Conservative Treatment for Hip OA
With millions of Americans facing hip osteoarthritis (OA) at some point in our lives – 25% of us – it is increasingly important for our healthcare system to focus on treatments that are both cost-effective and provide the best possible patient outcomes. Historically, conservative treatment for hip OA in the US focuses more on painkillers, NSAIDs, and waiting for it to get bad enough to warrant surgery rather than on modern and more effective therapies. Medications do nothing to counter the increasing restrictions of the joint capsule, tightening of muscles around the hips and decreasing mobility and functionality that comes with hip osteoarthritis. If not addressed, these deficits result in decreased activity and exercise leading to further deterioration in a physical condition which becomes a quality of life issue. A downward spiral begins that leaves patients increasingly inactive and more prone to co-morbidities such as heart disease, cancer, diabetes, depression, and addiction. If and when they are candidates for hip replacement surgery, they are in worse condition and health going into the surgery.
Our healthcare system – providers and insurers – is missing the boat here. Manual therapy, therapeutic exercise and patient education is a proven treatment for the signs and symptoms of hip osteoarthritis, providing both pain relief, improved range of motion and improved functional outcomes. The earlier physical therapy is introduced, the easier it is to help these individuals make gains, from both pain management and physical conditioning perspective. Conservative therapy can lead to lower costs for the healthcare system overall. By reducing medical utilization related to hip OA, decreasing lost workdays related to the disease, and decreasing the risk for very expensive co-morbidities, federal and private healthcare costs will be driven down. Get people moving and keep people moving. This is the key to decreasing all of our healthcare costs!
The UK is ahead of us here. In the UK, physical therapy is considered the first approach following a diagnosis of hip osteoarthritis. In the United States, we do have many surgeons and doctors who recognize this, however, the majority of patients seeking help for hip OA are not referred to physical therapy in a timely fashion. Why? The thought is that why send to a PT, there is no cure for hip OA so what can they do? The answer has been around for many decades and has been and continues to be proven in the literature. We do not treat the actual degenerative changes, but rather the signs and symptoms associated with that degeneration. Through manual therapy and therapeutic exercise, we can improve range of motion, create stronger and smarter muscles and improve the mechanics of our hips and legs so that we can unload, and more peacefully co-exist with, the degeneration. This leads to less pain, greater mobility, and a greater quality of life around their hip OA. The patient can work to be in the best shape they can be in when it is time for surgery. It really is a win-win-win situation for all, whether you are an insurance company, surgeon, or patient.
What can you do? As a provider, if you diagnose hip osteoarthritis and the patient is not yet a candidate for surgery, refer those patients to a physical therapist who specializes in manual therapy and therapeutic exercise for hip OA. As a patient, if you’re diagnosed with hip osteoarthritis and told that you are not yet a candidate for surgery, insist on physical therapy. For the rest of us, pass the word on and point anyone who questions it to the literature. You can find selected summaries of the literature here. on www.hiptrac.com/science.
Hip osteoarthritis affects about 30 million individuals in the United States alone. We CAN make a difference. Get people moving and keep people moving!