What are the treatment options for early osteoarthritis of the hips?

Treatment Options for Early Osteoarthritis of the Hips

Exercise is strongly recommended as the cornerstone of treatment for early hip osteoarthritis, including walking, strengthening, neuromuscular training, and aquatic exercise, with supervised exercise showing better outcomes. 1

Core Treatment Approaches

Non-Pharmacological Interventions (First-Line)

1. Exercise Therapy

   • Types of exercise:
     • Walking (treadmill or supervised community-based)
     • Strengthening exercises (resistance training with/without props)
     • Neuromuscular training
     • Aquatic exercise
   • Implementation tips:
     • Exercise should be supervised when possible
     • Focus on patient preferences to improve adherence
     • No specific exercise type is superior to others
     • Regular participation is more important than exercise type

2. Weight Management

   • Weight loss is strongly recommended for overweight/obese patients 1
   • Even modest weight reduction can significantly reduce joint load and pain

3. Physical Therapy Interventions

   • Manual therapy in combination with supervised exercise 1
   • Thermal therapies (local heat or cold applications) 1
   • Assistive devices (walking aids) as needed 1

4. Self-Management Education

   • Information about the condition and its management
   • Self-efficacy training
   • Activity pacing (avoiding peaks and troughs of activities) 1

Pharmacological Interventions (When Needed)

1. First-Line Medications

   • Acetaminophen (paracetamol) - regular dosing may be needed 1
   • Topical NSAIDs (for localized pain) 1

2. Second-Line Medications (if inadequate response to first-line)

   • Oral NSAIDs (including COX-2 inhibitors) at lowest effective dose for shortest time 1
     • Consider gastrointestinal, liver, and cardiorenal toxicity risks
     • Use with proton pump inhibitor in high-risk patients
   • Tramadol 1

3. Intra-articular Therapy

   • Corticosteroid injections for moderate to severe pain 1
   • No recommendation for hyaluronic acid injections due to insufficient evidence 1

Treatment Algorithm

1. Start with core treatments:

   • Supervised exercise program
   • Weight management (if applicable)
   • Patient education

2. If inadequate response, add:

   • Physical modalities (manual therapy, thermal applications)
   • Assistive devices if needed

3. If pain persists, introduce pharmacological therapy:

   • Begin with acetaminophen and/or topical NSAIDs
   • Progress to oral NSAIDs or tramadol if needed
   • Consider intra-articular corticosteroid injections for flares

4. For persistent symptoms despite comprehensive management:

   • Reassess treatment adherence and effectiveness
   • Consider referral for surgical consultation if appropriate 2

Important Considerations and Pitfalls

• Medication safety: When using NSAIDs, monitor for gastrointestinal, renal, and cardiovascular side effects, especially in older adults 3
• Exercise adherence: The effectiveness of exercise depends on regular participation; address barriers to participation early
• Avoid over-reliance on medications: Pharmacological treatments should complement, not replace, non-pharmacological approaches
• Multimodal approach: Evidence suggests that combining therapies (exercise + manual therapy + education) is more effective than single modalities 4, 5
• Disease progression: Current treatments are symptomatic; no disease-modifying agents have been proven effective for OA 1
• Unrealistic expectations: Educate patients that while treatments can improve symptoms and function, they may not completely eliminate pain

The evidence strongly supports a stepped approach to managing early hip osteoarthritis, beginning with non-pharmacological interventions and adding medications only when needed. This approach maximizes benefit while minimizing potential medication-related harms.