DJD of the hip, short for degenerative joint disease, is another name for osteoarthritis of the hip. It’s the most common form of joint disorder in the United States, affecting an estimated 27 million Americans across all joints. If you saw “DJD” on an imaging report or heard it from a doctor, it means the cartilage lining your hip joint is breaking down, causing pain, stiffness, and gradually reduced mobility.
What Happens Inside the Joint
Your hip is a ball-and-socket joint, with the rounded top of the thighbone (femoral head) fitting into a cup-shaped socket in the pelvis (acetabulum). A layer of smooth cartilage covers both surfaces, letting them glide against each other with very little friction. In DJD, that cartilage progressively wears away.
The breakdown isn’t purely mechanical “wear and tear,” despite the common nickname. The body’s own enzymes actively break down the two main components of cartilage: the protein scaffold that gives it structure and the molecules that keep it cushioned and hydrated. At the same time, the bone underneath the cartilage thickens and hardens, fluid-filled cysts can form within the bone, and bony growths called osteophytes (bone spurs) develop around the edges of the joint. The soft tissues around the hip, including the joint lining, ligaments, and surrounding muscles, can become inflamed and weakened as the disease progresses.
Where It Hurts and How It Feels
Hip DJD pain doesn’t always stay in the hip. The joint sends referred pain to several areas, which can make it confusing to pinpoint. Most people feel it in the groin, but it commonly shows up in the thigh, buttocks, or even the knee. Some people initially think they have a knee problem when the source is actually the hip.
Stiffness is typically worst first thing in the morning or after sitting for a long time. Early on, pain tends to flare during or after activity and ease with rest. As the disease advances, pain can become more constant, interfere with sleep, and limit how far you can move the joint. Everyday tasks like putting on shoes, getting in and out of a car, or climbing stairs often become noticeably harder.
Who Is Most at Risk
Age is the biggest risk factor. The older you are, the more cumulative stress your cartilage has absorbed and the less efficiently your body repairs it. Beyond age, several other factors raise your odds:
- Sex. People assigned female at birth develop hip osteoarthritis more often, though the exact reason isn’t fully understood.
- Previous injury. A hip fracture, labral tear, or dislocation from years or even decades ago can set the stage for earlier cartilage breakdown.
- Repetitive joint stress. Jobs or sports that load the hip repeatedly, like heavy lifting, running on hard surfaces, or certain labor-intensive trades, increase the risk over time.
- Genetics. Some people inherit a tendency toward osteoarthritis, meaning family history matters.
- Joint shape abnormalities. Being born with a shallow hip socket (dysplasia) or a misshapen femoral head can cause uneven cartilage loading, accelerating damage.
- Body weight. Extra weight increases the mechanical load on the hip with every step.
How DJD Is Graded on X-Ray
Doctors typically diagnose hip DJD with a standard X-ray. The most widely used rating system, the Kellgren-Lawrence scale, assigns a grade from 1 to 4 based on what the image shows:
- Grade 1 (doubtful). Possible slight narrowing of the joint space and possible small bone spurs around the femoral head.
- Grade 2 (mild). Definite narrowing of the space between the bones, visible bone spurs, and slight hardening of the bone underneath the cartilage.
- Grade 3 (moderate). Marked narrowing of the joint space, bone cysts forming, and early changes in the shape of the femoral head and socket.
- Grade 4 (severe). Near-complete loss of joint space, large bone spurs, significant cysts, and visible deformity of both the ball and socket.
It’s worth knowing that X-ray severity doesn’t always match symptom severity. Some people with grade 2 changes on imaging have significant pain, while others with grade 3 or 4 changes manage reasonably well. Treatment decisions depend on how much the condition affects your daily life, not just what the X-ray looks like.
First-Line Treatments
Non-surgical management is always the starting point. The core approach combines three strategies: movement, pain control, and load reduction.
Anti-inflammatory medications (NSAIDs like ibuprofen or naproxen) are the most supported first-line option. They reduce inflammation inside the joint and bring down pain levels. They work well for many people but aren’t meant for indefinite daily use because of potential effects on the stomach, kidneys, and cardiovascular system over time.
Physical therapy and structured exercise are recommended alongside medication. Strengthening the muscles around the hip, particularly the glutes and hip stabilizers, takes stress off the joint and can meaningfully reduce pain. Exercises like bridging, sit-to-stand movements, sideways hip lifts, and standing hip extensions are commonly prescribed starting points. When beginning a program, starting with 2 to 3 repetitions and building toward 2 sets of 15 is a practical approach. Some mild discomfort during exercise is normal early on, but pain should stay manageable and shouldn’t be worse the morning after. If it is, you’re doing too much too soon.
Weight management matters significantly. Every pound of body weight translates to multiple pounds of force on the hip during walking, so even modest weight loss can produce a noticeable difference in symptoms.
Joint Injections
When oral medications and therapy aren’t enough, injections directly into the hip joint are a common next step. These are done under ultrasound or fluoroscopic guidance because the hip is a deep joint that’s difficult to access blindly.
Corticosteroid injections are the most common option. They reduce inflammation quickly and can provide significant pain relief at rest and during activity within a few weeks. The limitation is duration: relief typically lasts a few months before wearing off. They’re most useful for managing flare-ups rather than providing long-term control, and repeated injections carry some risk of further cartilage damage.
Hyaluronic acid injections (sometimes called viscosupplementation) aim to restore some of the joint’s natural lubrication. Evidence for their effectiveness in the hip is less consistent than for the knee. Some studies show prolonged symptom relief, but the overall evidence remains mixed, and not all insurance plans cover them for hip use.
When Surgery Becomes the Next Step
Total hip replacement is considered when pain can no longer be adequately controlled with conservative treatment, daily function is significantly limited, and X-rays confirm joint degeneration. There’s no single pain score or X-ray grade that automatically triggers the recommendation. Instead, it’s a decision based on how much the condition interferes with your quality of life after you’ve given non-surgical options a fair trial.
In practice, most surgical candidates have tried activity modification, physical therapy, and medications for a sustained period without adequate relief. People with severe radiographic changes (Kellgren-Lawrence grade 3 or 4) who report high levels of pain and functional limitation are the clearest candidates. Modern hip replacements have a strong track record, with most lasting 20 years or more, which has made the procedure increasingly common in younger, active patients as well.
The surgery itself involves replacing the damaged ball and socket with metal, ceramic, or plastic components. Most people are walking with assistance within a day of surgery, and full recovery to normal activities typically takes 3 to 6 months. Physical therapy after surgery is essential for rebuilding strength and regaining range of motion.