What is hip osteoarthritis (coxarthrosis)?

Hip osteoarthritis (coxarthrosis) is a degenerative-dystrophic disease in which the cartilage tissue covering the joint surfaces of the femoral head and acetabulum is destroyed.

This is the second most common osteoarthritis disease after knee osteoarthritis (gonarthrosis). According to the German Society for Orthopedics and Trauma (DGOU), hip osteoarthritis is diagnosed in 5% of the population over 60 years old. Over 230,000 hip replacement surgeries are performed annually in Germany.

Stages of hip osteoarthritis:

Grade 1 — slight narrowing of the joint space, initial osteophytes. Pain after exertion
Grade 2 — moderate narrowing of the joint space, pronounced osteophytes, subchondral sclerosis. Pain while walking
Grade 3 — sharp narrowing of the joint space, cysts, deformation. Pain at rest, limited range of motion
Grade 4 — complete disappearance of the joint space, pronounced deformation

Risk factors:

Age over 50 years
Excess weight
Hip joint dysplasia
History of joint injuries
Avascular Necrosis of the Femoral Head
Genetic predisposition

Symptoms of hip osteoarthritis

Early signs

Pain in the groin after physical exertion
Morning stiffness (15-30 minutes)
Discomfort with prolonged sitting
Joint crepitus during movement

Progression

Pain while walking radiating to the knee
Limp
Limited hip rotation and abduction
Limb shortening
Atrophy of thigh and gluteal muscles

Late Stages

Pain at rest and at night
Inability to walk more than 500 m
Need for support while walking
Significant limitation of mobility
Decreased quality of life

Hip osteoarthritis (coxarthrosis): treatment options and what is known about them

The treatment plan is made by the clinic doctor after an examination and a review of your images. The table shows the options usually discussed for this diagnosis and how well they have been studied.

Option	What to expect	How well studied
Exercise therapy and physiotherapy	Reduces pain, strengthens muscles, improves function; the basis of treatment	Well studied, recommended
Load management, weight loss	Takes load off the affected area; if overweight, losing 5–10% noticeably reduces pain	Well studied, recommended
Painkillers and NSAIDs	Ease pain during flare-ups; long-term use is limited by side effects	Moderate evidence
Corticosteroid injection	Quickly reduces inflammation and pain, the effect is often temporary; frequent injections are undesirable	Limited or conflicting evidence
Hyaluronic acid	Reduces pain for a few months in some patients	Little data
PRP / CGF	Concentrate from your own blood; may reduce pain, growth of new tissue has not been shown	Limited or conflicting evidence
BMAC / MFAT	Cell preparations from bone marrow or fat; more expensive, no proven advantage over PRP	Little data
Hip replacement	If conservative treatment does not help or there is an indication	When indicated — the doctor decides

We send your request to several partner clinics. Some will suggest conservative treatment or injections, others surgery; each clinic quotes its own conditions and price. We help you compare the options.

Regenerative methods: realistic expectations

In osteoarthritis, regenerative injections can reduce pain and improve function for a period of several months to a year. PRP in knee osteoarthritis is the best studied: in a number of trials it reduced pain more than hyaluronic acid, but not in all of them. Restoration of damaged cartilage has not been shown. Cell-based methods (BMAC, MFAT) are less well studied and more expensive. Exercise and weight control remain the basis of treatment — injections add to them rather than replace them.

When surgery is discussed. Surgery is discussed when marked pain and restricted movement do not improve after 3–6 months of conservative treatment, and in advanced stages with deformity.

If an injection helps, the effect usually builds up over 6–12 weeks, and the result is assessed after 2–3 months. No clinic can guarantee a result.

Good to know: diagnosis, self-help, outlook

How to tell hip osteoarthritis from similar conditions

In hip osteoarthritis the groin hurts, sometimes the front of the thigh and the knee, and inward rotation of the hip is limited — putting on socks and shoes becomes difficult. Outer hip pain when lying on the side is typical of trochanteric pain syndrome, and back-related pain radiates down the leg with numbness. In young people with groin pain, impingement and avascular necrosis of the femoral head must be ruled out. A standing pelvic X-ray confirms the diagnosis.

What you can do yourself

Exercises for the gluteal and thigh muscles, cycling and swimming maintain mobility and reduce pain. Weight loss offloads the joint. A cane in the opposite hand and a raised seat make daily life easier during flare-ups.

Outlook and timelines

The rate of progression varies; exercise and painkillers help many people for years. An intra-articular corticosteroid injection relieves pain for weeks. With severe pain and loss of function, hip replacement is one of the most effective operations in orthopaedics.

Who it is not suitable for and possible risks

Contraindications

Active infection — at the injection site or systemic, with fever.
Active cancer or ongoing chemotherapy.
Blood clotting disorders or a low platelet count. Anticoagulants are discussed with the physician.
Pregnancy and breastfeeding — the procedure is usually postponed.
A corticosteroid injection into the same area in recent weeks.
Severe stage IV osteoarthritis with axial deformity and joint destruction — joint replacement is usually discussed instead.

Possible risks

Pain and swelling at the injection site for 1–3 days.
Bruising where blood or fat tissue is taken.
Rarely, infection. The procedure is therefore performed under sterile conditions with ultrasound or X-ray guidance.
The effect may be absent or smaller than expected.

If any of these apply to you, mention it in your request. The coordinator will check with the clinic physician whether treatment is possible. Contact a coordinator.

Scientific evidence

Studies of regenerative methods show mixed results. Clinic physicians rely on research including the following:

Ye Y et al. Platelet rich plasma versus hyaluronic acid in patients with hip osteoarthritis: A meta-analysis of randomized controlled trials. Int J Surg, 2018.
Bannuru RR et al. OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis. Osteoarthritis Cartilage, 2019.

Next steps: Treatment methods · Treatment cost · How treatment in Germany is organised

Frequently Asked Questions about Hip Osteoarthritis (Coxarthrosis) Treatment

Hip osteoarthritis (coxarthrosis): can surgery be avoided?

Often yes: in stages I–III treatment starts with exercise, weight loss, painkillers and injections. In severe osteoarthritis with deformity and constant pain, surgery is usually discussed.

Hip osteoarthritis (coxarthrosis): do PRP and cell-based methods help?

They can reduce pain for several months; this is best studied for PRP in knee osteoarthritis. Results vary, and injections do not restore cartilage. Cell-based methods cost more, and their advantage over PRP has not been proven.

When can I expect a result after an injection?

If an injection helps, relief usually builds up over 6–12 weeks. The result is assessed after 2–3 months; not everyone needs a repeat procedure. No clinic can guarantee a result.

Hip osteoarthritis (coxarthrosis): when is surgery needed?

Surgery is discussed when marked pain and restricted movement do not improve after 3–6 months of conservative treatment, and in advanced stages with deformity. The decision is made by the clinic doctor.

Treatment

Compare Methods

Cost

Clinic and method matching — free of charge

Describe your case and attach your MRI report. We will identify clinics that use the relevant methods and forward your request to them. No obligation; we reply within 24 hours.

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