Four Stages of Osteoarthritis of the Hip

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In hip osteoarthritis, the protective cartilage in the hip joint thins over time. The bone-on-bone rubbing that results causes hip joint wear and tear that leads to pain and stiffness in the groin, buttocks, and knee. This degeneration of the hip joint happens over time in stages.

The four stages of osteoarthritis of the hip are:

  • Stage 1: Minor wear and tear of the hip joint that may also include bone spurs. This is the earliest stage and involves little to no pain.
  • Stage 2: Joint cartilage begins to break down, and bone spurs may be evident on x-rays, but the space between joints still appears normal. Intermittent discomfort, pain, and stiffness are common in this stage, which is also known as mild hip osteoarthritis.
  • Stage 3: Significant erosion of joint cartilage, narrowing of the space between bones, and larger bone spurs can be seen in x-rays. In moderate hip osteoarthritis, everyday movements like walking, squatting, or bending cause pain and swelling in the joint.
  • Stage 4: The most severe stage of hip osteoarthritis involves chronic joint inflammation, thin and brittle cartilage, and significantly reduced synovial fluid. Pain and stiffness are present most of the time and can interfere with sleep and daily activities.

Your treatment will depend on the stage of your hip osteoarthritis.

a male jogger having pain in his left hip

 Jan-Otto / Getty Images

Stage 1

This is the earliest and mildest stage of hip osteoarthritis. During stage 1, there are very few signs of wear-and-tear between the hip joints, possibly with a few bone spurs. These spurs are irregular growths of bone that develop where two bones meet at joints.

Symptoms

Stage 1 hip osteoarthritis is associated with 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.

Treatments

Prevention will be the focus of treatment for this stage. Prevention can involve avoiding activities that may aggravate the condition, such as running.

People with this stage of hip osteoarthritis may also be asked to modify their exercise routine to minimize physical stress on their hip joints.

If you are overweight, weight loss can reduce the amount of stress placed on your hip joints and help slow down the progression of the disease. 

Supplements like glucosamine and chondroitin may be prescribed.

Living with Osteoarthritis

Self-care approaches like eating healthy can keep osteoarthritis from becoming worse.

Stage 2

This stage is commonly referred to as mild hip osteoarthritis. Bone spur growths may be seen on x-rays of hip and knee joints, and the space between the bones still appears normal.

Even though cartilage remains healthy at this stage, there is a breakdown of the cartilage matrix due to increased production of enzymes, like matrix metalloproteinases. 

Symptoms

People at this stage will begin to experience pain and discomfort in the hip area. They may notice stiffness, especially when they get up in the morning or after sitting for a long time.

Treatments

People with this stage of hip osteoarthritis are usually placed on a regular workout plan with energy-building exercises to prevent worsening of symptoms. 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 characterized by significant erosion of the cartilage between hip bones. The gap between the bones narrows as the joints become inflamed and collagen fragments are released into the synovial fluid that lubricates the joints. Larger bone spurs are formed, and the joints become rougher.

Symptoms

People with stage 3 hip osteoarthritis will feel pain with normal activities, like walking, running, squatting, extending, or kneeling. Swelling can increase, especially with prolonged activity.

Joint movement can cause popping or snapping sounds in the morning or after sitting for a long time. 

Treatments

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

Over-the-counter (OTC) pain-relieving pills, like acetaminophen and non-steroidal anti-inflammatory drugs are usually recommended at this stage. If these treatments don't help, your healthcare provider may prescribe a stronger pain-relieving medicine for you. 

Physical therapy may be recommended to strengthen the muscles around the joints and help ease the pain. Healthcare providers may also recommend steroid injections to decrease inflammation or lubricating fluids to replenish the fluids that naturally lubricate the joint.

Most people who have mild osteoarthritis experience relief with ice, rest, lifestyle modifications, pills, or joint injections. As the condition progresses, it often becomes less responsive to these treatments. Advanced stages of osteoarthritis may necessitate surgery, such as hip replacement surgery.

Stage 4

Stage 4 is the most severe stage of hip osteoarthritis.

At this stage:

  • The cartilage is thin and brittle
  • There is chronic inflammation of the joints
  • Bone spur growth is present
  • The synovial fluid is significantly diminished

Symptoms

In advanced osteoarthritis, pain and stiffness are present most of the time, even without activity or movement. The pain can disrupt daily activities and interfere with sleep. 

Treatments

Surgery is often considered at this stage.

  • Bone realignment surgery may be recommended. During this procedure, the orthopedic surgeon will cut the bones around the affected joint to realign them, reducing stress on the joint. This surgery helps to protect the hip by shifting the weight of the body away from the area of damage.  
  • Total hip replacement (also called total hip arthroplasty) is a procedure in which the damaged hip joint is removed and replaced with a prosthetic device. Recovery may take several weeks and involves physical and occupational therapy.

A Word From Verywell

Progression of osteoarthritis causes worsening symptoms and can substantially interfere with your daily life. If you are having a tough time coping, talk to your healthcare provider to review your treatment plan and determine if changes are needed. Also, be sure to modify any activities that may be aggravating your condition.

2 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Orthopaedic Specialty Group. The 4 stages of osteoarthritis.

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

Additional Reading

By Margaret Etudo
Margaret Etudo is a health writing expert with extensive experience in simplifying complex health-based information for the public on topics, like respiratory health, mental health and sexual health.