Four Stages of Osteoarthritis of the Hip

Osteoarthritis, also known as degenerative joint disease, is the most common type of arthritis. It results from wear-and-tear in the joints. In hip osteoarthritis, the cartilage in the hip joint slowly wears away over time, reducing the protective layer between bones and leading to bone-on-bone rubbing and symptoms such as pain and stiffness.

Osteoarthritis is a progression disease, and there are various stages of it. Depending on the stage at which a person is diagnosed, treatment will look different.

Risk Factors of Osteoarthritis

The risk factors associated with osteoarthritis include:

  • Obesity
  • Advancing age
  • Previous injury to the hip joint
  • Structural problems with the hip joint, such as hip dysplasia and femoroacetabular impingement
  • Family history of osteoarthritis

However, osteoarthritis of the hip may develop in people without these risk factors. If left untreated in the early stages, this condition can progress to the end stage within 15 years.

a male jogger having pain in his left hip

 Jan-Otto / Getty Images

Stage 1

This is the least severe stage of hip osteoarthritis. People with hip osteoarthritis in this stage have very few signs of wear-and-tear between the hip joints and a few bone spur growths (growths that are found where two bones meet at joints).


Those with stage 1 hip osteoarthritis typically feel little to no pain in the affected area. For that reason, people with this stage of hip osteoarthritis may not be aware that they have this condition.


For those with no history of osteoarthritis, a doctor will most likely leave their symptoms untreated. Prevention will be the focus of treatment for this stage. Supplements like glucosamine and chondroitin may be prescribed. People with this stage of hip osteoarthritis may also be asked to change up their exercise routine to minimize placing stress on their hip joints.

Stage 2

This stage is commonly referred to as mild hip osteoarthritis. It shows more bone spur growth on x-rays of hip and knee joints. Even though cartilage remains healthy at this stage, there is a breakdown of the cartilage matrix due to increased enzyme production, like metalloproteinases. 


People at this stage will begin to experience more pain and discomfort in the hip area. Nevertheless, the space between your bones still appears normal. They may notice stiffness, especially when they get up in the morning or after sitting for a long time.


To prevent worsening symptoms, people with this stage of hip osteoarthritis are usually placed on a regular workout plan with energy-building exercises. Strengthening the muscles around the arthritic joints can help stabilize them and keep them strong. Also, braces and knee supports may be used to protect the joints from strain and stress.

Stage 3

Often referred to as moderate hip osteoarthritis, this stage is where there is obvious erosion to the cartilage between hip bones. The gap between the bones narrows as there are collagen fragments released into the lubricant (synovial fluid) during progression. Larger bone spur growth increases, and the joints become rougher.


Besides experiencing pain and stiffness like in stage 2, people with stage 3 hip osteoarthritis will also feel pain while performing normal activities like walking, running, squatting, extending, or kneeling as the hip osteoarthritis progresses and joint inflammation increases. Swelling increases the longer someone stays active at this stage.

There may also be popping or snapping sounds when walking after sitting for long or waking up in the morning. 


People with moderate arthritis should continue what they have been doing for stage 1 and 2 to alleviate discomfort. Regular pain-relieving pills like acetaminophen and non-steroidal anti-inflammatory drugs are the first-line treatment at this stage. If that fails, your orthopedic doctor may recommend a strong pain-relieving medicine like codeine and oxycodone. 

For patients who are overweight, weight loss can reduce the amount of stress placed on the hip joints and help slow down the progression of the disease. 

Physical therapy may be recommended to help strengthen the joints and ease pain. Doctors may also recommend Injections of steroids to decrease inflammation or lubricating fluids to replenish the fluids that naturally lubricate the joint.

As osteoarthritis progresses and worsens, it often becomes less responsive to medical treatments such as pills or injections. Most patients who have mild arthritis can manage their condition with ice, rest, lifestyle modifications, pills, or joint injections. However, patients with more advanced stages of osteoarthritis may need surgery to manage their condition. Some with severe osteoarthritis may need total hip replacement surgery.

Stage 4

Stage 4 is the severe stage of osteoarthritis of the hip. At this stage, the cartilage is so thin and brittle and the synovial fluid so diminished that pain and stiffness are present most of the time, even without activity or movement.


The erosion of the cartilage leads to a chronic inflammation. This causes severe pain that can disrupt daily activities and sleep. X-rays will show advanced growth of more bone spurs, which cause more pain and difficulty in completing daily tasks. 


Surgery is the main treatment at this stage. Bone realignment surgery may be recommended. During this procedure, the orthopedic surgeon cuts the bones around the affected joint to help in realignment, hence reducing stress on it. This surgery helps to protect the hip by shifting the weight of the body away from the area with bone damage.  

Another surgery that people with this stage of hip osteoarthritis may undergo is total hip replacement (also called total hip arthroplasty), where the damaged hip joint is removed and replaced with a prosthesis device. Recovery may take several weeks and requires you to continue physical and occupational therapy to become fully mobile.

Living with Osteoarthritis

Self-management methods like engaging in weight loss programs and eating healthily are ways to keep osteoarthritis from becoming worse.

A Word From Verywell

Progression can cause drastic lifestyle changes that further aggravate osteoarthritis of the hip. If you are having a tough time coping, talk to your doctor to review your treatment plan and determine if changes are needed. Also, stop or reduce activities that may be hurting you to help minimize your symptoms.

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Article Sources
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  1. Orthopaedic Specialty Group. The 4 stages of osteoarthritis.

  2. Washington University Orthopedics. Arthritis of the hip - types, symptoms, diagnosis, treatment.

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