Hip Arthritis Non-Operative Treatment

When we think of lifestyle changes in the context of hip arthritis, there are three categories to consider: activity modification, weight loss, and exercise.

1. Activity modification: Activities that accelerate cartilage breakdown and further stress the hip joint are repetitive high-impact activities. So for patients with lower extremity arthritis in the hip, knee, or even the ankle, refraining from excessive running or explosive jumping or plyometric activities can help limit the extent of further cartilage breakdown in the joint. Conversely, the best activities for the hip joint are low-impact but high-motion activities. So swimming, cycling, elliptical use, and gentle walking are all examples of excellent low impact but high benefit/high motion exercises that keep the joint lubricated and healthy.
2. Ensuring a healthy weight: Weight loss is very important to help protect the cartilage from excessive load. While this is not an easy journey for many patients and losing weight is a sensitive topic, even a modest 5-10% weight loss can significantly improve symptoms, enhance quality of life, and slow down the progression of further joint deterioration. The focus of counseling patients on weight loss is not to be judgmental but to try to encourage them to get their best outcome. In order to achieve this, weight loss may take a combination of lifestyle changes, working with a nutritionist, and working with their primary care provider to see if medical therapies may be appropriate, such as GLP-1 agonists (ex. Ozempic) and even considering surgical options such as gastric bypass. All of these should be thoughtfully considered when a patient is trying to lose weight as the goal is not just to prevent further cartilage deterioration but to also reduce the risk of serious complications if the patient later in life decides to undergo a hip replacement surgery.
3. Strength and motion: Physical therapy and exercise can be very beneficial for the hip joint in the context of hip arthritis. Focusing on core strengthening as well as strengthening of the hip abductors, hip flexors, and hip extensors are very important to help decrease the strain on the joint. A professional physical therapist that provides a focused assessment and progression of the patient has improved the overall health of the joint and can be very helpful for some patients. Aquatic therapy can also be very beneficial for patients as they can remain active and improve their overall strength and flexibility, but avoid excessive joint load on the hip. Many patients have found aquatic therapy to be beneficial on their journey.

Medications can be very helpful when reducing inflammation and controlling pain ni patients with hip arthritis. Examples include

1. Acetaminophen (Tylenol): This medication can be helpful in providing mild pain control and for most patients, up to 3,000 milligrams of Tylenol a day is safe for most patients to take barring serious liver issues. However, Tylenol does not provide any significant anti-inflammatory effect but purely controls pain
2. Non-steroidal anti-inflammatory drugs (NSAIDs): With NSAIDs, many patients are familiar with ibuprofen or naproxen which belong to this class and are helpful not only for pain control but also for reducing inflammation within the joint due to the cartilage breakdown. As a word of caution, are risks with taking NSAIDs for an extended period of time including damage to the GI tract such as peptic ulcers, exacerbation of kidney disease, and cardiovascular risks especially in those with previous heart procedures such as stents or bypasses. In light of these, if a patient has any of these conditions they should be discussed with their primary care provider before proceeding with using them. However, when used judiciously and in a medically safe manner, the combination of Tylenol and NSAIDs can be very beneficial for patients in reducing inflammation
3. Topical agents: Topical medications such as Voltaren or even Lidocaine patches can provide local and targeted relief of hip arthritis.

When we think about assistive devices in the context of hip arthritis, there are several options. Many patients can find benefit from the proper use of a cane or rolling walker that helps distribute stress off the hip joint to other areas of the body. Additionally, for patients who have a difference in leg lengths or pelvic obliquity, the use of shoe inserts to equalize leg lengths or orthotics to control ankle motion can be helpful to normalize their gait and prevent falls.

When considering alternative therapies, there is mixed and limited evidence regarding the use of adjuncts such as heat therapy, cold therapy, TENS units, acupuncture, and nutritional supplements such as glucosamine or chondroitin sulfate or turmeric. But as these options are of very low risk, they are an option patients can consider as part of a multi-modal strategy to non-operatively treat their hip arthritis.