Far more publications are available for osteoarthritis of the knee than of the hip. Recognizing this research gap, the Arthritis Foundation, in partnership with the Hospital for Special Surgery, convened an in-person meeting of thought leaders to review the state of the science of and clinical approaches to hip osteoarthritis. This article summarizes the recommendations and clinical research gaps gleaned from 5 presentations given in the "how hip osteoarthritis begins" session of the 2023 Hip Osteoarthritis Clinical Studies Conference, which took place on February 17 and 18, 2023, in New York City., Competing Interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Young-jo Kim, MD, PhD, reports a relationship with Cytex. Nancy E. Lane, MD, reports a relationship with Biosplice. Michael B. Millis, MD, reports relationships with the Peabody Foundation, Elsevier, and University of Minnesota. Amanda E. Nelson, MD, reports relationships with the NIH/NIAMS, CDC (National Institutes of Health / National Institute of Arthritis and Musculoskeletal and Skin Diseases K23AR061406, L30AR056604, P60AR064166, and P30AR072580; Centers for Disease Control and Prevention U01DP006266), University of Alabama, and Osteoarthritis Research Society International. Mathias P. Bostrom, MD, reports a relationship with Smith + Nephew. The other authors declared no potential conflicts of interest., (© The Author(s) 2023.)