Hip Osteoarthritis: Assessment, Shared Decisions and Exercise-Based Care

Clinical pattern and assessment

• Hip OA often presents with activity-related groin/anterior-thigh pain, stiffness after rest and reduced internal rotation or flexion; buttock or knee symptoms may occur. No single finding confirms it.
• Ask about onset, irritability, walking, stairs, sleep, falls and goals. Assess gait, functional tasks, hip range/strength and lumbar, knee or neurological contributors.
• Consider lumbar referral, greater trochanteric pain syndrome, fracture or inflammatory disease if atypical. Suspected fracture, systemic illness with a hot joint, rapid deterioration or constitutional symptoms require medical assessment.

Outcome measures

Choose measures linked to goals: pain during a meaningful task, Patient-Specific Functional Scale, timed up-and-go, 30-second chair stand, HOOS or WOMAC. Repeat consistently and interpret change with the person's report.

Management and progression

• Agree goals and explain that imaging changes do not determine disability by themselves. Exercise and self-management are core care; weight-management support may be relevant.
• A starting template may be 2–3 strength sessions weekly, 1–3 sets of 8–12 controlled repetitions, adjusted to capacity and irritability. Combine strengthening with tolerable aerobic activity and task practice; progress one variable at a time.
• Persistent flare or sustained functional decline prompts dose review and reconsideration of the diagnosis. Manual therapy should not replace exercise.

Clinical summary

• Treat the clinical pattern, not an X-ray alone.
• Use red flags to challenge the working diagnosis.
• Track meaningful function and discuss medical review if disability remains substantial despite appropriate care.