What are the management options for osteoarthritis (OA) of the hip?

From the Guidelines

Management of osteoarthritis (OA) of the hip should prioritize a comprehensive approach combining non-pharmacological and pharmacological interventions, with a strong focus on exercise, weight management, and patient education, as recommended by the most recent guidelines 1. The cornerstone of treatment for hip OA involves non-pharmacological interventions, including:

• Exercise therapy, particularly low-impact activities like swimming, cycling, and walking, to strengthen muscles around the joint and improve function 1
• Weight management, with support for weight loss in overweight or obese individuals to reduce joint stress 1
• Patient education on self-management strategies, including information on the importance of maintaining a healthy weight, appropriate footwear, and the use of assistive devices like canes and walkers 1 Pharmacological interventions may be considered for pain relief, including:
• Acetaminophen as a first-line medication due to its safety profile 1
• NSAIDs like ibuprofen or naproxen for both pain relief and anti-inflammatory effects, although these should be used cautiously due to potential gastrointestinal and cardiovascular risks 1
• Topical NSAIDs for localized relief with fewer systemic effects 1
• Intra-articular corticosteroid injections for temporary relief during flare-ups 1 When conservative measures fail, total hip replacement surgery offers a definitive treatment option with high success rates. It's essential to tailor the management approach to the patient's specific needs, disease severity, and comorbidities, emphasizing a shared decision-making process between the patient and healthcare provider 1.

From the Research

Management Options for Osteoarthritis (OA) of the Hip

The management of OA hip involves a combination of non-pharmacological and pharmacological interventions. Some of the key management options include:

• Exercises and physical therapy to improve joint mobility and strength 2
• Weight loss, if appropriate, to reduce the stress on the hip joint 2
• Education on joint protection and pain management 2
• Topical or oral nonsteroidal anti-inflammatory drugs (NSAIDs) for pain relief, in patients without contraindications 2, 3
• Intra-articular steroid injections for short-term pain relief 2, 3
• Duloxetine, which has demonstrated efficacy in reducing OA pain 2, 4
• Acetaminophen (paracetamol) for mild to moderate pain, although its efficacy is modest compared to NSAIDs 5, 3, 4

Pharmacological Treatment

Pharmacological treatment options for OA hip are diverse and include:

• Oral NSAIDs, which are strongly recommended as first-line treatments due to their ability to improve pain and function, but are associated with increased risks in patients with certain comorbidities 3
• Topical NSAIDs, which are also recommended for their efficacy in improving pain and function 3
• COX-2 inhibitors, which are associated with increased risks, but may be used in certain patients 3
• Intra-articular hyaluronic acid, which may be used for patients who have not responded to other treatments 3
• Tramadol and capsaicin, which are more controversial and may be used in specific cases 3

Surgical Options

For patients with advanced symptoms and structural damage, total joint replacement is an effective option for relieving pain and improving function 2, 6. The American Academy of Orthopaedic Surgeons has released evidence-based clinical practice guidelines for the management of OA of the hip, which include recommendations for nonoperative and operative treatment 6.