Introduction

The Hip Osteoarthritis Masterclass, taught by Adam Culvenor and Jo Kemp, provides a complete overview of the assessment and management of Hip OA. This position statement provides clinically relevant, actionable information that may be useful to health professionals.

Part 1: Hip OA Background

OA is less prevalent than knee or hand OA, with one in four Australians developing hip OA, which is linked to a 31% rise in total hip replacements (THR). There is a big burden when it comes to direct and indirect costs due to arthritis in Australia per year. The factors that increase risk of hip OA are CAM lesions, hip dysplasia, sedentary lifestyle, physically demanding work and high impact elite sports.

• Treatment should be individualised to the patient. The program should also address any chronic health conditions.
• Although people with a CAM morphology are more at risk of developing OA, it is not advised to surgically remove an asymptomatic CAM lesion.

Part 2: Assessment of the Hip

A thorough assessment of the hip including the subjective exam, screening of red flags and objective exam can take time. An evaluation of impairments with strength, ROM and functional measurements should guide the management and tailor the rehab program.

• A subjective assessment should screen for red flags including history of cancer and burning with urination, including loading, family and sporting history.
• Objective assessment for hip OA should include ruling out the lumbar spine and pelvis, pain location, gait analysis, special tests including FADIR and flexion IR overpressure to see if it reproduces the patient’s familiar pain.
• If the patient is compliant with their program but their condition is non changing in around 6 weeks, then consider referring for a scan.
  
  

Part 3: Physio Treatment of OA

When considering physiotherapy treatment for hip OA, the first line approach should be education, exercise and weight control. Using manual therapy is a good adjunct for symptom modification and for patient buy-in for being compliant with their home program.

• The rehab should be done 2-3x a week and be a progressive program that targets hip, knee, trunk and functional strength including hip abduction, sit to stands, leg extension/flexion and planks as well as flexibility.
• Clinicians can refer patients to the GLA:D program as it consists of a minimum of 2x week for 6 weeks physio led treatment package for both hip and knee OA.
  

Part 4: Other Treatment of Hip OA

There are common pharmacological (NSAIDS and Paracetamol) supplementation and injection (Cortisone, PRP, Synvisc and Stem Cells) options for people with hip OA. If the patient’s quality of life is having a detrimental effect due to their symptoms, and they have exhausted all conservative measures, it is then appropriate to consider having a THR, as it has a high success rate of 90%.

• Supplements such as Glucosamine, Chondroitin and Turmeric seem to help with pain in the short term only and are low risk.
• Cortisone is good for short term pain reduction (6 weeks) but has no long term benefit and can potentially cause cartilage loss.