Non-Operative Hip Treatment

When you have hip arthritis, there are times when you may not feel like exercising, or you might worry that exercising may do more harm than good to your joints. However, research has shown that physical activity is the single most effective non-drug treatment for improving pain and function.

While it is important to maintain as much activity and joint motion as possible, you should be aware of and avoid activities that could worsen your condition. For example, impact activities such as running and jumping will often accelerate cartilage loss within the joint. If you are an active person, you may need to modify your workout to avoid putting stress on your joints.

The key is to focus on low-impact activities that do not require significant weight bearing on the hip joints. If you have arthritis, the following exercises are especially effective at helping you maintain hip range of motion, strength, and function:

• Walking
• Swimming
• Water aerobics
• Stationary or recumbent cycling
• Yoga and tai chi
• Strength training with weights and resistance bands

Be sure to consult your doctor about exercising with osteoarthritis and the specific exercises that are best for you. You may also want to visit a physical therapist to help you begin an appropriate and effective exercise regimen or modify your existing activities.

Physical and/or occupational therapy is an excellent way to start or modify an exercise program tailored specifically for your hip arthritis and needs (e.g., any co-existing medical conditions or physical limitations). The main goals of therapy are to relieve pain and improve function in your affected joint(s).

A physical or occupational therapist will develop an exercise plan designed to:

• Improve your mobility and flexibility
• Increase stability of your hip joint by strengthening the surrounding muscles
• Improve your coordination and balance
• Maintain fitness and the ability to perform daily activities

Aquatic therapy in a heated pool can be especially soothing and effective. The buoyancy of the water takes stress off the hips while exercising, and the resistance of the water can help strengthen your muscles and stabilize joints.

In addition to creating an individualized exercise program, your therapist may also:

• Apply heat to treat stiffness, and ice to decrease pain
• Recommend the use of assistive devices such as walkers, canes, braces, splints, or shoe inserts to help support your joints and relieve stress
• Instruct you on how to do your daily activities, such as getting dressed, doing housework, and preparing meals, using proper posture and body mechanics. This puts less stress on your joints and relieves pain.
• Suggest modifications to your home and work environments such as ergonomic chairs, cushioned floor mats, grab bars/rails, chairlift for stairs, etc. Making these changes can help relieve pain, improve posture, and add stability.

Weight loss is probably the single most effective intervention you can take on your own. For the average patient who is somewhat overweight, losing 20 pounds or more can often decrease your discomfort and delay the need for surgery.

Weight loss is also important for increasing the life span of a joint replacement. In addition, surgery is less risky for patients who are not severely overweight.

Injection therapies do not cure the underlying problems of arthritis but can be useful for short-term relief and for diagnostic purposes.

Steroid injections into the hip bursa are usually effective for bursitis and may be all that is required in combination with physical therapy and anti-inflammatory medications for resolution of a patient’s symptoms.

Injection of a hip joint is a deeper injection. It is typically quick and only takes a few minutes in the office, but it does require the use of a live X-ray machine (fluoroscopy) to ensure accurate placement. It often takes 5 to 7 days for the steroid to fully take effect.

Hip joint injections are useful in determining where a patient’s primary source of pain is originating from. They are also helpful in providing a few months of relief prior to hip replacement surgery.

Long-term use or overuse of steroid injections can weaken bones and tissues, but most orthopedic surgeons typically consider injections a few times a year to be acceptable.

A newer injection on the horizon may be hyaluronate (viscosupplementation) injections. While these are commonly used for knee injections, they are considered “off-label” and investigational for hip arthritis. We have periodically used this treatment for some patients with good results, but it is not usually covered by insurance or Medicare.