Overview
The femoral head and the acetabulum are both capped with articular cartilage, a smooth layer a few millimeters thick that lets the joint glide without friction. Hip arthritis is the loss of that layer. As it thins, the bone underneath hardens, spurs grow around the rim, and a joint that once rotated freely becomes stiff and painful.
Treatment is decided by function, not by the X-ray. A hip with severe changes on film that still walks a couple of miles and sleeps through the night is managed non-operatively; a hip that causes waking every night and has shortened walks to a few blocks is a hip that replacement will fix. Dr. O'Donnell's role is to confirm the hip is the source, exhaust the simpler measures, and lay out what replacement involves; the timing is the patient's decision.
Common Symptoms
- Groin pain with walking and standing, sometimes felt in the front of the thigh or referred to the knee
- Stiffness first thing in the morning or after sitting, easing with a few minutes of movement
- A limp, and a walking distance that has shrunk over months
- Difficulty with shoes and socks, toenails, or getting in and out of a low car
Groin pain with loss of rotation is the pattern of joint arthritis. Outer-hip pain that is tender to press on and worse lying on it is greater trochanteric bursitis, which often coexists; pain running below the knee with tingling is usually sciatica. Under 45, groin pain with a preserved joint space is more likely impingement.
Causes & Risk Factors
Over 60, most hip arthritis is primary: cartilage wear with age, accelerated by body weight and family history. Under 50 there is usually a reason the hip wore early. Cam impingement is the most common one, shearing cartilage off the socket rim with every deep bend in a former hockey, soccer or football player. Dysplasia, a childhood hip condition, a prior fracture, avascular necrosis and inflammatory arthritis each leave a hip that wears early.
How It Is Diagnosed
Dr. O'Donnell watches the walk for a limp, then measures motion. Internal rotation with the hip flexed is the first movement an arthritic hip loses, and a painful log roll — rolling the straight leg in and out on the table — points to the joint rather than the surrounding muscles. The FABER and Stinchfield tests reproduce joint pain, and the lumbar spine is examined because a stiff back and an arthritic hip commonly present together.
A standing AP pelvis and lateral hip X-ray make the diagnosis in almost every case: joint-space narrowing, spurs, subchondral hardening and cysts are all visible, and no MRI is needed. MRI is ordered only when the X-ray is normal but the hip hurts, to look for avascular necrosis or a stress fracture. Prior imaging can be uploaded through mymedicalimages.com before a visit.
Treatment Options
Non-operative care
Early and moderate arthritis is managed without surgery, often for years. Switching impact activity to cycling, swimming or an elliptical keeps fitness without loading the joint; weight loss reduces the force across the hip several-fold for every pound lost; and therapy focused on abductor strength keeps the gait even. A cane in the opposite hand unloads the hip substantially. An ultrasound-guided corticosteroid injection into the joint gives relief for weeks to a few months; it is not given within about 3 months of a scheduled replacement because of infection risk. Arthroscopy is not helpful once the joint space has narrowed.
Total hip replacement
When pain limits sleep, walking or work despite the measures above and the X-ray confirms the cartilage is gone, Dr. O'Donnell recommends total hip replacement. The worn head and socket are replaced with a metal stem and cup, a ceramic head and a cross-linked polyethylene liner, through a posterior approach that spares the abductor muscles responsible for a normal gait. Modern bearings are expected to last 20 years or more, so age is not the barrier it once was. There is no advantage to waiting until walking is impossible, and no penalty for continuing non-operative care as long as it is working.
Recovery & What to Expect
After replacement, weight bearing starts on the day of surgery and the priority for the first 6 weeks is protecting the new joint from dislocation while gait and strength return. The timeline follows Dr. O'Donnell's posterior-approach protocol.
| Phase | Timing | What happens |
|---|---|---|
| Mobility & precautions | Weeks 0–2 | Weight bearing as tolerated with a walker or crutches. Posterior precautions: no hip flexion past 90°, no crossing the legs, no internal rotation; raised toilet seat, wedge cushion and reacher. Quad and glute sets, gait and transfer training. |
| Strengthening & gait | Weeks 2–6 | Progressive glute and quad strengthening within precautions, balance, high-seat stationary bike. Walker weaned to a cane, then nothing, as gait normalizes. |
| Strengthening | Weeks 6–12 | Precautions lifted at about 6 weeks once confirmed by Dr. O'Donnell. Progressive hip and core resistance, single-leg balance, endurance and functional training. |
| Return to activity | Months 3–6 | Walking, cycling, swimming and golf as cleared. Running and jumping are avoided long term to protect the bearing. |
Most patients go home the same day or the next morning, do desk work from home within 2 to 3 weeks, and drive once off narcotic pain medication and walking without a walker, usually between 3 and 6 weeks. Full details are in the total hip replacement protocol PDF.
Frequently Asked Questions
Is walking good for hip arthritis?
Yes, within the distance that stays comfortable. Walking keeps the joint mobile and the abductors strong; stopping altogether makes the hip stiffer. When walking itself has become the problem, switch part of it to cycling or swimming, use a cane in the opposite hand, and keep the walk to a length that does not leave the hip aching that night.
Do injections help hip arthritis?
An ultrasound-guided corticosteroid injection into the joint reliably relieves pain for weeks to a few months and is useful for a flare, a trip, or to confirm the hip is the source of the pain. It does not slow the arthritis, and it is not given within 3 months of a planned replacement.
When should I have a hip replacement?
When pain is limiting sleep, walking distance or work despite activity changes, therapy and injection, and the X-ray confirms the cartilage is gone. Age is not the deciding factor. There is no benefit to waiting until you can barely walk, and no harm in continuing non-operative care while it works.
How long does a hip replacement last?
Modern implants with a ceramic head and a highly cross-linked polyethylene liner are expected to last 20 years or more in most patients. Wear is slower with low-impact use, which is why running and jumping are discouraged after replacement while walking, cycling, swimming, golf and doubles tennis are encouraged.
How long after a hip replacement can I drive?
Once you have stopped narcotic pain medication and can walk without a walker, which for most patients is between 3 and 6 weeks; a right hip takes the longer end of that range. Posterior precautions still apply in the car for the first 6 weeks: a higher seat, no crossing the legs, no bending past 90° to get in.
This page is for general education and is not a substitute for a medical evaluation. Treatment recommendations depend on your individual diagnosis and goals. Kevin O'Donnell, MD sees patients from Coral Gables, Miami, Brickell, Pinecrest and Coconut Grove at 475 Biltmore Way, and out-of-town patients by telemedicine.