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Primary osteoarthritis (OA) of the hip has a distinct etiology and epidemiology compared with other types of arthropathy in the hip joint. Arthritis of the hip can be secondary to conditions such as osteonecrosis, trauma, sepsis, or rheumatoid arthritis. Certain conditions, such as congenital hip disease and slipped capital femoral epiphysis, involve predisposing anatomic abnormalities; in such cases, the term "secondary OA" is used. When either an anatomic abnormality cannot be determined or other specific causative entities are not identified, primary OA is the diagnosis of exclusion. The prevalence of hip OA is about 3% to 6% in the Caucasian population and has not changed in the past four decades. In contrast, studies in Asian, black, and East Indian populations indicate a very low prevalence of hip OA. Statistics on patients who underwent total hip replacement for primary OA in San Francisco and Hawaii demonstrate a virtual absence of the condition in Asians and low rates in the black and Hispanic populations. Family studies from Sweden, Britain, and the United States show increased rates of hip OA in first-degree relatives of the index patient when compared with the normal population. Occupations requiring heavy lifting, farming, and elite sports activity are associated with increased rates of hip OA. The low prevalence of hip OA in Asian and black populations in their native countries; the low incidence of total joint replacement for primary OA in Asian, black, and Hispanic populations in North America; and the familial association of hip OA in Caucasians all suggest that genetic factors may be involved in the occurrence of this disease.