What causes hip pain when walking?

Three main causes: true hip joint pain (groin, deep, worse going upstairs), referred back pain (outer hip/buttock, radiates below knee), and trochanteric bursitis (over the outer hip bone, worse lying on the side). Each requires different treatment.

Most hip pain isn't an emergency. Red flags requiring urgent assessment: sudden inability to bear weight (fracture), fever with hot swollen hip (septic arthritis), or pain after a fall in older patients (occult fracture). Otherwise, 6–8 weeks of physiotherapy is the first line.

Can hip pain be treated without surgery?

Yes for most causes. Physiotherapy, weight management, walking aids, activity modification, and image-guided injections control symptoms in the majority of patients. Surgery is reserved for end-stage arthritis with daily-activity-limiting pain after conservative treatment fails.

Is my back causing my hip pain?

Possibly. Lumbar spine pathology often refers pain to the buttock and outer hip, mimicking hip joint disease. The pattern: pain with bending, radiating below the knee, normal hip examination, and pain unchanged by hip movement. A specialist examination distinguishes the two.

What is avascular necrosis (AVN) of the hip?

Loss of blood supply to the femoral head, causing bone cell death and eventual collapse. Risk factors: steroid use, alcohol, post-COVID, sickle cell disease. Early diagnosis (MRI) allows core decompression to preserve the joint; late presentation requires hip replacement.

Hip Pain When Walking — Causes & Treatment in Mohali | Dr. Harjoban Singh

Dr. Harjoban Singh — the only FIFA-approved orthopaedic surgeon in the Chandigarh Tricity — sees patients with this condition regularly. Most cases are treated without surgery first.

Differential

Three Different Pains, Three Different Diagnoses

1. True hip joint pain. Felt deep in the groin, sometimes radiating to the front of the thigh. Worse going upstairs, getting in and out of cars, and putting on socks. The classic test: pain on internal rotation of the hip.

2. Referred back pain. Felt over the buttock and outer hip, often radiating below the knee. Caused by lumbar spine pathology — not the hip joint itself. Common diagnostic confusion. Hip examination is normal.

3. Trochanteric bursitis. Felt over the outer hip bone (greater trochanter). Worse lying on the affected side at night. Tender to direct pressure. Local condition, not joint disease.

Patients who had "hip surgery" for what was actually back pain are not rare. Get the diagnosis right first.

Causes

Causes of True Hip Joint Pain

Hip osteoarthritis — commonest cause > 55. Gradual onset, morning stiffness, restricted internal rotation.
Avascular necrosis (AVN) of the femoral head — younger patients, often associated with steroid use, alcohol, or post-COVID. Can progress rapidly.
Femoroacetabular impingement (FAI) — younger patients, often athletic. Pain with deep flexion, sitting cross-legged.
Labral tear — often co-exists with FAI. Catching, clicking, deep groin pain.
Inflammatory arthritis — rheumatoid, ankylosing spondylitis. Bilateral, morning stiffness > 1 hour.
Hip fracture — in older patients after even minor falls. Always exclude with X-ray.

Imaging

MRI vs X-Ray — Which You Need

Plain X-ray first — always. Standing AP pelvis and lateral views diagnose osteoarthritis, fractures, and significant deformity. Cheap, low radiation, immediately available.

MRI when:

X-ray is normal but symptoms persist > 6 weeks — rules out AVN, labral tear, occult fracture.
Younger patient suspected of FAI or labral pathology.
Pre-operative planning when soft-tissue assessment matters.

Don't skip the X-ray. Many patients arrive with MRI showing "mild degeneration" in everyone > 40 — while a standing X-ray would have shown the actual joint space loss in 30 seconds.

Conservative

Non-Surgical Treatment First

Physiotherapy. Hip abductor strengthening, core stability, gait re-education. 6–8 weeks of structured physio is the foundation.

Weight loss. Each kg of body weight = 4 kg of force across the hip during walking. Often the single most effective intervention.

Cortisone injection. Image-guided intra-articular injection — useful for short-term symptom relief and as a diagnostic tool. Limited to 2–3 per year.

Walking aids. A cane in the opposite hand reduces hip joint load by up to 40%. Underused due to perceived stigma.

Activity modification. Substitute swimming and cycling for high-impact activities until inflammation settles.

When Surgery

When Hip Replacement Becomes Necessary

Hip replacement is considered when:

Pain limits daily activities despite 3+ months of conservative treatment.
X-ray confirms Grade 3–4 joint space narrowing or AVN with collapse.
Sleep is regularly disturbed by pain.
Walking distance progressively reducing.

Modern hip replacement: 1–2 nights in hospital, walking with frame day 1, walking unaided at 4 weeks, driving at 6 weeks. More on hip replacement at Gini →

For AVN diagnosed early (before femoral head collapse), core decompression — a less invasive alternative to replacement — may be appropriate.

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