Hip Osteoarthritis


  • The hip is a common site for osteoarthritis, affecting 10-25% of the population over the age of 55 (Felson 1988, Tepper 1993, Elders 2000).
  • Currently hip osteoarthritis affects 3 to 6% of all adults (Hoaglund 2001).
  • In the United States, between 1990 and 2002, the number of primary total hip arthroplasties rose from 119 000 to 193 000, an increase of 62% (Kurtz 2005).
  • In the United States it is estimated that the number of people with OA in any region of the body will increase from 43 to 60 million by 2020, resulting in an estimated cost of over 100 billion healthcare dollars per year (Elders 2000).

Clinical Presentation

  • Pain is usually located in the groin or lateral hip, the medial thigh, occassionally referring down to the knee (Khan 2004).
  • These patients will generally feel stiff in the morning, lose range of motion, and have pain when bearing weight on the affected extremity (Kean 2004; Wolfe 1999).
  • These impairments correlate with a loss in function, including negotiating the stairs, rising from a low chair, and dressing (Lin 2001).
  • Arokoski et al (2002) found a significant reduction in isometric hip abduction (31%) and adduction (25%) in males with OA versus without. Hip flexion strength was also lower (18-22%). Hip extension strength was not significantly different.


Radiographs are the gold standard for diagnosing hip OA (Reijman et al 2004). Radiographic findings indicative of osteoarthritis include joint space narrowing, osteophytes, and alterations in subchondral bone.

Altman et al (Altman 1991) developed a test item cluster for identification of hip osteoarthritis. More recently, a clinical prediction rule was developed to assist the clinician in diagnosing hip osteoarthritis (Sutlive 2008).

Physical Therapy and Exercise in Hip OA

A few systematic reviews have concluded that patients with hip OA will benefit from exercise, displaying reduced pain and disability (Roddy 2005; van Baar 1999). The problem is that these effects are only moderate and typically regress within a few years (van Baar 2001; Weigl 2004).

More recently, manual physical therapy appears to be more beneficial than exercise alone in treatment of those with hip OA. Hoeksma et al (2004) performed a randomized clinical trial comparing those treated with exercise versus those treated with exercise plus manual therapy. The manual therapy plus exercise group displayed superior results in measurements of range of motion and reduction in pain compared to the exercise group alone. A statistically significant difference was also found on the Harris Hip Score between the groups. This study was followed up by a case series detailing their treatment (MacDonald et al 2006).

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