Hip Pain or Knee Pain? How to Tell the Difference — And Why It Matters

I see this at least twice a week in my OPD. A patient comes in pointing to their knee — “Doctor, my knee has been hurting for months.” I examine the knee. Nothing particularly significant. I then ask them to lie down and rotate the hip. They wince. That’s where the problem actually is.

The hip and the knee share nerve pathways. Pain from a damaged hip joint regularly radiates down to the groin, thigh, and sometimes all the way to the knee. A patient can have severe hip osteoarthritis and genuinely, sincerely believe their knee is the source of the problem. It’s not a failure of intelligence. It’s anatomy.

Getting this wrong matters. Treating the wrong joint — or delaying treatment of the right one delaying treatment — costs months or years.

Where Does Hip Pain Actually Hurt?

This surprises most people: true hip joint pain typically isn’t felt on the outer side of the hip at all. Most patients with hip osteoarthritis describe their pain in the groin. Some feel it in the buttock. Some in the front of the thigh, halfway between the hip and the knee. Very few describe it as “right there on the side.”

Pain on the outer hip — what people often call hip pain — is more commonly a trochanteric bursitis or gluteal tendon problem. These are different conditions, managed differently, and usually not a sign of joint disease at all.

Knee pain is easier to localize. Patients can usually point to exactly where it hurts Knee pain — inside, outside, kneecap, back of the knee. It worsens with stairs, squatting, or prolonged sitting. It doesn’t radiate to the groin.

The Simple Test I Do in OPD

When I want to know whether a patient’s pain is coming from the hip, I do what’s called the FABER test — Flexion, ABduction, External Rotation. The patient lies on their back. I bend the knee, place the foot on the opposite thigh, and gently push the raised knee toward the table.

If the hip joint is the problem, that position reproduces the pain immediately. Patients often look surprised — “Yes, that’s the exact pain I’ve been feeling.”

If the hip is fine and the knee is the source, this manoeuvre is completely pain-free.

You can approximate this at home. Sitting in a chair, cross your ankle over the opposite knee and gently press down on the raised knee. If that reproduces your groin or thigh discomfort — it’s likely the hip. If it’s completely comfortable — look at the knee.

Pain That Moves: The Referred Pain Problem

Hip pathology can cause knee pain. This is referred pain — the nervous system mislocalizing the source of a signal. It’s the same reason a heart attack can present as left arm or jaw pain.

I’ve seen patients who have had knee arthroscopy, knee injections, and even partial knee replacements, only to later be diagnosed with severe hip osteoarthritis that was causing the knee-area discomfort all along. This is uncommon but not rare. It’s one of the reasons I always examine the hip in any patient with unexplained knee symptoms, even when they’re sure the knee is the problem.

Warning Signs That Mean See a Specialist Soon

Not every hip or knee ache warrants urgent attention. But these do:

Night pain: If your hip or knee is waking you up at night, that’s a sign of significant inflammation or structural damage. Pain at rest — not just with activity — is a red flag.

Limp developing: If you’ve started unconsciously altering your gait to protect a joint, the joint is telling you something important. A limp means your body is compensating, and compensation creates secondary problems in the opposite hip, knee, and lower back.

Joint giving way: A hip or knee that gives way — where you suddenly feel like the joint won’t support your weight — needs evaluation. This can indicate a loose body in the joint, ligament laxity, or cartilage damage.

Swelling that doesn’t resolve: A joint that swells and stays swollen for more than two to three weeks despite rest and anti-inflammatories needs an ultrasound or MRI. Persistent synovitis can indicate early inflammatory arthritis — rheumatoid, psoriatic, or others — that responds well to early treatment.

When Pain Isn’t About the Joint at All

I see a significant number of patients referred to me as “Hip Joint Replacement Doctor in Chandigarh” or “knee pain” who actually have referred pain from the lumbar spine. A compressed nerve at L3-L4 in the lower back can reproduce groin and thigh pain that is almost indistinguishable from hip joint pathology. A disc prolapse at L4-L5 can cause knee-area discomfort with no actual knee pathology.

This is why a good orthopaedic evaluation always includes the spine. If your imaging and examination don’t clearly point to joint pathology, the back needs to be evaluated before embarking on joint-focused treatment.

What Happens When You Come to See Me

When a patient comes to my OPD at Fortis Mohali with hip or knee pain, here’s what happens: I take a proper history — where exactly the pain is, when it started, what makes it worse, what makes it better, what you’ve already tried. Then I examine both the hip and knee, regardless of which one you came about. Then we look at your imaging together.

Most importantly, I tell you what I actually think — not what is fastest to treat, not what fills an OT schedule. If your Hip Pain Treatment in Chandigarh, I’ll tell you. If it doesn’t, I’ll tell you that too, and give you a sensible non-surgical plan.

Pain is the body communicating. The job of a good orthopaedic surgeon is to listen correctly.

CTA: If you’ve been managing hip or knee pain for more than three months without a clear diagnosis, come in for a consultation. OPD: Tuesday and Thursday at Fortis Hospital Mohali. Call +91 79735 06344 to book.