Hip & Generalised Osteoarthritis

Osteoarthritis (OA) is a whole-joint disease — cartilage loss, osteophyte formation and subchondral bone change. Obesity is the single most important modifiable risk factor. Hip and knee OA share the same RACGP guideline and largely the same management ladder. See Knee Osteoarthritis, Shoulder Osteoarthritis and hand OA for those joints.

Diagnosis

Hip OA can be diagnosed clinically, without imaging, in a person aged 45 or older with activity-related joint pain and no signs pointing to an alternative diagnosis — the same clinical-diagnosis approach as knee OA.

• History: groin, buttock or anterior thigh pain (hip disease can refer pain to the knee); morning stiffness under 30 minutes; pain and stiffness worse with activity, easing with rest.
• Examination: early physical signs of hip OA include restriction of internal rotation and abduction of the affected hip, with pain occurring at the end of the range of motion.
• Atypical features that suggest an alternative or additional diagnosis: history of trauma, prolonged stiffness, rapid symptom worsening, or a swollen hot joint. Consider tumour, septic arthritis, crystal arthritis, inflammatory arthritis, osteonecrosis or fracture if any concerning feature (severe local inflammation, erythema, pain unrelated to use) is present, and refer accordingly.
• Imaging: not needed for a typical presentation. Weight-bearing X-ray is reasonable for atypical features or when the diagnosis is uncertain, or before joint-replacement referral. Blood tests (rheumatoid factor, ESR, CRP) are only for excluding inflammatory disease when suggested by the history, not routine.

Generalised OA

Some people develop OA at multiple joint sites — hip, knee, hand and spine together — reflecting a shared predisposition rather than separate local injuries. Hand involvement (Heberden’s and Bouchard’s nodes) is common in this pattern; see the hand OA page.

Management doesn’t change: exercise and weight management remain first-line at every site. But multi-joint disease makes pain harder to localise, and strengthens the case for weight loss and a structured whole-body exercise program rather than single-joint measures alone.

Management

Exercise and weight management are the two strong recommendations. Everything else is conditional at best, and several interventions are actively not recommended for the hip.

• Exercise. Land-based exercise is strongly recommended for all people with hip OA to improve pain and function, regardless of their age, structural disease severity, functional status or pain levels. The best type of exercise for hip OA specifically isn’t established — prescribe an individualised, progressive program and refer to an exercise professional for supervision where useful. Aquatic exercise/hydrotherapy is a conditional option. A 2025 Cochrane review tempers the guideline’s strong recommendation with the actual effect size: exercise probably leads to small improvements in pain and joint function, although these may not be noticeable in daily life, compared with no treatment or usual care.
• Weight management. Strongly recommended for anyone overweight (BMI ≥25) or obese (BMI ≥30), with a minimum weight-loss target of 5–7.5% of body weight, and better results with more. Combine with exercise for greater benefit.
• Analgesia. Oral NSAIDs at the lowest effective dose for a short period are a conditional option, with monitoring for gastrointestinal, renal and cardiovascular adverse effects. Topical NSAIDs are an option for people wanting to avoid systemic exposure. Paracetamol has no guideline recommendation for or against — a short monitored trial is reasonable, stopping if ineffective.
• Intra-articular corticosteroid. Conditional option for short-term symptom relief, particularly during a flare with effusion; avoid frequent repeat injection because of cartilage-damage risk.
• Duloxetine. Conditional option when other pain relief is inadequate — not TGA-approved for OA, so this is off-label use.
• Topical capsaicin. The guideline is unable to recommend either for or against topical capsaicin for hip OA — unlike knee OA, where it carries a conditional recommendation against.

Not recommended for hip OA: viscosupplementation (hyaluronic acid) injection carries a strong recommendation against, unlike its conditional status for knee. Also not recommended, same as knee OA: oral and transdermal opioids, glucosamine/chondroitin, doxycycline, strontium ranelate, and stem cell therapy.

Referral

Total joint replacement surgery is the most cost-effective and clinically effective treatment for end-stage OA in appropriately selected individuals. Refer to an orthopaedic surgeon for severe disease with functional impairment refractory to conservative management — confirm severity on X-ray first. Optimise modifiable risk before surgery: weight, glycaemic control, smoking cessation, anaemia and dental clearance all improve outcomes (“prehabilitation”).

Safety-netting

Rapidly increasing symptoms, a hot swollen joint, or new systemic features (fever, weight loss) warrant reassessment rather than assuming an OA flare.