Early-Stage Symptomatic Hip Osteoarthritis: A Window of Opportunity

BACKGROUND: While hip osteoarthritis (OA) typically affects older adults, its prevalence in young adults is growing. Hip OA exists on a continuum; the early stages may be when treatments (surgical or nonsurgical) have the greatest chance of slowing or changing its trajectory. Most research and clinical interest have centered on early-stage symptomatic knee OA, with several global initiatives in place to improve diagnosis, classification, and treatment. Early-stage symptomatic hip OA has not had adequate attention. Clinicians and patients often do not recognize the condition or understand when and how to provide effective treatment. CLINICAL QUESTIONS: Why is it important to identify early-stage symptomatic hip OA? What are the benefits and challenges of developing classification criteria? Which candidate features should inform future consensus-based classification? What evidence exists regarding its development, trajectory, clinical and imaging characteristics, and management? KEY RESULTS: We propose candidate symptom, clinical, and imaging (radiographic and magnetic resonance imaging) criteria to stimulate clinical and research interest and to support future initiatives. Mechanical factors are implicated in the development and progression of early-stage symptomatic hip OA. A major clinical challenge is differentiating imaging findings indicative of symptomatic disease from normal age-related variation or incidental changes. Surgical and nonsurgical treatments may be appropriate for early-stage symptomatic hip OA. CLINICAL APPLICATION: Clinicians should consider early-stage symptomatic hip OA in patients with hip pain. While evidence specific to this stage of OA is still evolving, familiarity with its trajectory, key clinical and imaging findings, and factors associated with its development may improve early recognition and guide management decisions. J Orthop Sports Phys Ther 2026;56(7):399-412. Epub 26 May 2026. doi:10.2519/jospt.2026.14223.