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Most hip pain is not what you fear. Seeing what's actually happening — before you see a surgeon — is the value. Four questions map your pattern. A physician attests your next step.
Four questions. Your pattern routes you to the right next step — PT, surgeon, or home care.
Location is the single most useful piece of information.
The motion that brings on your pain points to the structure behind it. Mirror each cue, then tap the one that reproduces it most clearly.
Hip pain is not one diagnosis. The location and character of your pain are the most useful diagnostic clues.
Deep groin pain
Weight-bearing, morning stiffness, over age 50
Cartilage wear that develops gradually. The hip socket loses its smooth gliding surface. Pain typically worsens with loading — walking, stairs, getting out of a car. X-ray confirms the degree of joint space narrowing.
Affects 1 in 4 adults over 60
Orthopedic surgeon →Outer hip / lateral thigh
Worse lying on the side, climbing stairs, hip abduction
Inflammation of the fluid sac over the bony prominence of the outer hip. Common in runners, walkers, and middle-aged women. Does not typically cause groin pain. PT and a cortisone injection resolve most cases.
PT resolves 70% of bursitis cases without injection
Physical therapy first →Deep groin or anterior hip
Clicking, catching, or locking — often in active adults under 50
A tear in the fibrocartilage ring around the socket. Often caused by hip impingement (FAI) or sports-related stress. MRI arthrogram is the definitive diagnostic test. PT is first line; arthroscopy for refractory cases.
MRI arthrogram: 90% sensitivity for labral tears
Orthopedic evaluation →Posterior hip / buttock / leg
Pain travels down the leg, may follow a dermatomal pattern
The lumbar spine and hip share nerve pathways that make referral common and confusing. L3-L4 nerve root irritation mimics hip OA. A physical therapist can perform provocation tests — FABER, FADIR — to distinguish hip from spine.
Up to 40% of "hip pain" is actually spine-referred
Physical therapy evaluation →Treatment is matched to severity, not chosen arbitrarily. Knowing what each path delivers — and when it applies — is the most useful thing to know before your first appointment.
Strong evidence · 2024 AAOS CPG (Moderate Recommendation)
Start PTModerate evidence · 2024 AAOS CPG (Moderate Recommendation)
Talk to Sage about injectionsStrong evidence · 2024 AAOS CPG · NJR Annual Report 2023
See a surgeonTreatment decisions require individual clinical evaluation. This comparison is educational, not prescriptive. Always discuss options with a qualified healthcare provider.
The same Hip disability and Osteoarthritis Outcome Score your orthopedic surgeon would use. 12 questions, three subscales, one number that means something.
Pre-loaded with a sample patient so you can see what the result looks like. Edit any answer to make it yours.
Pain
19
/ 100
Function
25
/ 100
Quality of Life
19
/ 100
HOOS-12 Total
Your HOOS-12 score is consistent with end-stage hip disease. Patients with scores in this range often qualify for hip replacement (THA) and report dramatic improvement after surgery.
pain
How often is your hip painful?
Pain straightening your hip fully
Pain walking on a flat surface
Pain at night while in bed
function
Difficulty descending stairs
Difficulty rising from sitting
Difficulty putting on socks/stockings
Difficulty getting in/out of a car
Quality of Life
How often are you aware of your hip problem?
Have you modified your lifestyle to avoid hip-damaging activity?
How troubled are you by lack of confidence in your hip?
In general, how much difficulty do you have with your hip?
HOOS-12 © Klassbo, Larsson, Mannevik 2003. This widget is for education, not diagnosis. Subscale scoring follows the published HOOS user guide (0 = extreme problems, 100 = no problems).
Orthopedic surgeons use HOOS-12 scores alongside clinical findings and imaging to guide timing decisions. Here is what the published evidence says about each score range.
Scores in this range consistently predict surgery within 12–24 months. HOOS scores below 30 are associated with severe functional limitation — difficulty with basic activities. Most patients in this range are appropriate surgical candidates when conservative measures have been tried. THA produces the most dramatic functional improvement in this group.
Outcome data: Average post-THA HOOS improvement: +40–55 points. 90% of patients rate outcomes as 'good' or 'excellent' at 5 years.
This range represents the clearest surgical decision zone. AAOS 2024 guidelines recommend orthopedic evaluation when conservative care has been tried for 3–6 months without adequate improvement. Scores in this range are consistent with clinically meaningful hip dysfunction. The MCID (minimal clinically important difference) for HOOS-12 is approximately 10 points.
Outcome data: Most patients in this range achieve a post-operative HOOS of 75–90 after THA. Functional gain is consistently significant.
Mild-to-moderate range. Conservative care (PT, NSAIDs, activity modification, weight loss) should be maximized before surgical evaluation. Patients with active lifestyle limitations may still qualify for evaluation, but most in this range have not yet exhausted conservative options.
Outcome data: Structured PT produces HOOS improvement of 10–15 points in most patients in this range — often enough to avoid or significantly delay surgery.
Scores in this range generally do not meet surgical candidacy thresholds. The 2024 AAOS guideline does not recommend THA as a first-line treatment when HOOS is above 75 and conservative options have not been fully tried. Continued exercise and weight management are the evidence-based priority.
Outcome data: Prevention focus: maintaining HOOS above 75 with regular low-impact exercise and weight management is the goal.
~450,000
THA procedures per year (US)
Kurtz SM et al., JBJS 2007; projected to exceed 500K by 2030
90%
Good/excellent outcomes at 5 years
Wylde V et al., Bone Joint Res 2018
10 pts
HOOS-12 MCID
Minimal clinically important difference — Ayers DC et al., JBJS 2019
What surgeons evaluate beyond your HOOS score
Sources: AAOS Hip OA CPG 2024 (PMC12528243); Ayers DC et al., JBJS 2019; Ostendorf M et al., JBJS 2004; Wylde V et al., Bone Joint Res 2018.
Connect with a hip surgeonHOOS score thresholds are one input among many in surgical decision-making. Only a surgeon with access to your imaging, history, and physical examination can determine whether surgery is appropriate for you.
Ask anything about hip pain. Sage knows the evidence and routes you to the right care.
These patterns warrant prompt evaluation — do not wait for them to resolve on their own.
Hip pain that wakes you from sleep
Inability to bear weight on the affected leg
Sudden swelling, warmth, or redness around the hip
Hip pain after a fall, especially if over age 65
Groin pain that doesn't improve with rest
Progressive limping or shortening of the affected leg
Fever accompanying hip or joint pain
Numbness or tingling radiating down the leg
Your pattern determines the path. Three routes — all physician-attested.
Groin pain · weight-bearing · over 50
Connect with a surgeon who uses structured outcome tools — not just X-ray findings — to decide whether surgery is warranted.
SurgeonValue →Bursitis · labral irritation · referred spine pain
A targeted exercise program resolves most hip pain without surgery. CMS-tracked RTM so your surgeon sees your progress.
JointCoach →Post-replacement recovery · older adults
Worker-owned companion care. Physician-backed Letters of Medical Necessity unlock HSA/FSA for qualified care costs.
co-op.care →Real people who have been where you are. Real words. Real stories.
These are peer-to-peer stories, not medical advice. Always consult a qualified healthcare provider for diagnosis and treatment.
Evidence-based articles for patients who want to understand more.
Not all hip pain is equal. Most hip pain is musculoskeletal and can be managed with rest, physical therapy, and time. But certain presentations require urgent evaluation.
Seek emergency care immediately for: hip pain after a fall in a person over 65, especially with inability to bear weight (possible hip fracture); sudden severe pain with fever or chills (possible septic arthritis — a joint infection that destroys cartilage within hours and requires emergency surgery); hip pain with a known cancer history (possible metastatic disease); and any loss of bladder or bowel control accompanying back or hip pain (cauda equina syndrome — a surgical emergency).
See your doctor within 1–2 days for: a hip that clicks, locks, or gives way; progressive limping that has developed over weeks; hip pain waking you consistently at night; or pain that was mild and has become severe without explanation.
"Red flag" symptoms that warrant same-week evaluation include unexplained weight loss with hip pain, fever of any degree, or pain in a child or teenager — avascular necrosis and Legg-Calve-Perthes disease require early recognition in young patients.
Source: AAOS OrthoInfo; NHS Hip Pain Guidelines; BMJ Clinical Review 2023.
Real questions patients ask about hip pain. Answers reviewed by Josh Emdur, DO, board-certified internal medicine physician.
This information is for educational purposes only and does not constitute medical advice. Consult a qualified healthcare provider for diagnosis and treatment.
Reviewed by Josh Emdur, DO
Board-certified internal medicine. Licensed in all 50 states. altru.care
Last reviewed: April 2025
Medical disclaimer: The information on this website is for general educational purposes only and does not constitute medical advice, diagnosis, or treatment. It does not replace a consultation with a qualified healthcare provider. If you are experiencing a medical emergency, call 911 immediately. Always consult your physician or another qualified health provider with questions about a medical condition or before starting, stopping, or changing any treatment.
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