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Based on their association with early disease progression in RPOH, elevated serum matrix metalloproteinase-3 levels and spinopelvic malalignment may serve as predictive factors for subsequent bone destruction when only joint space narrowing is observed. This review also proposes potential mechanisms of pathogenesis and intervention strategies for RPOH at its initial stage. Cartilage matrix fragments generated by stress concentrations on the hip joint, resulting from spinopelvic malalignment, may trigger inflammatory pathways involving proinflammatory cytokines and inflammasome activation, ultimately leading to joint destruction in the initial phase of RPOH. Suppression of these early pathological events may prevent joint destruction caused by RPOH. 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