Treatment for hip arthritis typically starts with a combination of anti-inflammatory medication and exercise, then escalates to injections or surgery depending on how much pain and stiffness you’re experiencing. Most people manage symptoms for years before considering a hip replacement, and the 2023 clinical practice guidelines from the American Academy of Orthopaedic Surgeons lay out a clear progression from conservative care to surgical options.
Anti-Inflammatory Medication Is the First Step
Oral anti-inflammatory drugs like ibuprofen and naproxen are the strongest recommendation in current guidelines for reducing hip arthritis pain and improving function. They work by lowering inflammation inside the joint, which is the primary driver of pain in osteoarthritis. If you can’t tolerate these drugs due to stomach issues, a topical anti-inflammatory gel applied to the skin offers an alternative without the gastrointestinal side effects.
Acetaminophen (Tylenol) is another option, though the evidence supporting it is weaker. It can help with pain but doesn’t address inflammation directly. Guidelines recommend against using opioid painkillers for nonsurgical management of hip arthritis, given the risks of dependence and side effects like constipation and drowsiness.
If you’re over 60, have a history of stomach ulcers, or expect to take anti-inflammatories for more than three months, your doctor will likely add something to protect your stomach lining from the medication.
Exercise Therapy and Why It Works
Physical therapy carries a moderate recommendation for mild to moderate hip arthritis, and the data backs it up. A large meta-analysis found that exercise therapy produces a meaningful reduction in pain immediately after a treatment program, and that benefit persists six to nine months later, even after formal sessions end. That sustained effect is unusual for a non-drug treatment and makes exercise one of the most durable interventions available.
The specific type of exercise matters less than consistency. Land-based programs focusing on hip strengthening, flexibility, and balance all show benefit. Water-based exercise can be easier on the joint if weight-bearing movement is too painful. The goal is to strengthen the muscles around the hip so they absorb more of the load that would otherwise grind through damaged cartilage.
How Weight Loss Reduces Hip Pain
Every pound of body weight translates to roughly three to four pounds of force on the hip joint during walking. Losing just 10 pounds removes about 40 pounds of pressure from your hips with every step. For someone carrying 50 extra pounds, that’s approximately 200 pounds of additional stress the joint absorbs throughout the day. Even modest weight loss can noticeably reduce pain and slow the progression of cartilage damage.
Corticosteroid Injections for Short-Term Relief
When oral medications aren’t enough, a corticosteroid injection directly into the hip joint can reduce pain and improve function in the short term. These injections are particularly useful for people who can’t tolerate oral anti-inflammatories or who need temporary relief while deciding on surgery. The effect typically lasts weeks to a few months, and higher doses tend to extend the duration of relief.
Hyaluronic acid injections, which aim to supplement the joint’s natural lubricating fluid, are a different story. The AAOS strongly recommends against them for hip arthritis, finding they don’t reduce pain or improve function any better than a placebo injection. Despite being marketed widely, the evidence simply doesn’t support their use in the hip.
When Hip Replacement Becomes the Right Choice
Total hip replacement is the definitive treatment when conservative measures stop controlling your pain or when arthritis significantly limits your ability to walk, sleep, or do everyday activities. The surgery removes the damaged ball-and-socket joint and replaces both surfaces with metal and plastic components.
Two main surgical approaches exist: anterior (through the front of the groin) and posterior (through the back of the hip). The anterior approach separates muscles rather than cutting through them, which can mean less pain in the first two weeks of recovery. The posterior approach has been refined with newer techniques that preserve most of the surrounding muscles and tendons, largely closing the early recovery gap. A large randomized trial of about 400 patients found no differences in walking ability, return to function, or complication rates between the two approaches. Complication rates for either method sit around 1 in 1,000 operations.
Modern hip implants are durable. A pooled analysis published in The Lancet estimated that 85% of hip replacements are still functioning well at 20 years. Individual results ranged from 48% to 93% survival at 15 years depending on the specific implant and patient population, so the type of implant and your activity level both matter.
What Recovery From Hip Replacement Looks Like
Recovery moves faster than most people expect. You’ll bear full weight on the new hip and walk with a walker the same day as surgery, often covering several hundred feet before leaving the recovery unit. Here’s a general timeline of what comes next:
- Week 1: Rest, manage pain with medication, use a walker or cane, and begin gentle home exercises.
- Week 2: Work on balance, start phasing out the walker. Many people can drive by this point if they’re off pain medication and can stomp the brake pedal firmly with their right foot.
- Weeks 3 to 4: Resume daily activities and gradually increase exercise intensity.
- Weeks 5 to 6: Most people return to work. Those with physically demanding jobs may need more time or a gradual transition with shorter hours.
- Beyond week 6: Continued strengthening, building stamina, and returning to recreational activities with less pain.
Formal physical therapy after surgery is one option, but the evidence shows that a structured home exercise program produces equivalent outcomes. Either path works, so the choice comes down to whether you prefer guided sessions or are comfortable following a program independently.