Best Treatment for Moderate to Severe Bilateral Hip Arthrosis with Right Hip Pain
For patients with moderate to severe bilateral hip arthrosis with right hip pain upon walking, a comprehensive treatment approach including exercise therapy, weight management, and appropriate pharmacological interventions should be implemented, with total hip arthroplasty being the definitive treatment when conservative measures fail to provide adequate relief.
Non-Pharmacological Interventions (First-Line)
Exercise Therapy
- Strongly recommended land-based exercise programs 1:
- Cardiovascular/aerobic activities
- Resistance/strengthening exercises focusing on quadriceps and hip girdle muscles
- Range of motion/stretching exercises
- Strongly recommended aquatic exercises 1
- Exercise should be:
- Individualized based on patient's abilities
- Initially supervised (12+ sessions show better outcomes) 1
- Gradually integrated into daily routine
Weight Management
- Strongly recommended for overweight patients 1, 2
- Target minimum weight loss of 5-10% of body weight 2
- Structured programs with regular support meetings and self-monitoring are most effective 1
Assistive Devices and Adaptations
- Walking aids (cane used on contralateral side) 1
- Appropriate footwear 1
- Home/workplace adaptations (raised chairs, beds, toilet seats; handrails) 1
Additional Supportive Measures
- Self-management programs 1
- Manual therapy in combination with supervised exercise 1
- Thermal agents (heat/cold) 1
Pharmacological Interventions
First-Line Options
- Topical NSAIDs (for knee, less evidence for hip) 1, 2
- Oral NSAIDs or COX-2 inhibitors 1, 2
- Acetaminophen (though less effective than NSAIDs) 1, 2
Second-Line Options
- Intra-articular corticosteroid injections 1, 2
- Duloxetine (60 mg/day, requires daily use, not as-needed) 1, 2
Not Recommended
- Chondroitin sulfate and glucosamine 1
- Opioids, including tramadol 1, 2
- Viscosupplementation (hyaluronic acid injections) 1
Surgical Intervention
Total Hip Arthroplasty
- Strongly recommended when 1, 2:
- Conservative measures have failed
- Pain significantly impacts mobility or quality of life
- Radiographic evidence confirms advanced arthritis
Important Considerations for Surgery
- Should not be unnecessarily delayed once indicated 1
- Delaying surgery leads to increased pain, functional limitations, and risk of disability
- 93% of patients indicated for surgery do not want mandatory additional physical therapy 1
- Should be performed by experienced surgeons 1
Treatment Algorithm
Initial Phase:
- Begin with exercise therapy (both land and water-based)
- Weight management if overweight
- First-line pharmacological therapy (acetaminophen and/or NSAIDs)
- Assistive devices as needed
If inadequate response after 3-6 months:
- Intensify exercise program with physical therapy referral
- Consider second-line pharmacological options
- Evaluate for intra-articular corticosteroid injections
If continued inadequate response:
- Obtain weight-bearing radiographs
- Refer for surgical consultation for total hip arthroplasty
Special Considerations
- Age: Younger patients (under 50) may benefit more significantly from rehabilitation treatments 3
- Bilateral involvement: Focus initial treatment on the more symptomatic side (right hip in this case)
- Comorbidities: Adjust NSAID use based on cardiovascular and gastrointestinal risk factors
- Avoid rigid cutoffs for BMI or other parameters that may limit access to surgical care 1
By following this treatment approach, patients with moderate to severe bilateral hip arthrosis can experience improved pain control, enhanced function, and better quality of life, with total hip arthroplasty serving as the definitive treatment when conservative measures fail.