From the Guidelines
Conservative management for osteoarthritis of the left hip should prioritize a combination of regular exercise, weight loss, and pharmacological interventions, with a strong recommendation for participation in a regular, ongoing exercise program, as supported by the 2019 American College of Rheumatology guideline 1. To manage hip pain, it is essential to start with non-pharmacological approaches, including:
- Regular low-impact exercise like swimming, cycling, or walking for 30 minutes most days of the week to maintain joint mobility and strengthen supporting muscles
- Weight loss, if overweight, as each pound lost reduces hip pressure by 3-6 pounds For pain relief, pharmacological interventions can be added, including:
- Topical NSAIDs, such as diclofenac gel, applied to the hip area 3-4 times daily, which can provide localized relief with fewer side effects
- Oral NSAIDs, like ibuprofen or naproxen, for patients with hip OA or polyarticular involvement, as recommended by the 2019 ACR guideline 1 Additionally, other interventions like tai chi, cane use, and intraarticular glucocorticoid injections can be considered, as they have been shown to be effective in managing OA symptoms 1. It is crucial to note that the choice of interventions may vary over the course of the disease or with patient and provider preferences, and is optimally arrived at through shared decision-making, as emphasized in the 2019 ACR guideline 1.
From the Research
Conservative Hip Pain Management for Osteoarthritis
- Conservative management of hip pain in patients with osteoarthritis of the left hip can involve various non-pharmacological and pharmacological interventions 2, 3.
- Non-pharmacological conservative treatments such as manual therapy, exercise therapy, and patient education have been shown to be effective in improving pain, hip range of motion, and physical function in patients with mild to moderate hip osteoarthritis 2.
- Exercise therapy and manual therapy, either alone or in combination with patient education, provide benefits in pain reduction and improvement in physical function 2.
- Pharmacological interventions such as tramadol, acetaminophen, and non-steroidal anti-inflammatory drugs (NSAIDs) can also be used to manage hip pain in patients with osteoarthritis 4, 3, 5, 6.
- Tramadol has been shown to decrease pain intensity and improve function, but its benefits are small and it is often associated with adverse events such as nausea, dizziness, and tiredness 4, 5.
- Acetaminophen is less effective than NSAIDs in terms of pain reduction, but it has a similar safety profile and can be used as a first-line pharmacologic therapy for osteoarthritis 6.
- NSAIDs are superior to acetaminophen for improving knee and hip pain in people with osteoarthritis, but they have a higher risk of gastrointestinal, renal, and cardiovascular toxicities 3, 6.
Treatment Options
- Non-pharmacological conservative treatments:
- Manual therapy
- Exercise therapy
- Patient education
- Pharmacological interventions:
- Tramadol
- Acetaminophen
- NSAIDs
- Other treatment options:
- Intra-articular corticosteroid injections
- Physical therapy
- Weight loss
- Braces or heel wedges
- Acupuncture
- Tai chi 3