Hip Pain: When Is It Time to See a Surgeon?

Not all hip pain requires surgery. Learn when to see an orthopedic hip specialist, what conditions cause hip pain, and when conservative treatment is enough vs when surgery is needed.

Common Causes of Hip Pain

Hip pain has many possible causes — not all require a surgeon. Understanding the source helps determine the right specialist.

• Osteoarthritis — gradual cartilage wear in the hip joint (most common cause in adults over 50)
• Labral tears — damage to the cartilage ring lining the hip socket
• Femoroacetabular impingement (FAI) — abnormal bone shape causing pinching
• Avascular necrosis — loss of blood supply to the femoral head
• Hip fracture — typically from falls in older adults

• Bursitis — inflammation of the fluid-filled sacs around the hip
• Tendinitis — inflammation of tendons (IT band, hip flexor, gluteal)
• Referred pain from the lower back (sciatica can mimic hip pain)
• Muscle strain — especially hip flexor or groin strains

Signs You Should See a Surgeon

Schedule an appointment with an orthopedic hip specialist if you experience:

• Groin pain that worsens with walking, climbing stairs, or getting out of a chair
• Hip stiffness that prevents you from bending to tie shoes or put on socks
• Pain that wakes you at night or disrupts sleep despite positioning changes
• Limping that you cannot control or that worsens over time
• Clicking, catching, or locking in the hip joint
• Pain that persists despite 6-12 weeks of physical therapy and anti-inflammatory medications
• Difficulty with daily activities — walking, sitting, standing, or getting in/out of a car
• Pain after a fall or injury — rule out fracture or structural damage

What to Expect at Your First Appointment

An orthopedic hip consultation typically includes:

1. Medical history review — when pain started, what makes it better or worse, previous treatments
2. Physical examination — range of motion testing, gait analysis, impingement tests, strength testing
3. X-rays — standing hip X-rays to evaluate joint space (cartilage thickness) and bone shape
4. Treatment discussion — options ranging from conservative (therapy, injections) to surgical
5. MRI (if needed) — ordered if X-rays are normal but labral tear or soft tissue problem is suspected

Most surgeons will not recommend surgery at the first visit unless imaging clearly shows end-stage arthritis. Conservative treatment is almost always attempted first.

Conservative Treatments Tried Before Surgery

Before recommending surgery, most surgeons want to see that you have tried:

• Physical therapy — 6-12 weeks of targeted hip strengthening and stretching
• Anti-inflammatory medications — NSAIDs (ibuprofen, naproxen) for pain and inflammation
• Activity modification — avoiding positions and activities that trigger pain
• Weight management — every pound lost removes 3-6 pounds of pressure from the hip
• Cortisone injection — a steroid injection into the hip joint (provides temporary relief and helps confirm the hip joint is the pain source)
• Walking aids — a cane in the opposite hand reduces hip joint loading by 40%

If these measures fail to provide adequate relief after 3-6 months, surgery becomes a reasonable consideration.

When Surgery Cannot Wait

In rare cases, surgery should not be delayed:

• Hip fracture — requires urgent surgical repair (within 24-48 hours)
• Severe avascular necrosis — progressive bone collapse may worsen without intervention
• Rapidly worsening arthritis — bone-on-bone arthritis with significant functional decline
• Failed previous hip procedure — painful or loose implant requiring revision

For the vast majority of patients with hip arthritis, surgery is elective — you choose when you are ready. There is no deadline, but delaying too long can lead to muscle weakness and deconditioning that slows recovery.

Frequently Asked Questions

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