Low-Dose Radiation Therapy for Hip Osteoarthritis

Low-dose radiation therapy (LDRT) is an outpatient treatment that directs a very small amount of radiation at an arthritic joint to calm inflammation in the joint lining. Hip osteoarthritis is one of the conditions patients and programs discuss LDRT for, alongside the knee, hands, shoulders, elbows, ankles, and feet.

What the Evidence Covers

Be aware: the two best-known sham-controlled trials of LDRT, a 2025 Korean trial^[1] and a 2019 Dutch trial,^[2] both studied knee osteoarthritis only. No sham-controlled trial has focused on the hip, so the evidence for the hip is thinner than for the knee.

Most of what is known about the hip comes from treatment series in Germany. One review of 970 patients aged 65 and older, treated at two German university hospitals, included hips along with knees, shoulders, hands, and feet. Right after treatment, about 60% of treated sites had partial or complete pain relief, and the response did not differ significantly from one joint to another.^[3] Because there was no sham comparison group, this kind of study cannot separate the effect of the radiation from other reasons pain can improve. Hip patients are generally evaluated with the same dosing approach and candidacy framework used for other joints.

Joint replacement surgery is also a well-established option for advanced hip osteoarthritis when pain and disability remain severe despite non-surgical care. Where LDRT may fit is generally after conservative treatments have been tried and before or instead of surgery is being weighed, for patients who want to discuss a non-surgical option with a radiation oncologist.

Typical Schedule

• Total dose of about 3.0 Gy, split into 6 treatments of 0.5 Gy each
• Treatments given 2 to 3 times per week, over about 2 to 3 weeks
• Outpatient, no hospital stay, no sedation or recovery period

Who May Be a Candidate

Programs generally consider adults with hip osteoarthritis who have not found enough relief from medications, injections, physical therapy, or other conservative treatments. As with other joints, many programs are cautious about younger patients, since radiation-related risk has more time to develop, and patients with more advanced structural damage may be less likely to improve. LDRT does not rebuild cartilage or restore a severely damaged joint.

Is It the Hip Joint?

Pain around the hip does not always come from the hip joint. Osteoarthritis of the hip joint usually causes pain in the groin or the front of the thigh, and sometimes in the buttock or knee. Pain on the outside of the hip is often greater trochanteric pain syndrome, also called hip bursitis. Pain low in the back of the pelvis can come from the sacroiliac joint or the lower spine.

These are different conditions, and each is treated differently, so the first step is confirming where the pain comes from. See LDRT for Bursitis and LDRT for SI Joint Pain if either sounds more like your pain.

How Hip Treatment Is Planned

The hip sits deeper in the body than the knee or hand, close to the bladder, bowel, and reproductive organs. At the planning visit you will have a CT scan, and the radiation oncologist uses it to aim the treatment at the joint while keeping the dose to nearby organs as low as possible. It is reasonable to ask how they plan the field for your hip and what that means for you.

Questions to Ask at Your Consultation

• How many patients with hip osteoarthritis has your program treated, and how did they do?
• Are you confident my pain is coming from the hip joint itself?
• How will you limit the dose to nearby organs?
• If the first course does not help enough, would you consider a second course?
• If I may need a hip replacement later, how does LDRT fit with that plan?

References:
1. Kim BH, et al. Clinical Effectiveness of Single Course Low-Dose Radiation Therapy in Knee Osteoarthritis: Short-term Results from the Randomized, Sham-Controlled Trial. ASTRO 67th Annual Meeting Late-Breaking Abstract LBA 06. 2025. Abstract
2. Mahler EAM, et al. Effectiveness of low-dose radiation therapy on symptoms in patients with knee osteoarthritis: a randomised, double-blinded, sham-controlled trial. 2019. PubMed
3. Rühle A, et al. Low-dose radiotherapy for painful osteoarthritis of the elderly: a multicenter analysis of 970 patients with 1185 treated sites. Strahlentherapie und Onkologie. 2021;197:895-902. PubMed