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Hip Osteoarthritis (Hip Arthritis)

Hip osteoarthritis care in Midtown Manhattan: exercise, image-guided steroid injection and PRP, honest evidence on each, and a clear path to surgery.

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What to expect at your first visit

A 45–60 minute diagnostic consultation with Dr. Movshis, which may include an ultrasound exam. Review of any prior imaging (bring MRI, X-ray, or CT as a printed copy, or email it to info@modalpain.com ahead of your visit). Physical exam and discussion of your history. A clear diagnosis and a treatment plan by the end of the visit.

If a procedure is indicated, it's typically scheduled within 1–2 weeks at the same office.

Book a Consultation (646) 290-6660

Hip osteoarthritis is one of the most common causes of disabling adult hip and groin pain, and one of the most frequently misdiagnosed. At Modal Pain Management in Midtown Manhattan, Dr. Alex Movshis uses high-resolution imaging, a structured physical examination, and image-guided diagnostic and therapeutic injection to deliver a structured, non-surgical approach to hip arthritis, treating symptoms early and reserving surgery for the patients who need it. Most patients walk out of the consultation visit with a clear diagnosis, a written treatment plan, and a meaningfully better answer than “you’ll need a hip replacement someday.”

This page covers what hip osteoarthritis actually is, how it is reliably distinguished from the dozen other things that can cause groin and hip pain, how Dr. Movshis diagnoses it, the evidence-based image-guided non-surgical treatment ladder we use, when surgical referral is appropriate, and what to expect at your first visit.

Hip Osteoarthritis Is Not an Automatic Walk to the Operating Room

The usual story around hip osteoarthritis has been: conservative treatment fails, you get total hip replacement (THA), end of story. There is a middle ground. A structured, image-guided ladder of non-surgical treatments (exercise and weight management, corticosteroid injection, and, for selected patients, PRP) can control symptoms for a time in the right patients. The evidence behind each step differs a lot, and we say so plainly.

This matters for two reasons. First, hip implants wear out. In national registry data, about 58% of hip replacements were still in place at 25 years (Evans 2019), and revision surgery is technically harder than the first operation, so timing matters for younger and middle-aged patients. Second, X-ray findings and symptoms do not always match, and some patients told they need a hip replacement on the basis of an X-ray alone do well for a while on a structured non-surgical program. Dr. Movshis works alongside NYC-based orthopedic surgeons and refers when surgical replacement is the right answer — and helps patients delay it when it is not.

Why It Hurts There: The Anatomy of Hip Osteoarthritis

The hip is a ball-and-socket synovial joint formed by the femoral head (the ball) and the acetabulum of the pelvis (the socket). Both surfaces are covered with hyaline cartilage that distributes load, allows nearly frictionless motion, and absorbs the substantial forces transmitted through the hip during walking, running, and stair-climbing. The acetabular labrum — a fibrocartilaginous ring around the rim of the socket — increases joint stability and seals synovial fluid into the joint. The hip capsule, reinforced by the iliofemoral, ischiofemoral, and pubofemoral ligaments, encloses the joint and contains synovial fluid.

In hip osteoarthritis, the hyaline cartilage progressively thins, fissures, and finally wears away, exposing the underlying subchondral bone. As cartilage is lost, the joint space (the gap between the femoral head and acetabulum on X-ray) narrows. Subchondral bone responds by becoming sclerotic, by forming bony osteophytes (spurs) at the joint margins, and by developing subchondral cysts. The synovium becomes inflamed and produces pain-mediating cytokines (Murphy 2016). The capsule thickens and the joint loses range of motion — typically internal rotation first, then flexion and extension, then external rotation. Pain is generated by inflamed synovium, exposed subchondral bone, and an irritated capsule. The capsule’s nerve supply comes mainly from the obturator nerve and the nerve to quadratus femoris, with femoral nerve branches to the front, and it varies a lot from person to person (Tomlinson 2021).

Understanding this anatomy explains why image-guided treatment matters. The intra-articular space is small and sits close to major structures (femoral artery and vein, femoral nerve). Blind landmark injection reached the hip joint in 72% of injections in pooled studies, versus 100% for ultrasound guidance (Hoeber 2016), and the common anterior landmark approach reached the joint in only 60% of cadaver hips (Leopold 2001). Under ultrasound, 97% of needles were confirmed inside the joint by contrast fluoroscopy in one series (Smith 2009). Treatment delivered into the wrong tissue does not work.

Hip Osteoarthritis vs. The Other Causes of Hip and Groin Pain

The single most important step in evaluating hip pain is determining where the pain actually is and what is generating it. The differential diagnosis is wide and the wrong diagnosis leads to the wrong treatment.

Hip osteoarthritis typically produces deep anterior groin pain, mechanical (worse with weight-bearing, better with rest), with morning stiffness, restricted internal rotation on exam, and X-ray findings of joint space narrowing and osteophytes. The C-sign is classic — patients cup the hand around the lateral hip in a C-shape to localize the pain.

Greater trochanteric pain syndrome (hip bursitis / GTPS) produces lateral hip pain over the bony prominence on the outside of the upper thigh, worse lying on the affected side at night, with tenderness on direct palpation. This is gluteus medius and minimus tendinopathy with secondary bursal inflammation — Modal Pain Management treats it on a separate page.

Sacroiliac (SI) joint dysfunction produces deep buttock pain just inferior and medial to the dimples of Venus (the Fortin finger sign), worse with single-leg standing and asymmetric loading, with positive provocative tests (FABER, distraction, compression, thigh thrust). Frequently mislabeled as lumbar disc or hip pain. In a classic block study, the SI joint was the pain source in about 30% of patients with chronic low back pain centered below L5 (Schwarzer 1995).

Piriformis syndrome produces deep buttock pain that worsens with prolonged sitting and may radiate down the back of the leg, mimicking sciatica. Reproduced by the FAIR test.

Femoroacetabular impingement (FAI) and labral tear produces anterior groin pain with mechanical clicking, catching, or locking, classically reproduced by the FADIR test (flexion, adduction, internal rotation), more common in younger active patients (20s–40s) than osteoarthritis. May coexist with early OA.

Iliopsoas tendinitis or bursitis produces anterior groin pain reproduced by resisted hip flexion and direct palpation over the iliopsoas tendon. Often misdiagnosed as hip OA in active middle-aged patients with normal X-rays.

Inflammatory arthritis (rheumatoid, psoriatic, ankylosing spondylitis, reactive) produces hip pain with morning stiffness lasting more than 60 minutes, sometimes bilateral, with elevated inflammatory markers (ESR, CRP) and additional joint involvement. Requires rheumatology co-management.

Avascular necrosis (AVN) of the femoral head produces sudden or rapidly progressive groin pain in patients with risk factors (corticosteroid use, alcohol use, sickle cell disease, prior hip trauma, lupus). MRI is the test of choice — X-ray is normal in early disease.

Inguinal or sports hernia, adductor tendinopathy, and lumbar L3–L4 radiculopathy can all refer pain to the anterior hip and groin and must be considered.

Septic arthritis and fracture are emergencies that must be ruled out in the right clinical context (acute severe pain, fever, inability to bear weight). Metastatic malignancy must be ruled out promptly in a patient with a history of cancer and new hip pain.

The diagnostic workup at Modal Pain Management addresses each of these in a structured order so the right diagnosis drives the right treatment.

How Hip Osteoarthritis Is Diagnosed

The diagnosis of hip osteoarthritis is made by combining a structured history, a focused physical examination, targeted imaging, and — when needed — a diagnostic intra-articular injection.

The history asks about pain location (anterior groin is most specific for hip OA), pain character (deep mechanical ache rather than sharp shock), mechanical triggers (weight-bearing, stairs, getting up from low chairs), morning stiffness duration (usually under an hour in OA, while longer stiffness raises concern for inflammatory arthritis), prior hip injury or surgery, family history of joint replacement, occupational and recreational loading, and red flags (acute onset without trauma, fever, weight loss, history of cancer).

The physical examination systematically tests range of motion (internal rotation is the most sensitive early finding — restricted long before flexion or extension), provocative tests (FADIR for impingement and labral pathology, FABER for hip and SI joint, Stinchfield resisted-hip-flexion for iliopsoas), gait analysis (antalgic gait, Trendelenburg sign), muscle strength (hip abductors, flexors, extensors), neurovascular exam, and palpation of the trochanter, SI joint, and lumbar spine to address the differential.

Imaging begins with weight-bearing AP pelvis and frog-lateral hip X-rays — the standard initial workup that demonstrates joint space narrowing, osteophytes, subchondral sclerosis, subchondral cysts, and the Kellgren-Lawrence grade. MRI is reserved for cases where the X-ray does not match the clinical picture, where labral pathology, AVN, or stress fracture is suspected, or where surgical planning requires soft-tissue detail. High-resolution musculoskeletal ultrasound at the bedside during the consultation visit is increasingly valuable — it visualizes effusion, synovitis, dynamic impingement, iliopsoas tendinopathy, and guides therapeutic injection.

When clinical and imaging findings are mixed (early X-ray changes plus differential considerations), a diagnostic image-guided intra-articular hip injection with local anesthetic (with or without corticosteroid) is the reference test. Substantial pain relief during the anesthetic window makes the hip joint the likely main pain generator. This step changes management for many patients with confusing pictures.

Ready to get your hip pain evaluated? Book a consultation with Dr. Movshis — same-week appointments available. Or call (646) 290-6660.

The Image-Guided Treatment Ladder for Hip Osteoarthritis

Modal Pain Management uses a structured, evidence-based, image-guided ladder for hip osteoarthritis that is tailored to your disease stage, functional impairment, prior treatments, and goals.

Step 1 — Foundation: weight management plus structured physical therapy. The 2019 American College of Rheumatology/Arthritis Foundation guideline strongly recommends exercise for hip OA, and weight loss for people who are overweight (Kolasinski 2020). In a Cochrane review of hip OA trials, land-based exercise reduced pain and improved function, and the benefit lasted at least three to six months after supervised treatment ended (Fransen 2014). Structured physical therapy emphasizes hip abductor and core strengthening (the gluteus medius and minimus are the workhorses of pelvic stability), targeted range-of-motion work (especially internal rotation), gait retraining, and aquatic exercise for patients who cannot tolerate land-based loading. This foundation continues at every subsequent step on the ladder.

Step 2 — Image-guided intra-articular corticosteroid injection for fast flare control and to confirm the hip joint as the pain generator. Performed under fluoroscopic or ultrasound guidance, the injection delivers a corticosteroid-anesthetic mixture into the joint. In a placebo-controlled trial, 68% of steroid patients had at least a 20% pain improvement at 2 months versus 24% with placebo, and 58% versus 10% at 3 months (Lambert 2007). In another trial, benefit appeared within the first week (Atchia 2011). Injections are spaced at least 3 months apart and kept to the fewest that work, because repeated steroid exposure has been linked to faster cartilage loss in the knee (McAlindon 2017) and, uncommonly, to rapid joint damage after hip and knee injections (Kompel 2019). How often an injection can be repeated also depends on your plan’s rules.

Step 3 — Platelet-rich plasma (PRP) for selected patients who want to try it. Hyaluronic acid (gel) is not offered for the hip, because hip trials have not shown a reliable benefit over placebo injection (Leite 2018) and the 2019 American College of Rheumatology/Arthritis Foundation guideline strongly recommends against it for hip OA (Kolasinski 2020). Image-guided intra-articular PRP has weak evidence in the hip. In the main randomized trial, PRP improved pain and function from baseline but was no better than hyaluronic acid at 12 months (Battaglia 2013), a pooled analysis of hip trials found no difference between the two (Garcia 2020), and the supportive Sánchez series had no control group (Sánchez 2012). The American College of Rheumatology and OARSI both recommend against PRP for hip OA (Kolasinski 2020, Bannuru 2019). Most insurers do not cover it. PRP is typically delivered as a series of 2–3 injections spaced 2–4 weeks apart.

Step 4 — Surgical referral for total hip arthroplasty. Modal Pain Management refers patients to NYC-based orthopedic surgeons when severe daily pain limits function despite the steps above, when X-ray demonstrates Kellgren-Lawrence grade 3 or 4 disease, when night pain disrupts sleep, and when the patient is a reasonable surgical candidate. Modern total hip replacement is one of the most successful operations in medicine, with substantial pain and function gains in well-selected patients and implants that last for decades in many of them (Evans 2019). The role of pain management is to make sure that decision is being made for the right reasons and at the right time — not by default.

In parallel, patients with red flags or features suggesting inflammatory arthritis are referred for rheumatology workup, patients with suspected AVN or labral pathology get appropriate MRI and orthopedic consultation, patients with red flags suggesting septic arthritis or fracture are told to call 911 or go to the nearest emergency room, and patients with a history of cancer and new hip pain get prompt evaluation and imaging.

Physical Therapy and Self-Care for Hip Osteoarthritis

Image-guided injection works best when paired with a structured exercise program. Exercise is the part of hip OA care with the most consistent evidence (Fransen 2014), and an injection is most useful as a window that makes the exercise possible. The core elements:

  • Hip abductor strengthening — clamshells, side-lying leg lifts, banded lateral walks, single-leg bridges. The gluteus medius and minimus are the primary stabilizers of the pelvis during single-leg stance and are commonly weak in hip OA.
  • Core and hip extensor work — bridges, dead bugs, bird dogs, modified planks. Pelvic stability reduces the asymmetric loading that worsens hip arthritis.
  • Range-of-motion and stretching — gentle hip flexor stretches, internal rotation work in supine, supervised yoga or Pilates with appropriate modifications.
  • Aquatic exercise — pool walking and aquatic therapy take much of the body’s weight off the joint, more in deeper water, and suit patients who cannot tolerate land-based work.
  • Stationary cycling — low-impact cardiovascular conditioning that maintains hip range of motion without high joint load. Recumbent or upright bicycle, both work.

Self-care measures that consistently help: weight management (single most impactful), supportive footwear with cushioning, limiting deep flexion postures (low chairs, deep recliners, long airline flights), sleeping with a pillow between the knees on the unaffected side, a cane or walking poles during flares, and avoiding sudden increases in walking volume. Modal Pain Management coordinates these elements at the consultation visit.

When Hip Pain Is an Emergency

Most hip osteoarthritis is managed in the outpatient setting on the timeline of weeks. Certain presentations are emergencies and warrant immediate evaluation in the emergency department, not in the office:

  • Acute severe hip pain with fever, chills, or recent infection — septic arthritis is a surgical emergency.
  • Inability to bear weight on the leg after a fall or trauma — femoral neck or acetabular fracture must be ruled out, especially in older adults.
  • Acute, severe groin pain in a patient on long-term corticosteroids, with sickle cell disease, or with heavy alcohol use — avascular necrosis of the femoral head can present this way and requires urgent MRI.
  • New leg weakness, numbness, or loss of bowel or bladder control with hip and back pain — cauda equina syndrome requires emergency MRI and neurosurgical consultation.

If any of these apply, call 911 or go to the nearest emergency room first. New hip pain in a patient with a history of cancer needs prompt evaluation by a doctor and imaging to rule out spread to the bone. Call 911 or go to the nearest emergency room only if severe symptoms come with it: severe or rapidly worsening pain, new weakness or numbness in the legs, numbness in the groin or inner thighs, new trouble controlling bladder or bowels, or fever. Modal Pain Management is the right setting for non-emergency, structured hip osteoarthritis evaluation and treatment.

Why Modal Pain Management for Hip Osteoarthritis

Modal Pain Management treats hip osteoarthritis with the approach described above: image-guided diagnosis, image-guided therapy with the evidence for each option laid out plainly, structured physical therapy, and a clear referral pathway for surgical and rheumatology cases. Dr. Alex Movshis is a board-certified pain management physician based at 369 Lexington Avenue in Midtown Manhattan, with same-week consultations, most commercial PPO plans accepted, and image-guided procedures performed in-office under fluoroscopic or ultrasound guidance. The first visit takes 45–60 minutes and may include an ultrasound exam. Most patients leave it with a clear diagnosis and a written treatment plan, and most procedures are scheduled within 1–2 weeks. The goal is not to put off surgery for the sake of putting off surgery — it is to make sure that every patient with hip arthritis has had a fair shot at the high-quality non-surgical options that exist before going to the operating room.

References

  • Murphy NJ, Eyles JP, Hunter DJ. Hip Osteoarthritis: Etiopathogenesis and Implications for Management. Adv Ther. 2016;33(11):1921–1946. doi:10.1007/s12325-016-0409-3 · PubMed
  • Bannuru RR, Osani MC, Vaysbrot EE, et al. OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis. Osteoarthritis Cartilage. 2019;27(11):1578–1589. doi:10.1016/j.joca.2019.06.011 · PubMed
  • Kolasinski SL, Neogi T, Hochberg MC, et al. 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee. Arthritis Rheumatol. 2020;72(2):220–233. doi:10.1002/art.41142 · PubMed
  • Fransen M, McConnell S, Hernandez-Molina G, Reichenbach S. Exercise for osteoarthritis of the hip. Cochrane Database Syst Rev. 2014;2014(4):CD007912. doi:10.1002/14651858.CD007912.pub2 · PubMed
  • Lambert RG, Hutchings EJ, Grace MG, Jhangri GS, Conner-Spady B, Maksymowych WP. Steroid injection for osteoarthritis of the hip: a randomized, double-blind, placebo-controlled trial. Arthritis Rheum. 2007;56(7):2278–87. doi:10.1002/art.22739 · PubMed
  • Atchia I, Kane D, Reed MR, Isaacs JD, Birrell F. Efficacy of a single ultrasound-guided injection for the treatment of hip osteoarthritis. Ann Rheum Dis. 2011;70(1):110–6. doi:10.1136/ard.2009.127183 · PubMed
  • Smith J, Hurdle MF, Weingarten TN. Accuracy of sonographically guided intra-articular injections in the native adult hip. J Ultrasound Med. 2009;28(3):329–35. doi:10.7863/jum.2009.28.3.329 · PubMed
  • Leopold SS, Battista V, Oliverio JA. Safety and efficacy of intraarticular hip injection using anatomic landmarks. Clin Orthop Relat Res. 2001;(391):192–197. doi:10.1097/00003086-200110000-00021 · PubMed
  • Leite VF, Daud Amadera JE, Buehler AM. Viscosupplementation for Hip Osteoarthritis: A Systematic Review and Meta-Analysis of the Efficacy on Pain and Disability, and the Occurrence of Adverse Events. Arch Phys Med Rehabil. 2018;99(3):574–583.e1. doi:10.1016/j.apmr.2017.07.010 · PubMed
  • Battaglia M, Guaraldi F, Vannini F, et al. Efficacy of ultrasound-guided intra-articular injections of platelet-rich plasma versus hyaluronic acid for hip osteoarthritis. Orthopedics. 2013;36(12):e1501–8. doi:10.3928/01477447-20131120-13 · PubMed
  • Sánchez M, Guadilla J, Fiz N, Andia I. Ultrasound-guided platelet-rich plasma injections for the treatment of osteoarthritis of the hip. Rheumatology (Oxford). 2012;51(1):144–50. doi:10.1093/rheumatology/ker303 · PubMed
  • Garcia FL, Williams BT, Polce EM, et al. Preparation Methods and Clinical Outcomes of Platelet-Rich Plasma for Intra-articular Hip Disorders: A Systematic Review and Meta-analysis of Randomized Clinical Trials. Orthop J Sports Med. 2020;8(10):2325967120960414. doi:10.1177/2325967120960414 · PubMed
  • Kompel AJ, Roemer FW, Murakami AM, Diaz LE, Crema MD, Guermazi A. Intra-articular Corticosteroid Injections in the Hip and Knee: Perhaps Not as Safe as We Thought? Radiology. 2019;293(3):656–663. doi:10.1148/radiol.2019190341 · PubMed
  • McAlindon TE, LaValley MP, Harvey WF, et al. Effect of Intra-articular Triamcinolone vs Saline on Knee Cartilage Volume and Pain in Patients With Knee Osteoarthritis: A Randomized Clinical Trial. JAMA. 2017;317(19):1967–1975. doi:10.1001/jama.2017.5283 · PubMed
  • Evans JT, Evans JP, Walker RW, Blom AW, Whitehouse MR, Sayers A. How long does a hip replacement last? A systematic review and meta-analysis of case series and national registry reports with more than 15 years of follow-up. Lancet. 2019;393(10172):647–654. doi:10.1016/S0140-6736(18)31665-9 · PubMed
  • Schwarzer AC, Aprill CN, Bogduk N. The sacroiliac joint in chronic low back pain. Spine (Phila Pa 1976). 1995;20(1):31–7. doi:10.1097/00007632-199501000-00007 · PubMed
  • Hoeber S, Aly AR, Ashworth N, Rajasekaran S. Ultrasound-guided hip joint injections are more accurate than landmark-guided injections: a systematic review and meta-analysis. Br J Sports Med. 2016;50(7):392–396. doi:10.1136/bjsports-2014-094570 · PubMed
  • Tomlinson J, Ondruschka B, Prietzel T, Zwirner J, Hammer N. A systematic review and meta-analysis of the hip capsule innervation and its clinical implications. Sci Rep. 2021;11(1):5299. doi:10.1038/s41598-021-84345-z · PubMed

Treatment Options for Hip Osteoarthritis (Hip Arthritis)

Your treatment plan will be customized based on your specific condition and goals.

Hip Joint Injections

Image-guided (fluoroscopic or ultrasound) intra-articular hip injection, usually corticosteroid for flares. Hyaluronic acid is not used in the hip because it has not reliably beaten placebo there (Leite 2018)

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Platelet-Rich Plasma (PRP) Therapy

Image-guided intra-articular PRP for mild-to-moderate hip OA. No better than hyaluronic acid at 12 months (Battaglia 2013), and the ACR and OARSI guidelines recommend against it. Usually self-pay.

Learn More →

Physical Therapy

Hip strengthening, mobility and walking programs, the exercise therapy that OA guidelines put first

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Insurance May Cover Your Hip Osteoarthritis (Hip Arthritis) Treatment

We accept most commercial PPO plans (not Medicare, Medicaid or HMO plans). Let us verify your benefits before your first visit — at no cost or obligation.

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Hip Osteoarthritis (Hip Arthritis) Articles

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Central Sensitization Syndrome: Can It Go Away?

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Mar 24, 2025

Regenerative Injections for Pain: The Evidence

Hip Pain Treatment NYC: When to See a Specialist

Mar 30, 2026

Hip Pain Treatment NYC: When to See a Doctor

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Why Choose Modal Pain Management?

Mount Sinai Fellowship-Trained

Board-certified with fellowship training in interventional pain medicine at the Icahn School of Medicine at Mount Sinai.

In-Office Ultrasound & Fluoroscopy

Image-guided injections performed in-suite — no hospital referral, no waiting weeks for outside imaging.

Same-Site PT, Chiro & IV Therapy

Coordinated non-surgical care under one roof at 369 Lexington Avenue — physical therapy, chiropractic, and IV therapy all on site.

Non-Opioid by Design

Treatment plans built around interventional, regenerative, and rehabilitative care — not pills.

Frequently Asked Questions About Hip Osteoarthritis (Hip Arthritis)

The first signs of hip arthritis are usually subtle and easy to miss for months. The most specific early sign is deep groin pain in the front of the hip — not pain over the side of the hip (that is usually greater trochanteric bursitis) and not pain in the buttock (that is usually SI joint dysfunction or piriformis syndrome). Patients often describe wrapping the hand around the lateral hip in a C-shape to localize the pain — this is the classic 'C-sign.' Other early signs: morning stiffness in the hip and groin that loosens with movement, usually within an hour, difficulty putting on socks and tying shoes, a reluctance to climb stairs without using the handrail, a noticeable shortening of the stride length on the affected side, and a deep ache in the groin or thigh after a long day on your feet that is relieved by sitting. One of the most useful exam findings is reduced internal rotation of the hip, which is often restricted compared with the other side before X-rays show advanced joint space loss. If you have any combination of these findings, an evaluation by a pain management specialist with image-guided diagnostic capability is the right next step — most patients have meaningful non-surgical options at this stage.

Hip osteoarthritis cannot be biologically cured, because cartilage that has worn away does not regenerate. But the pain, stiffness, and disability of hip arthritis can often be controlled without hip replacement for a meaningful stretch of time, using a structured, image-guided non-surgical program. The treatment ladder Modal Pain Management uses includes weight loss for people who carry extra weight (the 2019 American College of Rheumatology/Arthritis Foundation guideline strongly recommends it), structured exercise and physical therapy emphasizing hip abductor and core strength, which reduce pain and improve function in trials (Fransen 2014), image-guided intra-articular corticosteroid injection for flare control, and platelet-rich plasma (PRP) for selected patients despite weak evidence in the hip. Some patients who have been told they need a hip replacement do well for years on this pathway, and others are better served by surgery. The consultation sorts out which group you are in.

There is no single best injection. The right one depends on your disease stage, how much function you have lost, and your goals. Corticosteroid injection (image-guided, into the joint) has the most evidence. In a placebo-controlled trial, 68% of steroid patients had at least a 20% pain improvement at 2 months versus 24% with placebo, and 58% versus 10% at 3 months (Lambert 2007), with benefit seen within the first week in another trial (Atchia 2011). Hyaluronic acid (gel) is not used in the hip at Modal Pain, because hip trials have not shown a reliable benefit over placebo injection (Leite 2018). Platelet-rich plasma (PRP) has weak evidence in the hip. The main randomized trial (Battaglia, 100 patients) found PRP no better than hyaluronic acid at 12 months, Sánchez and colleagues reported an uncontrolled series, and the American College of Rheumatology and OARSI recommend against PRP for hip OA. It is usually self-pay. Both should be given under fluoroscopic or ultrasound guidance. Blind hip injections reached the joint 72% of the time in pooled studies, versus 100% under ultrasound (Hoeber 2016). Dr. Movshis discusses the evidence and tradeoffs at the consultation and selects the injection that fits your stage and goals.

Hip osteoarthritis pain has a characteristic pattern that helps distinguish it from other causes of hip and groin pain. The pain is typically deep, dull, and aching, located in the anterior groin (the front of the hip where the leg meets the torso), and frequently radiates into the front of the thigh — occasionally as far as the knee, which is why some patients with hip arthritis present complaining of knee pain. The pain is mechanical — it is brought on by weight-bearing, walking, prolonged standing, climbing stairs, and getting up from a low chair, and relieved by sitting and resting. Morning stiffness usually lasts under an hour and loosens with gentle movement (longer than 60 minutes suggests inflammatory arthritis and a rheumatology workup). As disease progresses, patients describe a 'startup' pain with the first few steps after sitting that improves and then returns after extended walking. Sharp catching pain or true mechanical locking is unusual and suggests an additional problem like a labral tear or a loose body. Night pain that wakes the patient from sleep — particularly when rolling onto the affected side — is common in moderate-to-advanced disease. Pain that is exclusively over the side of the hip (the bony prominence on the outside) is almost never hip arthritis — it is usually greater trochanteric pain syndrome, which Modal Pain Management treats separately.

A hip replacement is the right answer for some patients with hip osteoarthritis but it is not the only answer, and most patients have non-surgical options before they reach that decision point. Hip replacement is most clearly indicated when you have severe daily pain that limits walking, sleep, and basic function, X-ray evidence of advanced joint space narrowing (Kellgren-Lawrence grade 3 or 4), and you have failed a structured trial of weight loss, physical therapy, and image-guided intra-articular injection. For mild-to-moderate hip arthritis, several non-surgical options can control symptoms for a time: image-guided injection, weight management, and a structured exercise program. For younger patients, timing matters because implants do wear out. In national registry data, about 58% of hip replacements were still in place at 25 years (Evans 2019), and revision surgery is more complex than the first operation. At Modal Pain Management, Dr. Movshis works with NYC-based orthopedic surgeons and can give an honest, evidence-based opinion about whether you have remaining non-surgical runway or whether it is time to consider surgical referral.

Several specific factors reliably aggravate hip arthritis pain and progression and addressing them is as important as any injection. Excess body weight — every step loads the hip with a multiple of body weight, and the 2019 American College of Rheumatology/Arthritis Foundation guideline strongly recommends weight loss for people with hip OA who are overweight (Kolasinski 2020). High-impact loading — running, jumping, basketball, racquet sports on hard surfaces, and downhill walking on uneven terrain all spike hip joint load. Prolonged sitting in deep flexion — long airline flights, low car seats, and deep recliners compress the anterior hip and are a frequent cause of post-flight or post-drive flares. Hip abductor weakness — when the gluteus medius and minimus are weak, the hip is loaded asymmetrically and pain worsens, and targeted strengthening helps. Stair climbing and getting up from low chairs — these maximally load the hip in flexion and are early triggers. Sudden increases in walking volume — vacation walking days, new jobs that require standing, and step-counter goals that ramp too quickly. Poor sleep posture — sleeping on the affected side without a pillow between the knees crowds the hip in adduction. Identifying which of these triggers apply to you and modifying them is part of the consultation visit at Modal Pain Management.

Yes — walking is one of the best evidence-based treatments for mild-to-moderate hip osteoarthritis, but the dose matters. Regular low-to-moderate volume walking on level surfaces lubricates the joint, maintains hip range of motion, strengthens the hip abductors and core, supports weight management, and is part of the land-based exercise that reduced pain and improved function in a Cochrane review of hip OA trials (Fransen 2014). A sensible starting point is comfortable-pace walking on level ground on most days, in supportive cushioned shoes, broken into shorter sessions if needed to stay below the pain threshold. The wrong dose — and a frequent reason patients have flares — is sudden high-volume walking (10,000+ step vacation days, long city-walking weekends, new step-counter goals that ramp too quickly), walking on uneven terrain or hills (which adds eccentric loading the hip is not conditioned for), or walking through severe pain (which signals tissue load above what the joint can handle). If walking consistently causes pain that lasts more than 24 hours after the activity, the dose is too high — reduce duration, switch to non-impact alternatives (stationary cycling and aquatic exercise are excellent for hip OA), and book an evaluation. A cane in the hand opposite the painful hip, or walking poles, can take some load off the joint during flares.

You should see a pain management specialist for hip arthritis when groin pain has been present for more than 6 weeks, when over-the-counter medications and rest are no longer giving you durable relief, when sleep is being disrupted, when you find yourself avoiding stairs or activities you used to enjoy, when you have been told 'you need a hip replacement' but want to know what non-surgical options exist first, or when you have a lifestyle event coming up (a wedding, a trip, a family obligation) that you need to be functional for. You should see a specialist urgently if hip pain is severe and started suddenly without injury (rules out septic arthritis, fracture, and avascular necrosis), if hip pain is associated with fever or significant unintentional weight loss (workup for infection or malignancy), if you cannot bear weight on the leg, if you have new neurologic symptoms in the leg, or if you have a history of cancer and develop new hip pain. At Modal Pain Management, the first visit takes 45–60 minutes, may include an ultrasound exam, and produces a clear diagnosis and a written treatment plan — most patients leave knowing exactly what their next step is, whether it is image-guided injection, physical therapy, additional imaging, or surgical referral. Same-week appointments are typically available.

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Schedule a consultation with Dr. Movshis — same-week appointments are routinely available.

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5.0 85 Google Reviews Dual ABA Board-Certified Anesthesiology & Pain Medicine 369 Lexington Ave, Floor 25 Midtown Manhattan, NYC 10017
★★★★★
5 out of 5 based on 85 reviews
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"From the day one, it was very clear I was in the hands of someone who truly cares. Dr. Movshis diagnosed my lumbar disc herniation with nerve compression to the details way…"

★★★★★
Dpak N4 months ago

"I’m so grateful to Dr. Alex for helping me recover from my hip pain. He was always professional, knowledgeable, and attentive, and took the time to listen to my concerns and…"

★★★★★
Yuka Mito2 months ago

"Dr. Alex is amazing, the kind of doctor you wish for in every way: punctual, professional, caring, thorough, knowledgeable. He helped me immensely with severe tennis elbow and I…"

Modal Pain Management NYC
369 Lexington Ave, Floor 25
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