Objective: This study aimed to clarify the characteristics of the patients who had hip osteoarthritis (hip OA) of more than K-L grade 3 and did not need total hip replacement (THR) two years after the diagnosis.Methods: Twenty-four patients who were followed up for at least 2 years were included and classified into surgical and non-surgical groups depending on the need for THR. Pain (rest pain, motion pain, gait pain), hip range of motion, performance tests (time up and go test (TUG), 10 m gait speed, 2-step test, one-leg standing time, chair standing-5 (CS-5)), and Japanese Orthopaedic Association Hip-Disease Evaluation Questionnaire (JHEQ) were evaluated at the initial visit.Results: Rest pain was significantly lower in non-surgical group compared to surgical group (p<0.01). JHEQ pain score (p<0.01), motor score (p=0.03), and mental health score (p<0.01) were significantly higher in non-surgery group than those in surgery group.Conclusion: Even if you have end-stage hip OA, those with low rest pain and a high JHEQ score at the time of initial diagnosis may be able to live for two years without undergoing surgery. In patients with hip OA of more than K-L grade 3, low rest pain and a high JHEQ score at the initial visit were associated with avoiding THR for two years.