From the Guidelines
The recommended treatment for a patient with degenerative changes in the right hip joint should prioritize conservative measures, including weight loss, physical therapy, and activity modification, before considering surgical options, as supported by the most recent guidelines from the American College of Rheumatology and American Association of Hip and Knee Surgeons 1.
Initial Management
The initial management of hip degenerative changes involves:
- Weight loss if the patient is overweight
- Physical therapy focusing on strengthening the hip muscles and improving range of motion
- Activity modification to avoid high-impact exercises
Pain Management
For pain management:
- Acetaminophen (500-1000mg every 6 hours, not exceeding 4000mg daily) is often the first-line medication
- NSAIDs such as ibuprofen (400-800mg three times daily with food) or naproxen (250-500mg twice daily with food) if acetaminophen is insufficient
- Topical NSAIDs like diclofenac gel (apply to affected area 4 times daily) may provide localized relief with fewer systemic side effects
Additional Interventions
For moderate to severe pain:
- Intra-articular corticosteroid injections (typically methylprednisolone 40-80mg or triamcinolone 20-40mg) can provide temporary relief for 3-6 months
- Assistive devices such as a cane used in the opposite hand can reduce joint loading by up to 30%
Surgical Considerations
If conservative treatments fail to provide adequate relief after 3-6 months and the patient has significant functional limitations, surgical interventions like total hip arthroplasty may be considered, as recommended by the 2023 American College of Rheumatology and American Association of Hip and Knee Surgeons clinical practice guideline 1.
Key Considerations
The treatment of hip OA should be tailored according to hip risk factors, general risk factors, level of pain intensity, disability, and handicap, location and degree of structural damage, and wishes and expectations of the patient, as outlined in the EULAR evidence-based recommendations for the management of hip osteoarthritis 1.
From the FDA Drug Label
In patients with osteoarthritis, the therapeutic action of naproxen has been shown by a reduction in joint pain or tenderness, an increase in range of motion in knee joints, increased mobility as demonstrated by a reduction in walking time, and improvement in capacity to perform activities of daily living impaired by the disease
The recommended treatment for a patient with degenerative changes in the right hip joint is naproxen to reduce joint pain or tenderness and improve mobility.
- Key benefits: reduction in joint pain or tenderness, increase in range of motion, increased mobility, and improvement in capacity to perform activities of daily living. 2
From the Research
Treatment Options for Degenerative Changes in the Right Hip Joint
- The primary goal of treatment is to reduce pain and other symptoms, maintain and/or improve joint mobility, and limit functional disability, with the overall management goal of improving the patient's quality of life 3.
- Nonpharmacologic measures should be tried first, with pharmacologic intervention used as an adjunct, including patient education, weight loss, physical therapy, occupational therapy, and exercise 3.
- Paracetamol, in doses of as high as 4000 mg/day, is the first-line drug of choice for the management of the pain of osteoarthritis, and if the patient does not respond to paracetamol, NSAIDs may be an appropriate alternative, provided they are not medically contraindicated 3.
Pharmaceutical Treatment
- Oral and topical NSAIDs, including COX-2 inhibitors, are strongly recommended first-line treatments for osteoarthritis due to their ability to improve pain and function, but are associated with increased risks in patients with certain comorbidities 4.
- Intra-articular corticosteroid injections are generally recommended for osteoarthritis management and have relatively minor adverse effects 4.
- Intra-articular non-steroidal anti-inflammatory drug injections may be an alternative therapy, possibly minimizing systemic side effects while maintaining efficacy, and have an excellent safety profile in small animals, large animals, and humans 5.
Recommendations for Management
- Higher-quality guidelines consistently recommend in favour of education, exercise, and weight management and non-steroidal anti-inflammatory drugs (hip and knee), and intra-articular corticosteroid injections (knee) 6.
- Higher quality guidelines consistently recommend against hyaluronic acid (hip) and stem cell (hip and knee) injections, and arthroscopy was consistently recommended against in higher-quality guidelines 6.
- Lack of consensus on some pharmacological options and adjunctive treatments creates challenges for guideline adherence, and future guidelines must prioritise providing implementation guidance, considering consistently low applicability scores 6.