Hip Pain After 50 | Dr Williams | Hip Surgeon Sydney

Why Does Hip Pain Become More Common After 50?

The hip is a major weight-bearing joint that absorbs stress from walking, standing, bending, and twisting over many decades. After 50, several age-related changes may contribute to hip pain:

Cartilage wear: The smooth cartilage that cushions the hip joint gradually thins, increasing friction
Reduced muscle strength: Supporting muscles weaken if activity levels drop
Loss of flexibility: Tendons and ligaments become stiffer over time
Bone density changes: Bones may weaken, increasing fracture risk
Previous injuries: Old injuries can resurface as our muscles decondition with age

These changes may occur slowly, which is why hip pain often develops gradually rather than suddenly.

Common Causes of Hip Pain After 50

There are many possible causes of hip pain in this age group. Some are related to the joint itself, while others involve surrounding soft tissues or the lower back.

Hip osteoarthritis: This is the most common condition that Dr Williams sees in patients over 50. Mostly occurring gradually over time, it involves cartilage wear and joint inflammation
Greater trochanteric pain syndrome: Pain from inflamed tendons or bursae on the outer hip
Hip bursitis: Inflammation of fluid-filled sacs that cushion the joint
Gluteal tendon tears: Degeneration or tearing of hip stabilising tendons (the gluteus medius and minimus)
Hip labral tears: Damage to the cartilage rim of the hip socket
Referred pain from the spine: Hip pain originating from lower back arthritis or disc issues
Stress fractures: Small cracks can develop in weakened bone or with overuse, more common with osteoporosis
Inflammatory arthritis: Conditions such as rheumatoid arthritis

Each condition has different symptoms, progression, and treatment options.

Where Hip Pain Is Commonly Felt

The location of hip pain often provides important clues about its cause.

Front of the hip or groin: Often linked to hip joint arthritis or labral tears
Side of the hip: Common in tendon problems and bursitis
Back of the hip or buttock: May be related to spinal issues or deep muscle irritation, such as ischiofemoral impingement, hamstring tendinopathy or gluteal tendinopathy. Can also be related to osteoarthritis.
Pain radiating down the leg: Can indicate nerve involvement, such as sciatica, rather than a hip joint problem. Hip pain from severe osteoarthritis can, however, also radiate down the front and inner aspect of the thigh to the knee and even into the shin.

Pain may be sharp, aching, stiff, or burning, and can worsen with activity or at night.

Early Warning Signs of Hip Pain Not to Ignore

Hip pain after age 50 should be evaluated if it interferes with daily activities or worsens over time. Warning signs include:

Persistent pain: Lasting more than a few weeks
Morning stiffness: Especially if lasting longer than 30 minutes
Reduced range of motion: Difficulty putting on socks or shoes, or lifting a leg into a car
Pain at night: Disrupting sleep
Limping: Or changes in walking pattern
Sudden severe pain: Especially after a fall or minor injury

Early assessment often leads to better outcomes and more treatment options.

Diagnosis of Hip Pain After 50

Diagnosis starts with a careful clinical assessment and may include imaging when needed.

Medical history: Symptoms, activity level, injuries, and medical conditions
Physical examination: Assessing movement, strength, gait, and pain triggers
X-rays: Commonly used to detect arthritis or fractures
Ultrasound: Helpful for tendon and bursa problems
MRI scans: Used for soft tissue injuries, labral tears, or early arthritis
Blood tests: Occasionally used to rule out inflammatory conditions

A clear diagnosis enables targeted treatment with surgical or non-surgical techniques.

Non-Surgical Treatment Options for Hip Pain

Many people with hip pain after 50 improve without surgery, particularly when treatment begins early.

Activity modification: Reducing aggravating movements
Physiotherapy: Strengthening hip and core muscles, improving flexibility
Pain relief medications: Paracetamol or anti-inflammatory medications when appropriate
Weight management: Reducing joint load and inflammation
Heat or ice therapy: For symptom relief
Injections: Cortisone or other guided injections such as Platelet Rich Plasma (PRP) to reduce inflammation

These treatments aim to reduce pain, restore movement, and slow disease progression.

When is Surgery Considered?

Surgery is generally considered when pain persists despite appropriate non-surgical care and significantly limits daily life.

Hip arthroscopy: Minimally invasive surgery for labral tears or impingement. In patients over 50, a labral tear is more likely to be associated with changes of early arthritis in the hip joint. If this is the case, a total hip replacement may be more suitable
Tendon repair: For significant gluteal tendon tears, after non-operative measures have been tried for at least 6 months
Hip replacement surgery: For hip osteoarthritis that is significantly impacting a patient’s quality of life
Hip resurfacing surgery: This more ‘bone preserving’ form of hip replacement may be appropriate for highly active patients under 55 with osteoarthritis.

Advances in surgical techniques mean many patients experience excellent pain relief and functional improvement when surgery is appropriate.

Lifestyle Changes That Protect Hip Health

Simple lifestyle adjustments can reduce symptoms and help protect hip function in the long term.

Regular low-impact exercise: Walking, swimming, cycling
Strength training: Focusing on hips, thighs, and core. Weight-bearing exercise promotes good bone density
Gentle Stretching: Maintaining joint flexibility
Supportive footwear: Reducing joint stress
Fall prevention: Improving balance and maintaining strength as we age is important for preventing hip fractures

Staying active is often better than avoiding movement altogether.

What is the Best Age for Hip Replacement Surgery?

This is one of the most common questions that patients ask once diagnosed with hip arthritis. Some patients with hip arthritis feel ‘too young’ for hip replacement surgery. Some patients, on the other hand, are worried that if they don’t have hip replacement now, they could be ‘too old’.

The answer is that there is no ‘best age’ to have a hip replacement, as the decision about when to proceed with surgery is a highly individual one based on several factors, including:

Whether other non-surgical or less invasive surgical treatments have been tried
The severity of the pain and functional impact
A patient’s functional goals and expectations
A patient’s other medical conditions that may increase surgical risk

The average age to have a hip replacement in Australia is 66. As implants improve and people increasingly expect to live pain-free, active lives into old age, more and more hip replacements are being performed in younger and older patients.

How young is ‘too young’ for hip replacement?

In the past, there was a reluctance to offer young patients with hip arthritis a hip replacement due to concerns about how long the implants would last. The general advice was to wait ‘as long as possible’. This was because the lifespan of hip replacements was limited by the quality of the medical-grade plastic (polyethylene) insert inside the socket. This wore out over time, with the average replacement lasting about 15 years. For the last 25 years, a change in the production process (irradiation of the plastic in a vacuum to create highly cross-linked chains of polyethylene) has dramatically reduced wear, meaning modern implants should theoretically last 30 years or more.

While it is still sensible to avoid surgery if you are managing your symptoms relatively well with non-surgical treatments, there is no strict age cut-off that is ‘too young’ for hip replacement.

How old is ‘too old’ for hip replacement?

Similarly, the old adage ‘age is just a number’ holds true when considering how old is ‘too old’ for hip replacement. Rather than age alone, the more important consideration is how medically fit a patient is for surgery and a general anaesthetic. In older patients with multiple medical problems, Dr Williams will commonly involve an aged care physician in the preoperative workup to thoroughly assess a patient’s individual risk. If a patient is otherwise healthy enough and their hip arthritis is likely to severely impact the quality of the time they have left, it may be reasonable to consider hip replacement even into the late 80’s and 90’s. Gentler surgical and anaesthetic techniques are employed to minimise risk.