Osteoarthritis of the Hip and Hip Replacement

Angela in London, England asks:

"I am sixty years old and have been diagnosed as having osteoarthritis of the hip. I would like to put off having a hip replacement for as long as possible. Which exercises will be best for my condition?"

Marc Bernier at the Alabama Sports Medicine and Orthopaedic Center (ASMOC), replies:

"Osteoarthritis of the hip can be a very debilitating condition that significantly restricts the performance of normal activities of daily living. These restrictions are primarily the result of pain which inhibits the ability to bear weight through the involved hip. As the pathology progresses, a subsequent loss of motion can occur which can place more stress on the joint and interferes with the ability to attain certain bodily positions.

"Surgical intervention in the form of a total hip replacement is usually the last option considered, primarily because of the "life expectancy" of the implanted prosthesis. It is generally believed that the prosthesis will last anywhere from 10 to 15 years, depending on the patient's age and activity level. Patients are encouraged to delay the surgery for as long as they can tolerate the pain or until their ability to perform normal activities is significantly compromised; this will minimize the possibility that a revision hip replacement will have to be performed due to a wearing out of the prosthesis.

"Therefore, patients are commonly sent to our facility to educate them on appropriate exercises that can be performed to delay the need for this surgery. In my experience, there are 4 activities that seem to provide the most relief of symptoms:

Gentle hip stretching.
Hip range of motion exercises in non-weight bearing position.
Stationary bicycling.
Aquatic therapy.

Gentle hip stretching

"In patients with osteoarthritis of the hip, there is a progressive decrease in mobility of the hip, which will result in tightness of the muscles surrounding the hip joint. This tightness will result in more pressure being placed on the joint, causing more pain. Gentle hip stretching will alleviate some of this stress, thereby decreasing pain.

"It is important to note that the stretching exercises should be non-painful, and internal rotation of the hip should be avoided due to the joint compression that occurs during this motion. Emphasis can be placed on hamstring stretching, as this can be performed with relative ease as it it usually symptom free.

Hip range of motion exercises

"The performance of pain-free range of motion exercises will help modulate pain from a neural perspective, and will also act as a non-strenuous method of muscular strengthening. These exercises are performed in a standing position with the involved leg in a non weight-bearing position so as to minimize the joint compression that would occur during weight-bearing. The patient should hold lightly onto a fixed object in order to maiantain balance.

"The first exercise is 'Hip Flexion', in which the knee is slowly raised up towards the chest, held for 2-3 seconds, and then slowly lowered. The patient is instructed to raise the leg only as far as they can without pain. The second exercise is 'Hip Abduction', in which the leg is raised out to the side with the knee straight. Once again, this is performed pain-free. The third exercise is 'Pendulums', in which the leg is gently swung forward and back through a very small range. The leg should be relatively relaxed and limp (like a piece of cooked spaghetti) with momentum being responsible for most of the movement.

Stationary bicycling

"Stationary bicycling can be a tremendous benefit for patients with this condition. The cycling motion will also modulate pain, and it will also 'loosen up' the joint which will decrease the patient's symptoms. It is important to note that it is vital that the patient use a bicycle that is comfortable for them, and in patients with advanced arthritis, range of motion restrictions may prohibit use of a bike. It is best to check this with your doctor or physiotherapist.

Aquatic therapy

"The final exercise that is suggested, aquatic therapy, is the most highly encouraged activity for several reasons. Patients are encouraged to obtain a membership to a local pool (preferably an indoor heated pool) where they can perform independent exercises that focus on range of motion and gentle strengthening. Various walking patterns (forward, backwards, side-stepping, high knee walking) and other exercises (knee to chest, cycling, lunges, squatting) are prescribed.

"The reasons this form of exercise is so beneficial are numerous: the heated water helps relax tense muscles; the buoyancy of the water reduces the patients bodyweight, allowing the performance of weight-bearing strengthening exercises; and the ability to perform pain-free exercise that can assist in weight loss (to name a few).

"One last concept that is stressed to patients relates to the ultimate goal of this program. While it has been known on occasion to completely alleviate all symptoms associated with osteoarthritis of the hip, complete resolution of symptoms is not the norm. The more realistic expectation is to help reduce the pain encountered during the day to allow the performance of normal activities as much as possible, and delay the inevitable need for total hip replacement surgery.

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Article published: 15th March 2004