Four stages of hip osteoarthritis (2023)

arthrosis hookIt is a progressive disease in which the hip joints undergo unfavorable changescartilageand bones and gradually decay over time. These changes occur in four different phases:

  • Level 1: This is the initial stage where it can cause wear and tear on the hip jointbony protrusionsbut usually without pain.
  • Phase 2: then the articular cartilage begins to disintegrate, but the space between the joints remains normal. Occasional stiffness or pain is common.
  • phase 3: then cartilage erosion narrows the joint space, making everyday movements like walking or squatting painful or difficult.
  • phase 4: This is the most advanced stage where the loss of cartilage and lubrication of the joints causes the bones to rub, resulting in chronic pain, stiffness and loss of mobility.

This article details the four stages of hip osteoarthritis, including symptoms and treatment options for each stage.

10 surprising facts about osteoarthritis

Four stages of hip osteoarthritis (1)

1st degree hip osteoarthritis

This is the initial and easiest stage of the hip.osteoarthritis (OA). During stage 1 there are few signs of wear and tear between the hip joints, with the exception of small bony bumps known asosteophytes.

Osteophytes are irregular bone growths caused byinflammationin case of joint injuries. As part of the inflammatory response, a protein called transforming growth factor-beta (TGF-Ξ²) causes bone mineral to accumulate improperly.


Stage 1 hip OA is broadasymptomatic(no symptoms) and causes little or no pain. For this reason, people with stage 1 hip OA may not know they have the condition.


Prevention is the main focus of treatment for stage 1 hip OA. This may include avoiding activities that aggravate the affected joint, such as brisk running. People with stage 1 hip OA may need to change their exercise routine to reduce stress on the hips, such as avoiding squats with heavy weights.

If you are overweight, losing weight can reduce the amount of stress on your hip joints and help slow the progression of the condition.

Add-ons likeglucosaminegchondroitincan be prescribed. Although the evidence supporting these supplements is conflicting, they are generally considered safe.

How fast does hip arthritis progress?

Some people may take years to progress to more advanced stages of hip osteoarthritis. Others may progress within six to nine months.

Factors that can affect the rate of progression include:

  • Older
  • History of hip injury or strain (such as manual labor)
  • Severity of symptoms when they first appear

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stage 2 hip osteoarthritis

Stage 2 hip OA is generally known as mild osteoarthritis of the hip. Bone spur growths can be seen inX recording, but the space between the bones will still look normal.

Although the articular cartilage remains healthy at this stage, gradual breakdown of the cartilage will occur.collagen(one of the main proteins found in cartilage) due to the increased production of the so-calledmetalloproteinase.


People with stage 2 hip OA will begin to feel:

  • Pain and discomfort in the hip joint, usually only on one side
  • Joint pain or weakness after strenuous activity
  • Stiffness of the joints, especially in the morning or after sitting for a long time


People with grade 2 hip OA are usually put on a regular exercise plan that includes strengthening exercises. Strengthening the muscles around the joints can help stabilize the hips and keep them strong.

Knee pads can also be used if you have themknee osteoarthritis. If the knee becomes unstable, it can affect the position of the hip and worsen the symptoms of osteoarthritis of the hip.

When to contact a healthcare professional

Talk to your doctor or see a bone and joint specialistorthopedistif you develop early signs of osteoarthritis of the hip, including:

  • Hip pain that gets worse when walking, running and standing
  • Stiffness of hips in morning.
  • Difficulty bending and crossing the legs
  • Weakness or laxity in the hip
  • Problems getting up from a chair

lives with osteoarthritis

stage 3 hip osteoarthritis

Often called moderate osteoarthritis of the hip, stage 3 hip OA is characterized by significant erosion of the cartilage between the bones of the hip joint. As the space between the bones decreases, inflammation in the joints increases and encourages the growth of bone spurs.

At the same time, collagen fragments from the damaged cartilage are released into the lubricating fluid that surrounds the joints (so-calledsynovial fluid), changing its viscosity (density and stickiness) while additionally increasing joint inflammation.


People with stage 3 osteoarthritis of the hip will experience:

  • Hip pain with normal activities such as walking, running, squatting or kneeling
  • Joint swelling with prolonged activity or standing
  • Stiffness of the joints in the morning or after sitting for a long time
  • Popping, grinding, or popping as the hip joint moves
  • A "grabbing" sensation when the hip joint moves.
  • Irregular or limp gait
  • Increased hip weakness


People with moderate hip arthritis should continue with the recommended lifestyle strategies for stages 1 and 2.

Over-the-counter pain relievers, such asTylenol (paracetamol)onon-steroidal anti-inflammatory drugs (NSAIDs)such as Advil (ibuprofen) are generally recommended. If these treatments don't help, your doctor may prescribe a stronger NSAID, such asCelebrex (celekoksib).

Physical therapyit can be recommended to strengthen the muscles around the joints and improve their mobility.

Your doctor can also give youcorticosteroid (steroid) the joint space to reduce inflammation and relieve long-term pain.

How is osteoarthritis treated?

stage 4 hip osteoarthritis

Stage 4 hip OA is also known as advanced hip osteoarthritis. At this stage, the articular cartilage has become thinner and extremely fragile. Chronic joint inflammation contributed to the formation of large osteophytes and loss of synovial fluid.

Stage 4 hip OA suggests that bone is rubbing against bone and joint function is compromised.


With stage 4 hip OA, symptoms are usually severe and often include:

  • Constant joint pain and stiffness with or without movement
  • Significant loss of hip range of motion.
  • Hip weakness or feeling like your hip might give out under you
  • Pain in the opposite hip as it is forced to compensate for the affected hip
  • Loss of muscle mass in the legs due to loss of mobility
  • Interruption of sleep due to pain.

People with stage 4 osteoarthritis are also at greater risk of falls.


Surgery is often delayed with treatments such ashyaluronic acidinjections aimed at improving joint lubrication. Repeated steroid or oral injectionsopioid pain relieverscan also be offered.

Walking aids such as canes, crutches, walkers or wheelchairs can help with mobility and stability problems.

If surgery is recommended, it may include:

  • bone realignment surgery: During this procedure, the bone around the affected joint is removed so that the joint can be adjusted to a more stable mobile position. This surgery is usually an option for people under the age of 60.
  • total hip replacement: Also known astotal arthroscopy cake(THA), is a procedure in which the damaged hip joint is removed and replaced with a prosthesis. Recovery can take several weeks and includes physical and occupational therapy.

Final stage of osteoarthritis of the hip

Stage 4 OA is sometimes called end-stage osteoarthritis because the damage is so severe that joint replacement is the only remaining treatment option. Total hip arthroplasty is indicated when:

  • All other treatments or surgical efforts have failed.
  • Persistent, debilitating pain and loss of mobility prevented a person from managing daily life.

What to expect from a total hip replacement

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Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts in our articles. read ourspublication processto learn more about how we fact-check and keep our content accurate, reliable and trustworthy.

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  2. Shen J, Li S, Chen D.TGF-Ξ² signaling and the development of osteoarthritis.Res. broom.2014;2:14002. doi:10.1038/boneres.2014.2

  3. DiNubile N.Glucosamine and chondroitin sulfate: what has been learned from the glucosamine/chondroitin arthritis intervention study.Orthopedics. 2018;41(4):200-7. doi:10.3928/01477447-20180511-06

  4. Teirlinck CH, Dorleijn DMJ, Bos PK, Rijkels-Otters JB, Bierma-Zeinstra SMA, Luijesterburg PAJ.Prognostic factors for the progression of osteoarthritis of the hip: a systematic review.Artrite Res Ther. 2019 Aug 23;21(1):192.doi:10.1186/s13075-019-1969-9

  5. [ PubMed ] Lespasio MJ, Piuzzi NS, Husni ME, Muschler GF, Guarino A, Mont MA.Osteoarthritis of the knee: Introduction.Constant J. 2017;21:16-183. doi:10.7812/TPP/16-183

  6. Bayliss LE, Culliford D, Monk AP, et al.The effect of patient age at the time of intervention on the risk of implant revision after total hip or knee arthroplasty: a population-based cohort study.lanceta. 2017;389(10077):1424-30. doi:10.1016/S0140-6736(17)30059-4

  7. American Academy of Orthopedic hip replacement.

Four stages of hip osteoarthritis (2)

AfterThe Daisy Study
Margaret Etudo is a professional health writer with extensive experience in simplifying complex health information for the public on topics such as respiratory health, mental health and sexual health.

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