Is reduced range of motion a common finding in osteoarthritis (OA) of the hips?

Reduced Range of Motion in Hip Osteoarthritis

Yes, reduced range of motion is a characteristic and common finding in hip osteoarthritis, with internal rotation being the most predictive movement restriction for identifying radiographic OA.

Clinical Presentation of ROM Limitations

Hip osteoarthritis consistently demonstrates restricted range of motion across multiple planes, with specific patterns that help distinguish it from other hip pathology:

• Internal rotation restriction is the most discriminatory finding for radiographic hip OA, with sensitivity of 86% for moderate OA and 100% for severe OA when any single plane shows restriction 1
• Patients demonstrate reduced maximal hip flexion and extension during functional activities like walking 2
• All planes of motion show progressive limitation as disease severity increases, including flexion, extension, abduction, adduction, internal rotation, and external rotation 3
• When restriction occurs in all three primary planes (flexion/extension, abduction/adduction, rotation), specificity for severe OA reaches 88% 1

Structural and Clinical Determinants

The ROM limitations in hip OA are driven by multiple interconnected factors:

• Joint space narrowing is strongly associated with reduced ROM in all planes of motion 3
• Osteophytosis, flattening of the femoral head, and femoral buttressing correlate with lower hip ROM in two or more planes 3
• Pain and morning stiffness independently contribute to ROM restrictions beyond structural changes 3
• Higher BMI and male gender are associated with greater ROM limitations 3

Functional Impact During Gait

The ROM restrictions translate directly into observable gait abnormalities:

• Patients walk with decreased dynamic hip ROM (17 ± 4 degrees compared to normal) 4
• A characteristic hesitation or reversal in hip extension motion occurs during stance phase, representing a compensatory mechanism to achieve functional extension through increased anterior pelvic tilt and lumbar lordosis 4
• Patients with greater passive flexion contractures demonstrate more pronounced hesitation patterns during gait 4
• Reduced stride length and decreased contralateral hip motion accompany the ipsilateral ROM restrictions 2

Clinical Assessment Implications

While ROM measurement has uncertain clinical utility for routine management according to the International Hip-Related Pain Research Network, there is conflicting evidence about whether it should be routinely measured 5:

• The heterogeneity in measurement methods (active vs. passive, positioning, stabilization) contributes to inconsistent findings across studies 5
• When ROM is measured, methods with the highest clinimetric properties should be chosen, though optimal standardized methods remain undefined 5
• The purpose of measurement matters—ROM assessment may be more relevant for surgical planning or baseline screening than for routine clinical monitoring 5

Management Considerations

Despite ROM limitations, exercise remains strongly recommended and can improve functional capacity:

• Exercise programs incorporating range of motion work in low-impact environments (such as aquatic exercise) are beneficial 5
• Supervised exercise programs are more effective than unsupervised home programs for improving pain and function 5
• Physical therapy referral is beneficial for appropriate instruction in exercises that address ROM limitations 5

Common Clinical Pitfalls

• Do not assume ROM restrictions contraindicate exercise—patients with pain and functional limitations due to OA demonstrate improvements in OA-specific outcomes with appropriate exercise programs 5
• Internal rotation testing during physical examination reproduces symptoms and is highly predictive of radiographic OA 5, 1
• Small-arc range of motion may not reproduce pain even when end-range motion is severely limited and symptomatic 5