The most common form of hip arthritis is Osteoarthritis. Osteoarthritis is a gradual wearing down and degeneration of the joint surfaces or articular cartilage. Osteoarthritis is most common in people who are middle age or adults over the age of 50, and people who are overweight. Women are more likely to develop osteoarthritis, which can affect one hip or both. Hip osteoarthritis is the most common cause of disability.

Common causes of hip osteoarthritis include:

  • Genetics and family history can predispose individuals to developing osteoarthritis and joint degeneration
  • Traumatic injury or fracture of the hip can result in the development of osteoarthritis.
  • Significant trauma that effects the circulation of the head of the femur. This condition is called aseptic necrosis and can result in the degeneration of the ball, or femoral head.
  • Excessive use of steroids or steroid medication can result in degeneration of the joint and cartilage.
  • Obesity that causes increased weight and pressure on the hip joints, when performing everyday activities. This puts added stress on the hips, which increases force on the joint cartilage.
  • Diseases of the joint cartilage
  • Pain and achiness in the hip joint during activities. Hip pain may be reported on the outside of the hip, groin and even refer down the leg to the knee.
  • Difficulty with walking and weight bearing on the involved leg.
  • Loss of motion of the hip in several directions including abduction (moving out) flexion (moves toward chest) and internal rotation (turning the hip in). Stiffness that may improve with movement.
  • Noticeable swelling around the joint.
  • Weakness that makes it difficult to get out of chair, squat, kneel or climb stairs
  • Cracking, grinding, crunching or joint noises called crepitus that occur when moving the hip. This may happen as the cartilage surfaces wear and there is bone-on-bone rubbing, or bony spurs.

Treatment of hip osteoarthritis will depend on the severity of the condition. Some important guidelines should be followed at the onset.

Physical Therapists are professionals, educated and trained to administer interventions. As defined by The Guide to Physical Therapist Practice, interventions are the skilled and purposeful use of physical therapy methods and techniques to produce changes consistent with the diagnosis, prognosis and the patient or client’s goals.

Your physical therapist will perform a thorough evaluation to assess and determine the following:

  • Joint: a series of measurements will be performed to determine which joint is involved and the extent to which the inflammation is acute
  • Strength: resisted testing is performed to determine if there is associated weakness or strength imbalances
  • Flexibility: range of motion measurements will be taken to determine if there is reduced joint movement
  • Technique and ADL: the therapist will review what activities you have difficulty with and will help you make modifications in technique to reduce stress on the involved joint.
  • Gait, Balance and Alignment: the therapist will assess your gait and balance on even and uneven surfaces. An assistive device such as a cane or walker may be indicated to improve safety, gait and reduce stress on the effected joint.

Physical therapy for hip osteoarthritis must remain conservative at the onset to avoid aggravating the condition. Emphasis will be placed on rest, reducing the inflammation, protecting the joint and increasing the blood circulation for healing. Once the initial inflammation has reduced, a program of stretching and strengthening will be initiated to restore flexibility and improve strength to reduce stress on the hip joint. An assistive device for ambulation, or moving around, may be necessary to decrease weight bearing on the hip and normalize the gait.

Common Physical Therapy interventions in the treatment of Hip Osteoarthritis include:

  • Manual Therapeutic Technique (MTT): hands on care including soft tissue massage, stretching and joint mobilization by a physical therapist to improve alignment, mobility and range of motion of the hip. The use of mobilization techniques also helps to modulate pain.
  • Therapeutic Exercises (TE) including stretching and strengthening exercises to regain range of motion and strengthen muscles of the hip and lower extremity to support, stabilize and decrease the stresses place on joint cartilage and the hip joint.
  • Neuromuscular Reeducation (NMR) to restore stability, retrain the lower extremity and improve movement techniques and mechanics (for example, walking, bending, or stair climbing) of the involved lower extremity to reduce stress on the joint surfaces in daily activities. Gait and balance training may be indicated in those individuals who have problems with walking.
  • Modalities including the use of ultrasound, electrical stimulation, ice, cold, laser and others to decrease pain and inflammation of the involved joint.

Avoiding the activities that produce the pain or stress the involved joint is the first line of treatment.

  • RICE: Rest, Ice, Compression, Elevation should be used to reduce the stress on the joint.
  • NSAIDS (Non steroidal anti-inflammatory drugs) to reduce pain
  • Use of an assistive device such as a cane or walker may reduce stress on the hip while reducing a limp or gait deviation.
  • Injection of steroids may be indicated to reduce inflammation of the involved joint.
  • In severe recurrent conditions surgery may be indicated. In cases of severe arthritis or joint degeneration a hip joint resurfacing or total hip replacement procedure may be recommended.

Prognosis

Outcomes and prognosis for individuals with hip osteoarthritis will depend on the severity of the joint degeneration, motion loss, weakness and age of the individual.

Mild: Individuals with mild degeneration respond well to conservative treatment, which includes medication for pain and inflammation and a program of exercises for stretching and strengthening of the knee joint and surrounding muscles. Most patients show improvement in pain and function in 4-6 weeks.

Moderate: Individuals with moderate degenerative changes usually experience greater loss of motion, pain, weakness and loss of function. In some cases a joint resurfacing of the hip may be indicated. Recovery may take from 8-12 weeks following surgery with emphasis on reduction of swelling and restoration of range of motion, strength and function.

Severe: Individuals with severe joint degeneration have significant pain, stiffness, loss of motion and function. The cartilage on the joint surfaces has been eroded and X-rays reveal a loss of joint space and “bone on bone” contact. Joint replacement is the treatment of choice. At this point quality of life becomes a concern. Following a joint replacement the artificial hip will be different from the natural joint and there will be some limitations of motion and function. However, a patient’s quality of life is usually significantly improved following a total joint replacement. Recovery following hip replacement can take 3-4 months of intensive physical therapy and rehabilitation. Improvements and functional gains can continue to develop for up to a year following the procedure.

Hip Resurfacing

This surgical procedure is an alternative to total hip replacement. Younger individuals who are not overweight are good candidates for this procedure. It involves the placement of a cap over the head of the femur and the use of a metal cup in the acetabulum (socket) of the pelvis. There is less bone loss required in this procedure and the risk of dislocation is reduced. It is recommended for patients who do not have large bone loss, rheumatoid arthritis or hip osteoarthritis.

Hip Replacement

Total hip replacement may be indicated in severe cases of hip osteoarthritis, secondary to a fracture. It may be indicated in the case of aseptic necrosis in which the circulation of the head of the femur is compromised resulting in degeneration of the ball of the hip. There are several different designs for hip replacements but all have two components: the ball made of highly polished strong metal or ceramic and the socket, a durable cup made of plastic, metal, or ceramic material. Cement may or may not be used to stabilize the prosthesis on the existing bone.

Prevention

Once the pain and inflammation is reduced, and motion and strength are improved it is important that the patient returns to full activity gradually. Instruction in daily activities and a comprehensive home program are helpful for reducing a reoccurrence of flare-ups and slowing the degenerative process. As a preventive measure individuals should:

  • Movement: keep moving and avoid a sedentary lifestyle. Joints are meant to move and depend on movement for lubrication. Sitting and remaining sedentary will reduce the joint’s available range of motion.
  • Stretching: stretching regularly, in addition to before and after activity, will reduce the chances of developing joint stiffness and pain. Stretching will also improve and maintain the elasticity and flexibility of muscles and tendons of the joint. Hold stretches for 20 seconds and do not bounce. Remember, as joints age flexibility is lost. It is part of the aging process.
  • Strength: performing a regular strength program will keep muscles strong enough to absorb the stresses placed on the joints. Weak muscles allow the stress and forces of every day activities to be transferred to the joint surfaces. Remember, as people get older weakness increases.
  • Protection: Avoid activities that place increased stress on the hips. This includes running or high impact activities.

Schedule an
Appointment!

Get back to doing what you love.

We are dedicated physical therapists that genuinely care. We strive to restore you to your former self, no matter the injury.

SCHEDULE APPOINTMENT

Real People, Real Testimonials.

"I went from being almost totally debilitated by a pelvic fracture to being able to negotiate 6 flights of stairs. Therapy was intense, therapist are knowledgeable, helpful,encouraging and respectful. I highly recommend this facility."

Stephanie R.

The Bridgewater Location is excellent! Every single staff person is on point. From day one when I called to schedule my first appointment and throughout my treatment staff were helpful, professional, and overall a caring and compassionate team. Their professionalism and caring was evident not only in my treatment, also in the treatment of other patients. Being in a room with multiple treatment stations you cannot help but notice the care received by other patients. My ankle is 100% better and if I ever need PT again I would not hesitate to return. I was always a part of the therapy process, if I had questions they were answered. If I wanted to improve my ankle health at home I was provided clear instructions for exercises. Staff were skilled and knowledgeable. I highly recommend this location to family and friends.

Constance C.

“After my bilateral hip replacement I had a choice where to do my outpatient therapy. I chose to go to Twin Boro because of the positive experience I had there previously. Every staff person I worked with knew what they were doing, were friendly and contributed to a very positive experience for me.”

Wiken

“As a new patient I was a little nervous of not knowing what to expect from Twin Boro. But, since the first day of therapy treatment the staff made me feel like I was home. They really showed how much they care for their patients.”

Leonides

View all Testimonials

We have 23 convenient locations

We love being close to our patients. Find out which of our premier facilities is nearest you!

VIew a list of all locations