Hip osteoarthritis is a degenerative disease of the hip joint that progresses in four characteristic stages. With each stage ofosteoarthritisof the hip, symptoms such as pain, stiffness, and loss of joint mobility will progressively worsen.
Diagnosing the stage of hip osteoarthritis helps direct the appropriate treatment, ranging from weight loss and over-the-counter (OTC) pain relievers tohip replacement surgery.
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Stages of Hip Osteoarthritis
With this happens, a normal process called bone remodeling—in which old bone is continuously broken down and replaced with new bone minerals—is disrupted. Over time, the joint bones will become misshapen and less able to move smoothly within the joint socket.
As weight-bearing joints, the hips are vulnerable to OA along with the spine and knees. Hip OA affects roughly 20% of adults over 50 in the United States (although only around 4% experience symptomatic disease).
OA of the hip (or any other joint of the body) progresses in four stages:
Stage 1: Minor
Also known as early arthritis, this is a largelyasymptomatic(symptom-free) stage in which wear and tear on the hip joint leads to the gradual erosion of joint cartilage. People withobesityare at high risk due to the increased weight-bear stress placed on the hip joints.
During stage 1, the cartilage is healthy enough to function normally. Even so, the loss of cartilage will be enough to trigger aninflammatory responseas the body tries to repair the damage. Over time, the repairs will become increasingly haphazard, leading to the formation of bony overgrowths known asosteophytes(a.k.a. “bone spurs”).
People with stage 1 hip OA are often unaware that they have OA and may only experience mild aches after a long day of strenuous activity.
Stage 2: Mild
Stage 2 hip OA is commonly referred to as mild hip osteoarthritis. At this stage, bone spurs may be readily seen onX-rays, but the space between the bones will still appear relatively normal.
With that said, there will be dramatic changes in the cartilage itself. Among these, the joint will experiencefibrillationin which cartilage will start to split and develop areas of fraying.
This can lead to more pronounced symptoms, such as:
Stage 3: Moderate
At the same time, fragments ofcollagen(one of the main structural proteins found in cartilage) will start to break off and mix withsynovial fluidslubricating the joint. This will make the fluid more sticky and viscous.
As this process continues, the body will respond with even more inflammation, causing the hip joint to swell and bone spurs to scrape against exposed bone and broken cartilage.
Symptoms of stage 3 hip OA include:
Stage 4: Severe
Stage 4 hip OA is also known as advanced orsevere hip osteoarthritis. At this stage, the loss of cartilage is extreme. Chronic inflammation has further contributed to the formation of large bone spurs and the loss of synovial fluid.
Stage 4 hip OA suggests that bone is rubbing against bone and the function of the joint has been severely compromised. The body’s attempts to repair itself have led to dramatic changes in the joint architecture, all but diminishing the normal function of the joint.
With stage 4 hip OA, symptoms include:
Treatments
The stage of hip OA is based largely on imaging studies such as a hip X-ray,computed tomography (CT) scan, ormagnetic resonance imaging (MRI). Thediagnosisis essential to delivering the appropriate treatment to not only ease symptoms but also help slow disease progression.
Stage 1
Prevention is the main focus of treatment for stage 1 hip OA. This mainly involves avoiding activities that aggravate the hip joints, such as strenuous running or performing squats with heavy weights.
Other common treatments for stage 1 hip OA include:
Stage 2
The treatment of stage 2 hip OA is focused on symptom relief and supporting the muscles that help stabilize the hip joints.
These include options such as:
Knee braces may be used if you also haveknee osteoarthritis. If the knee is destabilized, it can affect the position of the hip and make hip OA symptoms worse.
Stage 3
People with moderate hip arthritis should continue the lifestyle strategies recommended for stages 1 and 2. Other important interventions may include:
Stage 4
Nonsurgical treatments for stage 4 hip OA are mainly aimed at delaying hip replacement surgery. This is because hip prosthetics have a limited lifespan and mostorthopedic surgeonsprefer to implant one when it is most likely to last you the rest of your life.
In the meantime, the treatment may involve repeated steroid or hyaluronic acid injections, oralopioid pain relievers, and assistive walking devices such as a cane, crutches, or a walker.
If surgery is recommended, it may include:
Prevention
Not everyone with stage 1 or stage 2 hip OA will progress to stage 3 or stage 4. In fact, with the appropriate treatment, a person with stage 3 hip OA may live the rest of their life without further disease progression.
Even if you don’t have hip OA, you may need to take preventive steps if you have risk factors for the disease. This includes having obesity,diabetes, a family history of OA, a previous hip injury, or an occupation that involves heavy lifting or the carrying of heavy loads.
Key preventive efforts include:
Summary
Hip osteoarthritis (OA) progresses in four stages, starting from stage 1 which is largely asymptomatic to stage 2 in which symptoms are more pronounced. By stage 3, changes in the architecture of the hip may cause limping and chronic pain. By stage 4, surgery may be needed to overcome pain and disability, including the use of a total hip replacement.
12 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Lespasio MJ.Hip osteoarthritis: a primer.Perm J.2018;22:17-084. doi:10.7812/TPP/17-084Kim C, Linsenmeyer KD, Vlad S, et al.Prevalence of radiographic and symptomatic hip osteoarthritis in an urban US community: the Framingham Osteoarthritis Study.Arthritis Rheumatol. 2014 Nov;66(11):3013–3017. doi:10.1002/art.38795Shen J, Li S, Chen D.TGF-β signaling and the development of osteoarthritis.Bone Res.2014;2:14002. doi:10.1038/boneres.2014.2Damen J, Van Rijn RM, Emans PJ, et al.Prevalence and development of hip and knee osteoarthritis according to American College of Rheumatology criteria in the CHECK cohort.Arthritis Res Ther. 2019;21(1):4. doi:10.1186/s13075-018-1785-7DiNubile N.Glucosamine and chondroitin sulfate: what has been learned since the Glucosamine/Chondroitin Arthritis Intervention Trial.Orthopedics. 2018;41(4):200-7. doi:10.3928/01477447-20180511-06Lespasio MJ, Piuzzi NS, Husni ME, Muschler GF, Guarino A, Mont MA.Knee osteoarthritis: a primer.Perm J. 2017;21:16-183. doi:10.7812/TPP/16-183Bayliss LE, Culliford D, Monk AP, et al.The effect of patient age at intervention on risk of implant revision after total replacement of the hip or knee: a population-based cohort study.Lancet. 2017;389(10077):1424-30. doi:10.1016/S0140-6736(17)30059-4American Academy of Orthopaedic Surgeons.Total hip replacement.American Academy of Orthopaedic Surgeons.Hip osteoarthritis.Veronese N, Cooper C, Reginster JY, et al.Type 2 diabetes mellitus and osteoarthritis.Semin Arthritis Rheum. 2019 Jan 11;49(1):9–19. doi:10.1016/j.semarthrit.2019.01.005Unverzagt S, Bolm-Audorff U, Frese T, et al.Influence of physically demanding occupations on the development of osteoarthritis of the hip: a systematic review.J Occup Med Toxicol.2022;17:18. doi:10.1186/s12995-022-00358-yOffice of Dietary Supplements.Calcium: fact sheet for consumers.
12 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Lespasio MJ.Hip osteoarthritis: a primer.Perm J.2018;22:17-084. doi:10.7812/TPP/17-084Kim C, Linsenmeyer KD, Vlad S, et al.Prevalence of radiographic and symptomatic hip osteoarthritis in an urban US community: the Framingham Osteoarthritis Study.Arthritis Rheumatol. 2014 Nov;66(11):3013–3017. doi:10.1002/art.38795Shen J, Li S, Chen D.TGF-β signaling and the development of osteoarthritis.Bone Res.2014;2:14002. doi:10.1038/boneres.2014.2Damen J, Van Rijn RM, Emans PJ, et al.Prevalence and development of hip and knee osteoarthritis according to American College of Rheumatology criteria in the CHECK cohort.Arthritis Res Ther. 2019;21(1):4. doi:10.1186/s13075-018-1785-7DiNubile N.Glucosamine and chondroitin sulfate: what has been learned since the Glucosamine/Chondroitin Arthritis Intervention Trial.Orthopedics. 2018;41(4):200-7. doi:10.3928/01477447-20180511-06Lespasio MJ, Piuzzi NS, Husni ME, Muschler GF, Guarino A, Mont MA.Knee osteoarthritis: a primer.Perm J. 2017;21:16-183. doi:10.7812/TPP/16-183Bayliss LE, Culliford D, Monk AP, et al.The effect of patient age at intervention on risk of implant revision after total replacement of the hip or knee: a population-based cohort study.Lancet. 2017;389(10077):1424-30. doi:10.1016/S0140-6736(17)30059-4American Academy of Orthopaedic Surgeons.Total hip replacement.American Academy of Orthopaedic Surgeons.Hip osteoarthritis.Veronese N, Cooper C, Reginster JY, et al.Type 2 diabetes mellitus and osteoarthritis.Semin Arthritis Rheum. 2019 Jan 11;49(1):9–19. doi:10.1016/j.semarthrit.2019.01.005Unverzagt S, Bolm-Audorff U, Frese T, et al.Influence of physically demanding occupations on the development of osteoarthritis of the hip: a systematic review.J Occup Med Toxicol.2022;17:18. doi:10.1186/s12995-022-00358-yOffice of Dietary Supplements.Calcium: fact sheet for consumers.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Lespasio MJ.Hip osteoarthritis: a primer.Perm J.2018;22:17-084. doi:10.7812/TPP/17-084Kim C, Linsenmeyer KD, Vlad S, et al.Prevalence of radiographic and symptomatic hip osteoarthritis in an urban US community: the Framingham Osteoarthritis Study.Arthritis Rheumatol. 2014 Nov;66(11):3013–3017. doi:10.1002/art.38795Shen J, Li S, Chen D.TGF-β signaling and the development of osteoarthritis.Bone Res.2014;2:14002. doi:10.1038/boneres.2014.2Damen J, Van Rijn RM, Emans PJ, et al.Prevalence and development of hip and knee osteoarthritis according to American College of Rheumatology criteria in the CHECK cohort.Arthritis Res Ther. 2019;21(1):4. doi:10.1186/s13075-018-1785-7DiNubile N.Glucosamine and chondroitin sulfate: what has been learned since the Glucosamine/Chondroitin Arthritis Intervention Trial.Orthopedics. 2018;41(4):200-7. doi:10.3928/01477447-20180511-06Lespasio MJ, Piuzzi NS, Husni ME, Muschler GF, Guarino A, Mont MA.Knee osteoarthritis: a primer.Perm J. 2017;21:16-183. doi:10.7812/TPP/16-183Bayliss LE, Culliford D, Monk AP, et al.The effect of patient age at intervention on risk of implant revision after total replacement of the hip or knee: a population-based cohort study.Lancet. 2017;389(10077):1424-30. doi:10.1016/S0140-6736(17)30059-4American Academy of Orthopaedic Surgeons.Total hip replacement.American Academy of Orthopaedic Surgeons.Hip osteoarthritis.Veronese N, Cooper C, Reginster JY, et al.Type 2 diabetes mellitus and osteoarthritis.Semin Arthritis Rheum. 2019 Jan 11;49(1):9–19. doi:10.1016/j.semarthrit.2019.01.005Unverzagt S, Bolm-Audorff U, Frese T, et al.Influence of physically demanding occupations on the development of osteoarthritis of the hip: a systematic review.J Occup Med Toxicol.2022;17:18. doi:10.1186/s12995-022-00358-yOffice of Dietary Supplements.Calcium: fact sheet for consumers.
Lespasio MJ.Hip osteoarthritis: a primer.Perm J.2018;22:17-084. doi:10.7812/TPP/17-084
Kim C, Linsenmeyer KD, Vlad S, et al.Prevalence of radiographic and symptomatic hip osteoarthritis in an urban US community: the Framingham Osteoarthritis Study.Arthritis Rheumatol. 2014 Nov;66(11):3013–3017. doi:10.1002/art.38795
Shen J, Li S, Chen D.TGF-β signaling and the development of osteoarthritis.Bone Res.2014;2:14002. doi:10.1038/boneres.2014.2
Damen J, Van Rijn RM, Emans PJ, et al.Prevalence and development of hip and knee osteoarthritis according to American College of Rheumatology criteria in the CHECK cohort.Arthritis Res Ther. 2019;21(1):4. doi:10.1186/s13075-018-1785-7
DiNubile N.Glucosamine and chondroitin sulfate: what has been learned since the Glucosamine/Chondroitin Arthritis Intervention Trial.Orthopedics. 2018;41(4):200-7. doi:10.3928/01477447-20180511-06
Lespasio MJ, Piuzzi NS, Husni ME, Muschler GF, Guarino A, Mont MA.Knee osteoarthritis: a primer.Perm J. 2017;21:16-183. doi:10.7812/TPP/16-183
Bayliss LE, Culliford D, Monk AP, et al.The effect of patient age at intervention on risk of implant revision after total replacement of the hip or knee: a population-based cohort study.Lancet. 2017;389(10077):1424-30. doi:10.1016/S0140-6736(17)30059-4
American Academy of Orthopaedic Surgeons.Total hip replacement.
American Academy of Orthopaedic Surgeons.Hip osteoarthritis.
Veronese N, Cooper C, Reginster JY, et al.Type 2 diabetes mellitus and osteoarthritis.Semin Arthritis Rheum. 2019 Jan 11;49(1):9–19. doi:10.1016/j.semarthrit.2019.01.005
Unverzagt S, Bolm-Audorff U, Frese T, et al.Influence of physically demanding occupations on the development of osteoarthritis of the hip: a systematic review.J Occup Med Toxicol.2022;17:18. doi:10.1186/s12995-022-00358-y
Office of Dietary Supplements.Calcium: fact sheet for consumers.
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