Clinical diagnosis is based on the patient's history and physical exam:

• Persistent activity-related joint pain in one or more joints

• Age greater than 45 years

• Morning stiffness less than 30 minutes in duration

Examination of the suspected joint may demonstrate mild tenderness to palpation, usually without evidence of inflammation. Crepitus, bony enlargement, decreased range of motion, joint effusion, and osteophytes along the periphery of the joint may be detectable.

Synovial fluid analysis, serum inflammatory markers, and joint radiographs can be used to assist in diagnosis

Typical features seen on radiographs include joint space narrowing, subchondral sclerosis, osteophytes at the periphery of joints, and subchondral cysts.

The Kellgren and Lawrence (KL) classification is a common method of classifying the severity of OA based on the presence of joint space narrowing and osteophytes

This case focused on an elderly male patient with multiple comorbidities as a candidate for an exercise program designed for improvement in hip osteoarthritis

In addition to weight loss, the patient showed marked improvement in the strength and use of the affected leg

With proper education and supervision, osteoarthritis can be improved in patients by the use of daily exercise, even if complex comorbidities are present

Wainwright, T. W., Immins, T., & Middleton, R. G. (2015). Hip osteoarthritis: patients with complex comorbidities can make exceptional improvements following intensive exercise and education. BMJ case reports, 2015, bcr2014208529. https://doi.org/10.1136/bcr-2014-208529

Inaba, M., & Ranganathan, P. (n.d.). Osteoarthritis. Washington Manual, 11(Rheumatology), 1–11.

The patient’s Oxford hip score and HOOS function values before and after treatment showed empiric improvement in the above figure.

The patient stated he felt markedly better after the six week program, and he continued to be physically active at home due to his success in regaining strength and range of motion in the affected hip.

Despite complex comorbidities, physicians should still evaluate an exercise plan for patients that is geared towards their abilities.

Exercise proves beneficial, not only in the relief of arthropathies, but also in the improvement of the patient’s other coexisting disorders. 

This patient underwent the “CHAIN” program: “Cycling against Hip PAIN”, consisting of a weekly one hour group session (thirty minutes of education/advice and thirty minutes of static cycling) for six weeks

• An additional home-based cycling and exercise program was implemented

• Education sessions discussed cycling technique, diet and pain relief

Due to the patient’s underlying conditions, the patient required additional time and education for optimal posturing on the bike and breathing control techniques

After evaluating this approach as a team, we agreed that physicians can undermine the importance of exercise with any treatment of diseases, especially chronic ones. Even those this patient was presented with the "complexity" of comorbidities, the patient's overall health improved with this exercise program, not only the goal of improving the patient's OA symptoms/difficulties.

National Institute for Health and Care Excellence (NICE) guidelines for all patients:

• Education, advice and access to information

• Exercise: muscle strengthening and aerobic fitness training

• Weight loss if overweight or obese

After completing the basic guideline, some patients may benefit from drugs or injections, but very few need surgery.