What is the initial management for moderate symmetric osteoarthropathy of both hips with osteitis pubis?

Initial Management for Moderate Symmetric Osteoarthropathy of Both Hips with Osteitis Pubis

The initial management for moderate symmetric osteoarthropathy of both hips with osteitis pubis should include a comprehensive individualized treatment plan consisting of rest, activity modification, physical therapy with hip strengthening exercises, and NSAIDs for pain and inflammation, with conservative measures being the first-line approach before considering more invasive interventions. 1, 2

Core Non-Pharmacological Management

Exercise Therapy

• Implement a regular individualized daily exercise regimen that includes:
  • Strengthening (sustained isometric) exercises for both legs, focusing on quadriceps and proximal hip girdle muscles
  • Aerobic activity and exercise
  • Range of motion/stretching exercises 1
• Follow important exercise principles:
  • "Small amounts often" (pacing approach)
  • Link exercise regimens to daily activities
  • Start with exercises within the individual's capability and gradually increase intensity 1

Pain Management

• When not contraindicated, use oral NSAIDs for symptomatic hip OA 1
• Acetaminophen may be considered as an alternative when NSAIDs are contraindicated 1
• For osteitis pubis specifically, rest and anti-inflammatory medications are the mainstay of treatment 3

Weight Management

• If the patient is overweight or obese, implement individualized weight loss strategies:
  • Regular self-monitoring with monthly weight recording
  • Regular support meetings to review progress
  • Structured meal planning
  • Reduced fat intake and increased fruit and vegetable consumption
  • Portion control 1

Assistive Devices and Adaptations

• Consider walking aids to reduce pain and increase participation:
  • Walking stick used on the contralateral side
  • Walking frames or wheeled walkers if needed
• Home adaptations may include:
  • Increasing the height of chairs, beds, and toilet seats
  • Hand-rails for stairs
  • Bathroom modifications 1

Specific Management for Osteitis Pubis

• Initial treatment should focus on rest and activity modification to reduce inflammation 2, 4
• Physical therapy should target strengthening of hip girdle and core muscles 2, 5
• NSAIDs are effective for managing inflammation and pain 4, 3
• For non-athletic patients with osteitis pubis, conservative treatment is usually sufficient, with surgery rarely required 4

Monitoring and Follow-up

• Regular assessment of pain levels and functional improvement
• Consider more invasive interventions only if conservative measures fail after 4-6 weeks 2
• If symptoms persist despite conservative treatment, consider:
  • Intra-articular corticosteroid injections for hip OA 1
  • Further imaging studies such as MRI to evaluate for other pathology 2

Cautions and Pitfalls

• Distinguish osteitis pubis (inflammatory) from osteomyelitis pubis (infectious) - the latter requires antibiotic treatment 3
• Osteitis pubis is self-limiting but may take time to resolve completely 5
• Failure to improve with conservative treatment should prompt reassessment for possible osteomyelitis or other conditions 3
• Surgical intervention (such as pubic symphysis curettage or arthrodesis) should only be considered after failure of comprehensive conservative management 6

By implementing this comprehensive approach to management, most patients with moderate symmetric osteoarthropathy of both hips with osteitis pubis can achieve significant improvement in pain and function without requiring surgical intervention.