From the Guidelines
When treating a patient with both spinal problems and hip osteoarthritis, the hip OA should be treated initially because hip pathology can often refer pain to the spine, potentially resolving some apparent spinal symptoms once the hip is treated. This approach is supported by the 2020 US Department of Veterans Affairs/US Department of Defense clinical practice guideline for the non-surgical management of hip and knee osteoarthritis, which recommends a self-management program including regular self-directed exercise, comprehensive lifestyle intervention for weight reduction, and pharmacotherapy with topical agents, acetaminophen, or nonsteroidal anti-inflammatory drugs (NSAIDs) 1.
Key considerations in treating hip OA include:
- Discussing a self-management program with the patient
- Prescribing regular self-directed exercise and comprehensive lifestyle intervention for weight reduction
- Considering referral for physical therapy
- Using pharmacotherapy such as topical agents, acetaminophen, or NSAIDs for pain management
- Avoiding opioids due to limited benefit and high risk of adverse effects 1
A thorough physical examination, including the FABER test, straight leg raise, and gait analysis, helps differentiate the primary pain generator. Initial treatment typically includes physical therapy focusing on core strengthening and hip mobility, NSAIDs such as naproxen 500mg twice daily or celecoxib 200mg daily for 2-4 weeks, and activity modification. If conservative measures fail, diagnostic injections can help determine which condition is primarily responsible for symptoms - a response to intra-articular hip injection suggests hip pathology predominance, while epidural steroid injections may indicate spinal pathology. Advanced imaging including MRI of both areas may be necessary before proceeding to surgical interventions like hip replacement or spinal procedures. This approach is based on the biomechanical relationship between the hip and spine, where dysfunction in one area often affects the other through altered movement patterns and compensatory mechanisms.
From the Research
Treatment Approach for Spinal Problems and Hip OA
When treating a patient with both spinal problems and hip osteoarthritis (OA), the decision on which condition to treat first can be complex. The following points summarize the key considerations:
- The treatment approach may depend on the specific clinical scenario, including the type and severity of spinal problems and hip OA 2.
- In some cases, hip surgeons may recommend treating the hip first, while in other cases, spine surgeons may recommend treating the spinal condition first 2.
- The presence of neurological symptoms can influence the decision-making process, with some surgeons prioritizing treatment of the spinal condition if it is causing significant neurological symptoms 2.
Factors Influencing Treatment Decision
Several factors can influence the decision on which condition to treat first, including:
- The severity of symptoms and functional impairment associated with each condition 3.
- The presence of other health conditions or comorbidities that may impact treatment outcomes 4.
- The potential benefits and risks of each treatment approach, including surgical and non-surgical options 5, 4.
Non-Surgical Treatment Options
Before considering surgical treatment, non-surgical options may be explored, including:
- Pharmacological therapies, such as acetaminophen and NSAIDs, for managing pain and inflammation 6.
- Intra-articular injections, such as corticosteroids and hyaluronic acid, for reducing pain and improving function 5.
- Lifestyle modifications, such as weight loss and exercise, to reduce stress on the affected joints 4.
Surgical Treatment Options
If non-surgical options are ineffective, surgical treatment may be considered, including: