Hip Osteoarthritis Treatment

Several treatments can reduce hip osteoarthritis pain and potentially slow down the disease's progress. Nonsurgical treatments are usually tried first. Therapeutic injections and surgery are also available. Most people will never need surgery.

Treating Hip Osteoarthritis Without Surgery

The most commonly recommended nonsurgical treatments for hip arthritis are described below.¹Allen KD, Golightly YM. Epidemiology of osteoarthritis: Curr Open Rheumatol. 2015 May:27(3): 276-283.^,2Bannuru RR et al. OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis. Osteoarthritis Cartilage. 2019 Jul 3. pii: S1063-4584(19)31116-1. doi: 10.1016/j.joca.2019.06.011.^,3Teo C, Hinman RS, Egerton T, Dziedzic KS, Bennell KL. Identifying and Prioritizing Clinical Guideline Recommendations Most Relevant to Physical Therapy Practice for Hip and/or Knee Osteoarthritis. J Orthop Sports Phys Ther. 2019 Jul;49(7):501-512. doi: 10.2519/jospt.2019.8676.

Education
A physician, physical therapist, or allied health care provider can provide information regarding the diagnosis, prognosis, and the risks and benefits of treatment options. This information can help a person make informed health care decisions that are based on his or her personal preferences, values, and lifestyle.

Physical activity
Committing to an exercise routine often decreases pain and increases function of an osteoarthritic joint. It also promotes a healthy lifestyle and decreases the risk of developing other conditions, such as heart disease or diabetes. The goals of physical activity include increasing muscle strength and aerobic capacity.

See Exercising with Arthritis

Activity modification
Work or recreational activities that aggravate hip arthritis pain may need to be modified. For example:

• A person who does heavy manual labor may be advised to adopt new lifting mechanics or to cut back on work hours, if possible.
• A golfer may be advised to make swing adjustments to minimize the effects of twisting the torso, or to play 9 holes instead of 18.

Some people may decide to change jobs or take up alternative activities (such as cycling or swimming) that exert less stress on the hip joint.

See Water Therapy for Osteoarthritis

Physical therapy
A physical therapist or other healthcare professional who provides physical therapy may:

• Prescribe an exercise program to strengthen and stretch the muscles around the hip
• Help improve and individual’s walking gait and balance through specific exercises
• Introduce a supportive device, such as a cane

The goal of physical therapy is to improve quality of life by reducing strain on the hip.

Watch 3 Easy Stretches for Hip Osteoarthritis Pain Relief Video

Weight loss
Losing weight can take pressure off the hip joint, potentially reducing pain and slowing down the progression of hip osteoarthritis. Losing excess weight can also reduce body-wide inflammation, which may contribute to hip arthritis pain.⁴Sartori-Cintra AR, Aikawa P, Cintra DE. Obesity versus osteoarthritis: beyond the mechanical overload. Einstein (Sao Paulo). 2014;12(3):374–379. doi:10.1590/S1679-45082014RB2912.^,5Rosen, CJ, "Pathogenic mechanisms of obesity-induced osteoarthritis: new clues from old joints." Osteoarthritis and Cartilage (2019), doi:10.1016/j.joca.2019.02.007; Phone interview, June 10, 2019. (Obesity is defined as a BMI ≥ 30.)

Supportive devices
Certain orthopedic products can help stabilize or take pressure off the hip. Examples include:

• Cushioning shoe inserts to ease the pressure put on the hip joint when walking
• A cane to provide extra stability
• A walker to help ensure independent mobility without risking a fall (for severe cases in which people may have balance issues)

Additionally, there are many supportive devices that can help with day-to-day activities. For example, a "sock donner" and a shoe horn with an extended handle can help a person put on socks and shoes without deep bending at the hip.

Pain medications
Hip arthritis pain may be relieved temporarily with pain medications.²Bannuru RR et al. OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis. Osteoarthritis Cartilage. 2019 Jul 3. pii: S1063-4584(19)31116-1. doi: 10.1016/j.joca.2019.06.011.

• Over-the-counter oral pain medication. Non-steroidal anti-inflammatory drugs (NSAIDs), such as such as ibuprofen (Advil), or naproxen (Aleve), can reduce pain as well as the inflammation that contributes to pain. Acetaminophen has not been found to be as useful. Use of over-the-counter medications should be discussed with a physician if there is a history of ulcers, gastrointestinal disorders, or heart disease.
• Prescription oral medication. When pain does not respond to over-the-counter products, doctors may recommend prescription-level doses of medications such as NSAIDs. For those with gastrointestinal issues this can include COX-2 inhibitors (Celebrex).

See Pain Medications for Arthritis Pain Relief

Topical pain relievers are typically not recommended for hip pain. Topical medications are usually most effective for treating joint pain located near the skin’s surface, such as joints in the hand; the hip joint is located deep within soft tissue.

See Topical Pain Relief for Arthritis

Opioids are generally not recommended to treat hip osteoarthritis pain.

Doctor and patient should discuss medication in the context of the patient's lifestyle, severity of pain, and potential side effects and drug interactions.

Injections for Hip Osteoarthritis

The degree of pain relief patients get from therapeutic injections varies. While often effective, the results from the injections are usually temporary, lasting weeks or months.

Injections may provide enough pain relief to enable a person to start a physical therapy program to rehabilitate the hip. Injections may also be a good option for individuals who are sensitive to medications.

• Steroid injections injections are the most common type of injection with goal of reducing inflammation and thereby alleviate hip stiffness and pain.
  • The number and frequency of steroid injections should be limited. Repeated injections may further damage cartilage and injure other surrounding tissue. Some doctors prefer to avoid steroid injections for osteoarthritis altogether because of this risk.
  • Steroid injections are generally avoided within 3 months of joint replacement surgery due to a small but increased risk of infection after surgery.

  See Cortisone Injections (Steroid Injections)

• Hyaluronic acid injections provide lubrication for the hip joint, as hyaluronic acid mimics the viscous synovial fluid that naturally lubricates the hip joint.

  See What Is Hyaluronic Acid?

• Regenerative medicine injections typically use platelet-rich therapy (PRP) or stem cells and may trigger the healing of natural tissue in some patients.

There is limited research data to support the use of hyaluronic acid, PRP or stem cells at this time, although their availability has increased over the last several years.

To ensure that the injection needle is safely and accurately placed in the hip joint, an injection should be done using medical imaging, such as ultrasound or fluoroscopy.

Injection therapies are generally considered safe but do carry certain risks, such as infection or an increase of pain right after the injection.

See Cortisone Injection Risks and Side Effects

Radiofrequency Ablation (RFA)

Occasionally, a doctor may recommend a nonsurgical treatment called radiofrequency ablation. Limited research suggests this treatment may be used to destroy nerves to reduce or eliminate hip osteoarthritis pain.⁶Chye CL, Liang CL, Lu K, Chen YW, Liliang PC. Pulsed radiofrequency treatment of articular branches of femoral and obturator nerves for chronic hip pain. Clin Interv Aging. 2015;10:569–574. Published 2015 Mar 16. doi:10.2147/CIA.S79961.^,7Tinnirello A, Todeschini M, Pezzola D, Barbieri S. Pulsed Radiofrequency Application on Femoral and Obturator Nerves for Hip Joint Pain: Retrospective Analysis with 12-Month Follow-up Results. Pain Physician. 2018 Jul;21(4):407-414. PubMed PMID: 30045597.

During this procedure, pulsed radiofrequency—electrical current produced by radio waves—is delivered to the affected nerves in the hip. This treatment targets and destroys sensory nerves that communicate pain signals to the brain. Medical imaging, such as ultrasound, is used to make sure nerves that control movement and motor skills are not affected. It involves local anesthetic and needles; no incisions, stitches or staples are required.

This outpatient procedure is not common. Patients and doctors considering radiofrequency ablation should discuss potential benefits and risks.

When hip osteoarthritis pain persists despite treatments, surgery may be recommended.