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:1

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

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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.1

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.2

Symptoms

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.1

Treatments

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.1

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.3

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.4

Factors that may influence the rate of progression include:4

Older age

A history of hip injury or strain (such as from manual work)

Severity of symptoms when they first appear

 20 Supplements and Vitamins for Arthritis

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.1

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.2 

Symptoms

People with stage 2 hip OA will start to experience:1

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

Treatments

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.5

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:1

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

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.1

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.1

Symptoms

People with stage 3 hip osteoarthritis will experience:1

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

Treatments

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).1

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

Your healthcare provider may also give corticosteroid (steroid) injections into the joint space to decrease inflammation and deliver longer-term pain relief.1

 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.1

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

Symptoms

With stage 4 hip OA, symptoms tend to be severe and commonly include:1

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.

Treatments

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.1

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 60.6

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.7

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 living7