Hip osteoarthritis: Treatment considerations for women
Hip osteoarthritis (OA) is a leading cause of disability in Australia, and can significantly affect peoples’ quality of life. Based on recent growth, OA-related hip-and-knee joint replacements are expected to cost $AUD5.32b by 2030 (1). As physios, our top priority is to improve the quality of life for people experiencing osteoarthritis – how do we do this? Many of us will jump to answer that question with an emphatic “exercise, education and weight management!”. These are the first-line treatments for osteoarthritis which should be offered to everyone – however, how much do you consider the effects of hormonal changes when developing management plans for women?
In her hip OA Masterclass, expert physio Dr. Joanne Kemp explains how we can optimise our treatment for women with hip osteoarthritis. This blog will give you an overview of some key treatment considerations. If you want to learn more about optimising your management of hip osteoarthritis from an industry leading expert, watch Dr. Kemp’s full hip osteoarthritis Masterclass HERE.
Research suggests the burden of hip osteoarthritis is higher for women than men; one third of women progress to a total hip replacement within 10 years of hip OA diagnosis as a young adult (2).
The prevalence and risk of OA increases rapidly from menopause (approx. 50 years) to 75 years of age, when compared to men of the same age (3). Menopause is a significant event in which a woman experiences various changes which may influence her experience of hip osteoarthritis. Below are some of the changes Dr Joanne Kemp outlines in her Masterclass:
- Reduced muscle mass
- Reduced strength
- Increased pain
- Increased central adiposity (increased inflammation)
- Weight gain
- Disturbed sleep
- Poor concentration
- Poor temperature regulation
These are all things to keep in mind when treating postmenopausal women with hip osteoarthritis.
Making sure the hip is actually the source of pain is obviously the first step in ensuring you’re developing an appropriate management plan. Below are a few key takeaways on hip assessment from Dr Joanne Kemp’s Masterclass:
A thorough subjective history is key for the diagnosis of hip OA. Firstly, gaining a good understanding of the current symptoms, such as aggravating factors and the 24-hour pattern is useful, as well as ruling out any red flags. You also want to know their past medical history – particularly if they have a history of hip dysplasia (80% of people who experience hip dysplasia are women!). Additionally, asking about the client’s history of elite and contact sports can contribute to the overall clinical picture.
The objective assessment involves gathering information about current functional capacity, Range of Motion (ROM) and strength. Often, it’s a case of trying to differentiate between the hip and the spine as a source of pain – some useful tips from Dr Joanne Kemp are:
- It’s 14x more likely hip > spine if your client has a limitation in hip internal rotation ROM
- It’s 7x more likely hip > spine if your client is walking with a limp
The treatment considerations
Women can experience reduced muscle mass and strength as a result of menopause (4). Strength is an important part of conservative management for hip osteoarthritis – we need to consider how our exercise prescription for postmenopausal women may differ. Dr Joanne Kemp suggests building strength can take 6-9 months, and requires progressive strength training with low reps and heavy load in order to mitigate the effects of reduced muscle mass. This is something to consider when building a management plan for your postmenopausal clients.
As always, we need to think about whether any additional referrals are needed. For postmenopausal women, Hormone Replacement Therapy (HRT) may be indicated. A systematic review suggested that estrogen therapy may help with maintaining healthy cartilage and bone turnover (5), and one study reported reduced rates of hip arthroplasty in women receiving estrogen treatment (6). Referral to a general practitioner may be required to consider HRT.
Additionally, weight management becomes more difficult following menopause – this being a fundamental part of the first-line management of osteoarthritis, it may be appropriate to consider whether additional help is required, such as from a dietitian. It’s also important to keep in mind that psychologist referrals may be indicated for women experiencing anxiety or depression.
We know the research supports education, exercise and weight management as the first-line options for treatment of hip osteoarthritis – there are programs such as the GLA:D program which have had positive results in improving quality of life and delaying the need for joint replacement. While a program such as GLA:D may have a positive effect, it’s important to consider the additional steps which may need to be taken to optimise our treatment; perhaps a better understanding of the effects of menopause may help us to reduce the gender gap in the burden of hip osteoarthritis.
If you’d like to learn more about the optimal assessment and treatment for hip OA from an expert, watch Dr Joanne Kemp’s full Masterclass HERE.
Want to learn from an expert on hip OA?
Dr Joanne Kemp has done a Masterclass lecture series for us!
“Hip Osteoarthritis: Optimising your Assessment and Treatment”
You can try Masterclass for FREE now with our 7-day trial!
- Ackerman IN, Bohensky MA, Zomer E, Tacey M, Gorelik A, Brand CA, et al. The projected burden of primary total knee and hip replacement for osteoarthritis in Australia to the year 2030. BMC Musculoskeletal Disorders. 2019 Feb 23;20(1):90.
- Wyles, C.C., et al., The John Charnley Award: Redefining the Natural History of Osteoarthritis in Patients With Hip Dysplasia and Impingement. Clin Orthop Relat Res, 2017. 475(2): p. 336-350.
- Mahajan A, Patni R (2018) Menopause and osteoarthritis: Any association? J Midlife Health. 9(4): 171-172.
- Maltais ML, Desroches J, Dionne IJ (2009) Changes in muscle mass and strength after menopause. J Musculoskelet Nueronal Interact. 9(4): 186-197.
- Tanamas SK, Wijethilake P, Wluka AE, Davies-Tuck ML, Urquhart DM, Wang Y, Cicuttini FM (2011) Sex hormones and structural changes in osteoarthritis: A systematic review. Maturitas. 69: 141-156.
- Karsdal MA< Bay-Jensen AC, Henrikesen K, Christiansen C (2012) The pathogenesis of osteoarthritis involves bone, cartilage and synovial inflammation: May estrogen be a magic bullet? Menopause. 18: 139-146.
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