From the Guidelines
Physical therapy is a core treatment in the management of osteoarthritis (OA) of the knees and hips, and should be offered as part of a comprehensive management plan. When examining patients with OA of the knees and hips, physical exam findings typically include joint tenderness, crepitus, reduced range of motion, joint effusion, and bony enlargement 1. For knee OA, patients may exhibit varus or valgus deformities, joint line tenderness, and a positive bulge sign indicating effusion. In hip OA, physical exam reveals pain with internal rotation of the hip, decreased range of motion, and pain in the groin or lateral hip. Patients may demonstrate an antalgic gait, limping to minimize weight-bearing on the affected side. Some key points to consider in the management of OA include:
- Bracing with soft braces or valgus or varus knee braces may improve pain and self-reported physical function in the knee, but it is essential to combine bracing with appropriate exercise to avoid atrophy and functional loss 1
- A self-management program, including exercise and weight loss, is recommended for patients with OA of the hip and knee 1
- Topical nonsteroidal anti-inflammatory drugs are recommended for patients with pain associated with OA of the knee, while the evidence for their use in hip OA is insufficient 1
- Acetaminophen and/or oral nonsteroidal anti-inflammatory drugs may be offered for pain associated with OA of the hip and knee, but opioids should be avoided due to the risk of addiction and other adverse effects 1
From the Research
Physical Exam Findings for OA Knees and Hips
- The physical exam findings for OA knees and hips are not explicitly stated in the provided studies, however, the management and treatment of OA are discussed in detail 2, 3, 4, 5, 6.
- Studies suggest that OA in knees and hips can be managed with conservative approaches such as lifestyle changes, weight loss, and anti-inflammatory regimens 2, 3.
- Exercise therapy and education are also recommended as core first-line treatments for OA, providing effective pain relief without serious adverse effects 3.
- Injections, such as intra-articular hyaluronic acid and corticosteroids, may be used for symptom relief when other nonoperative options are ineffective 4, 5.
- Pharmacological treatments, including nonsteroidal anti-inflammatory drugs and opioids, may also be used to alleviate symptoms such as pain and loss of function 6.
Treatment Recommendations
- Higher-quality guidelines consistently recommend education, exercise, and weight management, as well as non-steroidal anti-inflammatory drugs and intra-articular corticosteroid injections (knee) 5.
- Guidelines also consistently recommend against hyaluronic acid (hip) and stem cell (hip and knee) injections, as well as arthroscopy 5.
- Other pharmacological recommendations, such as paracetamol and intra-articular corticosteroid (hip), are less consistent across guidelines 5.
Management of OA
- The management of OA should prioritize a conservative approach, with lifestyle changes, weight loss, and anti-inflammatory regimens as initial treatments 2, 3.
- Exercise therapy and education should be individualized to the patient's preferences and needs, with at least 12 supervised sessions initially 3.
- Injections and pharmacological treatments may be used as supplementary interventions when necessary 4, 5, 6.