Hip arthritis or hip bursitis: which is more likely?

Hip pain is a common problem that affects people of all ages. Two of the most frequent causes are hip osteoarthritis and trochanteric bursitis, also known as greater trochanteric pain syndrome (GTPS).

Although both conditions can cause pain around the hip region, they affect different structures and often produce different symptoms. Understanding these differences can help patients seek the right treatment and avoid unnecessary delays in diagnosis.

In this article, we explain the key differences between hip arthritis and hip bursitis, including where the pain is felt, what causes each condition and when an ultrasound-guided injection may be considered.

What is hip osteoarthritis?

Hip osteoarthritis is a degenerative condition affecting the hip joint itself. The hip is a ball-and-socket joint lined by smooth cartilage. This cartilage allows the joint surfaces to move freely with minimal friction.

Over time, the cartilage can gradually wear down. As this happens, the joint may become inflamed, stiff and painful.

Hip osteoarthritis is more common with increasing age but can also occur following previous injury, abnormal hip anatomy that can predispose to arthritis or certain medical conditions.

Common symptoms include:

• Pain deep within the groin

• Stiffness of the hip joint

• Reduced range of movement

• Pain during or after activity

Symptoms often develop gradually over months or years.

What is hip bursitis?

Trochanteric bursitis is one of the most common causes of pain on the outside of the hip.

A bursa is a small fluid-filled sac that helps reduce friction between tissues. Around the outer aspect of the hip lies the greater trochanter, a prominent bony structure where several tendons attach.

Pain in this region is often referred to as trochanteric bursitis, although many patients also have irritation or degeneration of the nearby gluteal tendons. For this reason, the broader term greater trochanteric pain syndrome is now commonly used.

Unlike hip arthritis, this condition does not arise from within the hip joint itself.

Common symptoms include:

• Pain on the outer side of the hip

• Tenderness when pressing over the side of the hip

• Pain when lying on the affected side

Symptoms can also include:

• Pain when walking for prolonged periods

• Pain when climbing stairs

• Discomfort when standing from a seated position

• The pain can sometimes extend down the outer thigh.

  
  

Where is the pain usually felt?

One of the easiest ways to distinguish between the two conditions is by considering the location of pain.

Hip arthritis

Pain is usually felt:

• Deep in the groin

• At the front of the hip

• Occasionally into the buttock

• Sometimes radiating towards the thigh

Patients often place their hand over the groin when describing symptoms.

Hip bursitis

Pain is usually felt:

• On the outside of the hip

• Directly over the bony prominence at the side of the hip

• Down the outer thigh

Patients commonly point to the side of the hip rather than the groin.

Although these patterns are helpful, there can be overlap and some patients may have both conditions at the same time.

Why is it easy to confuse the two conditions?

Many patients simply describe "hip pain" without realising that the pain may be coming from very different structures.

The hip joint itself is located deep within the groin region, while bursitis affects tissues on the outside of the hip. However, symptoms can sometimes overlap, particularly if a patient has more than one problem occurring simultaneously.

For example, someone with hip arthritis may occasionally feel discomfort extending into the buttock or outer thigh. Equally, patients with bursitis may alter the way they walk because of pain, creating additional symptoms around the hip and pelvis.

This overlap is one reason why a proper assessment is often important before deciding on treatment.

How does movement affect the symptoms?

The activities that aggravate symptoms can provide useful clues.

Hip arthritis

Symptoms often worsen with:

• Walking longer distances

• Getting in and out of a car

• Twisting movements

• Putting on footwear

• Reduced hip mobility

• Prolonged weight-bearing activities

Many patients notice increasing stiffness first thing in the morning or after sitting for long periods.

Hip bursitis

Symptoms are often aggravated by:

• Lying on the affected side

• Climbing stairs

• Walking uphill

• Standing on one leg

• Crossing the legs

• Prolonged walking

Night pain when lying directly on the painful side is particularly common.

How are these conditions diagnosed?

A clinical assessment is usually the first step.

The pattern of symptoms, location of pain and physical examination findings frequently provide important clues.

Imaging may also be useful in confirming the diagnosis.

Ultrasound

Ultrasound is particularly helpful for assessing:

• Trochanteric bursitis

• Gluteal tendinopathy

• Tendon tears

• Fluid collections around the hip

Ultrasound also allows accurate ultrasound-guided injections when required.

X-rays

X-rays are commonly used to assess hip osteoarthritis and may demonstrate:

• Loss of joint space

• Osteophytes (bone spurs)

• Joint degeneration

• Changes associated with arthritis

MRI

MRI may occasionally be recommended if symptoms remain unclear or more detailed assessment is required.

Can you have both conditions at the same time?

Yes.

In fact, it is not unusual for patients to have both hip arthritis and trochanteric bursitis simultaneously.

This can make diagnosis more challenging because symptoms may overlap. A patient may have arthritis causing groin pain while also having irritation of the tendons and bursa causing pain on the outer side of the hip.

In these situations, careful assessment is important to determine which condition is responsible for most of the symptoms and therefore which treatment is most likely to help.

How are they treated?

Treatment depends on the underlying diagnosis and severity of symptoms.

Treatment for hip arthritis

Management may include:

• Activity modification

• Weight management

• Physiotherapy

• Pain relief medication

• Exercise programmes

• Ultrasound-guided hip steroid injection

For more advanced arthritis, hip replacement surgery may eventually be considered.

Treatment for hip bursitis

Management may include:

• Physiotherapy

• Activity modification

• Gluteal strengthening exercises

• Tendon rehabilitation programmes

• Ultrasound-guided trochanteric bursa injection

Many patients improve with a combination of exercise therapy and targeted treatment.

When might an injection be considered?

An injection may be considered when symptoms are limiting daily activities and conservative measures have not provided sufficient relief.

The type of injection depends on the source of pain.

For hip arthritis

An ultrasound-guided injection can be placed directly into the hip joint to reduce inflammation and improve symptoms.

For some patients, this can provide meaningful pain relief and improved mobility.

For hip bursitis

An ultrasound-guided injection can target the bursa or surrounding tendons depending on the underlying findings.

Accurate diagnosis is important because injecting the wrong structure is unlikely to provide significant benefit.

When should you seek medical advice?

You should seek assessment if:

• Hip pain persists for several weeks

• Symptoms are affecting sleep

• Walking becomes difficult

• Daily activities are becoming restricted

• Pain is progressively worsening

• Over-the-counter medication is no longer helping

Early diagnosis may help identify the source of symptoms and guide the most appropriate treatment plan.

Conclusion; hip arthritis or bursitis

Hip arthritis and hip bursitis are two common causes of hip pain, but they affect different structures and often produce different symptom patterns.

As a general rule, groin pain is more commonly associated with hip arthritis, while pain on the outside of the hip is more commonly related to trochanteric bursitis or greater trochanteric pain syndrome.

However, symptoms can overlap and some patients may have both conditions at the same time. A thorough clinical assessment, often supported by imaging, can help establish the correct diagnosis and ensure that treatment is directed at the true source of pain.