Evaluation and management of early hip osteoarthritis

The early stages of hip osteoarthritis (OA) remain less clearly defined, particularly regarding the optimal therapeutic interventions to slow or prevent disease progression. This review synthesizes current evidence on the diagnosis and management of early hip OA, with an emphasis on hip preservation techniques. Initial management typically involves conservative measures, including nonsteroidal anti-inflammatory drugs (NSAIDs), physical therapy, and corticosteroid injections. For select patients, modern surgical hip preservation techniques such as hip arthroscopy and peri-acetabular osteotomy (PAO) offer promising outcomes by preserving joint integrity and delaying or preventing the need for arthroplasty. Proper patient selection is critical for optimizing outcomes, with factors such as age, severity of arthritis, and baseline function influencing treatment success. Hip arthroscopy yields favorable results in patients with minimal joint space narrowing, Tönnis grade less than or equal to one, and mild chondral damage. PAO is most effective in younger patients with acetabular dysplasia and minimal arthritic changes. Although hip resurfacing arthroplasty remains an option for young, active male patients with good bone quality, concerns about complications have limited its use. Total hip arthroplasty (THA) remains the gold standard for advanced disease but may have less predictable outcomes in patients with minimal radiographic changes. Shared decision-making and thorough preoperative counseling are essential to set realistic patient expectations and guide treatment decisions. To that end, this review underscores the importance of a patient-centered approach in managing early hip OA to optimize outcomes and satisfaction.