Treatment Options for Osteoarthritis of the Hip

Non-Pharmacological Treatments

The American College of Rheumatology recommends education and self-management programs for all patients with hip OA, which should include regular education about the condition and self-management strategies 2, 3
Land-based cardiovascular and/or resistance exercise is strongly recommended for patients with hip OA, and should be supervised by a physical therapist in combination with manual therapy 2, 1
Aquatic exercise is also strongly recommended for patients with hip OA 2
Weight loss is strongly recommended for overweight or obese patients with hip OA 2, 3
Walking aids, such as canes or walkers, should be provided as needed to patients with hip OA 2, 3
Local heat or cold applications can be used for symptomatic relief in patients with hip OA 3
Psychosocial interventions should be incorporated into management plans to address mood disorders, stress, and coping skills that often accompany chronic pain conditions in patients with hip OA 2, 5

The European League Against Rheumatism recommends acetaminophen as the first-line oral analgesic for mild to moderate pain in patients with hip OA, up to 4g/day 3, 1
NSAIDs should be added or substituted when acetaminophen provides inadequate response in patients with hip OA, and the lowest effective dose should be used for the shortest possible period 1, 3
Topical NSAIDs should be considered before oral NSAIDs, particularly for patients with comorbidities 3
Opioid analgesics, such as tramadol, may be useful alternatives when NSAIDs are contraindicated, ineffective, or poorly tolerated in patients with hip OA 2
Intra-articular corticosteroid injections may be considered for patients with flares unresponsive to analgesics and NSAIDs, and should be guided by ultrasound or x-ray 1

The American Academy of Orthopaedic Surgeons recommends joint-preserving procedures, such as osteotomy, for young adults with symptomatic hip OA, especially with dysplasia or varus/valgus deformity 1
Total hip replacement should be considered in patients with radiographic evidence of hip OA who have refractory pain and disability despite conservative management 1
For elderly patients with poor bone quality, cemented femoral fixation should be considered to reduce periprosthetic fracture risk 4, 6

The American College of Rheumatology does not recommend glucosamine and chondroitin for patients with hip OA, based on current guidelines 2, 3
Intra-articular hyaluronic acid (viscosupplementation) is not recommended for patients with hip OA, as evidence does not support its use 2
Electroacupuncture is not recommended for patients with hip OA 3