Part of Hip osteoarthritis
Where is hip arthritis pain felt? Groin, thigh, buttock and knee
Warning signs, and when to get help
Where is hip arthritis pain felt?
The hip joint is a ball and socket buried deep in the pelvis, roughly behind the crease at the top of your thigh and a few finger widths in from the bony lump you can feel on the side. Nothing you do with your fingers reaches it, so the pain it produces turns up somewhere else. These are the usual places, roughly in order of how often they come up:
- The groin, deep and inside, often described as a band or a wedge, not a point. AAOS names this as the commonest site.
- The front of the thigh, sometimes the whole way down it.
- The knee, usually the inner side or the front of it, and occasionally below the knee.
- The buttock, as a dull ache and not a shooting pain.
Two or three of those run together in the same hip, and which one shouts loudest changes from week to week. What does not happen, as a rule, is a single tender spot you can put a finger on. If there is one, read the section on the outside of the hip further down.
How strong is each clue? Groin pain is the one to take seriously, and the numbers behind it are easy to misread, so here they are in the direction the studies measured them. The hospital study that set out to separate hip from spine found groin pain pointed to the hip with a sensitivity of 84.3 percent and a specificity of 70.3 percent (Khan and colleagues, 2004), in a group where one of those two was already the answer.
The picture in the general population is looser than that. Kim and colleagues treated the X-ray as the test and compared it with where people said the pain was: among hips with groin pain, 36.7 percent in the Framingham study and 16.5 percent in the Osteoarthritis Initiative had arthritis on the film, and among the Framingham hips that did show arthritis, only 6.0 percent had groin pain (Kim and colleagues, 2015).
Read those together and the practical lesson is a modest one. Groin pain moves the hip joint up your list and settles nothing, and a hip with no groin pain is not a hip without arthritis.
Why does it hurt in the groin and not where you point?
Pain from a deep structure is reported in a region, not at a point. That is true of a gallbladder, a tooth root and a hip. The nerves that supply the hip joint capsule also supply skin and muscle further down the limb, and the brain has no way to separate the two signals, so it puts the pain where it has more practice feeling things.
The second reason is that the thing most people call the hip is not the joint. The bony lump on the side is the greater trochanter, a lever arm for the muscles that hold your pelvis level. It sits a hand's width away from the socket. Pointing there and feeling nothing is normal in hip arthritis, and it catches out plenty of clinicians too.
A couple of minutes with your own fingers will test that. Press firmly all over the bony lump and the soft tissue around it: if that reproduces your pain, the joint is an unlikely culprit, because you cannot compress it from outside. If pressing does nothing and the pain only arrives when you move or load the leg, the joint stays in the frame.
Can you feel hip arthritis in the knee, the buttock or down the leg?
Yes to all three, and the knee is the one that causes real trouble. One study compared 60 people waiting for a hip replacement with 60 waiting for spinal surgery. In the hip group, 47 percent reported pain below the knee, and 88.5 percent of the orthopedic trainees surveyed in the same study thought hip pain does not go that far down (Khan and colleagues, 2004). Those patients had arthritis severe enough to be listed for an operation, so the figure belongs to that group and not to every aching hip. Even so, a surgical team at a US arthroplasty center described 21 people treated for knee pain whose problem was in the hip, and 12 of them had already had an operation on the knee without relief (Dibra and colleagues, 2017).
That question has its own page, and can hip arthritis cause knee or back pain covers the mechanism, the home tests and what to say at your appointment. The short version for this page: knee pain with a knee that is not swollen, not stiff and not sore to press is a reason to have the hip assessed.
Buttock ache is a weaker signal. The lower back, the sacroiliac joint and the gluteal tendons all report into the same patch of skin, and in the Khan study buttock pain was commoner in the hip group than the spine group but not decisive on its own. Pain that travels from buttock to calf with pins and needles belongs to sciatica until proven otherwise.
What if the pain is on the outside of the hip?
Pain over the bony point, tender when you press it, worse when you lie on that side and worse again going up a slope, fits greater trochanteric pain syndrome, now understood as coming mainly from the gluteal tendons rather than from a bursa (Grimaldi and Fearon, 2015). The greater trochanteric pain syndrome program treats it, and outer hip pain covers the full list of things that cause pain in that spot.
In a hip that has been stiff for years, the muscles at the side are working around a joint that will not turn, so tendon pain on the outside of a worn hip is a routine finding rather than an alternative diagnosis. Hip arthritis or bursitis sets out how to tell which of the two is producing today's pain.
What else goes with it, besides pain?
Stiffness is the one people mention without being asked, and it tells you more quickly than the pain map does. It is at its worst first thing in the morning and after you have been sitting still, and it loosens once you get moving. AAOS describes hip stiffness that makes walking and bending difficult, with pain and stiffness worse in the morning or after sitting. NICE puts a limit on it: in people 45 and over, osteoarthritis can usually be diagnosed without an X-ray when the joint aches with activity and morning stiffness either is absent or lasts no longer than 30 minutes. Stiffness that runs on for an hour or more, in several joints, is a different conversation and belongs with your doctor, not with this page.
Movement is lost quietly, and the end of it feels blocked instead of sore. Turning the leg inward is often the first movement to go, and people rarely notice it directly. What they notice is the result: getting into a bath needs a handhold, a sideways shuffle appears when you get out of a low car seat, and the foot on that side becomes hard to bring up to trim a nail. Standing on one leg to pull on trousers stops being automatic.
A limp usually gets spotted by somebody else before you feel it. The step on the sore side gets shorter, and most people pick up a small lean over that hip as their weight passes across it. Hip pain when walking goes into what that changes and what helps.
Pain at rest tends to arrive later on. AAOS lists pain that flares up with vigorous activity, and says that over time painful symptoms may occur more often, including during rest or at night. If night pain is your main complaint, sleeping positions and night pain with hip arthritis is the page for it, and the warning list below sets out the night pain that needs a doctor instead of a pillow.
When is hip pain not the hip joint?
The lower back and the nerves leaving it do a good impression of a hip. Pain that runs down the back of the leg with pins and needles, numbness or weakness points there: see sciatica. Pain in both legs, saddle numbness or a change in bladder or bowel control is an emergency and sits at the top of the warning list below.
The groin has its own long list, including hernias, the pubic bones and the hip flexor tendons, and groin pain works through it.
In a younger or more active hip, the joint surfaces and the rim of the socket can produce a map that looks identical. Hip impingement and hip labral tear cover those, and a pinching catch at the front of the hip on deep bending is more their line than arthritis.
A location never makes the diagnosis, and more than one of these is often true at once. What it does is narrow the field, which is exactly what you want before an appointment.
When to see a physio or doctor
Book a routine appointment with a doctor or physio if hip, groin or thigh pain is interfering with sleep or with what you normally do, if it keeps returning, or if it has not improved after 2 weeks of looking after it at home (NHS). Go sooner if the hip is stiff for more than 30 minutes after you wake.
Where the pain starts, where it spreads, whether you can press on it, which movements feel blocked instead of sore, and what you cannot do now that you could last year will narrow the field faster than anything else in the appointment. If a knee has already been investigated and nothing was found, say so and ask for the hip to be checked. The hip osteoarthritis program is the exercise side of treatment once you know what you are dealing with, and treating hip arthritis without surgery covers the rest of the options.
Some signs need help faster than a routine appointment, from an emergency visit to a doctor within a few days. They are listed under the warning signs below.
Related exercise programs
Warning signs
Get emergency help now
- Emergency: you have had a fall or an injury and now have severe hip pain, or you cannot walk or put weight on the leg. Call emergency services or go to an emergency department. This can be a sign of a broken hip (hip fracture).
- Emergency: tingling or loss of feeling in the hip or leg after a fall or injury. Call emergency services or go to an emergency department.
- Emergency: pain, tingling, numbness or weakness in both legs, numbness or altered feeling around your genitals or bottom, or new trouble peeing or controlling your bladder or bowels. The same applies if you lose feeling in one leg. Call emergency services or go to an emergency department straight away. These can be signs of pressure on the nerves at the base of the spine (cauda equina syndrome).
Get help today
- Same day: the hip is hot and swollen, or the skin over it has changed color, or you have hip pain with a high temperature or feel hot, cold or shivery. Get medical help the same day, and go to an emergency department if you feel very unwell. A joint infection needs treatment quickly. If you have a very high or very low temperature, shivering you cannot control, you are breathing very fast or finding it hard to breathe, you are confused or your speech is slurred, your skin, lips or tongue look blue, gray, pale or blotchy (on brown or black skin this can be easier to see on the palms of the hands or soles of the feet), or you have a rash that does not fade when you press it, call emergency services, as this can be sepsis.
- Same day: severe hip pain that came on suddenly without a fall, or pain that is getting worse quickly over a few days. Get medical advice the same day.
- Same day: new hip or groin pain after a fall, even a small one, if you are older, have low bone density (osteoporosis) or have taken steroid tablets for a long time, even if you can still walk. Get medical advice the same day. A broken hip is not always obvious at first.
- Same day: a leg or foot that is getting weaker, for example your foot drags, catches on the ground or slaps down when you walk (foot drop). Get medical advice the same day. If the weakness is getting worse by the hour, go to an emergency department.
- Same day: a child or teenager has sudden pain in the hip, thigh or knee, is limping, or cannot put weight on one leg. Get an urgent appointment with a doctor the same day. If they have a high temperature or seem very unwell, go to an emergency department. This page is for adults, and hip pain in children has different causes.
- Same day: hip or groin pain that is worse at night or does not ease with rest, and keeps getting worse. If you are being treated for cancer now, contact your cancer team the same day.
Book an appointment
- Within a day or two: hip or groin pain that is worse at night or does not ease with rest, and keeps getting worse. If you have had cancer, now or in the past, or are losing weight without trying, see your doctor sooner, within a day or two, and mention it. This applies even if the pain is not getting worse.
- Within a few days: hip or groin pain that is worse at night or does not ease with rest, and keeps getting worse. See your doctor within a few days.
- Within a few days: new groin or hip pain and you take steroid tablets long term, or have in the past, or you regularly drink a lot of alcohol. This can be a sign of a problem with the blood supply to the top of the thighbone (avascular necrosis). Book an appointment with your doctor within a few days and mention the steroids or alcohol.
- Within 2 weeks: pain that spreads down the leg below the knee, especially with numbness or tingling in the leg or foot. The pain may be coming from your lower back rather than the hip. Book an appointment with a doctor or physio.
Common questions
Where do you feel hip arthritis pain?
Deep in the groin most often, and across the front of the thigh. AAOS lists groin pain as the commonest site, with thigh pain that spreads out to the buttock or the knee. The giveaway is depth: it sits inside, you cannot put a finger on it, and it is usually a broad ache spread across a region.
Does hip arthritis cause groin pain?
Yes, and of all the places people put the pain, the groin points at the joint most. Keep the strength of that pointer modest, though. In the study comparing people awaiting a hip replacement with people awaiting spinal surgery, groin pain had a sensitivity of 84.3 percent and a specificity of 70.3 percent for the hip being the problem (Khan and colleagues, 2004), in a group where one of those two was already the answer. In two large community cohorts the link was looser in both directions: among hips with groin pain, 36.7 percent in the Framingham study and 16.5 percent in the Osteoarthritis Initiative had arthritis on X-ray, and most hips that did show arthritis had no groin pain at all (Kim and colleagues, 2015). So groin pain argues for the hip joint, and no groin pain does not argue against it.
Can hip arthritis be felt in the buttock?
It can. AAOS names the buttock as one of the places hip joint pain spreads to. Buttock pain on its own is a weaker clue than groin pain, because the lower back, the sacroiliac joint and the gluteal tendons all speak from the same area. What separates them is usually what the hip does: a joint that has lost its turn inward and feels blocked at the end of a movement points back toward the hip.
Is pain on the outside of the hip arthritis?
Usually not. Pain you can press on, over the bony point at the top of the thigh bone, and pain that is at its worst lying on that side fits greater trochanteric pain syndrome, which comes mostly from the gluteal tendons (Grimaldi and Fearon, 2015). Our page on hip arthritis or bursitis sorts the two out. Both can be present in the same hip, which is the part online comparisons tend to skip.
Does hip arthritis pain go down the leg?
Sometimes well past the knee. Among 60 people waiting for a hip replacement, 47 percent reported pain below the knee, while 88.5 percent of the orthopedic trainees surveyed in the same study believed hip pain does not radiate below the knee (Khan and colleagues, 2004). Those were people with advanced arthritis, so the figure describes that group rather than every sore hip. It is still the reason worth knowing: hip pain can reach the shin.
Why does my hip hurt in front but not where I point?
Because the joint is not where most people point. The ball and socket sits deep, roughly in line with the crease at the top of your thigh, a few finger widths in from the bony lump on the side. Pain from a structure that deep is felt across a region, and the nerves supplying the joint also supply the front of the thigh and the knee, so that is where it is reported.
Does a scan tell you where the pain is coming from?
Less than you would hope. The pattern is what matters. In the Framingham cohort only 15.6 percent of hips in people with frequent hip pain had arthritis on X-ray, and in the larger Osteoarthritis Initiative cohort only 9.1 percent did (Kim and colleagues, 2015). NICE advises that from age 45 osteoarthritis can usually be diagnosed without an X-ray when the joint aches with activity and there is either no morning stiffness at all or morning stiffness lasting no longer than 30 minutes.
References
- Khan AM, McLoughlin E, Giannakas K, Hutchinson C, Andrew JG. Hip osteoarthritis: where is the pain? Annals of the Royal College of Surgeons of England. 2004;86(2):119-121. https://doi.org/10.1308/003588404322827518
- Kim C, Nevitt MC, Niu J, et al. Association of hip pain with radiographic evidence of hip osteoarthritis: diagnostic test study. BMJ. 2015;351:h5983. https://doi.org/10.1136/bmj.h5983
- Dibra FF, Prieto HA, Gray CF, Parvataneni HK. Don't forget the hip! Hip arthritis masquerading as knee pain. Arthroplasty Today. 2017;4(1):118-124. https://doi.org/10.1016/j.artd.2017.06.008
- Grimaldi A, Fearon A. Gluteal tendinopathy: integrating pathomechanics and clinical features in its management. Journal of Orthopaedic and Sports Physical Therapy. 2015;45(11):910-922. https://doi.org/10.2519/jospt.2015.5829
- National Institute for Health and Care Excellence. Osteoarthritis in over 16s: diagnosis and management (NG226). 2022. https://www.nice.org.uk/guidance/ng226
- American Academy of Orthopaedic Surgeons. Osteoarthritis of the hip. OrthoInfo. https://www.orthoinfo.org/en/diseases--conditions/osteoarthritis-of-the-hip/
- NHS. Hip pain in adults. https://www.nhs.uk/symptoms/hip-pain/
Written and checked by the PocketPhysio editorial team. Last updated 2026-10-18.
This page is general education, not a diagnosis or a personal treatment plan. See a physiotherapist or doctor for advice about your own situation.