Evidence-based care for hip osteoarthritis gets an update in 2025 Clinical Practice Guidelines

The American Physical Therapy Association (APTA) has released revised clinical practice guidelines for hip osteoarthritis management as an update on their 2017 recommendations based on newer research on the topic. The Physiopedia Hip Osteoarthritis page has recently been updated to include these latest findings.

Hip osteoarthritis affects nearly one in five adults over 55 in the United States, with prevalence rates reaching 8.6% globally. The newly published Hip Pain and Mobility Deficits—Hip Osteoarthritis: Revision 2025 guidelines from the APTA provides updated recommendations based on more recent evidence since 2017.

Notably the new guidelines recommend (citing Strong Evidence) that physiotherapists use manual therapy with soft tissue and joint mobilisation, including high-force and low-force long-axis hip distraction and hip mobilisation with movement, to increase range of motion, decrease pain and improve function. A new recommendation based on Expert Opinion advises modifying manual therapy procedures and force amplitude according to the patient’s bony hip morphology and tissue tolerance or irritability. However, the authors acknowledge that further research is needed on specific techniques for varying degrees of hip arthritis and whether short-term benefits translate to longer-term outcomes.

Exercise prescription receives substantial updates too. Physiotherapists are recommended (citing Strong Evidence) to prescribe an individualised exercise programme , potentially including aquatic therapy, to improve range of movement, strength, function and pain, with doses ranging from one to five times per week, each lasting 30 to 120 minutes, over five to sixteen weeks. This expands the 2017 recommendation, now explicitly including aquatic therapy. Progressive strength training demonstrates superiority over aerobic exercise, with both approaches proving more beneficial than unsupervised home programmes.

A significant addition introduces dry needling as a new evidence-based intervention. Physiotherapists are recommended (citing Strong Evidence) to use dry needling to treat myofascial trigger points in the iliopsoas, rectus femoris, tensor fasciae latae, gluteus medius and gluteus minimus muscles for short-term (3 weeks) improvements in muscle extensibility, pain, range of movement, function and muscle force production in those with grades two and three hip osteoarthritis.  The authors note that whilst short-term effectiveness is established, long-term effects remain unknown, and research exploring its effectiveness when combined with other interventions is needed.

Patient education recommendations (citing Moderate Evidence) expand to include internet-based pain coping skills training combined with exercise and manual therapy, alongside activity modification, exercise guidance, weight reduction support and methods of unloading arthritic joints. The authors acknowledge that research on patient education remains limited since 2017.

Weight management remains in the recommendations, with physiotherapists encouraged (citing Moderate Evidence) to collaborate with physicians, nutritionists or dietitians to support weight reduction in individuals with hip osteoarthritis who are overweight or obese.

The 2025 revision provides new imaging guidance for countries where physiotherapists possess direct referral rights, including the United Kingdom, Ireland, Australia, Norway, Sweden, parts of Canada and several United States jurisdictions, recommending use of American College of Radiology criteria for chronic hip pain.

Conflicting Evidence supports the recommendation that ultrasound may be added to conventional physiotherapy through shared decision-making, and patients should be informed of conflicting evidence on its efficacy and any potential costs.

The revision introduces best practice points for hip examination, recommending at least one self-reported measure and one physical performance measure alongside comprehensive physical impairment measures including hip range of movement and muscle strength for all movement directions. Recommendations for functional, gait and balance training remain unchanged from 2017 (citing Weak Evidence), as no new studies investigated these interventions, highlighting an important evidence gap. Similarly, bracing recommendations remain unchanged and based on Expert Opinion, with bracing not recommended as first-line treatment but potentially considered after exercise or manual therapies prove unsuccessful.

Physiopedia’s Hip Osteoarthritis page has been updated to incorporate these updated recommendations into the information on the page, ensuring physiotherapists worldwide can access current best practice guidance.

As the largest freely accessible rehabilitation knowledge resource globally, Physiopedia remains committed to maintaining excellent quality pages by continuing to update with evolving evidence and clinical practice guidelines. The full Hip Pain and Mobility Deficits—Hip Osteoarthritis: Revision 2025 clinical practice guidelines are available open access too.