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I've heard there are some new rules for treating hip arthritis. I have arthritis in my left hip from a bad fall off a horse years ago. I try to keep up with the latest in arthritis treatment. Is there anything in these rules that could help someone like me?

You may be referring to the recently published Clinical Practice Guidelines for physical therapists treating patients with primary or posttraumatic hip osteoarthritis. Although these were written for physical therapists, there's nothing wrong with you taking these to your therapist and asking if you have covered everything in treatment that's appropriate for your situation.

The guidelines are based on evidence from published studies compiled, reviewed, and summarized by a panel of experts. The authors say the guideline will be reviewed again in five years (2013) or sooner if new evidence comes to light. Here's a brief summary of the main points and recommendations given for physical therapists evaluating and treating patients with hip osteoarthritis:

  • Therapists should evaluate hip movement with special tests of the hip abductor muscles.
  • Therapists should assess patients for risk factors for hip osteoarthritis including age, developmental disorders, and previous hip joint injuries.
  • Patients with hip osteoarthritis have the following history and/or symptoms: pain along the front and/or side of the hip when putting weight on the leg. Age over 50. Morning stiffness lasting less than one hour (gets better with movement). Hip motions that are limited include internal rotation and flexion. Compare the involved side with the other nonpainful side. More than a 15-degree difference is significant.
  • Two good tests to use before and after treatment to measure results should include the Western Ontario and McMaster Universities Osteoarthritis Index and the Harris Hip Score. These are valid tests of functional outcomes. Other useful tests of physical performance include the 6-minute walk, timed up-and-go test, self-paced walk, and stair measure.
  • Evidence supports the importance of patient education about exercise, weight loss, activity modification, and balance training.
  • Manual therapy can help provide short-term pain relief and improve hip motion for patients with mild hip osteoarthritis. This treatment approach helps improve mobility and function.
    • Reference: 

    Michael T. Cibulka, DPT, et al. Hip Pain and Mobility Deficits - Hip Osteoarthritis. Clinical Practice Guidelines Linked to the International Classification of Functioning, Disability, and Health from the Orthopaedic Section of the American Physical Therapy Association. In Journal of Orthopaedic & Sports Physical Therapy. April 2009. Vol. 39. No. 4. Pp. A1-A25.

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