Hip Osteoarthritis: A Physiotherapy-Driven Model for Conservative Management

Physiotherapist performing joint mobilization on a patient with hip osteoarthritis

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