From the Guidelines
Management of osteoarthritis (OA) of the hip should prioritize non-pharmacological interventions, including weight loss, cardiovascular and/or resistance land-based exercise, aquatic exercise, and self-management programs, as strongly recommended by the American College of Rheumatology in 2012 1. The goal of these interventions is to reduce joint stress, improve mobility, and strengthen supporting muscles.
- Weight loss is crucial for overweight patients, as it reduces joint stress by 3-6 pounds per pound lost.
- Exercise therapy, such as low-impact activities like swimming, cycling, and water aerobics, helps maintain joint mobility and strengthen supporting muscles.
- Physical therapy focusing on hip-specific exercises can improve function and reduce pain. For pain management, acetaminophen is conditionally recommended as a first-line therapy, while oral NSAIDs and tramadol are also conditionally recommended, according to the American College of Rheumatology in 2012 1.
- Topical NSAIDs can provide localized relief with fewer systemic effects.
- Intra-articular corticosteroid injections may offer temporary pain relief for 4-8 weeks. Assistive devices, such as canes and hip braces, can improve mobility and reduce pain during activities. The management approach should be individualized based on symptom severity, functional limitations, comorbidities, and patient preferences, as recommended by the EULAR standing committee in 2005 1. For patients with severe symptoms unresponsive to conservative measures, total hip replacement surgery provides definitive treatment with high success rates.
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 For the relief of osteoarthritis, the recommended dosage is 100-150 mg/day in divided doses, 50 mg twice a day or three times a day
The management options for osteoarthritis (OA) of the hip include nonsteroidal anti-inflammatory drugs (NSAIDs) such as naproxen and diclofenac.
- Naproxen has been shown to reduce joint pain and tenderness, and improve mobility and daily functioning in patients with OA.
- Diclofenac is recommended at a dosage of 100-150 mg/day in divided doses for the relief of OA. 2 3
From the Research
Management Options for Osteoarthritis (OA) of the Hip
The management of OA of the hip involves a combination of non-pharmacological and pharmacological modalities of therapy. The following are some of the management options:
- Non-pharmacological modalities:
- Education and self-management 4
- Regular telephone contact 4
- Referral to a physical therapist 4
- Aerobic, muscle strengthening, and water-based exercises 4, 5
- Weight reduction 6, 4
- Walking aids 4
- Knee braces 4
- Footwear and insoles 4
- Thermal modalities 4
- Transcutaneous electrical nerve stimulation 4
- Acupuncture 4
- Pharmacological modalities:
- Acetaminophen 6, 4
- Non-steroidal anti-inflammatory drugs (NSAIDs) 7, 6, 8, 4
- Cyclooxygenase-2 (COX-2) inhibitors 4
- Topical NSAIDs and capsaicin 4
- Intra-articular injections of corticosteroids and hyaluronates 6, 4
- Glucosamine and/or chondroitin sulphate for symptom relief 4
- Opioid analgesics for refractory pain 4
- Surgical modalities:
Individualized Treatment Approach
Treatment of patients with OA of the hip should be individualized and tailored to the severity of the disease 7. In individuals with mildly symptomatic disease, treatment may be limited to patient education, physical and occupational therapy, other non-pharmacologic modalities, and drug therapy with a non-opioid oral analgesic 7. In patients who are unresponsive to this treatment regimen, the use of an NSAID in addition to non-pharmacologic therapy is appropriate unless it is medically contraindicated 7. Patients with severe symptomatic OA of the hip require an aggressive approach to decreasing pain, increasing mobility, and improving function; such patients may benefit from orthopedic consultation and evaluation for osteotomy or total joint arthroplasty 7.