Conservative Management of Hip Pain

Abstract

Thomas H. Hudgins, MD, and Joseph T. Alleva, MD, MBA cetabular dysplasia and femoral acetabular impingement are thought to e precursors of osteoarthritis. Likewise, disruption of the joint integrity hrough labral tears may also lead to early osteoarthritis. The goal of a omprehensive nonoperative approach to these entities is to restore unction and manage pain. Physical therapy to implement a home xercise program is the cornerstone of conservative care. Strengthening nd flexibility exercises around the hip joint are emphasized. The patient s instructed on a program that addresses his or her biomechanical mbalances. Typically, the patient will have decreased motion in hip exion and hip internal rotation. Therefore, promoting flexibility with hip exor stretches and hip external rotator stretches, such as the piriformis tretch, are part of the program. Strengthening exercises are conducted hrough closed kinetic chain exercises, such as step-ups and lunges, to educe sheer stress on the hip joint and simulate everyday functional asks. After pain is reduced, the patient is advanced to the maintenance hase of rehabilitation with sports-specific training. Oral medications such as nonsteroidal anti-inflammatory drugs NSAIDs) are effective to reduce acute inflammation and provide pain elief. Cox 2 inhibitors are used in patients with risks of gastrointestinal leeding. Acetaminophen (1000 mg 3 times per day) has been shown to e as effective as NSAIDs for pain management while reducing risk of astrointestinal toxicity. Glucosamine–chondroitin has not shown any adiographic improvement of hip osteoarthritis, but may reduce pain. It hould be taken at dosages of 1500 mg daily for 3-6 months for an dequate trial and can be combined with methylsulfonylmethane or hondroitin for additive benefit. Injections have been shown to provide temporary relief and can provide stopgap measure for patients who are not surgical candidates because of omorbidities or are waiting for surgery. Two approaches are generally ccepted, an anterior approach and a lateral approach. The procedures