The patient was a 41-year-old man who was referred to a physical therapist with a chief complaint of right anterior hip/groin pain. The patient’s symptoms started 6 months earlier after dunking a basketball and were exacerbated while moving boxes 4 months later. The patient reported morning stiffness and constant pain that was exacerbated by squatting and prolonged sitting. Right hip range of motion was limited to 85° of flexion and 0° of internal rotation with a painful “pinching” sensation noted in the groin region at end range of motion; these range-of-motion findings were consistent with a clinical diagnosis of hip osteoarthritis. Given the lack of improvement with conservative measures, the patient was referred to an orthopaedic surgeon. Radiographs revealed decreased offset of the femoral head-neck junction, greater on the right than on the left, which is suggestive of cam-type femoral acetabular impingement. Moderate degenerative osteoarthrosis of the right hip was also noted. The patient’s symptoms improved for 3 weeks following a corticosteroid injection, but then returned to baseline. The patient subsequently underwent a Birmingham hip resurfacing procedure. In this patient, conservative management of his hip osteoarthritis may have been complicated by the presence of femoral acetabular impingement.

J Orthop Sports Phys Ther 2011;41(3):201. doi:10.2519/jospt.2011.0406

KEY WORDS: Birmingham hip resurfacing, radiography

Study Design: Case series describing the outcomes of individual patients with hip osteoarthritis treated with manual physical therapy and exercise.
Case Description: Seven patients referred to physical therapy with hip osteoarthritis and/or hip pain were included in this case series. All patients were treated with manual physical therapy followed by exercises to maximize strength and range of motion. Six of 7 patients completed a Harris Hip Score at initial examination and discharge from physical therapy, and 1 patient completed a Global Rating of Change Scale at discharge.
Outcomes: Three males and 4 females with a median age of 62 years (range, 52-80 years) and median duration of symptoms of 9 months (range, 2-60 months) participated in this case series. The median number of physical therapy sessions attended was 5 (range, 4-12). The median increase in total passive range of motion of the hip was 82° (range, 70°-86°). The median improvement on the Harris Hip Score was 25 points (range, 15-38 points). The single patient who completed the Global Rating of Change Scale at discharge reported being ‘‘a great deal better.’’ Numeric pain rating scores decreased by a mean of 5 points (range, 2-7 points) on 0-to-10-point scale.
Discussion: All patients exhibited reductions in pain and increases in passive range of motion, as well as a clinically meaningful improvement in function. Although we cannot infer a cause and effect relationship from a case series, the outcomes with these patients are similar to others reported in the literature that have demonstrated superior clinical outcomes associated with manual physical therapy and exercise for hip osteoarthritis compared to exercise alone.

J Orthop Sports Phys Ther. 2006;36(8):588-599. doi:10.2519/jospt.2006.2233. The original article was corrected in September 2007, and the amended article PDF is provided here. Please see Correction: Altman's criteria for osteoarthritis of the hip and knee. J Orthop Sports Phys Ther. 2007; 37(9):573.

Key Words: arthritis, Harris Hip Score, manipulation, mobilization, passive range of motion