Hip arthritis decision guide
Hip arthritis: test what helps—and know when it is time for a surgery talk.
We compare the scan with your motion, strength, walking, sleep, and the tasks you care about. Then we test a repeatable plan and set a clear review point. The goal is not to delay surgery at all costs. It is to make the next decision with better evidence from your own function.
Reviewed August 5, 2026Evidence through August 5, 2026About 12 minutes
The short answer
- Exercise, education, and a walking aid can help pain and daily function. Physical therapy is a reasonable option, especially for mild or moderate symptoms.1,5,10
- Medication and injection choices belong with the clinician who knows your health history. Oral anti-inflammatory medicine may help when it is medically safe; a hip steroid injection may help for a short time. Hyaluronic acid injections are not recommended for hip arthritis.2,5,10
- If symptoms are severe, non-surgical care has not been enough, and a surgeon says you are a candidate, more PT should not become an endless gate before surgery. Two randomized trials found larger gains with hip replacement than with exercise-only care in that group.7,8,9
Start with pattern fit
A hip scan is one clue. Your day is the rest of the story.
Hip osteoarthritis often causes groin pain, stiffness after rest, and trouble with bending, chairs, or walking. Pain can also spread into the thigh, buttock, or knee. But not every pain near the hip comes from the joint.4
Clues that often fit
Groin or front-of-thigh pain, stiff first steps, less hip rotation, a limp, and more trouble with shoes, socks, low chairs, stairs, or getting into a car.
Clues to look beyond the hip
Strong back symptoms, new numbness, pain driven by coughing, marked tenderness on the outside of the hip, or a pattern that does not change when the hip is tested.
When imaging adds value
Typical osteoarthritis can often be diagnosed from age, symptoms, and an exam. Imaging is more useful when the story is unusual, the diagnosis is not clear, symptoms changed fast, or surgery is being considered.5
“We do not treat the words on an X-ray. At Argan, we test what your hip is stopping you from doing—and whether a safe plan changes it.”Zakaria Nadif, PT, DPT, OCS, CSCS, Cert. Dry Needling
A useful non-surgical trial
Pick one goal, build the plan, and choose the review date before you start.
“Try PT first” is too vague. A real trial has a target, a dose you can repeat, and a point when you decide whether to continue, adjust, or ask for a surgical opinion.
- Name the anchor taskChoose one task that matters: a store walk, shoes and socks, getting into the car, stairs, sleep, golf setup, or standing to cook.
- Record the starting pointNote what stops the task: pain, stiffness, weakness, balance, fear, shortness of breath, or the time it takes. Use the same check each time.
- Match the programBuild hip and leg strength, useful motion, and low-impact aerobic work around the finding—not around a generic sheet of exercises.
- Change daily loadBreak up long tasks, change the route or setup, and consider a fitted cane or walker when it makes walking safer or more tolerable.
- Set the review pointAgree on when you will compare the same task. If the plan is not changing the target, check the diagnosis, dose, barriers, and other medical options instead of repeating it forever.
A simple response check
- During
- Can you keep good control, breathe normally, and avoid a sharp or unstable feeling?
- Later
- Does the hip settle after the session, or does pain keep climbing through the day?
- Next morning
- Are you near your usual baseline and still able to do the next planned session?
This is a practical monitoring method, not a universal medical cutoff. Your plan should change if symptoms are escalating or your function is shrinking.
What the evidence supports
Use each option for the job it can actually do.
No single option fits every person. The choices below address pain, movement, or function; none can promise to regrow lost hip cartilage.
The decision boundary
Surgery is not a failure. It is another tool when the tradeoff makes sense.
A referral is reasonable when pain, stiffness, or lost function is substantially affecting quality of life and non-surgical care has been ineffective or is not suitable. Use a clinical conversation, not one score, age cutoff, or scan phrase.5
Keep testing the plan when…
- Your anchor task is improving enough to matter.
- Symptoms settle and the program stays repeatable.
- You still have useful, acceptable activity choices.
- You understand the options and prefer more non-surgical care.
Start or return to the surgery talk when…
- Pain or stiffness keeps taking away sleep and daily function.
- A well-matched plan did not change what matters enough.
- Medication, injections, or walking aids are ineffective, unsafe, or unacceptable to you.
- You want to compare expected benefit, recovery, and personal risk with a hip surgeon.
What two randomized trials add
For people already at the surgical decision point, replacement improved pain and function more than exercise-only care.
2024 · severe arthritis
In 109 adults age 50 or older who had severe hip arthritis and an indication for surgery, hip replacement produced a much larger six-month improvement in the Oxford Hip Score than resistance training. About 21% assigned to training had replacement within six months.8
2026 · moderate-to-severe arthritis
In 120 adults, hip replacement plus rehabilitation produced larger 12-month gains in pain, function, quality of life, walking, chair rise, and stairs than a self-directed exercise plan. About 38% assigned to conservative care had replacement during the study.9
Boundary: These trials studied people with moderate-to-severe disease who were eligible for surgery. They do not mean every painful hip needs replacement. They do mean exercise should not be sold as an equal substitute once severe symptoms and surgical indication are already present.
Shared decision-making
Bring better questions to the next visit.
Good decisions connect evidence with your health, your goals, and what you are willing to trade. A surgeon can explain candidacy and risk. Argan can help you measure function, test a plan, and prepare for the work before or after surgery.
- Which daily task do I most want back?
- Is the hip joint the best fit for my symptoms, or is another source possible?
- What have I tried, at what dose, and what changed?
- What result would make non-surgical care “enough” for me?
- If I am a candidate, what benefit and recovery are realistic for my case?
- Which health risks can be improved without turning them into an automatic barrier?
- What help, equipment, and home setup would I need after surgery?
Where PT fits near surgery
Prehab should improve readiness—not prove that you deserve surgery.
Before surgery
Use the time to learn the first recovery tasks, practice with the right walking aid, improve the strength and fitness you can safely build, plan stairs and sleeping, and line up help. The purpose is preparation, not a guarantee of a faster recovery.
After surgery
Rehabilitation helps restore safe walking, strength, daily tasks, and a stepwise return to activity. The exact plan depends on the surgeon’s instructions, your health, the surgical approach, and how recovery is going.
Medical concerns come first
A fall, a hot joint, or a fast unexplained change should not wait for routine PT.
Emergency after injury
Get emergency help for severe pain after a fall, a leg that looks out of place, or an inability to stand or bear weight.
Possible infection
Seek urgent medical care for a hot or swollen joint with fever, chills, a rash, or feeling very ill.
Fast or unusual change
Arrange a prompt medical exam for rapid worsening, sudden severe pain without injury, new numbness or weakness, night sweats, or unexplained weight loss.
These are examples, not a complete emergency list. Call 911 for a medical emergency. Atypical features should be assessed before they are labeled routine osteoarthritis.5
Common questions
Clear answers before the next step.
Does a “bone-on-bone” X-ray mean I must have surgery?
No. The image matters, but symptoms, daily limits, health, goals, and preference decide whether surgery makes sense. If pain and lost function are acceptable, you may keep using non-surgical care. If they are not—and a well-matched plan has not helped enough—a surgical opinion is reasonable.
Can physical therapy regrow hip cartilage?
No. PT does not regrow lost joint cartilage. It can improve strength, movement options, walking, confidence, and how much useful activity you can tolerate. That may reduce symptoms and improve function, but it is not a structural cure.
Which exercises are best for hip arthritis?
How much soreness is acceptable after exercise?
A brief, mild increase can happen when exercise starts. The useful question is whether symptoms settle and you can repeat the plan without losing more function. Sharp pain, a giving-way feeling, steadily rising pain, or a worse baseline the next morning calls for a dose change or reassessment. This is guidance, not a universal cutoff.
Would a cane help, and which hand should hold it?
A cane can help when hip pain, stability, or walking is meaningfully limited. For one painful hip, it is often used in the opposite hand, but the setup should account for your balance, grip, shoulders, and other joints. Height and timing matter, so have it fitted if you are unsure.10
What should I know about cortisone and gel injections?
A hip corticosteroid injection may give short-term relief and is usually image-guided. Hyaluronic acid, sometimes called a gel injection, is not recommended for hip osteoarthritis because strong evidence has not shown a meaningful benefit over placebo. Ask the medical clinician doing the procedure about your risks, timing, and alternatives.2,5,10
When is it time to talk with a hip surgeon?
Consider a referral when pain, stiffness, sleep loss, or reduced function is substantially affecting quality of life and non-surgical care has not helped enough or is not suitable. A referral is a conversation, not a commitment. If you already meet surgical criteria and have chosen replacement, more required conservative care should not create an unsupported delay.5,7
Can age or BMI automatically block a referral?
NICE says not to exclude people from joint-replacement referral based only on age, sex or gender, smoking, other health conditions, or BMI. Those factors can still change surgical risk and deserve an individual plan. ACR/AAHKS also supports nicotine reduction and better blood-sugar control when relevant.5,7
Evidence and scope
Clinical sources
I reviewed guidance and research available through August 5, 2026. Guidelines support decisions; they do not replace an exam or a discussion with your medical team.
- American Academy of Orthopaedic Surgeons. Osteoarthritis of the Hip Clinical Practice Guideline. Published December 1, 2023.
- AAOS. Updated Clinical Practice Guideline for the Management of Hip Osteoarthritis. January 23, 2024.
- AAOS. Management of Osteoarthritis of the Hip: Evidence-Based Clinical Practice Guideline. Full guideline, 2023.
- AAOS OrthoInfo. Osteoarthritis of the Hip. Symptoms, examination, and treatment overview.
- National Institute for Health and Care Excellence. Osteoarthritis in over 16s: diagnosis and management. NG226, published October 19, 2022.
- American College of Rheumatology and American Association of Hip and Knee Surgeons. Optimal Timing of Total Hip and Knee Arthroplasty. 2023 guideline materials.
- ACR/AAHKS. New Guideline Introduces Recommendations for Optimal Timing of Elective Hip or Knee Arthroplasty. March 14, 2023.
- Frydendal T, et al. Total Hip Replacement or Resistance Training for Severe Hip Osteoarthritis. New England Journal of Medicine. 2024;391:1610–1620.
- Talonpoika A, et al. Total hip arthroplasty compared with conservative treatment with a self-directed exercise programme in moderate-to-severe hip osteoarthritis. The Bone & Joint Journal. 2026;108-B:588–596.
- Kolasinski SL, et al. 2019 ACR/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee. Arthritis Care & Research. 2020;72:149–162.
- AAOS. Osteoarthritis of the Hip: Plain Language Summary. 2024.
- American Physical Therapy Association, ChoosePT. Physical Therapy Guide to Hip Osteoarthritis.
A clear next step
Want to test the hip before you make a larger decision?
Argan provides one-on-one, in-home physical therapy. We can compare the hip pattern with your real tasks, build a focused trial, and decide what the response means. If the findings point back to your medical clinician or a hip surgeon, We will say so.
Core service area: Southlake and Colleyville. Selected nearby DFW addresses may be available with a travel fee. New care is self-pay; I confirm fit, price, and location before booking.