5 Methods to Manage Hip Osteoarthritis
It’s time to bring hip osteoarthritis into the limelight. It is a fact that most of the scientific literature to date has been concentrated on knee osteoarthritis or a mixed population of hip and knee OA. Consequently, the results of these studies have , more often than not, been generalized to those with hip OA. (1)
The aim of this blog is to inform the readers how Physio Network by the medium of their monthly research reviews, have tried to bring hip OA to the forefront so it can be managed effectively. Hip and knee OA are responsible for creating a huge economic burden for society according to the Global Burden of Disease study. (2)
Here are 5 tips that are sure to help:
1. Mind the subtle differences
In 2019, 3.20 million Australians were estimated to have osteoarthritis, the increase in prevalence of hip OA being (+171%) higher than knee (+126%) and hand (+110%) from 1990-2019 suggesting that hip OA is not being managed efficiently (3).
Are there any differences between hip and knee OA? Possibly.
This Physio Network review aims to highlight the differences between hip and knee OA with respect to prevalence, prognosis, epigenetics, pathophysiology, anatomical and biomechanical factors, clinical presentation, pain, clinical practice recommendations and clinical guidelines. The review found out that certain prognostic factors like age, obesity, and malalignment are all risk factors for knee OA but not for hip OA.
Another noticeable finding of this review was the potential differences in the inflammatory processes involved in hip and knee OA, which can be paramount in how joint-specific treatments are developed. With shorter symptom duration and restricted range of motion, hip OA may have a slightly different presentation than knee OA, potentially informing the administration of successful treatment plans.
2. Communicate and educate
Significant amount of literature suggests that exercise is a crucial part of first-line treatment for people with hip OA. (4) However, this Physio Network review suggests that the reasons why exercise seem to help with hip OA are complex and multifactorial. It is important to communicate the benefits of exercise to those with hip OA while also highlighting that exercise is not a panacea for osteoarthritis. Discussing the concept of load management and activity modification goes a long way in helping the patient stay physically active.
3. Manage pain flare ups
This Physio Network review suggests that manual therapy might be considered along with exercise to manage pain flareups in the short term. However, to keep the manual therapy approach going for a long term might not be of any additional use. This piece of knowledge plays a significant role in communicating and arming the patient with knowledge about the potential advantage of adding manual therapy to exercise. Adding manual therapy does not seem to impact function at any time point!
4. Understand goals and prescribe appropriate dose
This Physio Network review stressed the importance of appropriately dosed strength training at an intensity that causes fatigue after 12 reps. Moderate to high aerobic exercises are recommended 5 times/week along with strengthening of major muscle groups 3 times/week. Power training also shows promise with hip OA. Furthermore, this review stated that patients undergoing total hip replacement may benefit from exercise and education given preoperatively.
So, understand the goals of the patient and prepare them accordingly. Understand where they want to go and get them there by not fearing exercise but by promoting it.
5. Ensure they do their exercises
It is not uncommon to see patients not adhering to their exercise program due to pain, kinesiophobia, unhelpful beliefs about the benefits of exercise, lack of resources and social support. It is our job as physiotherapists to identify the barriers to exercise adherence barriers. This Physio Network review gives out some valuable pointers like incorporating a booster session to improve adherence. Also, positive reinforcement and positive feedback is considered a behavioral graded person-focused exercise approach. Finally, using an ‘exercise diary’ and ‘treatment contract’ can prove to be beneficial strategies in improving patient adherence.
To sum up, it is imperative to understand the subtle differences between hip and knee OA in order to prescribe efficient rehabilitation plans. Patient education is the key while managing hip OA along with honest communication with the patient regarding the effects of exercise. Maintaining appropriate training dose and managing flare ups can help the patient reach their goals safely. Last, but not least, exercises are only good if the patient is doing them. Strategies to improve quality of life and function in hip OA should include identifying and dealing with exercise adherence barriers by removing roadblocks.
If you are interested in learning more about how to implement OA research into clinical practice then check out my blog here.
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- Bannuru RR, Osani MC, Vaysbrot EE, Arden NK, Bennell K, Bierma-Zeinstra SMA, Kraus VB, Lohmander LS, Abbott JH, Bhandari M, Blanco FJ, Espinosa R, Haugen IK, Lin J, Mandl LA, Moilanen E, Nakamura N, Snyder-Mackler L, Trojian T, Underwood M, McAlindon TE. OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis. Osteoarthritis Cartilage. 2019 Nov;27(11):1578-1589.
- Cross M, Smith E, Hoy D, Nolte S, Ackerman I, Fransen M, Bridgett L, Williams S, Guillemin F, Hill CL, Laslett LL, Jones G, Cicuttini F, Osborne R, Vos T, Buchbinder R, Woolf A, March L. The global burden of hip and knee osteoarthritis: estimates from the global burden of disease 2010 study. Ann Rheum Dis. 2014 Jul;73(7):1323-30.
- Ackerman IN, Buchbinder R, March L. Global Burden of Disease Study 2019: An opportunity to understand the growing prevalence and impact of hip, knee, hand and other osteoarthritis in Australia. Intern Med J. 2022 Sep 16.
- Fransen M, McConnell S, Harmer AR, Van der Esch M, Simic M, Bennell KL. Exercise for osteoarthritis of the knee. Cochrane Database Syst Rev. 2015 Jan 9;1:CD004376.
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