Treatment Plan for Mild Degenerative Changes of the Hips Post-Fall
For patients with mild degenerative changes of the hips following a fall, the treatment plan should include weight-bearing as tolerated, multimodal pain management, and a structured rehabilitation program to restore function and prevent future falls.
Initial Assessment and Imaging
- Evaluate for occult fractures, especially in older adults, as hip fractures can present with vague symptoms
- Consider advanced imaging (MRI) if pain persists despite negative radiographs 1
- Assess pain patterns, particularly with internal/external rotation of the hip
- Document pre-fall mobility status and functional goals
Pain Management
First-line medications:
- Regular acetaminophen/paracetamol administration 2
- Carefully prescribed opioid analgesia as needed for breakthrough pain
Non-pharmacological pain control:
- Early application of ice for acute inflammation
- Proper positioning to minimize discomfort
- Regular pain evaluation as part of routine observations 2
Mobility and Weight-Bearing
- Immediate weight-bearing as tolerated is recommended for most patients with degenerative changes without fracture 2
- Use appropriate assistive devices (cane, walker) initially if needed
- Progress weight-bearing status as pain and function improve
Rehabilitation Program
Early Phase (1-2 weeks post-fall)
- Gentle range of motion exercises
- Isometric strengthening
- Bed mobility and transfer training
- Gait training with appropriate assistive device
Middle Phase (2-6 weeks)
- Progressive strengthening of hip musculature
- Balance training
- Functional mobility exercises
- Manual therapy techniques (joint mobilization, soft tissue work) 3
Late Phase (6+ weeks)
- Advanced strengthening
- Continued balance and proprioceptive training
- Return to prior level of function activities
- Fall prevention education and exercises 4
Fall Prevention Strategies
- Home safety assessment and modification
- Review of medications that may increase fall risk
- Vision assessment
- Appropriate footwear recommendations
- Balance and strength training continuation 4
Lifestyle Modifications
- Adequate calcium (1000-1200 mg/day) and vitamin D (800 IU/day) intake 2
- Smoking cessation and alcohol limitation 2
- Weight management for overweight patients
- Activity modification to avoid aggravating movements 5
Follow-Up and Monitoring
- Regular reassessment of pain, range of motion, and function
- Consider bone health evaluation, especially for older adults
- Monitor for worsening symptoms that may indicate disease progression
- Assess need for additional interventions if conservative management fails
Special Considerations
- For elderly patients with multiple comorbidities, orthogeriatric co-management is recommended 2
- Patient education about degenerative hip disease progression and self-management techniques is essential
- Consider nutritional supplementation in malnourished patients 2
When to Consider Surgical Referral
- Failure to improve with 3 months of conservative management
- Progressive functional decline despite appropriate treatment
- Development of intractable pain
- Evidence of rapid joint deterioration on follow-up imaging
Conservative management has shown good results even in younger patients with hip arthrosis 6, and proper implementation of non-pharmacological treatments can significantly improve pain and physical function in patients with mild to moderate hip osteoarthritis 3.