Causes of Hip Pain: Osteoarthritis or Impingement?

Causes of Hip Pain: Osteoarthritis or Impingement?

The hip joint is one of the largest and most weight-bearing joints in the body. Constantly moving during daily activities, pain in this joint can significantly impact quality of life. The causes of hip pain span a wide range—from simple muscle strains to cartilage wear (osteoarthritis) or bone structural mismatches (impingement syndrome).

Patients often find it difficult to identify the source of their pain. Pain originating from the groin, aching on the side of the hip, or radiating to the knee can provide clues about the underlying problem. Distinguishing between osteoarthritis and femoroacetabular impingement (FAI) is the critical first step to determine the appropriate treatment approach. This guide examines the main mechanisms, symptoms, and current treatment options for hip pain, supported by scientific evidence.

Common Causes of Hip Pain

Hip pain can arise from the joint itself (intra-articular) or from surrounding soft tissues (extra-articular). Understanding hip anatomy is essential for accurate pain assessment. The structure of the hip joint and pain origination areas are illustrated in the diagram below.

The hip joint functions through the congruent articulation of the femoral head with the socket of the pelvis (acetabulum). Disruption of this harmony leads to a range of conditions termed hip joint disorders, which cause pain.

Hip Osteoarthritis

Known commonly as osteoarthritis, this condition involves gradual wearing and degeneration of the cartilage covering the joint surfaces. According to the World Health Organization (WHO), it is a leading cause of mobility limitations worldwide. As cartilage deteriorates, bone surfaces rub against each other, causing severe pain, reduced motion, and joint sounds. The progression stages of osteoarthritis are summarized in the infographic below.

Femoroacetabular Impingement Syndrome (FAI)

FAI, or hip impingement syndrome, is a significant cause of hip pain particularly in young and middle-aged active individuals. It results from an anatomical mismatch between the femoral head and the hip socket. The abnormal bone contact and impingement mechanism are depicted in the following diagram.

Structural bone overgrowths (cam or pincer lesions) in FAI damage cartilage and the labrum during hip movements. For more information, visit our femoroacetabular impingement page.

Muscle Strains and Tendinitis

Overuse or sudden movements can strain muscles around the hip, leading to common pain causes. Especially in athletes, groin strains (adductor injuries) or hip flexor tendinitis can be confused with intra-articular problems. These pains typically improve with rest and physical therapy, but chronic cases warrant thorough evaluation.

Bursitis and Other Inflammatory Causes

Bursitis is inflammation of the fluid-filled sacs (bursae) acting as cushions between muscles and bones. Trochanteric bursitis, causing lateral hip pain, is a frequent cause. Systemic inflammatory diseases such as rheumatoid arthritis can also provoke hip joint pain and damage.

Hip Pain in Young People: Sports and Developmental Factors

Hip pain is not limited to older adults; hip pain in young people is common and usually linked to sports or developmental issues. Among active young individuals, FAI and labral tears are prominent causes. Moreover, athletes with knee injuries like anterior cruciate ligament (ACL) tears may develop secondary hip pain due to biomechanical imbalance.

Another cause of persistent groin pain in young athletes is athletic pubalgia, characterized by weakness or tears where abdominal muscles attach near the groin. Understanding what athletic pubalgia is is particularly important for individuals involved in sports involving sudden directional changes such as football.

Symptoms and Differential Diagnosis of Hip Pain

Pain location and characteristics offer vital clues to pinpoint its origin. The body map below indicates common pain areas and their possible causes.

Typically, groin pain suggests intra-articular problems (osteoarthritis, FAI), while lateral hip pain points to soft tissue issues (bursitis). Spinal problems like herniated discs can also cause referred hip pain. For distinguishing hip pain from back problems, see our article on hip pain versus herniated disc differentiation.

Although osteoarthritis and impingement syndromes can cause pain in similar regions, their symptom onset and characteristics differ. The table below compares symptoms of osteoarthritis and FAI.

Treatment Options: Surgical and Non-Surgical Approaches

Treatment is tailored based on the cause of pain, patient age, and activity level. According to guidelines from the American Academy of Orthopaedic Surgeons (AAOS), initial management usually involves non-surgical methods such as physical therapy, medications, and activity modification.

When conservative treatments fail or there is a mechanical issue (e.g., FAI or labral tear), surgery may be indicated. Hip arthroscopy is a minimally invasive surgical technique offering rapid recovery and effective treatment. Detailed information about hip arthroscopy can help patients understand the process.

Specifically for impingement syndrome, arthroscopic bone reshaping and labral repair are successfully performed. The procedure details are available on our femoroacetabular impingement treatment page.

In early osteoarthritis or soft tissue injuries, regenerative therapies may provide adjuvant support. Advances in regenerative medicine allow treatments such as PRP and stem cell therapies to promote tissue healing.

Post-treatment rehabilitation, including return-to-sport and daily activity planning, is an integral part of recovery. Following your doctor’s recommendations on when injured athletes can resume sports reduces the risk of recurrence.

When Should You See a Doctor?

Not all hip pain requires urgent care; however, certain symptoms warrant prompt medical evaluation. According to Mayo Clinic experts, seek orthopedic consultation immediately if you experience:

• Sudden and severe pain,
• Pain following trauma or fall,
• Significant swelling, redness, or warmth around the joint,
• Inability to bear weight on the leg,
• Pain disrupting sleep at night,
• Accompanying fever and fatigue.

This content is for informational purposes only and does not constitute professional medical advice, diagnosis, or treatment. Always consult your doctor or a qualified healthcare professional regarding any health concerns. Do not disregard or delay seeking medical care based on the information provided on this site.