Jump to content

Hip Osteoarthritis

Original Editor - Eric Robertson, Kim Presiaux

Top Contributors - Kim Presiaux, Dorien De Strijcker, Lucinda hampton, Davy Duverger, Leana Louw, Vidya Acharya, Nupur Smit Shah, Kim Jackson, Admin, Johnathan Fahrner, Laura Ritchie, Rachael Lowe, Van Horebeek Erika, Scott Buxton, Kai A. Sigel, Eric Robertson, Alexandra Stead, Areeba Raja, Shaimaa Eldib, Vijay Rajaram, Saud Alghamdi, 127.0.0.1, Lauren Lopez, Bram Van Roost, Kevin Vandebroucq, Marius De Bruyn and Loïc Byl

Introduction

Hip OA diagram

Osteoarthritis is a common degenerative condition marked by joint pain and stiffness from progressive cartilage erosion. Hip osteoarthritis (OA) frequently impairs mobility and function, sometimes necessitating joint replacement. Hip OA possess a major global public-health burden. [1].

Epidemiology

The prevalence of hip osteoarthritis increases with age[2][3]. Hip OA is found to be highest in Europe, followed by North America, Asia, and is lowest in Africa, with no differences noted between men and women[2]

Pathology

Severe OA 1. osteophytes 2. subchondral thickening 3. cyst 4. jt space narrowing

Osteoarthritis is distinguished by an active progressive alteration of the whole synovial joint, being due to a combination of mechanical, inflammatory and metabolic factors. It is caused by an imbalance between the destruction and repair of the affected tissues. The disease can affect the following:

  • Hyaline cartilage: loses its structural integrity due to composition changes.
  • Subchondral bone
  • Joint capsule
  • Synovium
  • Ligaments and the periarticular muscles.

Risk Factors

Risk factors that increase the likelihood of developing osteoarthritis of the hip include:

Diagnosis

Advanced OA of a hip.

The following criteria should be used to classify adults over the age of 50 with hip OA:

  1. Moderate anterior or lateral hip pain during weight-bearing activities
  2. Morning stiffness less than 1 hour in duration after wakening
  3. Hip internal rotation range of motion less than 24° or internal rotation and hip flexion 15° less than the nonpainful side, and/or increased hip pain associated with passive hip internal rotation.[5]

Radiographic evidence: joint space narrowing, marginal osteophytes, subchondral sclerosis, and bone cysts.[6][7].

Clinical Presentation

Hip OA - Elderly lady

Pain characteristics

  • Slowly progressive hip pain, or hip-related groin pain radiating into the thigh, buttocks or knee.
  • The pain can be worse at night, at rest or with strenuous activity, reducing the range of motion and limiting walking distance. It can be associated with stiffness particular in the morning or after rest.

Other symptoms include locking, grinding and joint instability, fatigue and pain-related psychological stress.[8]

Key Clinical Examination Findings

  • Age >50 years
  • Moderate anterior or lateral hip pain during weight bearing
  • Morning stiffness of < 1 hour
  • Hip IR ROM <24 degrees
  • Hip IR and rotation less than 15 degrees than non painful side
  • Pain during passive movement of hip IR[9]

Management

A biopsychosocial approach offers the best outcome.[10] Management of hip osteoarthritis varies according to the severity of the condition. A multidisciplinary team may be involved, including: doctors, physiotherapists, dietitians, and occupational therapists.

Physiotherapy plays an important role through customized exercise programs, patient education, manual therapy, impairment-based functional training, gait and balance training, and instruction on proper use of assistive devices (canes, crutches, walkers) for patients with activity limitations, balance impairment, or gait deficits.[5][11] Patients should be taught activity modification, weight reduction measures, exercises, and methods of unloading arthritic joints.[12]

Multidisciplinary Approach

Clinicians should collaborate with physicians, nutritionists, or dietitians to support weight reduction in individuals with hip OA who are overweight or obese.[11] The RACGP 2018[13] guideline strongly recommends targeting a minimum 5–7.5% body weight reduction,a minimum weight loss target of 5–7.5% of body for those who are overweight (body mass index [BMI] ≥25 kg/m2 ) or obese (BMI ≥30 kg/m2 ). It has been shown that every 1% of weight loss was associated with a 2% reduced risk of knee replacement and a 3% reduced risk of hip replacement. [14]

Pharmacology Management

Includes topical or oral nonsteroidal anti-inflammatory drugs(NSAIDs), COX-2 (cyclooxygenase-2) inhibitors, and steroid injections are effective treatments for relief of symptoms in patients with hip OA. However there are serious gastrointestinal side effects associated with oral NSAIDs.[5] Intra-articular steroid injections provide short-term pain relief and duloxetine has demonstrated efficacy. Opiates should be avoided.[7]

Surgical interventions like Total hip replacement is considered in patients with symptomatic and radiographic osteoarthritis characterized by refractory pain and disability. Osteotomy and hip resurfacing should be considered in younger patients with symptomatic secondary osteoarthritis due to acetabular dysplasia, femoroacetabular impingement, varus or valgus deformity.[8]

Physiotherapy Management

Physiotherapy plays in major role in the management of patients with hip osteoarthritis. The goal is to  improve strength, mobility and increase range of motion. Physiotherapy also helps relieve pain and restores normal movement in the hip and legs and also addresses pain management and functional adaptions. Patient-specific exercise programmes has shown to decrease pain and improve function in hip osteoarthritis.[15][10]

Education

Patients should be educated on:

  • The role of physiotherapy and expected outcomes of interventions
  • The importance of weight reduction[11] through a combination of diet and exercise
  • Activity modification and strategies to unload arthritic joints[11]
  • Self-management of pain using modalities such as heat and ice, relaxation techniques, and coping strategies, automated internet-based pain coping skills training[11][16][17][15]

Assistive Devices

Mobility assistive devices like walking sticks/canes, crutches, or walking frames can improve mobility and independence of the patient. Occupational therapy also plays a role here, as they often also assists the patients with functional assistive devices like a long-handled reacher to pick up low-lying things, which will helps to avoid movements that may cause pain. RACPG 2018 guidelines Assistive walking device-Hip OA[13] recommends an assistive walking device (eg cane) , depending on a person’s preference and capability for people with knee and/or hip OA.

Exercise Therapy

Exercise therapy is an effective treatment modality for hip osteo-arthrosis.[10] Specific exercises can increase range of motion and flexibility, as well as strengthen the muscles of the hip and leg. Physiotherapists work together with the patient to develop an individualized, customized exercise program that meets the needs and lifestyle of the patient.[10][16] The benefits of exercise can assist the patients in their self-management of hip osteoarthritis.

Hip abduction exercise

RACGP 2018 guideline[13] recommends prescribing an individualised, progressive land-based exercise program for patients with hip OA, tailored to the person's preferences, capabilities, and access to local facilities.

Recommended activities include combining muscle strengthening, stretching, range of motion exercises, aerobic conditioning, neuromuscular and balance training, cycling, Tai Chi, and yoga to improve pain and function, regardless of age, structural disease severity, functional status, or pain levels. The overall evidence for land-based exercise is graded as moderate; however, the evidence for individual exercise types such as walking, muscle strengthening, stationary cycling, Tai Chi, and Hatha yoga is very low. Accordingly, the guideline provides a strong recommendation for when combining all studies of land-based exercise but remains neutral on recommending one type over another.

The 2025 Hip Pain and Mobility Deficits – Hip Osteoarthritis CPG recommends an individualized exercise program including aquatic therapy, to improve motion, strength, function, and pain, with dosages ranging from 1 to 5 times per week, each lasting 30–120 min, over a duration of 5–16 weeks.[11]

Manual Therapy

Hip Posterior to Anterior Glide

A range of manual therapies is used in the treatment of hip osteoarthritis:[10]

  • Soft tissue techniques and stretches
  • Mobilization of accessory and physiological movements
  • Manipulation

Research is inconclusive on the effect of manual therapy in the treatment of hip osteoarthritis.[15] The immediate effect of a manual therapy, specifically joint mobilization decrease pain and improve hip range of motion, especially in the elderly population. Joint mobilization might reduce pain, might ‘provide a stretching effect on the joint capsules and muscles, thus restoring normal arthrokinematics or may induce pain inhibition and improved motor control’ and might reduce kinesiophobia.[18] 

RACPG 2018 guidelines suggest massage and manual therapy (stretching, soft tissue and/or joint mobilisation and/ or manipulation) to be considered as an adjunct to active management strategies [13]

The 2025 Hip Pain and Mobility Deficits – Hip Osteoarthritis CPG recommends manual therapy interventions that include high- and low-force long-axis hip distraction and hip mobilization with movement to increase ROM, decrease pain, and improve function for patients with mild-to-moderate hip OA and impairments.[11]

Hydrotherapy

It is effective in the management of hip osteoarthritis. The combination of buoyancy and the reduction of gravity greatly assists patients struggling to weight-bear due to the pain from the hip osteoarthritis.[16] Clinical trials further suggest that it can postpone the need of total hip replacement surgery.[16] The RACGP 2018 guideline provides a conditional recommendation for aquatic exercise in hip OA, based on low-quality evidence, suggesting it as an alternative for patients who experience excessive pain with land-based activities.[13] The 2025 Hip Pain and Mobility Deficits-Hip Osteoarthritis CPG recommends an individualized aquatic-based exercise program to improve ROM, strength and functional abilities.[11]

Dry Needling

2025 Hip Pain and Mobility Deficits – Hip Osteoarthritis CPG recommends use of dry needling of myofascial trigger points in the iliopsoas, rectus femoris, tensor fasciae latae, gluteus medius, and gluteus minimus muscles for patients with Grades II and III Hip OA (for 3 weeks) to achieve improvements in muscle extensibility, pain, ROM, function, and muscle force production. This is a new recommendation not included in the previous 2017 CPG.[11]

Outcome Measures

The Future

Highly prevalent among the elderly, Hip osteoarthritis (OA) is highly prevalent among the elderly and carries a heavy burden of disease. Guidelines for the management of hip OA are often extrapolated from knee OA research, despite clear differences in the etiopathogenesis and response to treatments of OA at these sites. True inroads in reducing the burden of hip OA are most likely to be seen with an increased focus on risk factor modification prior to or in the early stages of the condition’s pathogenesis. Risk calculators such as those that currently exist for heart disease could be developed, incorporating imaging and even genetic biomarkers to enable stratification of people into varying risk levels for appropriate monitoring and management. With improved understanding of the etiopathogenesis of hip OA, intervention prior to or early in the disease course in a disease-modifying manner is likely to become feasible in the future. The management of hip OA has the potential to be an area of medicine undergoing substantial advancement in the decades to come.[19]

Resources

References

  1. ↑ Fu M, Zhou H, Li Y, Jin H, Liu X. Global, regional, and national burdens of hip osteoarthritis from 1990 to 2019: estimates from the 2019 Global Burden of Disease Study. Arthritis research & therapy. 2022 Dec;24(1):1-1.Available;https://arthritis-research.biomedcentral.com/articles/10.1186/s13075-021-02705-6#Sec9 (accessed 15.11.2022)
  2. ↑ 2.0 2.1 Fan Z, Yan L, Liu H, Li X, Fan K, Liu Q, Li JJ, Wang B. The prevalence of hip osteoarthritis: a systematic review and meta-analysis. Arthritis research & therapy. 2023 Mar 29;25(1):51.
  3. ↑ Fu M, Zhou H, Li Y, Jin H, Liu X. Global, regional, and national burdens of hip osteoarthritis from 1990 to 2019: estimates from the 2019 Global Burden of Disease Study. Arthritis research & therapy. 2022 Jan 3;24(1):8.
  4. ↑ Radiopedia Hip OA Available:https://radiopaedia.org/articles/osteoarthritis-of-the-hip (accessed 15.11.2022)
  5. ↑ 5.0 5.1 5.2 Cibulka MT, Bloom NJ, Enseki KR, MacDonald CW, Woehrle J, McDonough CM. Hip pain and mobility deficits—hip osteoarthritis: revision 2017: clinical practice guidelines linked to the international classification of functioning, disability and health from the orthopaedic section of the American Physical Therapy Association. Journal of Orthopaedic & Sports Physical Therapy. 2017 Jun;47(6):A1-37.Available:https://www.jospt.org/doi/10.2519/jospt.2017.0301 (accessed 15.11.2022)
  6. ↑ Brandt CD. Diagnosis and non-surgical management of osteoarthritis. USA: Professional Communications, Inc. 2010.
  7. ↑ 7.0 7.1 Katz JN, Arant KR, Loeser RF. Diagnosis and treatment of hip and knee osteoarthritis: a review. Jama. 2021 Feb 9;325(6):568-78. Available: https://jamanetwork.com/journals/jama/article-abstract/2776205(accessed 23.1.2022)
  8. ↑ 8.0 8.1 Radiopedia OA of the hip Available: https://radiopaedia.org/articles/osteoarthritis-of-the-hip?lang=us(accessed 23.1.2022)
  9. ↑ 9.0 9.1 Koc Jr TA, Cibulka M, Enseki KR, Gentile JT, MacDonald CW, Kollmorgen RC, Martin RL. Hip Pain and Mobility Deficits—Hip Osteoarthritis: Revision 2025: Clinical Practice Guidelines Linked to the International Classification of Functioning, Disability and Health from the Academy of Orthopaedic Physical Therapy and American Academy of Sports Physical Therapy of the American Physical Therapy Association. Journal of Orthopaedic & Sports Physical Therapy. 2025 Nov;55(11):CPG1-31.
  10. ↑ 10.0 10.1 10.2 10.3 10.4 Bennell K. Physiotherapy management of hip osteoarthritis. J Physiother. 2013; 59(3):145–157.
  11. ↑ 11.0 11.1 11.2 11.3 11.4 11.5 11.6 11.7 11.8 Koc TA Jr, Cibulka M, Enseki KR, Gentile JT, MacDonald CW, Kollmorgen RC, Martin RL. Hip Pain and Mobility Deficits-Hip Osteoarthritis: Revision 2025. J Orthop Sports Phys Ther. 2025 Nov;55(11):CPG1-CPG31. doi: 10.2519/jospt.2025.0301. PMID: 41165671.
  12. ↑ Dalmas I, Agius TP, Sciriha A. Core muscle strengthening exercises in the management of hip osteoarthritis: outcomes of a 12-week programme. European Journal of Physiotherapy. 2023 Mar 27:1-8.
  13. ↑ 13.0 13.1 13.2 13.3 13.4 2018 RACGP Guidelines for hip and knee arthritis Available from: https://www.racgp.org.au/download/Documents/Guidelines/Musculoskeletal/guideline-for-the-management-of-knee-and-hip-oa-2nd-edition.pdf (last accessed 21.11.25)
  14. ↑ Salis Z, Sainsbury A, Keen HI, Gallego B, Jin X. Weight loss is associated with reduced risk of knee and hip replacement: a survival analysis using Osteoarthritis Initiative data. International Journal of Obesity [Internet]. 2022 Jan 11;46(4):874–84.
  15. ↑ 15.0 15.1 15.2 Murphy NJ, Eyles JP, Hunter DJ. Hip osteoarthritis: Etiopathogenesis and implications for management. Advances in therapy 2016;33(11):1921-46.
  16. ↑ 16.0 16.1 16.2 16.3 Zhang W, Doherty M, Arden N, Bannwarth B, Bijlsma J, Gunther KP, Hauselmann HJ, Herrero-Beaumont G, Jordan K, Kaklamanis P, Leeb B. EULAR evidence based recommendations for the management of hip osteoarthritis: Report of a task force of the EULAR Standing Committee for International Clinical Studies Including Therapeutics (ESCISIT). Annals of the rheumatic diseases 2005;64(5):669-81.
  17. ↑ American Academy of Orthopaedic Surgeons. Diseases and conditions: Osteoarthritis of the hip.https://orthoinfo.aaos.org/en/diseases--conditions/osteoarthritis-of-the-hip (accessed 14/07/2018).
  18. ↑ Beselga C, Neto F, Alburquerque-Sendín F, Hall T, Oliveira-Campelo N. Immediate effects of hip mobilization with movement in patients with hip osteoarthritis: A randomised controlled trial. Man Ther. 2016;22:80-5.
  19. ↑ Murphy NJ, Eyles JP, Hunter DJ. Hip osteoarthritis: etiopathogenesis and implications for management. Advances in therapy. 2016 Nov 1;33(11):1921-46. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5083776/ (last accessed 19.11.2019)
Retrieved from "https://www.physio-pedia.com/w/index.php?title=Hip_Osteoarthritis&oldid=374118"