---
title: "Hip pain: diagnosis, investigations and treatment options."
description: Hip pain is discomfort in or around the hip joint, which can stem from the joint or surrounding tissues. Learn more about it in our article.
---

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# [Hip pain: diagnosis, investigations and treatment options.](https://www.orionortho.sg/articles/hip-pain-diagnosis-investigations-and-treatment-options)

 Written by [Orion Orthopaedic Surgery](https://www.orionortho.sg/articles/author/orion-orthopaedic-surgery) | 17 Jun, 2025 9:43:41 AM

## What Is Hip Pain?

[Hip pain](https://www.orionortho.sg/hip-pain) refers to discomfort located in or around the hip joint, which may originate from the joint itself or from surrounding soft tissues. Depending on the cause, pain can be felt in the groin, outer hip, thigh, or buttocks.

## Hip Joint Anatomy

The hip is a ball-and-socket joint, where the femoral head represents the ball and the acetabulum is the socket. Both the ball and socket are covered with cartilage, a thick and smooth layer with permits painless and seamless movement of the hip. The labrum is a ‘rubber lining’ which deepens the socket and stabilises the joint. There are various sets of muscles surrounding the hip joint which provides movement, stability and strength around the hip as we go about our daily activities.

- **Type: **Ball-and-socket synovial joint,
- **Bones Involved:** 
    - **Femoral head: **The "ball" at the top of the thigh bone,
    - **Acetabulum: **The "socket" in the pelvis,
- **Articular Cartilage: **Covers joint surfaces to allow smooth motion,
- **Labrum: **Fibrocartilaginous ring that deepens the socket and stabilises the joint,
- **Ligaments: **Iliofemoral, pubofemoral, and ischiofemoral ligaments stabilise the joint,
- **Surrounding Muscles:** 
    - **Flexors: **Iliopsoas, rectus femoris,
    - **Extensors: **Gluteus maximus, hamstrings,
    - **Abductors: **Gluteus medius and minimus,
    - **Rotators: **Piriformis, obturator internus.

When patients describe hip pain, it is essential for the doctor to determine the exact location and source of the pain. It may come from within the hip joint itself or from any of the associated structures outside the hip. A thorough clinical history and examination are therefore important to help determine this.  

## Typical Symptoms described by patients

- **Groin pain: **Suggests joint pathology (e.g., arthritis, [labral tear](https://www.orionortho.sg/hip-labral-tears)),
- **Lateral hip pain: **Often from bursitis or tendinopathy,
- **Posterior hip pain: **May be referred from the spine or sacroiliac joint,
- **Clicking, locking, or instability: **Suggest intra-articular problems,
- **Stiffness, limping, or reduced range of motion**: difficulty putting on socks or cutting toenails.

## Common Causes of Hip Pain

### Intra-articular Causes

**Osteoarthritis**: Hip arthritis, most commonly **[osteoarthritis](https://www.orionortho.sg/hip-arthritis) (OA)**, is a degenerative joint disease where the cartilage that cushions the hip joint wears down over time. This leads to:

- Pain (especially in the groin or buttocks)
- Stiffness
- Reduced range of motion
- Difficulty walking, climbing stairs, or standing up
- **Femoroacetabular impingement (FAI)**: Abnormal bone shape causes joint damage. Impingement may happen due to bone sputs at the acetabulum or femoral head/neck junction
- **Labral tear:**  
  Often from [trauma](https://www.orionortho.sg/sports-injury-singapore), repetitive motion, or impingement.  
  Tears of the labrum often cause pain or clicking in the hip. They may happen in patients with dysplasia or FAI.
- **Avascular necrosis (AVN)**: Loss of blood supply to femoral head that causes secondary arthritis. 

### Extra-articular Causes

### Referred Pain

## Radiological Investigations

### 1. Plain X-ray (AP and lateral views)

First-line for bony abnormalities (e.g., OA, fractures, FAI).

This X-ray shows severe arthritis of the right hip. There is no space between the femoral head and the acetabulum, which represents worn-out cartilage.

### 2. MRI

Gold standard for soft tissue and cartilage evaluation (e.g., labral tears, AVN) 

This MRI shows avascular necrosis of the right hip.

### 3. MRI Arthrogram

Better visualisation of labral pathology.

### 4. CT Scan

Superior for detecting subtle bone morphology (e.g., FAI) or surgical planning

### 5. Ultrasound

Helpful in guiding injections or assessing superficial bursitis/tendinopathy

### 6. Bone Scan or SPECT:

May be used for occult fractures, stress injuries, or metastatic disease

 

## Conservative Treatments for Hip Pain

Conservative therapy is often effective for non-advanced conditions and should be tried before surgery in most cases.

Hip injections are given either under X-ray or ultrasound guidance. This is to ensure the accuracy of the injection into the hip joint.

## Surgical Options

There are several surgical procedures which orthopaedic surgeons perform for specific causes of hip pain. These are brief descriptions of the procedures. You should get more detailed information about your hip pain from your orthopaedic surgeon.

### 1. [Hip Arthroscopy](https://www.orionortho.sg/hip-arthroscopic-surgery)

### 2. Core Decompression (for AVN)

### 3. Partial hip Replacement (Hemi-arthroplasty)

These operations are frequently performed for elderly patients who have experienced a hip fracture after a fall. These patients often have brittle bones or [osteoporosis](https://www.orionortho.sg/osteoporosis). A minor fall can be enough to cause a fracture. While some fractures may be fixed with metal implants, other hip fractures, which are more severely displaced, have to be replaced. Due to the frailty of these elderly patients, a partial hip replacement is often sufficient for them to regain their mobility. This is a shorter and less risky surgery than a total hip replacement. Only the femur is replaced while the acetabulum is left alone.

### 4. Total Hip Replacement

[Hip replacement surgery](https://www.orionortho.sg/total-hip-replacement-using-direct-anterior-approach-daa) replaces the worn-out parts of the hip joint and allows patient to regain their active and healthy lifestyle. Implants are inserted, and patients are allowed to start walking the day of surgery itself.

Hip implants comprise the femoral stem and head as well as the acetabular cup and liner. 

## Physiotherapy and rehabilitation for Hip Arthritis

### 1. Patient Education

 2. Exercise Therapy

The most effective, evidence-based intervention.

#### **A. Strengthening Exercises**

Target the hip abductors, gluteal muscles, core, and quadriceps:

#### **B. Stretching Exercises**

Improve flexibility of the hip and surrounding muscles:

#### **C. Range of Motion (ROM) Exercises**

Gentle movements to maintain joint mobility:

#### **D. Balance and Proprioception Training**

Improves stability and reduces fall risk:

### 3. Manual Therapy (Optional, by Physiotherapist)

### 4. Modalities (Adjuncts)

May be used to manage symptoms during flare-ups:

### 5. Functional Training

Helps improve daily activities:

### 6. Aquatic Therapy (Hydrotherapy)

Exercising in water reduces joint loading while allowing movement:

## Rehab after a total hip replacement (THR)

There are several methods surgeons use to perform a THR. Just like there are many ways to enter a house (front or back door, side window), the surgeon may choose to enter the hip through the front, back or side. This detail is crucial as each surgical approach is associated with specific pros and cons. Rehabilitation begins within **24 hours** after surgery and progresses through several **phases** over 3–6 months (or longer, depending on individual factors).

### Phase 1: Immediate Postoperative Phase (Day 0–7)

#### **Goals:**

#### **Key Components:**

### Phase 2: Early Recovery (Weeks 2–6)

#### **Goals:**

#### **Exercises:**

### Phase 3: Strengthening & Conditioning (Weeks 6–12)

#### **Goals:**

#### **Exercise Progression:**

#### **Functional Goals:**

### Phase 4: Advanced Strengthening & Return to Activities (3–6+ Months)

#### **Goals:**

#### **Activities Allowed:**

#### **Activities to Avoid (Long-term):**

## Long-Term Tips for THR Success

## Conclusion

 There are many reasons patients experience pain in the hip. It is important for the orthopaedic surgeon to come to an accurate diagnosis through thorough history taking, clinical examination as well as through the appropriate imaging modality e.g. MRI scan. Once the diagnosis is obtained, the surgeon will then be able to advise which conservative or surgical treatment option is appropriate for you. The details of the procedure and post-procedure rehabilitation should be explained so that patients understand what to expect.

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