Русский 
English 
Deutsch 
Español 
العربية 
中文 
Türkçe 
Français 
Italiano 
Causes of hip joint pain
Important: hip joint pain is often felt not in the joint itself, but in the groin, anterior thigh, buttock, or even the knee. If the knee hurts but no pathology is found there — check the hip joint.
Degenerative Diseases
Hip Osteoarthritis (Coxarthrosis)
The most common cause of chronic hip joint pain after age 50. Destruction of the cartilage covering the femoral head and acetabulum. Stages: 1 — pain after prolonged walking; 2 — pain with normal load, limping, restricted rotation; 3 — pain at rest, leg shortening, contracture; 4 — complete immobility. Traditional medicine offers joint replacement at stages 3-4. Regenerative treatment is effective at stages 1-3.
→ Treatment of Hip Osteoarthritis (Coxarthrosis) using a regenerative method
Avascular Necrosis of the Femoral Head
Death of bone tissue due to impaired blood supply. Risk factors: corticosteroid use, alcohol, trauma, sickle cell anemia, radiation therapy. ARCO stages: I — MRI changes without X-ray findings; II — sclerosis/cysts on X-ray; III — subchondral collapse (crescent sign); IV — secondary osteoarthritis. Cells and growth factors mainly reduce inflammation and support tissue repair; how much the tissue recovers cannot be predicted.
Structural Pathologies
Femoroacetabular Impingement (FAI)
Pathological contact between the femoral head and the acetabular rim. Types: cam (head thickening), pincer (excessive coverage), mixed. Groin pain with flexion and internal rotation, restriction with squatting and driving. Common in young athletes.
Acetabular Labrum Injury
Tear of the cartilage ring at the acetabular rim. Clicking, locking, groin pain. Often accompanies FAI. May not be visible on standard MRI — MR arthrography is needed.
Perthes Disease
Avascular necrosis of the femoral head in children aged 4-10 years. Limping, groin and knee pain. Timely treatment is critically important for normal joint development.
Periarticular Pathologies
Greater Trochanteric Bursitis (Trochanteritis)
Inflammation of the bursa over the greater trochanter. Pain on the lateral thigh surface, worsening when lying on the affected side. Common in women aged 40-60, runners. Tenderness on palpation of the greater trochanter.
Adductor Muscle Tendinopathy
"Groin strain" — overload of the hip adductor muscles. Groin pain with leg abduction, physical exertion. Common injury in soccer, hockey.
Piriformis Syndrome
Spasm of the piriformis muscle compressing the sciatic nerve. Buttock pain radiating to the posterior thigh. Mimics sciatica, but the source is the muscle, not the spine.
Referred Pain
Lumbar Spine
L2-L4 disc herniations can cause groin and anterior thigh pain, mimicking hip joint pathology. If there is back pain combined with "hip" discomfort — MRI of both regions.
Sacroiliac Joint
Sacroiliitis may present with pain in the buttock and posterior thigh. Provocative tests (FABER, Gaenslen) help differentiate.
Diagnosis of Hip Joint Pain
MRI of the Hip Joint
Gold standard. Visualizes cartilage, labrum, bone marrow (necrosis!), tendons, bursae. If labrum injury is suspected — MR arthrography with contrast. If necrosis is suspected — mandatory: X-ray may be normal at stage I.
Standing Pelvis X-ray
Both sides for comparison. Assessment: joint space, osteophytes, femoral head shape (cam/pincer), Wiberg angle (coverage), signs of necrosis (crescent sign, collapse).
Clinical Tests
FABER/Patrick test (Hip Joint vs SI joint), FADIR test (impingement), Trendelenburg test (abductor weakness), log-roll test (intra-articular pathology). Limitation of internal rotation — early sign of Hip Osteoarthritis (Coxarthrosis).
Diagnostic Injection
If pain source is unclear — injection of anesthetic under ultrasound guidance into the Hip Joint. If pain completely resolves — source confirmed.
How it is treated: the cause comes first
Treatment depends on the cause of the pain, so it starts with an examination and, if needed, imaging — X-ray, ultrasound or MRI. The same pain can be caused by osteoarthritis or by a tendon, nerve or disc problem.
Most patients are helped by conservative treatment: exercise therapy, load management, short courses of painkillers and sometimes injections. Regenerative methods (PRP, cell preparations) are discussed once the diagnosis is known and there is at least limited evidence for it; no method guarantees a result.
We send a description of your case and your images to several partner clinics. The clinic doctors give a preliminary opinion, suggest a plan and quote a price, and we help you compare the options.
Diseases of the Hip Joint
Hip Osteoarthritis (Coxarthrosis)
Hip Joint osteoarthritis. Pain while walking, limping, restricted rotation.
Avascular Necrosis of the Femoral Head
Bone tissue death. Progressive pain, risk of femoral head collapse.
Labral Tear
Acetabular labrum tear. Clicking, catching, groin pain.
Hip Impingement (FAI)
Pathological contact. Pain on flexion, restricted squatting.
Hip Bursitis
Trochanteritis. Pain along lateral thigh, pain when lying on side.
Perthes Disease
Necrosis in children. Limping, groin and knee pain in child 4-10 years old.
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
Questions about Hip Joint Pain
The most common cause is Hip Osteoarthritis (Coxarthrosis). Also: Avascular Necrosis of the Femoral Head, Labral Tear, Hip Bursitis, Hip Impingement (FAI). For accurate diagnosis, MRI of the Hip Joint is required.
In early hip osteoarthritis, often yes: exercise, weight loss, painkillers and, during flare-ups, injections help many people for years. In early avascular necrosis of the femoral head, core decompression with bone marrow cells is sometimes used, but halting the disease cannot be guaranteed. With severe pain and joint destruction, hip replacement is the most reliable option. The clinic physician assesses what is possible in your case based on MRI and X-ray.
Death of bone tissue due to impaired blood supply. Risk factors: corticosteroids, alcohol, trauma. Without treatment, it leads to femoral head collapse and the need for joint replacement.
Yes, groin pain is typical referred pain in Hip Joint pathology. Pain may also radiate to the anterior thigh, knee, and buttock. If the knee hurts without pathology — check the Hip Joint.
MRI of the Hip Joint (primary), standing pelvis X-ray (joint space, osteoarthritis stage). If necrosis is suspected — MRI is mandatory; X-ray may be normal in early stages.