Osteoarthritis (OA) is the tenth most common problem in general practise and is self-reported in 7.3% of the Australian population. Due to the proportional increase in the older population, this figure is set to rise increasing the burden on the individual and the community (National Health and Medical Research Council, 2009).
Due to limited OA studies for the hip, some studies looking at OA of the knee have been included. Berman, Lao, Greene, Anderson, Wong, Langenberg, et al. (1995) looked knee OA and patients had significant reductions in both WOMAN score [see appendix 2] and Lequesne index (Osteoarthritis Research Society International, 2012). 7 patients responded so well, they did not want an operation. Witt, Brinkhaus, Jena, Linde, Streng, Wagenpfeil, et al. (2005) studied knee OA in a well-conducted trial concluded that pain and joint function improved with acupuncture after 8 weeks of treatment over minimal or no acupuncture. Witt, Jena, Brinkhaus, Liecker, Wegscheider, and Willich (2006) also showed that acupuncture along with routine care was associated with a clinical improvement for chronic OA associated pain of the knee or hip. Ahsin, Saleem, Manzoor Bhatti, Iles, and Aslam (2009) showed an improvement to knee OA using electro-acupuncture (EA).
The review by Manheimer, Cheng, Linde, Lao, Yoo, Wieland, et al. (2010) looked at a study by Stener-Victorin, Kruse-Smidje, and Jung (2002) covering 3 types of treatment; EA, hydrotherapy and a patient education group which had low follow up numbers. Overall conclusion was that “EA and hydrotherapy, both in combination with patient education, offer clear advantages for patients with hip pain caused by…as shown by reduced pain, increased function, and increased quality of life.”
Kwon, Pittler, and Ernst (2006) also conducted a systematic review of the treatment of OA with acupuncture and concluded that it was considered favourable due to its safety profile and is worth considering. Linde, Weidenhammer, Streng, Hoppe, and Melchart (2006) did a large uncontrolled observational study of acupuncture treatment for OA for the knee and hip. Of the 70 patients suffering from OA of the hip, it was found that stiffness and function in the hip improved. The German statutory sickness fund has included acupuncture as a routine medical option in the treatment of pain for OA of the knee.
The conservative treatments presented do not reliably inform us of their efficacy from current research, yet may play a role in the reduction of pain and the improvement of function and mobility in patients with OA. Interestingly, Zhang, Moskowitz, Nuki, Abramson, Altman, Arden, et al. (2008) notes that in their systematic review to develop clear clinical guidelines, there was no significant difference in outcomes for the use of non-pharmacological therapies or pharmacological therapies.
Aquatic Exercise has “gold level evidence that for OA of the hip or knee…slightly reduced pain and improves function over 3 months” (Bartels, LundHagen Kåre, Dagfinrud, Christensen, & Danneskiold-Samsøe, 2009). Bennell & Hinman (2011) mentioned aquatic exercise as improving pain and function in people with OA. Some research suggests Tai Chi may offer a small improvement in pain and disability for arthritis (Hall, Maher, Latimer, Ferreira, 2009).