Stages of hip osteoarthritis

Hip pain

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The individual stages of hip osteoarthritis

The Hip osteoarthritis (Synonyms: hip joint arthrosis, coxarthrosis) is a degenerative disease of the hip joint, which is characterized by the fact that the cartilage in the hip joint slowly and progressively perishes. It runs in several stages.

In principle, the Hip arthrosis three stages are used: The general classification of all types of osteoarthritis into three stages, also one specific for coxarthrosis radiological Classification and one clinical Classification for which various scores are available.

Any form of arthrosis can be in Stages organize:

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Who am I?
My name is dr. Nicolas Gumpert. I am a specialist in orthopedics and the founder of .
Various television programs and print media report regularly about my work. On HR television you can see me every 6 weeks live on "Hallo Hessen".
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The hip joint is one of the joints that are exposed to the greatest stress.
The treatment of the hip (e.g. hip arthrosis, hip impingement, etc.) therefore requires a lot of experience.
I treat all hip diseases with a focus on conservative methods.
The aim of any treatment is treatment without surgery.
Which therapy achieves the best results in the long term can only be determined after looking at all of the information (Examination, X-ray, ultrasound, MRI, etc.) be assessed.

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Further information about myself can be found at Dr. Nicolas Gumpert

  • Stage 1 describes clinically silent osteoarthritis. This does not cause any complaints in those affected and therefore usually goes unnoticed for a long time. Therefore, a diagnosis at this early stage is usually an incidental finding, for example if a joint is x-rayed for another reason and the changes in the cartilage characteristic of osteoarthritis are discovered. How long a patient is in stage 1 hip osteoarthritis before moving on to the next stage varies from person to person.
  • Stage 2 is then characterized by the pain in the joint area typical of osteoarthritis, which is why a doctor is usually consulted. One speaks of activated osteoarthritis, which means that an inflammatory process has started, which is responsible for the pain. However, this pain is not always present and can sometimes be treated without drug therapy.
  • In stage 3, there is finally a clinically manifest osteoarthritis, which is characterized by permanent pain and a reduction in function and restricted mobility of the affected joint. These are caused by the moderate to strong inflammatory reaction. Because of the intensity of the pain, drug, physical therapy and / or surgical therapy must be carried out in stage 3. Once osteoarthritis has progressed to stage 2, sooner or later it will always move to the third stage if early treatment is missed.

Depending on the stage, a different triad of symptoms is distinguished:
In the early stage this consists of starting, fatigue and exertion pain, in the later stage of continuous, night and muscle pain. In the early stage, radiating pain can be added (in the case of hip osteoarthritis, this is usually knee pain), in the late stage, the pain is often accompanied by limited mobility in the joint.

Radiological staging

The radiological staging of hip arthrosis usually takes place according to the classification of Kellgren and Lawrence. It relates to the findings in the X-ray image show and will be in degrees of 0 to 4 divided, whereby from the second degree the diagnosis of hip arthrosis can be regarded as certain.

  • Grade 0: normal finding, there are no signs of osteoarthritis.
  • Grade 1: There are small osteophytes, but their relevance is still unclear at this point in time. Osteophytes are degenerative changes of bonethat are typical of osteoarthritis. These are new bone formations in the form of small protrusions on the edge of a bone. In osteoarthritis, they represent the body's attempt to increase the contact surface in the joint in order to reduce the pressure exerted. In the case of coxarthrosis, the hip socket is widened and thus loses its original spherical shape. At this stage osteoarthritis is suspected.
  • Grade 2: The osteophytes are clearly visible, the joint space is still normal, but one speaks of a minor hip osteoarthritis.
  • Grade 3: This finding is assessed as moderate coxarthrosis. There is already a slight narrowing of the joint space, and there are also rubble cysts. These are signs of wear and tear in the joint and correspond to depressions in the bone that are filled with synovial membrane, pieces of cartilage, scar tissue and / or fluid.
  • Grade 4: Here is a difficult one Hip arthrosis in front. The joint space is massively reduced, which can be explained by the advanced loss of cartilage tissue, and bony deformations in the joint can be seen. In addition, a subchondral sclerotherapy clear. This is the result of long-term, excessive mechanical stress on the joint, to which the bone reacts with structural compaction. The deformities can result in a misalignment of the axis of the hip joint, which leads to instability in the joint, which is why it is sometimes called "Schlotterwinkel“Is known. In this final stage, in the worst case, stiffening (Ankylosis) of the entire joint.

The X-ray findings in one Hip arthrosis are very reliable, but must nevertheless be evaluated with caution, as they do not always correlate with the extent of the patient's complaints.

Clinical staging

The clinical staging a coxarthrosis uses different Scores. The so-called "Harris Hip Score“.
With this classification, points are distributed for various factors, so that you ultimately get a value between 0 and 100 can reach. Should less than 70 points are obtained, this result is classified as bad, all from 80 points counts as Well. The subgroups represented here are:

  • Pain
  • daily activities (such as climbing stairs or putting on shoes and stockings on your own)
  • the Walking ability and finally
  • Deformities or. Bad posture

The Score to Merle d’Aubigné and Postel. In this, points are awarded in the areas of pain, mobility and walking ability, which are in each case 7 degrees of severity (from 0 to 6) split.
A distinction is made between the calculated score absolute values, where only the points for pain and walking ability are added up and so on one Maximum number of 12 comes (everything under 7 is considered critical) and relative values.
The relative values ​​should be used to compare the patient's condition before and after an operation. The points for pain and walking ability are doubled in this case. Everything above 7 is to be regarded as good here, a value below 3 indicates that the operation has failed. There is also the Lequesne score, which evaluates pain, maximum walking distance and everyday activities. Although this score correlates very well with the clinical complaints of those affected, it correlates only very poorly with the findings of one X-ray image. Finally, sometimes the SF-36 questionnaire Use that is the only one that deals not only with the patient's clinical complaints, but also with the analysis of his quality of life.

In general, it should also be noted that all stages are mainly used to monitor the progress of the Hip osteoarthritis serve. You can also help to make a suitable decision Therapy of hip arthrosis contribute, but should never be the primary clue for choosing a particular treatment path, as they say too little about the patient's individual suffering.