Introduction

Hip osteoarthritis (OA) is a degenerative joint disease that significantly impacts mobility, function, and quality of life. Although pharmacological management and eventual total hip arthroplasty (THA) are standard considerations, physiotherapy offers a non-invasive, evidence-based solution that can reduce pain, improve gait mechanics, and delay or prevent surgery.

We invite referring physicians to consider a structured physiotherapy protocol as a primary intervention or prehabilitation strategy for patients with mild to moderate hip OA.

Clinical Presentation

Typical features of hip OA include:

  • Groin or anterior thigh pain
  • Reduced internal rotation and flexion
  • Morning stiffness <30 minutes
  • Trendelenburg gait or compensatory patterns

Pain is often activity-related and progressive, leading to fear-avoidance and deconditioning.

Physiotherapy Approaches: Evidence from RCTs

1. Exercise Therapy & Education

  • Fernandes et al. (2010): Demonstrated that an exercise + education protocol significantly reduced WOMAC pain and disability scores compared to education alone in patients with hip OA.
  • Bennell et al. (2014): In a randomized trial of 131 participants, home-based physiotherapy resulted in statistically and clinically significant improvements in pain and physical function scores at 6 and 12 months.

2. Manual Therapy & Mobilization

  • Combined approaches including capsular mobilization and soft tissue release have been shown to enhance movement efficiency and reduce stiffness (French et al., 2011).

3. Prehabilitation Before THA

  • Rooks et al. (2006): A structured exercise program prior to THA improved early postoperative functional outcomes and reduced hospital stay.

Treatment Components

  • Targeted strength training: Gluteus medius, maximus, and hip rotators
  • Manual therapy: Joint mobilizations to restore capsular extensibility
  • Neuromotor retraining: Correcting compensatory gait patterns
  • Education: Load management, activity pacing, pain science education
  • Outcome tools: HOOS, 30s chair stand, 6MWT, and functional reach testing

Indications for Referral

  • Persistent or recurrent pain > 6 weeks
  • Mild/moderate OA with declining mobility
  • THA waitlisted patients (for prehab)
  • Patients ineligible or unwilling to pursue surgery
  • Post-surgical rehab following THA

Conclusion

Physiotherapy is a first-line, guideline-endorsed intervention for hip osteoarthritis. It can slow disease progression, reduce pain, and restore function. Our interdisciplinary collaboration with physicians ensures continuity of care through non-pharmacologic, movement-based strategies rooted in current best evidence.

References:

Bennell, K. L., Egerton, T., Pua, Y. H., Abbott, J. H., Sims, K., Metcalf, B., … & Hinman, R. S. (2014). Efficacy of a physiotherapist-delivered physical activity intervention for people with hip osteoarthritis: A randomized controlled trial. Osteoarthritis and Cartilage, 22(6), 930–939. https://doi.org/10.1016/j.joca.2014.03.009

Fernandes, L., Storheim, K., Nordsletten, L., & Risberg, M. A. (2010). Efficacy of patient education and supervised exercise vs. patient education alone in patients with hip osteoarthritis: A single blind randomized clinical trial. Osteoarthritis and Cartilage, 18(10), 1237–1243. https://doi.org/10.1016/j.joca.2010.07.004

French, H. P., Cusack, T., Brennan, A., Caffrey, A., Conroy, R., & O’Connell, P. (2011). Exercise and manual physiotherapy arthritis research trial (EMPART): A multicenter randomized controlled trial. BMJ Open, 1(1), e000036. https://doi.org/10.1136/bmjopen-2010-000036

Rooks, D. S., Huang, J., Bierbaum, B. E., Bolus, S. A., Rubano, J., Connolly, C. E., … & Katz, J. N. (2006). Effect of preoperative exercise on measures of functional status in men and women undergoing total hip and knee arthroplasty. Arthritis & Rheumatism, 55(5), 700–708. https://doi.org/10.1002/art.22223