What are the physical exam findings of Osteoarthritis (OA) of the bilateral hips?

From the Guidelines

Physical therapy should be offered as part of a comprehensive management plan for patients with osteoarthritis of the hip or knee, as it is a core treatment in the management of OA, with substantial evidence supporting its use 1. When examining a patient with suspected hip OA, you should assess for pain on passive internal rotation, which is often the most sensitive physical finding. Patients may demonstrate decreased hip flexion, internal rotation, and abduction. The FABER test (Flexion, ABduction, External Rotation) often reproduces pain. You might observe an antalgic gait with decreased stance phase on the affected side(s), and patients may have difficulty with activities like putting on socks or shoes. Some key physical exam findings for osteoarthritis (OA) of bilateral hips include:

• Limited range of motion
• Pain with internal rotation
• Antalgic gait
• Decreased hip flexion, internal rotation, and abduction
• Positive FABER test
• Difficulty with daily activities
• Muscle atrophy in the gluteal and quadriceps muscles
• Leg length discrepancy in advanced cases
• Crepitus (grinding sensation) during passive movement These findings result from cartilage degradation, bone remodeling, and synovial inflammation in the hip joints, causing the characteristic pain and functional limitations seen in hip OA. The physical exam should be comprehensive, as bilateral involvement can present with varying severity between the two hips, and a self-management program, including exercise and weight loss, is suggested for osteoarthritis of the hip and knee 1.

From the Research

Physical Exam Findings for OA Bilateral Hips

• Osteoarthritis (OA) is a highly prevalent cause of chronic hip pain, affecting 27% of adults aged over 45 years and 42% of adults aged over 75 years 2
• Patients with OA of the hip frequently have decreased quality of life due to pain and limited mobility, with additional comorbidities such as diabetes, cardiovascular disease, poor sleep quality, and obesity 2
• Physical therapy and exercise are important components of a multimodal approach to osteoarthritic hip pain, with manual therapy and exercise therapy shown to be effective in improving pain, hip range of motion, and physical function 3

Treatment Options for OA Bilateral Hips

• Initial treatment with conservative medical management can provide effective symptomatic relief, with non-pharmacological conservative treatments such as exercise therapy and manual therapy providing benefits in pain and improvement in physical function 3, 4
• Intra-articular injections, including corticosteroids, hyaluronic acid, and platelet-rich plasma, are commonly used to treat hip OA, with evidence suggesting that intra-articular saline injections may be as effective as these treatments 5
• The American Academy of Orthopaedic Surgeons has released evidence-based clinical practice guidelines for the management of osteoarthritis of the hip, including recommendations for nonoperative and operative treatment 4

Management of OA Bilateral Hips

• A multimodal approach to osteoarthritic hip pain, including physical therapy, exercise, and intra-articular injections, may be effective in managing symptoms and improving quality of life 2, 3, 5
• Further investigation is necessary to improve knowledge about the effects of non-pharmacological conservative treatments on pain, hip range of motion, and physical function in patients with hip OA 3