Hip Osteoarthritis Treatment

Hip Osteoarthritis
Hip osteoarthritis. Click to enlarge

Changes to the hip joint due to osteoarthritis cannot be reversed, but the disease's progress can be slowed down. Most treatments, such as weight loss and muscle strengthening, aim to reduce the load carried by the hip joints. Medical treatments, such as medications, injections and surgery, may be used for cases of moderate to severe hip osteoarthritis.

A good treatment plan will account for lifestyle factors and balance the need for activity with rest. The sooner treatment begins the better the odds for conserving joint integrity.

Non-Surgical Treatment for Hip Osteoarthritis

Physical therapy and exercise
A physical therapist, or other healthcare professional providing physical therapy, might do one or more of the following:

  • Prescribe an exercise program that strengthens and stretches the muscles around the hip, thereby better supporting the hip joint and easing the strain on the hip.
  • Work with an individual to improve gait and balance through specific exercises. A physical therapist may also introduce a supportive device such as a cane.
  • Perform manual therapy, manipulating the hip joint to increase range of motion.

Activity modification
While exercise is important to treating hip osteoarthritis, some types of activities and exercise will aggravate the hip joint. These activities should be avoided and alternatives may be identified. For example, golf, which requires twisting at the hip, and high impact activities such as jogging, may be replaced with gentle yoga, cycling or swimming, which exert less stress on the hip joint.

Article continues below
Advertisement

Periodic rest
A little discomfort is to be expected as stiff joints loosen up in the morning or at the beginning of exercise. However, when people feel bone on bone pain or searing pain, they should not try to "work through the pain." Moderate or intense hip pain is a signal that the joint needs a rest.

Weight loss
The hip supports an exponential amount of body weight: gaining 10 pounds can mean an extra 60 pounds of pressure placed on the hip with each step.15 Losing pounds to maintain a healthy weight is often the most simple, effective way to reduce hip osteoarthritis pain.

Medications and Injections for Hip Osteoarthritis

Medications for hip osteoarthritis The medications listed below can be used to alleviate the symptoms and slow the progression of hip osteoarthritis. Doctor and patient should discuss medication in the context of the patient's lifestyle, severity of pain and medical history. Potential side effects and interaction with other drugs and vitamins/supplements should also be considered.

  • Analgesics. Analgesic drugs such as acetaminophen (e.g. Tylenol) do not reduce swelling but can reduce pain with few or no side effects.
  • Non-steroidal anti-inflammatory drugs, or NSAIDs. Patients with moderate to severe pain may benefit from anti-inflammatory medications, such as aspirin, ibuprofen (e.g. Advil), naproxen (e.g. Aleve) or cox-2 inhibitors (e.g. Celebrex) to reduce the swelling and inflammation that are a common cause of pain. While very useful, long-term use of NSAIDs can cause gastrointestinal bleeding and caution should be used.
  • Topical analgesics. These creams can be applied directly onto the skin surface of the hip. Some involve topical preparations of NSAIDs that are touted to carry less risk of side effects. Some of these creams contain counterirritants, such as wintergreen and eucalyptus, which stimulate the nerve endings and distract the brain from joint pain. These creams are often sold over the counter and are available in most drug stores. Examples of brand names include Ben-Gay, Icy-Hot and Zostrix. Most can be used in combination with oral pain medications.

Supplements to treat hip osteoarthritis
Glucosamine sulfate and chondroitin sulfate occur naturally in the body's cartilage. In clinical trials conducted by the American College of Rheumatology, some patients with osteoarthritis reported benefits from taking supplements containing glucosamine sulfate or a combination of glucosamine sulfate with chondroitin sulfate. At the time of this article, more clinical study is needed to fully understand how glucosamine and chondroitin supplements affect the symptoms of hip osteoarthritis.16

Steroid and hyaluronic acid injections
Two types of injections are used for treatment of severe pain from hip osteoarthritis: steroid injections and hyaluronic acid injections.

  • Steroid injections reduce swelling and thereby alleviate hip stiffness and pain.
  • Hyaluronic acid injections provide lubrication for the hip joint, as hyaluronic acid mimics the viscous synovial fluid that naturally lubricates the hip joint.

The degree of pain relief from injections is variable. If effective, the results from the injections are temporary, typically lasting 6 to 12 months.

Steroidal and/or hyaluronic acid injections are usually used with the goal of providing enough pain relief to enable the patient to get started with a physical therapy program to strengthen muscles and rehabilitate the hip. Injections may also be an option for individuals who are sensitive to medications.

Other Non-Surgical Treatments for Hip Osteoarthritis

Supportive devices
Certain orthopedic products may be used to help stabilize or take pressure off the hip. Some examples include:

  • Cushioning shoe inserts can ease the pressure put on the hip joint when walking.
  • Using a cane can provide extra stability.
  • In more severe cases where an individual's balance may be in jeopardy, a walker may be used to increase independent mobility without risking a fall.

Additionally, there are many supportive devices that can help with day-to-day activities. For example, a "sock donner" and a shoe horn with an extended handle can help a person put on socks and shoes without deep bending at the hip.

Coping techniques
To manage the pain, patients may employ techniques such as relaxation (e.g. relaxation tapes, meditation), visual imagery, biofeedback or hypnosis. For many, these techniques, along with a positive attitude that focuses on what activities are possible, can have a significant impact in increasing the patient's ability to function and moderating the hip pain.

Surgery for Hip Osteoarthritis

If treatments don't succeed and hip pain seriously impinges on lifestyle, surgery may provide relief. Surgery options include:

  • Arthroscopy to remove loose pieces of cartilage or bone spurs,
  • Osteotomy to properly align bones and reduce friction, and
  • Arthroplasty, or total hip replacement, to replace the hip joint with an artificial one.

While still major surgery, hip replacement surgery is considered less invasive and easier to recover from than knee replacement surgery. Improvements in hip replacement have made it a more common option, even for older patients. In 2000, nearly half of the 254,000 hip replacement surgeries in the U.S. were performed on patients over the age of 75.17

References:

  1. "Osteoarthritis," Arthritis Foundation Disease Center, accessed April 30, 2011, http://www.arthritis.org
  2. Loes M, "Natural Medicine and Pain Relievers: A Review," Natural Medicine Online
  3. "Osteoarthritis factsheet," National Institutes of Health, accessed May 16, 2011, http://report.nih.gov
Pages:
Written by Andrew Cole, MD
More Resources in the Osteoarthritis Center