Hip Osteoarthritis (Coxarthrosis)

The hip refers its pain to the groin, the front of the thigh and sometimes the knee, so a painful hip is regularly treated as a back or knee problem for months. The signs that point to the hip are stiffness rather than instability, difficulty reaching the foot, a limp that appears with distance, and pain on turning the leg inwards.

By the time the diagnosis is made, the muscles around the joint — the gluteals above all — have usually weakened, and that weakness produces the limp and the back pain that come with it.

Strength in the muscles that control the hip, range of motion, and the way the leg is used in walking and in rising from a chair. Hydrotherapy starts the loading where land exercise is too painful; the functional training system and the gait laboratory take it on from there.

Pain treatments — laser, radiofrequency, and where indicated an image-guided injection — are used to make the exercise possible. They are not the programme.

Hip range, gluteal strength, walking speed and stride, the chair-rise test and a validated hip score, at the start and the end. The gait analysis shows the compensation in the back and the other leg, which is where the next problem would otherwise come from.

The figures are reported whether or not they moved, because a hip that does not improve on a well-delivered programme is a hip that is telling you the timing of surgery.

Hip replacement is one of the most successful operations in medicine 5, and the case for it is made by pain and function, not by the X-ray. When the assessment shows the joint is past conservative treatment, the programme shifts to preparing for surgery: exercise before a replacement improves strength and function afterwards, although the effect fades and is mostly confined to the first six months 4.

Rehabilitation after the operation is described on its own page, and the two can be planned as one journey with a written plan for both halves.

Enough to matter, although the average effect is modest. A Cochrane review found high-quality evidence from nine trials with 549 participants that land-based exercise reduced hip pain by about 8 points on a 0–100 scale and improved function by about 7 points, with one additional person benefiting for every six treated 1. The pain reduction was still present three to six months after supervised treatment ended 1.

Quality of life showed no clear gain, but only three small trials measured it 1. Guidelines also note that supervised programmes tend to work better than exercise done alone at home 3.