hip muscle flexibility more than three weeks of self-stretching (Ceballos-Laita, Complement Ther Clin Pract 2022). All three measured the effect straight after the course of treatment, and a systematic review of needling at the hip called the results promising but lacking strong certainty, with small samples and short follow-up (Forogh, Acupunct Med 2023). The injected form has a single case report at this joint, in which trigger point injection was combined with acupuncture and cupping (Chantasirivisal, Cureus 2026).
Pairing reviewed 2026-10-01.
Where it fits for you
Directed at a tender band in the hip flexors or gluteal muscles that reproduces part of your hip pain, alongside the loading programme. It does not treat the joint itself, and the trials behind it used a needle without an injectate and measured the effect over days rather than months.
Ultrasound-guided injections Guidance means we can see the needle reach the target. What goes into the needle depends on the diagnosis. Short-term relief
What it involves
The injection is performed under ultrasound so the needle can be watched into the target structure. What is injected is decided by the diagnosis — and corticosteroid is used sparingly, for the reasons set out below.
What the evidence shows
The hip is the joint where this row's exact procedure has been tested in a large trial. In 199 people with hip osteoarthritis, a single ultrasound-guided injection of triamcinolone and lignocaine added to advice and education reduced pain over six months by 1.43 points out of 10 more than advice and education alone (95% CI -2.15 to -0.72). It was not significantly better than an ultrasound-guided injection of lignocaine alone (-0.52, -1.21 to 0.18), and it worked better where ultrasound showed an inflamed or swollen joint. One participant with a replacement heart valve died of a heart-valve infection four months after the corticosteroid injection, judged possibly related (Paskins, BMJ 2022). An earlier systematic review found five small trials, all showing less pain at three to four weeks and two showing benefit to eight weeks (McCabe, Osteoarthritis Cartilage 2016). The risk worth knowing about is rapid joint destruction. Among 688 hips injected under X-ray guidance, 5.4% developed rapidly destructive hip disease at an average of five months; the risk was low after a single dose of 40 mg or less and higher with doses of 80 mg or more and with repeated injections (Okike, J Bone Joint Surg Am 2021). No trial has compared ultrasound with X-ray guidance head to head at this joint (Brookes, Musculoskeletal Care 2024).
Pairing reviewed 2026-10-02.
Where it fits for you
Most useful when a flare of pain is preventing rehabilitation, particularly where ultrasound shows the joint is inflamed. Used sparingly, at a low dose and not as a repeated series — see the note on cortisone.
V-ACTOR vibration therapy (vibration therapy) Low-frequency vibration applied over tender muscle. Not a shockwave, despite sharing the machine. Plausible — no studies
What it involves
A vibration handpiece is moved over the tender muscle and fascia for a few minutes. It runs from the same STORZ MASTERPULS icon console as radial shockwave but is a separate handpiece delivering a different, gentler form of energy. No needles, no anaesthetic, no downtime.
What the evidence shows
No published clinical trial of this device in this condition. It is a vibration handpiece delivered from the same console as radial shockwave, and the rationale is myofascial rather than tendon- or bone-directed.
Pairing reviewed 2026-08-30.
Where it fits for you
A comfort measure used within a session where muscular tightness is limiting movement. Never the reason for the appointment, and not a substitute for the treatments that do have evidence.
Energy-based treatment options
Radial pressure wave, focused shockwave and EMTT have different targets and different evidence. They are assessed separately rather than treated as one category.
Radial or focused shockwave? Read the overviewRadial shockwave (radial pressure wave) Broad treatment across tender muscle and fascia, close to the surface. Focused device did better
What it involves
A handpiece is moved over the tender tissue while ballistic pressure pulses are delivered, using a transmitter head chosen for the tissue — including heads shaped for fascia and for the muscle either side of the spine. The pulse is strongest at the skin and weakens with depth, so this is mainly a myofascial treatment, though it can reach deeper in some areas. No anaesthetic, no downtime, usually a course of sessions about a week apart.
What the evidence shows
There is one randomised trial of shockwave at this joint, and it tested both devices against a dummy treatment. One hundred and forty-eight people with hip osteoarthritis were randomised to focused, radial or sham treatment: pain and every WOMAC score fell in both treated groups at four and eight weeks and not in the sham group, and the focused device was clearly ahead of the radial one on every comparison (Şah, J Pers Med 2022). That is a single trial of pilot size in each arm with eight weeks of follow-up, and there is no synthesis at the hip — the pooled shockwave evidence in osteoarthritis is all knee (Liao, Biomedicines 2022).
Pairing reviewed 2026-09-25.
Where it fits for you
Worth discussing for the tender gluteal and lateral hip muscle that usually accompanies an arthritic hip, which is often a bigger part of the day-to-day pain than the joint is. A hip joint sits too deep for a radial pulse to reach it, so where the joint itself is the target the focused form is the one with the evidence.
Focused shockwave (ESWT) A true shock wave converging at depth — for tendon, joint, ligament and bone. Beat sham in a 148-person trial
What it involves
A focused system generates an acoustic shock wave that converges at a focal point set at a defined depth, concentrating the energy where the target is. This is the form we use for tendon, joint, ligament and bone. Typically four to six sessions about a week apart, no anaesthetic and no formal downtime.
What the evidence shows
Shockwave has been tested at the hip against a dummy treatment, and the focused form came out best. One hundred and forty-eight people with hip osteoarthritis were randomised to focused, radial or sham shockwave: pain and every WOMAC score improved in both treated groups at four and eight weeks and not in the sham group, and focused was clearly ahead of radial on every comparison (Şah, J Pers Med 2022). It is the first and so far the only trial at this joint, from a single centre with eight weeks of follow-up, so how long the benefit lasts is not yet known. The larger body of evidence sits at the knee, where pooled trials favour shockwave over sham for pain and function (Tang, Int J Surg 2024; Silva, Clin Rehabil 2022).
Pairing reviewed 2026-10-04.
Where it fits for you
A reasonable, non-invasive option for hip arthritis pain, and the right form for a joint this deep: the focal point can be set at the depth of the hip, which a radial pulse cannot reach. Offered alongside the strength and weight-management work, and worth trying before or between injections. It treats pain and function, not the joint surface.
EMTT (magnetotransduction therapy) High-energy magnetic pulses applied over the area. Painless, no contact. Plausible — no studies
What it involves
You sit with the applicator positioned over the area for a short session. Painless, no gel or contact required, and usually delivered as a course — commonly alongside shockwave.
What the evidence shows
There are no published randomised trials of EMTT in this condition, or in any musculoskeletal condition, that we can point to. The supporting work is laboratory work: EMTT increased tenocyte proliferation, migration and collagen expression in cultured human tendon cells (Mancini, Int J Mol Sci 2025). The nearest human evidence for a related electromagnetic therapy is negative — a randomised trial of pulsed electromagnetic field therapy added to eccentric exercise for Achilles tendinopathy found no improvement in outcome scores or tendon neovascularity over eccentric exercise alone (Ko, Orthop J Sports Med 2024).
Pairing reviewed 2026-08-30.
Where it fits for you
Offered only as an adjunct alongside treatment that does have evidence, never as the plan itself, and only after that gap is explained. Much of the EMTT literature is manufacturer-affiliated, which is part of why we describe it this way.
Biologic and joint injection options
Each injection is assessed independently for the named diagnosis. Cost, uncertainty, likely benefit, risks and alternatives are part of the decision.
Platelet-rich plasma (PRP) Your own blood, concentrated and injected under ultrasound guidance. Edge over hyaluronic acid, not saline
What it involves
Blood is taken from your arm, spun to concentrate the platelets, and injected into the target under ultrasound guidance in the same appointment.
What the evidence shows
Tested in a series of randomised trials at the hip, and they do not agree. Most compared PRP with hyaluronic acid rather than with a dummy injection. Pooling seven of them (465 people), PRP was ahead on pain at six months by a small margin (standardised difference -0.38) and on WOMAC pain at six and twelve months, with no difference in hip function, and the authors call the effect limited (Zhang, Pain Res Manag 2026); an earlier pooled analysis of six trials found no difference between the two (Belk, Arthroscopy 2021). In the largest single trial, 111 people had three weekly ultrasound-guided injections and the PRP group had the lowest pain at every follow-up - 21 out of 100 against 44 for hyaluronic acid at six months (Dallari, Am J Sports Med 2016). The one trial against a saline dummy injection found no advantage: in 60 people given three weekly ultrasound-guided injections there was no difference in pain, function or quality of life over six months (Topaloglu, Turk J Phys Med Rehabil 2024). Two network meta-analyses point the same way from a wider base. Across 11 trials and 1,353 people, and again across 14 studies and 1,254 people, no hip injection, PRP included, did better than a saline or standard-care comparison, while saline itself was followed by a clinically important fall in pain (Gazendam, Br J Sports Med 2020; Liu, Orthop J Sports Med 2026).
Pairing reviewed 2026-10-08.
Where it fits for you
An option that can be discussed for hip arthritis pain that has not settled with exercise, weight management and simple pain relief, on the understanding that the one placebo-controlled trial found it no better than a saline injection. If used, it is given into the joint under ultrasound guidance, the response is reviewed at about three months, and it is not repeated without a clear benefit. It is not expected to rebuild cartilage.
Prolotherapy (dextrose) A course of dextrose injections into and around the structure and its attachments. Beat exercise in one small trial
What it involves
Hypertonic dextrose is injected at the tender ligament and tendon attachments, and into the joint where relevant, usually as a series of treatments a few weeks apart.
What the evidence shows
Tested once in a randomised trial at the hip, in arthritis caused by hip dysplasia. 41 people (46 hips) on a waiting list for hip replacement had either up to six sessions of ultrasound-guided dextrose injections three weeks apart, into the tendon attachments around the hip and, in the milder forms of dysplasia, into the joint itself, together with home exercise, or a supervised 12-week strengthening program. At twelve months pain had fallen by 4.5 points out of 10 against 2.9, and the Harris hip score had risen by 24 points against 17 (Gül, Med Sci Monit 2020). There was no dummy-injection group, patients knew which treatment they had, and three people had severe pain at the injection sites for up to a week. No trial has studied ordinary hip osteoarthritis, and a 2025 review of hip and knee injections found the evidence insufficient to support routine use of prolotherapy (Seah, J Bone Joint Surg Am 2025). A search on 12 October 2026 for dextrose or prolotherapy in hip arthritis returned six records, with this the only trial.
Pairing reviewed 2026-10-12.
Where it fits for you
Prolotherapy is offered here and can be discussed for hip arthritis pain that persists despite a properly dosed strengthening program, with the limits stated: one small trial, in dysplastic hips, without a placebo group. As in that trial, it is given alongside continued exercise as a way of loading the hip with less pain, and it is not expected to change the joint or to replace a hip replacement when one is needed.
Viscosupplementation (hyaluronic acid) A gel-like injection into an arthritic joint. Widely used, and genuinely contested. No better than saline in trials
What it involves
One or a short series of hyaluronic acid injections into the joint under ultrasound guidance.
What the evidence shows
This is evidence of no benefit rather than an absence of evidence: hyaluronic acid has been tested against a dummy injection at the hip several times. In the largest trial, 357 people had a single image-guided injection of hylan G-F 20 or saline, and pain on walking fell by the same amount in both groups over 26 weeks (2.19 against 2.26 points out of 10), with pain falling by about 35% after saline alone (Brander, Osteoarthritis Cartilage 2018). A multicentre trial of 85 people found a single X-ray-guided injection no more effective than placebo at three months, with a third of each group responding (Richette, Arthritis Rheum 2009). Pooling five placebo-controlled trials in 591 people, hyaluronic acid was not better than placebo for pain or function at any time point (Liao, Med Sci Monit 2019), and a second meta-analysis concluded that viscosupplementation is not recommended for hip osteoarthritis (Leite, Arch Phys Med Rehabil 2017). A review of 25 osteoarthritis guidelines found that the higher-quality ones consistently recommend against hyaluronic acid at the hip (Gibbs, Osteoarthritis Cartilage 2023). Two things point the other way and are named for completeness. A hyaluronate chemically linked to diclofenac reduced hip pain by 0.81 points out of 10 more than placebo over 12 weeks in 90 people (Kubo, BMC Musculoskelet Disord 2022), which is a different product and says more about the diclofenac than about viscosupplementation. And a European panel of viscosupplementation specialists supports its use at the hip, citing observational studies and its own experience (Migliore, Cartilage 2026).
Pairing reviewed 2026-10-08.
Where it fits for you
Not offered for hip arthritis, because the placebo-controlled trials at this joint consistently show it does no better than a saline injection. Where an injection is appropriate for a hip flare, the ultrasound-guided corticosteroid injection earlier in this pathway is the one with trial evidence behind it.
Nerve-targeted options
Relevant when examination identifies a superficial neuropathic pattern or a compressed peripheral nerve—not simply because pain is present.
Lyftogt perineural therapy (perineural injection therapy) A series of small dilute dextrose injections just under the skin, over tender superficial nerves. Plausible — no studies
What it involves
Small injections of low-concentration dextrose, usually 5%, placed just beneath the skin along tender superficial nerves. Given as a series of short sessions.
What the evidence shows
A PubMed search for perineural or hydrodissection injection with dextrose in hip osteoarthritis returns no study of any design.
Pairing reviewed 2026-09-05.
Where it fits for you
Not offered. The hip joint is deep and the pain comes from the joint rather than from a compressed superficial nerve, so the rationale for a perineural injection does not apply.
Ultrasound-guided nerve hydrodissection Fluid placed around a nerve to free it from the surrounding tissue. Only if relevant
What it involves
Under ultrasound, fluid is placed in the plane around the nerve to separate it from the tissue that is tethering or compressing it.
What the evidence shows
No study has tested hydrodissection for hip osteoarthritis. A scoping review that screened 138 studies of the technique for joint pain searched the hip among other joints, and the conditions it found a signal in were adhesive capsulitis, greater trochanteric pain syndrome and knee osteoarthritis rather than hip arthritis (Leahy, Front Pain Res 2026). Searching hydrodissection and hydrorelease directly against hip osteoarthritis, the hip joint and coxarthrosis returns nothing on the subject.
Pairing reviewed 2026-09-15.
Where it fits for you
Only where the assessment finds a nerve contributing separately to the hip or groin pain. The arthritis itself is treated by the options higher up this page.
This is general information only and suitability is assessed individually. Treatments with limited or condition-dependent evidence may still be discussed, but only with clear explanation of the uncertainty, the expected benefit, risks, cost and alternatives. Red flags, progressive neurological symptoms or suspected serious pathology require a different pathway.
Every treatment above is described in full on the non-surgical treatments page, including what each one is used for and what the evidence supports. Ratings apply to the named diagnosis; an adjacent muscle, tendon, joint or nerve problem is assessed as a separate target. The method behind the ratings, and the treatments we do not offer, are set out on the evidence page.
Corticosteroid injection is reviewed separately for each diagnosis.
Cortisone reliably reduces pain in the short term, and that can be genuinely useful when pain is stopping you sleeping or moving enough to rehabilitate. Beyond that window the picture changes. A systematic review of 41 randomised trials and 2,672 participants found that corticosteroid injection reduced pain in the short term but that the effect reversed at intermediate and long term; in pooled analysis for lateral epicondylalgia the short-term effect was large (SMD 1.44, 95% CI 1.17 to 1.71) while no intervention was favoured at 26 weeks (-0.40, -0.67 to -0.14) and at 52 weeks (-0.31, -0.61 to -0.01) (Coombes, Lancet 2010). In a randomised trial in lateral epicondylalgia, 83 per cent of the corticosteroid group had completely recovered or much improved at one year against 96 per cent given a placebo injection, and recurrence ran at 54 per cent against 12 per cent; adding physiotherapy made no significant difference at one year (Coombes, JAMA 2013). In joints, repeated corticosteroid injections have been associated with cartilage loss. It does not repair anything.
So we do not build treatment plans around it. Where an injection is the right call, we review the specific diagnosis and target, discuss what is being injected and why, keep the number low, and pair it with the loading work that changes the longer-term course.
When we would still consider it
- Pain severe enough to block rehabilitation
- A clear inflammatory or bursal target on imaging
- A specific short-term goal — a trip, a procedure, a return to work
- Diagnostic use, where the response tells us where the pain is coming from
When a cortisone injection is worth doing, and when it is not
Other hip & pelvis conditions
Pain in the same area can come from more than one source, and the label matters less than what the examination and history point to. These are the other guides for this region.
Related articles
Shorter articles that answer the questions patients ask most often about this.
Frequently asked questions
Can hip osteoarthritis be cured?
Should I avoid exercise?
When is a hip replacement considered?
Ready for a clearer plan for your back or musculoskeletal pain?
Book an assessment with Dr Joshua Hatch.
Your assessment focuses on understanding the likely source of your pain and the most appropriate non-surgical options for your diagnosis, with the aim of reducing pain and improving function.
Book an appointment