Knee and Hip Pain: Causes and Treatment

Leg joint pain is one of the most common reasons people see a doctor. According to the WHO, osteoarthritis — a degenerative joint disease — affects more than 500 million people worldwide. But knee or hip pain does not always mean arthritis: causes range from ligament and meniscus injuries to inflammatory diseases and even malignancy. This article covers the main causes of leg joint pain, how to recognise them, and when surgery is needed.

Knee pain: arthritis, meniscus, ligaments

The knee is one of the most complex and load-bearing joints in the body. It consists of bones, cartilage, menisci (cartilage pads), ligaments, and tendons. Knee pain can arise from damage to any of these structures.

Knee osteoarthritis (gonarthrosis) — degenerative cartilage breakdown. The most common cause of knee pain in people over 50. Characteristic symptoms:

• pain with activity (walking, climbing stairs), relieved by rest;
• morning stiffness lasting less than 30 minutes;
• crunching and creaking in the knee with movement;
• gradual reduction in range of motion;
• joint deformity in late stages (bow-legged or knock-kneed appearance).

Meniscus injury — more common in young people from sports injuries (sharp twist, jump), but also occurs in older adults with degenerative changes. Symptoms: sharp pain at the moment of injury, pain with specific movements (especially twisting), joint "locking" (the knee gets stuck in a position), joint swelling.

Ligament injury — more common in sports injuries. Anterior cruciate ligament (ACL) rupture is one of the most common sports knee injuries. Symptoms: a characteristic "pop" at the moment of injury, immediate swelling, joint instability ("the knee gives way").

Bursitis — inflammation of a joint bursa. Prepatellar bursitis ("housemaid's knee") — swelling and pain directly in front of the kneecap. Common in people who work on their knees.

Patellofemoral syndrome — pain under the kneecap when climbing stairs, squatting, or sitting with bent knees for a long time. More common in young active people, especially women.

Hip pain: coxarthrosis and bursitis

The hip is the largest joint in the body, bearing the main load during walking and running. Pain in the hip area may originate from the joint itself or from the surrounding structures.

Coxarthrosis (hip osteoarthritis) — degenerative cartilage breakdown in the hip joint. One of the leading causes of disability in older adults. Symptoms:

• pain in the groin, thigh, or buttock, sometimes radiating to the knee;
• restricted hip rotation (difficulty putting on socks, sitting cross-legged);
• limping;
• leg shortening in late stages.

Trochanteric bursitis (greater trochanteric pain syndrome) — inflammation of the bursa over the greater trochanter of the femur. Pain along the outer thigh, worsening when lying on the affected side and when walking. More common in middle-aged women. Often confused with coxarthrosis, but with trochanteric bursitis, joint movement is preserved.

Piriformis syndrome — compression of the sciatic nerve by the piriformis muscle. Pain in the buttock radiating down the back of the thigh (mimics sciatica). Worsens with prolonged sitting.

Avascular necrosis of the femoral head — disrupted blood supply and death of bone tissue. Occurs with corticosteroid use, alcohol misuse, or after trauma. Requires urgent treatment — delay leads to joint destruction.

When joint pain is a symptom of a systemic disease

Joint pain does not always mean a "local" problem. Sometimes it is a manifestation of a systemic disease affecting the whole body. Signs pointing to systemic pathology:

• Inflammation in several joints simultaneously (polyarthritis) — characteristic of rheumatoid arthritis, systemic lupus erythematosus, reactive arthritis.
• Morning stiffness lasting more than 1 hour — a sign of inflammatory arthritis (with osteoarthritis, stiffness resolves within 30 minutes).
• Symmetric joint involvement — both hands, both knees — characteristic of rheumatoid arthritis.
• Joint pain with skin rash — psoriatic arthritis, systemic lupus erythematosus.
• Back pain in young men with restricted mobility — ankylosing spondylitis.
• Acute pain in one joint with redness and swelling — gout (most often the big toe or knee) or septic arthritis (joint infection — requires urgent care).

If you're troubled by joint pain, try describing your symptoms to our assistant — this helps determine whether you need a rheumatologist or orthopaedist.

Tests and investigations for joint pain

The scope of investigation depends on the suspected cause. Basic workup for joint pain:

• X-ray of the joint — assessing the degree of arthritis (joint space narrowing, osteophytes), ruling out fractures. X-ray is the first and mandatory method when arthritis is suspected.
• MRI — the best method for assessing cartilage, menisci, ligaments, tendons, and early-stage arthritis. Indicated when soft tissue injury, avascular necrosis, or tumour is suspected.
• Joint ultrasound — assessing effusion (fluid in the joint), bursitis, and tendon condition. Cheaper and more accessible than MRI, but less informative for cartilage.
• Full blood count and ESR — inflammation, anaemia.
• CRP (C-reactive protein) — inflammation marker. Elevated in inflammatory arthritis and infection.
• Rheumatoid factor and anti-CCP antibodies — when rheumatoid arthritis is suspected.
• Uric acid — when gout is suspected. Normal: up to 360 µmol/L in women, up to 420 µmol/L in men.
• HLA-B27 — genetic marker associated with ankylosing spondylitis and reactive arthritis.

When surgery is needed and when it can be avoided

Most joint conditions are treated conservatively. Surgical treatment is considered when conservative methods are exhausted or in specific indications.

Arthroscopy — minimally invasive surgery through small incisions. Used for: meniscus injury (partial removal or repair), ligament injury (ACL reconstruction), removal of loose bodies from the joint. Not indicated for isolated osteoarthritis without mechanical symptoms.

Joint replacement (arthroplasty) — for severe arthritis (grade 3–4) when pain significantly limits life and does not respond to conservative treatment. Modern prostheses last 15–25 years. Total hip replacement is one of the most effective operations in orthopaedics: 90–95% of patients report significant improvement in quality of life.

Conservative treatment remains the foundation for grade 1–2 arthritis: weight loss (every extra kilogram creates 3–4 kg of additional load on the knee joint during walking), therapeutic exercise (strengthening muscles around the joint), physiotherapy, non-steroidal anti-inflammatory drugs (NSAIDs), intra-articular injections (corticosteroids, hyaluronic acid).

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Frequently asked questions

Does a clicking knee mean arthritis?

Not necessarily. Joint clicking without pain or restricted movement is normal — it is related to gas bubble movement in the joint fluid or tendon gliding. Clicking in arthritis is usually accompanied by pain and a sensation of "grinding" in the joint. If clicking appeared after an injury or is accompanied by pain, a doctor's assessment is needed.

Do chondroprotectors help with arthritis?

Evidence is mixed. Glucosamine and chondroitin are widely used and well tolerated, but their effectiveness in high-quality trials is moderate. European guidelines (EULAR) allow their use in knee osteoarthritis as symptomatic agents. They do not restore destroyed cartilage, but may reduce pain with long-term use (3–6 months).

What is gout and how is it recognised?

Gout is a condition in which uric acid crystals deposit in joints. A classic attack: excruciating pain in the big toe joint (or another joint), redness, swelling, heat — often at night. Triggered by alcohol, red meat, and dehydration. Diagnosed by blood uric acid level and characteristic clinical picture. Treated with diet and medication (allopurinol, colchicine).

Can I exercise with arthritis?

Yes, and it is necessary. Physical activity with arthritis does not accelerate cartilage breakdown — on the contrary, it strengthens the muscles around the joint, reduces load on it, and decreases pain. Recommended: swimming, cycling, Nordic walking, yoga. Avoid: running on hard surfaces, jumping, deep squats with knee arthritis.

When does hip pain require urgent medical attention?

See a doctor immediately for: severe acute pain after a fall (possible femoral neck fracture — especially in older adults); pain with high fever and joint redness (septic arthritis); progressive pain at rest and at night without injury (possible avascular necrosis or tumour); inability to bear weight on the leg.

Symptomatica is an informational reference service. Not a medical service; does not diagnose or prescribe treatment. For any symptoms, please consult a doctor.

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