What are the treatment options for hip arthritis?

From the Guidelines

Treatment for hip arthritis should prioritize a comprehensive, multimodal approach, including non-pharmacological and pharmacological interventions, with a focus on individualized care and shared decision-making with patients, as recommended by the 2024 EULAR guidelines 1. The management of hip arthritis requires a tailored approach, considering factors such as hip risk factors, general risk factors, level of pain intensity, disability, and handicap, as well as the patient's wishes and expectations 1. Non-surgical treatments, including weight loss, physical therapy, and activity modification, should be tried first to reduce pressure on the joint and alleviate symptoms.

• Weight loss can help reduce pressure on the joint, with a goal of achieving a healthy weight through a combination of diet and exercise.
• Physical therapy can help strengthen supporting muscles and improve joint mobility, with exercises tailored to the individual's needs and abilities.
• Activity modification can help avoid high-impact exercises that may exacerbate symptoms, with a focus on low-impact activities such as swimming or cycling. Pain management can be achieved with medications such as acetaminophen, NSAIDs, and topical NSAIDs, as well as intra-articular injections, including corticosteroids and hyaluronic acid, which may provide temporary relief for 3-6 months 1.
• Acetaminophen can be used up to 3000mg daily in divided doses, with caution advised in patients with liver disease.
• NSAIDs, such as ibuprofen or naproxen, can be used at doses of 400-800mg three times daily or 250-500mg twice daily, respectively, with caution advised in patients with gastrointestinal or renal disease.
• Topical NSAIDs can be used to provide localized relief, with minimal systemic absorption. Assistive devices, such as canes or walkers, can help reduce weight-bearing stress, and physical therapy is crucial after surgery to improve functional outcomes and reduce the risk of complications 1.
• Assistive devices can help improve mobility and reduce the risk of falls, with proper fitting and use essential to maximize benefits.
• Physical therapy after surgery can help improve range of motion, strength, and functional ability, with a focus on individualized exercises and progression. When conservative measures fail to control pain or maintain function, surgical options, including total hip replacement, hip resurfacing, or hip fusion, may be considered, with the goal of improving functional outcomes and reducing pain and disability 1.
• Total hip replacement is the most common surgical option, with a focus on implant selection and surgical technique to maximize outcomes.
• Hip resurfacing and hip fusion are alternative surgical options, with a focus on individualized selection based on patient factors and disease severity.

From the FDA Drug Label

Celecoxib capsules was evaluated for treatment of the signs and the symptoms of OA of the knee and hip in placebo- and active-controlled clinical trials of up to 12 weeks duration In patients with OA, treatment with celecoxib capsules 100 mg twice daily or 200 mg once daily resulted in improvement in WOMAC (Western Ontario and McMaster Universities) osteoarthritis index, a composite of pain, stiffness, and functional measures in OA

Treatment Options for Hip Arthritis:

• Celecoxib capsules 100 mg twice daily
• Celecoxib capsules 200 mg once daily These options have been shown to provide significant reduction in joint pain and improvement in functional measures in OA patients, including those with hip arthritis 2.

From the Research

Treatment Options for Hip Arthritis

The treatment options for hip arthritis can be categorized into non-pharmacological conservative treatments and pharmacological interventions.

• Non-pharmacological conservative treatments:
  • Manual therapy and exercise therapy have been shown to be effective in improving pain, hip range of motion, and physical function in patients with mild to moderate hip osteoarthritis 3.
  • Combined therapies, such as exercise therapy and manual therapy with patient education, provide benefits in pain and improvement in physical function 3.
• Pharmacological interventions:
  • Intra-articular injections of hyaluronic acid and corticosteroids have been shown to improve pain and functional outcomes in patients with mild to moderate hip osteoarthritis 4.
  • Intra-articular saline injections have been found to be as effective as corticosteroids, platelet-rich plasma, and hyaluronic acid for hip osteoarthritis pain 5.
  • Glucocorticoid injections have been shown to have a moderate clinical benefit in pain reduction, while hyaluronic acid injections have a marginal clinical benefit 6.
  • Intra-articular hyaluronic acid injections have been found to be effective in reducing pain and improving function in patients with mild to moderate hip osteoarthritis, with a full course of three injections providing the best result in pain control 7.

Intra-Articular Injections

Intra-articular injections are a common treatment option for hip osteoarthritis.

• The efficacy of different types of intra-articular injections, including hyaluronic acid, corticosteroids, and platelet-rich plasma, has been compared in several studies 4, 5, 6.
• The results of these studies suggest that intra-articular injections can provide significant improvements in pain and functional outcomes, but the optimal selection of patients and the choice of injection type remain to be defined 6.

Exercise Therapy and Manual Therapy

Exercise therapy and manual therapy are non-pharmacological conservative treatments that have been shown to be effective in improving pain, hip range of motion, and physical function in patients with mild to moderate hip osteoarthritis.

• These treatments can be used alone or in combination with other therapies, such as patient education 3.
• The effects of combined therapies, such as exercise therapy and manual therapy with patient education, remain unclear and require further investigation 3.