Management of Hip Pain

Non-Pharmacological Interventions

• Exercise is beneficial for hip osteoarthritis with a significant effect on pain (effect size of 0.39) and functional improvement (effect size of 0.31) 1
• Patient education can reduce pain, although its effect may be limited 1
• Weight loss is recommended for overweight patients, as obesity is associated with an increased risk of hip osteoarthritis (odds ratio = 2.3) 1, 3
• Assistive devices (canes) and orthotics can help reduce unfavorable mechanical forces on the joint, although specific evidence for the hip is limited 1

Pharmacological Interventions

• Paracetamol (up to 4 g/day) is recommended as the initial treatment for mild to moderate hip pain 1, 4
  • It has a modest but significant analgesic effect (effect size of 0.21) 1
  • It has a superior safety profile compared to NSAIDs, particularly for long-term use 2
  • The number of patients needed to treat (NNT) to achieve a clinical benefit is 4 1
• Tramadol, with or without paracetamol, is a useful alternative when NSAIDs are contraindicated or ineffective 5
• SYSADOA (glucosamine sulfate, chondroitin sulfate, diacerein, avocado and soybean unsaponifiables, hyaluronic acid) may have a symptomatic effect with low toxicity 6
  • Glucosamine sulfate shows an effect size of 0.44 for pain relief 6
  • Chondroitin sulfate has an effect size of 0.78 for pain relief 6

Post-Operative Pain Management

• For intense post-operative pain after total hip arthroplasty, a multimodal approach is recommended, combining COX-2 inhibitors or conventional NSAIDs with paracetamol, with or without weak opioids 7
• Peripheral nerve blocks (femoral nerve block or lumbar plexus block) can be effective in reducing post-operative pain 7

Treatment Algorithm

• Tramadol (50-100 mg every 4-6 hours, max 400 mg/day)
• SYSADOA as adjunctive treatment 6