Where hip pain is felt
Groin pain often suggests an intra-articular hip source, while pain over the outer hip may arise from the gluteal tendons or bursa. Buttock pain, pain below the knee, tingling or back-related symptoms can point toward referred spinal pain, although patterns can overlap.
Hip osteoarthritis
Hip arthritis may cause gradual groin pain, stiffness, reduced walking distance and difficulty with socks, shoes, stairs or getting in and out of a car. It may follow age-related joint change, childhood hip disorders, previous injury or structural differences. Treatment is guided by symptoms and function, not X-ray appearance alone.
Avascular necrosis (AVN)
Avascular necrosis, also called osteonecrosis, occurs when blood supply to part of the femoral head is disrupted and bone may weaken or collapse. Risk factors can include corticosteroid exposure, heavy alcohol use, some medical conditions and previous trauma, but AVN can also occur without an obvious cause. Earlier assessment may preserve more options.
Lateral hip pain and bursitis
Pain and tenderness over the outer hip is often grouped as greater trochanteric pain syndrome. Gluteal tendon irritation or tearing is frequently involved; the bursa may be reactive rather than the only problem. Pain when lying on that side, climbing stairs or standing on one leg is common.
Labral and other intra-articular causes
The labrum is a rim of tissue around the hip socket. Labral injury, femoroacetabular impingement and other intra-articular problems can cause groin pain, clicking, catching or pain with flexion and rotation. Imaging findings must be matched to symptoms because labral changes can also be seen in people without pain.
Referred pain from the spine
Lumbar spine conditions may cause buttock, thigh or leg pain and can coexist with hip disease. Back pain, numbness, tingling, weakness and symptoms altered by spinal posture are useful clues. Examination of both the hip and the lower back is important.
Trauma and fracture
A fall, collision or sudden force can cause fracture, dislocation, muscle injury or an aggravation of a pre-existing condition. An older adult or someone with osteoporosis who cannot bear weight after a fall requires urgent assessment even if the leg does not look deformed.
The hip examination
Assessment includes gait, posture, leg length, range of motion, pain with specific movements, strength and tenderness around the hip. The clinician may examine the lumbar spine, sacroiliac region, knee and neurological function to identify referred pain or overlapping causes.
Why X-rays are commonly first
Standing pelvis and hip X-rays can show arthritis, fracture, deformity, joint space change, calcification and some signs of AVN. They provide a baseline for many hip complaints, but a normal X-ray does not exclude early AVN, stress injury, labral pathology or tendon disease.
When MRI is appropriate
MRI can assess early AVN, occult or stress fracture, marrow changes, tendons, muscles, fluid collections and selected labral or cartilage questions. It is usually ordered when examination and X-rays leave a clinically important unanswered question or when the result would change treatment.
Nonsurgical treatment
Depending on the diagnosis, care can include activity modification rather than complete rest, targeted physiotherapy, progressive hip and trunk strengthening, a walking aid for short periods when needed, and medicines discussed with a clinician. Image-guided injections may have a role for selected conditions but should be part of a diagnosis-led plan.
When surgery may be discussed
Surgery is not a single solution for hip pain. It may be considered for selected fractures, advanced symptomatic arthritis, some structural intra-articular problems or particular cases of AVN. The diagnosis, joint condition, overall health and goals determine whether an operation is reasonable.
Red flags and urgent symptoms
Urgent assessment is important when serious injury, infection, vascular compromise or neurological compromise is possible. Night pain, unexplained weight loss or a history of cancer should prompt medical assessment, particularly when symptoms are persistent or worsening.
- Inability to bear weight after meaningful trauma
- A deformed leg, severe pain after trauma or suspected fracture or dislocation
- A hot painful hip with fever or feeling systemically unwell
- Major new weakness, numbness, or bowel or bladder changes
- Appropriate concern for serious underlying disease
Is outer hip pain always bursitis?
No. Gluteal tendon problems are common in lateral hip pain, and the bursa may be only part of the picture. Examination helps guide treatment.
Can hip arthritis cause knee pain?
Yes. Hip joint pain can be referred to the thigh or knee, which is why the hip is examined in some people presenting with knee pain.
When is MRI needed for hip pain?
MRI is useful for specific questions such as suspected early AVN, occult fracture, stress injury, tendon disease or selected intra-articular pathology. It is not necessary for every hip complaint.
What are early symptoms of AVN?
Groin or buttock pain that worsens with weight bearing may occur, but symptoms vary. Risk factors or persistent unexplained pain warrant clinical assessment.
Can physiotherapy help hip arthritis?
A tailored programme can improve strength, movement confidence and function for many people. It does not reverse advanced structural arthritis, and the plan should be adapted if symptoms flare significantly.
When should hip pain be treated urgently?
Seek urgent care after trauma if you cannot bear weight, and for severe pain with deformity, fever with a hot painful joint, or new major neurological symptoms.
Written and medically reviewed by: Dr. Yousef Abuodeh Consultant Orthopedic Surgeon Last medically reviewed: September 2, 2026