Hip Osteoarthritis

Hip Osteoarthritis2018-02-20T12:32:18-05:00

hip-osteo-1-web

Problem:

Approximately 20% of the aging population will experience Hip Osteoarthritis in their lifetime. Hip Osteoarthritis is one of the most serious musculoskeletal complications not only to patients, but also to the healthcare system. Hip OA causes patients a serious amount of pain and also affects the healthcare system economically. By observing the numbers of those affected by Hip OA, the future functional disability and mortality of a population can be forecasted. About 20% of those with Hip OA on x-ray testing will undergo a complete hip replacement 11-28 years following diagnosis. It is crucial for this population to have quality conservative care.
hip-osteo-2-webInterventions:

Clinical practice guidelines recommend that patients with Hip OA manage their musculoskeletal condition through a balance of weight reduction, education, gait and balance training, exercise, and manual therapy. Manual therapy interventions are critical as they help to mobilize joints and reduce pain. Manual therapy also improves range of motion and disability in patients whose Hip OA is less advanced stages.

Evidence:

Eighty-one percent of patients have reported that overall their condition improved when they incorporated manual therapy into their treatment as opposed to exercise alone. These patients experienced reduced pain and disability, as well as held a high level of perceived recovery. Manual therapy and exercise are more clinically effective and cost-effective compared to usual care. The exercise interventions that supported the impact on reducing pain and disability included the following: flexibility/range of motion exercise, strengthening, and aerobic exercise.

hip-osteo-3-webRefer:

Clinical clusters of Hip OA include one of the following:

1. All 3 findings
a. Pain in hip
b. <115 degrees hip flexion
c. <15 degrees hip internal rotation

2. All 3 findings

a. Pain with hip internal rotation
b. 50 years of age 81% of patients reported reduced pain, disability, and a high level of perceived recovery following a treatment plan of manual therapy compared to exercise alone.

Pinto et al. reported that compared to usual care, a combination of manual therapy and exercise was more clinically effective and cost-effective for those who have Hip OA. The exercise interventions that are helpful for these patients are flexibility/range of motion exercise, strengthening, and aerobic exercise as these interventions are effective in reducing pain and disability.

hip-osteo-4-webSutlive et al. reported a cluster of findings including the following demonstrated a (+)LR of 24.3 or 5.2 for 4/5 or 3/5 findings respectively.

1. Squatting as aggravating factor
2. (+) active hip flexion causing lateral hip pain
3. (+) scour test causing lateral hip or groin pain
4. Active hip extension causes hip pain
5. Passive internal rotation range of motion

 

References:

  1. Odding, E. et al. Determinants of locomotor disability in people aged 55 years and over: the Rotterdam Study. Eur J Epidemiol. 2001. 17(11):1033-1041
  2. Nuesch, E et al. All cause and disease specific mortality in patients with knee and hip osteoarthritis: population based cohort study. BMJ. 2011.
  3. Franklin, J. et al. Natural history of hip OA: A retrospective cohort study with 11-28 years of follow up. Arthritis Care Res. 2011. 63(5):689-95
  4. Cibulka, M. et al. Hip Pain and Mobility Deficits – Hip Osteoarthritis. Clinical practice guidelines. JOSPT. 2009. 39(4):A1-A25.
  5. Hoeksma H et al. Comparison of manual therapy and exercise therapy in osteoarthritis of the hip: a RCT. Arthrtis Rheum. 2004. 51:722-729.
  6. Altman R, Alarcon G, Appelrouth D, et al. The American College of Rheumatology criteria for the classification and reporting of osteoarthritis of the hip. Arthritis Rheum. 1991;34:505-514.
  7. Sutlive, T. et al. Development of a clinical prediction rule for the diagnosis of hip OA in individuals with unilateral hip pain. J Orthop Sports Phys Ther 2008;38(9):542-550.
  8. Pinto, D. et al. Manual therapy, exercise therapy, or both, in addition to usual care, for osteoarthritis of the hip or knee. Economic evaluation alongside a RCT. Osteoarthritis and cartilage. 2013.