Four Stages of Osteoarthritis of the Hip (2023)

Hip osteoarthritis is a progressive disease in which the hip joints experience adverse changes to cartilage and bone and gradually deteriorate over time. These changes develop in four distinct stages:

  • Stage 1: This is the earliest stage in which wear and tear of the hip joint may cause bone spurs but typically no pain.
  • Stage 2: This is when joint cartilage starts to break down, but the space between joints is still normal. Occasional stiffness or pain is common.
  • Stage 3: This is when the erosion of cartilage narrows the joint space, making everyday movements like walking or squatting painful or difficult.
  • Stage 4: This is the most advanced stage in which the loss of cartilage and joint lubrication causes bone to rub on bone, resulting in chronic pain, stiffness, and loss of mobility.

This article describes the four stages of hip osteoarthritis in detail, including the symptoms and treatment options of each stage.

10 Surprising Facts About Osteoarthritis

Four Stages of Osteoarthritis of the Hip (1)

Stage 1 Hip Osteoarthritis

This is the earliest and mildest stage of hip osteoarthritis (OA). During stage 1, there are few signs of wear-and-tear between the hip joints, with the exception of tiny bone spurs known as osteophytes.

Osteophytes are irregular bone growths caused by inflammation in deteriorating joints. As part of the inflammatory response, a protein called transforming growth factor-beta (TGF-β) causes bone minerals to clump together irregularly.


Stage 1 hip OA is largely asymptomatic (without symptoms) and causes little to no pain. For this reason, people with stage 1 hip OA may not be aware that they even have the disease.


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

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

Supplements like glucosamine and chondroitin may be prescribed. While the evidence supporting these supplements is conflicted, they are generally regarded as safe.

How Fast Does Hip Arthritis Progress?

It can take some people years to progress to more advanced stages of hip osteoarthritis. Others can progress within a matter of six to nine months.

Factors that may influence the rate of progression include:

  • Older age
  • A history of hip injury or strain (such as from manual work)
  • Severity of symptoms when they first appear

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(Video) Osteoarthritis in the Hips

Stage 2 Hip Osteoarthritis

Stage 2 hip OA is commonly referred to as mild hip osteoarthritis. Bone spur growths may be seen on X-rays, but the space between the bones will still appear normal.

Although joint cartilage remains healthy at this stage, there will be a gradual breakdown of collagen (one of the main proteins found in cartilage) due to an increased production of enzymes called metalloproteinases.


People with stage 2 hip OA will start to experience:

  • Pain and discomfort in the hip joint, typically on one side only
  • Aching or weakness in the joint after strenuous activity
  • Joint stiffness, especially in the morning or after sitting for a long time


People with OA stage 2 hip are usually placed on a regular exercise plan that includes strength-building exercises. Strengthening the muscles around the joints can help stabilize the hips and keep them strong.

Knee braces may be used if you also have knee osteoarthritis. If the knee is destabilized, it can affect the position of the hip and make hip OA symptoms worse.

When to See a Healthcare Provider

Speak with your healthcare provider or meet with a bone and joint specialist called an orthopedist if you develop early signs of hip osteoarthritis, including:

  • Hip pain that worsens when you walk, run, and stand
  • Hip stiffness in the morning
  • Problems crouching and crossing your legs
  • Hip weakness or limping
  • Problems rising from a chair

Living With Osteoarthritis

Stage 3 Hip Osteoarthritis

Often referred to as moderate hip osteoarthritis, stage 3 hip OA is characterized by the significant erosion of the cartilage between the bones of the hip joint. As the gap between the bones narrows, joint inflammation increases and promotes the growth of osteophytes.

At the same time, collagen fragments from deteriorating cartilage are released into the lubricating fluid around joints (called synovial fluid), altering its viscosity (thickness and stickiness) while further increasing joint inflammation.


People with stage 3 hip osteoarthritis will experience:

  • Hip pain with normal activities like walking, running, squatting, or kneeling
  • Joint swelling with prolonged activity or standing
  • Joint stiffness in the morning or after sitting a long time
  • Popping, grating, or snapping sounds as the hip joint moves
  • A "catching" sensation as the hip joint moves
  • An uneven gait or limping
  • Increasing hip weakness


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

Over-the-counter painkillers like Tylenol (acetaminophen) or non-steroidal anti-inflammatory drugs (NSAIDs) such as Advil (ibuprofen) are usually recommended. If these treatments don't help, your healthcare provider may prescribe a stronger NSAID like Celebrex (celecoxib).

Physical therapy may be recommended to strengthen the muscles around the joints and improve your mobility.

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Your healthcare provider may also give corticosteroid (steroid) injections into the joint space to decrease inflammation and deliver longer-term pain relief.

How Osteoarthritis Is Treated

Stage 4 Hip Osteoarthritis

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

Stage 4 hip OA suggests that bone is rubbing on bone and the function of the joint has been compromised.


With stage 4 hip OA, symptoms tend to be severe and commonly include:

  • Constant joint pain and stiffness with or without movement
  • A significant loss in the range of motion of the hip
  • Hip weakness or a sense that the hip may collapse under you
  • Pain in the opposite hip, as it is forced to compensate for the affected hip
  • Muscle thinning in the legs due to the loss of mobility
  • Disruption of sleep due to pain

Those with stage 4 osteoarthritis are also at an increased risk of falling.


Surgery is often delayed with treatments like hyaluronic acid injections that aim to improve joint lubrication. Repeated steroid injections or oral opioid painkillers may also be offered.

Assistive walking devices, such as a cane, crutches, walker, or wheelchair, can help with mobility and stability issues.

If surgery is recommended, it may include:

  • Bone realignment surgery: During this procedure, bone is removed from around the affected joint so that the joint can be aligned into a more stable, mobile position. This surgery is typically an option for people under 60.
  • Total hip replacement: Also known as total hip arthroscopy (THA), this 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.

End-Stage Hip Osteoarthritis

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

  • All other treatments or surgical efforts have failed
  • Persistent, debilitating pain and loss of mobility have made it impossible for a person to manage daily living

What to Expect With a Total Hip Replacement

7 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. Lespasio MJ. Hip osteoarthritis: a primer. Perm J.2018;22:17-084. doi:10.7812/TPP/17-084

  2. 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

  3. 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

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

  5. 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

  6. 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

  7. American Academy of Orthopaedic Surgeons. Total hip replacement.

(Video) How To Clearly Tell Where You Are In The 4 Stages Of Knee Arthritis

Four Stages of Osteoarthritis of the Hip (2)

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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.

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(Video) What Options are Available for Patients with Grade 4 (Severe) Arthritis?


Four Stages of Osteoarthritis of the Hip? ›

There are four stages of osteoarthritis (OA): early, mild, moderate, and severe. You can also be diagnosed with a stage called pre-osteoarthritis. OA is a progressive joint disease caused by cartilage breakdown.

What are the 4 stages of osteoarthritis in the hip? ›

Hip Osteoarthritis: The Four Stages
  • The first stage: Minor. At first, there will only be small signs of tension, making it easy to surpass this stage without even realising. ...
  • 2: The second stage: Mild. Eventually, X-rays will pick up on the slowly-developing bone spurs. ...
  • The third stage: Moderate. ...
  • The fourth stage: Severe.
Jul 27, 2021

What stage of osteoarthritis requires hip replacement? ›

Stage 4 OA is also sometimes called end-stage osteoarthritis because the damage is so severe that a joint replacement is the only remaining treatment option. Total hip replacement is indicated when: All other treatments or surgical efforts have failed.

How do you treat Stage 4 osteoarthritis in the hip? ›

When a person has stage 4 hip osteoarthritis, doctors will usually consider surgery. Surgical options include the following: Hip arthroscopy: This is keyhole surgery and involves a surgeon scraping away the damaged cells within the hip.

What does Stage 4 osteoarthritis look like? ›

Stage 4: Severe osteoarthritic stage

In stage 4 OA, the joint space between your bones reduces considerably, and the bone spur becomes large in size, with apparent deformity of the bone ends and formation of a large area of connective tissue in the joint.

How do you stop hip osteoarthritis from progressing? ›

Get Physical. Physical activity is the best available treatment for OA. It's also one of the best ways to keep joints healthy in the first place. As little as 30 minutes of moderately intense exercise five times a week helps joints stay limber and strengthens the muscles that support and stabilize your hips and knees.

When is it too late to get a hip replacement? ›

There is no official cut-off age for getting a hip replacement. In fact, trends indicate that hip replacements have a higher success rate in older patients than younger ones! This means, as long as patients are healthy, hip replacements are possible well past the 75 – 79 age bracket.

What aggravates hip osteoarthritis? ›

Nonsurgical Treatments for Hip Arthritis

Avoid activities that aggravate hip arthritis, such as running, jumping and other high-impact exercises. Lifestyle modifications, such as weight loss, can help reduce stress on the hip joint.

When is surgery needed for osteoarthritis? ›

Because osteoarthritis tends to get worse over time, you may get to the point where other treatments are no longer effective. Your doctor will look at your joint on an X-ray, and when the test shows a substantial issue — bone rubbing against bone — it may be time to consider knee replacement surgery.

How fast does hip osteoarthritis progress? ›

How quickly does OA progress? Experts confirm that once OA starts, it may take years to reach a severe stage. However, in extreme cases, OA progresses rapidly to complete the destruction of the cartilage within a few months.

How serious is Stage 4 osteoarthritis? ›

Stage 4 – Severe

This is the most severe stage of OA, which means it is also the most painful. At this point, the cartilage is almost completely gone, leading to an inflammatory response from the joint. The bone spurs that developed in the earlier stages have now multiplied, often causing excruciating pain.

How bad is Stage 4 osteoarthritis? ›

Stage 4 is the most severe stage of osteoarthritis. Because of the fully progressed state of cartilage breakdown and bone-on-bone friction, you typically experience more intense (even excruciating) pain and discomfort when moving.

What is the best painkiller for osteoarthritis in the hip? ›

Many doctors recommend acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs), which include aspirin, ibuprofen, and naproxen. These medications are taken by mouth and are available at drugstores.

What exercises can you do with Stage 4 osteoarthritis? ›

Walking, biking, swimming, tai chi, yoga, and water aerobics are all good aerobic exercises for people with osteoarthritis. Water exercise is especially ideal because of water's soothing warmth and buoyancy. It's a gentle way to exercise joints and muscles -- plus it acts as resistance to help build muscle strength.

How do I know if my osteoarthritis is severe? ›

you have joint pain that gets worse the more you use your joints. the stiffness in your joints is not there in the mornings, or lasts less than 30 minutes.

Does hip replacement get rid of osteoarthritis? ›

Total hip replacement eliminates osteoarthritis in the hip entirely. It may dramatically improve your quality of life by alleviating pain and restoring stability and range of motion to the hip. A surgeon performs total hip replacement using spinal or general anesthesia.

Is it OK to walk with hip osteoarthritis? ›

Walking: Bone and joint specialists suggest that walking is one of the best forms of exercise for hip arthritis. Walking boosts blood flow to your cartilage, giving it the nutrients necessary to provide cushion to the ends of your joints.

What happens if hip osteoarthritis is left untreated? ›

Untreated arthritis will add to the degradation of the structures in and around the joint leading to more and more pain and a loss of function. The progression of arthritis may lead to requiring a total joint replacement.

What can you never do after hip replacement? ›

The Don'ts
  • Don't cross your legs at the knees for at least 6 to 8 weeks.
  • Don't bring your knee up higher than your hip.
  • Don't lean forward while sitting or as you sit down.
  • Don't try to pick up something on the floor while you are sitting.
  • Don't turn your feet excessively inward or outward when you bend down.

What will happen if I don't replace my hip? ›

In many cases, hip damage and dysfunction will worsen without treatment. Inactivity can lead to loss of muscle strength and increased stiffness of the hip joint. Without a hip replacement, weak hip muscles and joint stiffness could lead to a noticeable limp.

What is the alternative to hip replacement for arthritis? ›

Hip resurfacing surgery is an alternative to standard hip replacements for patients with severe arthritis. In a hip resurfacing surgery, the implant is smaller, and less normal bone is removed.

What to do when your hip is bone on bone? ›

Exercises or physical therapy to strengthen hip and leg muscles and improve flexibility and range of motion. Medication. Your surgeon may recommend over-the-counter pain relievers like NSAIDS (nonsteroidal anti-inflammatory drugs, such as naproxen and ibuprofen) or prescription medications.

What activities make hip arthritis worse? ›

Types of exercises to avoid
  • Exercises with sudden changes in movement and direction. Sports and exercises that involve sudden stops and movements, such as tennis and baseball, put heavy stress on the joints.
  • Exercises on uneven terrain. ...
  • High impact exercises. ...
  • Prolonged standing exercises. ...
  • Weightlifting exercises.
Feb 10, 2022

What is the new surgery for osteoarthritis? ›

Genicular nerve radiofrequency ablation is a minimally invasive treatment for knee pain due to osteoarthritis of the knee, and can significantly reduce pain, especially for adults who are 50 and older.

How painful is a hip replacement? ›

You can expect to experience some discomfort in the hip region itself, as well as groin pain and thigh pain. This is normal as your body adjusts to changes made to joints in that area. There can also be pain in the thigh and knee that is typically associated with a change in the length of your leg.

How serious is osteoarthritis of the hip? ›

Osteoarthritis of the hip is a serious condition. Osteoarthritis is the most common of the more than 100 kinds of arthritis and the hip joint is the second most commonly affected large joint in the body. Osteoarthritis is a chronic disease that can takes months to years to appear.

What is the average age for hip osteoarthritis? ›

Osteoarthritis usually starts in people over the age of 45 and is more common in women than men. Research has shown that injuries, and jobs that involve heavy lifting or long periods of standing up, are associated with an increased risk of developing hip osteoarthritis.

What is the most common symptom of hip osteoarthritis? ›

The most common symptom of hip osteoarthritis is pain. This hip pain develops slowly and worsens over time, although sudden onset is also possible. Pain and stiffness may be worse in the morning, or after sitting or resting for a while.

What mimics hip osteoarthritis? ›

One common pain, two different problems

Two likely causes of hip pain are osteoarthritis and bursitis. They have similar symptoms, but very different reasons for causing pain. Hip osteoarthritis occurs when the slippery, protective cartilage in the hip joint thins or disappears.

What is considered end-stage osteoarthritis? ›

End-stage arthritis is the progressive wearing down of the cartilage that is present between the bones of a joint causing the bones to come in contact with each other and painfully rub against each other during movement of the joint. This results in severe pain with loss of movement and function.

How long can you live with severe osteoarthritis? ›

Arthritis by itself is not fatal, but research has shown that the complications that may arise in more severe cases can shorten lifespan by six to seven years. There are many ways to reduce your risk of complications from arthritis.

What is the average age of severe osteoarthritis? ›

Its signs and symptoms typically show up more often in individuals over age 50, but OA can affect much younger people, too, especially those who have had a prior joint injury, such as a torn ACL or meniscus.

Can Stage 4 osteoarthritis reversed? ›

We can't reverse osteoarthritis changes. However, by changing your lifestyle and exercising regularly, you can stop the progression of this disease.

Can hip arthritis cause pain down leg? ›

If you have a problem with your hip joint you may feel pain in the groin, down the front of the leg and in the knee. Sometimes knee pain is the only sign of a hip problem – this is called referred pain or radiated pain and is fairly common.

Can Stage 4 osteoarthritis be cured? ›

There's no cure for osteoarthritis, but the condition does not necessarily get any worse over time. There are a number of treatments to help relieve the symptoms. The main treatments for the symptoms of osteoarthritis include: lifestyle measures – such as maintaining a healthy weight and exercising regularly.

Why can't you use Voltaren on your hips? ›

Why can't I use Voltaren Arthritis Pain Gel for shoulders, hips, etc.? Voltaren has not been studied for the relief of arthritis pain in the shoulders, hips, and back.

What is the first line treatment for hip osteoarthritis? ›

The initial oral medication of choice in the treatment of OA involves oral NSAIDs.

What makes hip osteoarthritis worse? ›

The pain associated with osteoarthritis of the hip is generally worse with weight bearing (walking standing) or twisting.

What is the best treatment for osteoarthritis of the hip? ›

If osteoarthritis of the hip causes aching pain and limits your ability to move without discomfort, your doctor may recommend an over-the-counter pain relief medication. Many doctors recommend acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs), which include aspirin, ibuprofen, and naproxen.

What causes osteoarthritis flare ups? ›

The most common triggers of an OA flare are overdoing an activity or trauma to the joint. Other triggers can include bone spurs, stress, repetitive motions, cold weather, a change in barometric pressure, an infection or weight gain.

What is the drug of choice for osteoarthritis? ›

NSAIDs are the most effective oral medicines for OA. They include ibuprofen (Motrin, Advil) naproxen (Aleve) and diclofenac (Voltaren, others). All work by blocking enzymes that cause pain and swelling.

What should you not drink with arthritis? ›

Beverages to avoid with arthritis
  • Red wine and other alcohol. It's true that red wine contains resveratrol, an antioxidant that may have health benefits. ...
  • Sugar-sweetened drinks. Sugary beverages, like sodas, may significantly increase your risk of arthritis. ...
  • Coffee. ...
  • Milk.

What is lacking in osteoarthritis? ›

Osteoarthritic joints have low levels of aggrecan, proteoglycan, type-II collagen, and runt-related transcription factor 1(RUNX1).

What chair is best for hip osteoarthritis? ›

ANY saddle seat is better for hip OA than ANY conventional chair. The open hip angle position on a saddle seat relieves pressures on the hip joint cartilage, increases the space inside the hip joint, and improves circulation through the hip area.

Should I keep walking if my hips hurt? ›

Walking is good for hip pain and you should try to walk as much as you can each day. You'll find that in time and with consistency, your hip pain will diminish, and in a best case scenario, it will disappear altogether.

Is sitting bad for hip osteoarthritis? ›

If a person sits too long at their desk all day not only will their joints get stiff but their muscles will shorten. Muscle tightness can also increase stress on the joints which will then in-turn increase the pain in those joints affected by RA or OA.


1. Osteoarthritis of the Hip
(Somerset NHS Foundation Trust)
2. Osteonecrosis Of The Hip Ficat Classification - Everything You Need To Know - Dr. Nabil Ebraheim
(nabil ebraheim)
3. What are the 4 stages of osteoarthritis?
(Ask About HEALTH)
4. Hip Arthritis Do's and Don'ts!
(Ortho Eval Pal with Paul Marquis PT)
5. Diagnosing an Arthritic Hip Joint
(Holy Cross Health)
6. Classic Sign of Hip Arthritis:This is the SIMPLEST test to identify it!
(Ortho Eval Pal with Paul Marquis PT)
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