Conservative Management of a Young Adult with Hip Arthrosis

Kyle M. Cook, PT1 and Bryan Heiderscheit, PhD, PT2

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The publisher's final edited version of this article is available at J Orthop Sports Phys Ther

Abstract

Study Design

Case report

Background

Clinical practice guidelines regarding the conservative management of degenerative hip conditions in older adults routinely incorporate therapeutic exercise and manual therapy. However, the application of these recommendations to young, active adults is less clear. The purpose of this case report is to describe the management of a young adult with advanced hip arthrosis using a multi-faceted rehabilitation program.

Case Description

A 28-year old female with severe left hip degeneration per diagnostic imaging was referred to physical therapy. Reduced hip range of motion and strength, sacroiliac joint asymmetries, and a modified Harris Hip Score of 76 were observed. She was seen for 12 visits over a 3-month period and treated with an individualized program including manual therapy, therapeutic exercise, and neuromuscular re-education.

Outcome

Substantial improvements were noted in pain, hip range of motion and strength and function (modified Harris Hip Score of 97). In addition, she discontinued the use of anti-inflammatory medications and returned to her prior level of activity. Improvements were maintained at a 3 month follow up, with symptom recurrence managed using a self mobilization technique to the left hip and massage to the left iliopsoas.

Discussion

Degenerative hip conditions are common among older adults but are relatively rare in the younger population. Although it is likely that this patient will experience a return of her symptoms and functional limitations as her hip disease progresses, the immediate improvements may delay the need for eventual surgical management. These outcomes suggest that physical therapy management should be considered in those with an early onset of degenerative hip disease and are consistent with results previously reported in the older population.