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10 9 8 7 6 5 4 3 2 1 The arthrosis of the hip (as elsewhere in the body) is classified as primary or secondary. in primary OA, the disease is of idiopathic origin (no known cause) and usually affects multiple joints in a relatively elderly population. Secondary OA usually is a monoarticular condition and develops as a result of a defined disorder affecting the joint articular surface or a combination of risk factors. The initiating event in primary OA is unknown but is believed to be due to at least one or a combination of the following: Genetic factors—namely genes which code for inflammatory cytokines. Age related changes in chondrocytes ,like apoptosis along with decreased rates of cell division; Aging is assumed to contribute to the development of hip OA mainly because of the inability to specifically define an underlying anatomic abnormality or specific disease process leading to the degenerative process. Mechanical factors (wear and tear) due to repetitive trauma, athletes involved in high impact sports or persons with abnormal joint alignment, Slipped Upper Femoral Epiphysis; Biochemical factors, decreased levels of prostaglandins . Genetic factors also may play a role in hip OA, possibly by the inheritance of an anatomical abnormality such as acetabular dysplasia. A sibling study demonstrated a higher risk for hip OA among those who had an affected sibling, as demonstrated by structural changes noted on hip radiographs Secondary (from a known cause) OA results from conditions that change the cartilage environment. occurs when a condition results in an anatomic abnormality, which can be relatively subtle, that predisposes the hip to mechanical factors that lead to degen- erative changes. In contrast secondary OA is due to a known predisposing factor which might include any of those listed above or one of the following: Previous trauma; Mechanical incongruity of the joint due to a congenital malalignment or previous trauma to the joint surface; Previous inflammatory joint disease, septic arthritis/bone disease, Paget disease; Neuropathic joint disease; Previous repeated steroid injections; Endocrinopathies , Cushing’s disease, haemochromatosis.  Blood dyscrasias, haemophilia with recurrent hemarthrosis;