Thus therapists should be mindful of the effects of cane use on the ipsilateral side particularly if the patient has bilateral symptoms. A recent case series found that although initial use of a cane led to decreased gait velocity and cadence in people

with hip osteoarthritis compared to walking unaided, these were restored after practice. However, there was no significant improvement in hip pain and function with four weeks of cane use, although inconsistent use may have contributed to this lack of benefit (Fang et al 2012). Patient education pointing out the value of a gait aid in improving function and reducing load at the hip joint may assist with adherence. Being overweight or obese may be a risk factor for hip osteoarthritis (Jiang et al 2011). Greater body weight could have detrimental effects on joint structure by placing Selleckchem PD0325901 additional loads on the lower limb during walking and other daily activities as well as via general increases in substances that can directly degrade the joint or increase joint inflammation (Vincent et al 2012). Weight loss is recommended for those with lower limb osteoarthritis who are overweight or obese, S3I-201 in vivo generally defined as a body mass index > 25 kg/m2 (Hochberg et al 2012, Zhang et al 2005). There are no randomised trials of weight loss interventions in people with hip osteoarthritis. However, a recent prospective cohort study found that an 8-month combined intervention

of exercise and dietary weight loss resulted in a 33% improvement in self-reported physical function as well as reduced pain (Paans et al 2013). This provides preliminary evidence that exercise and weight loss combined are effective in people with hip osteoarthritis. While the amount of weight loss needed for clinical benefits is unknown, based on a limited number of trials in knee osteoarthritis,

patients should reduce body weight by at least 5% using a combination of diet and exercise (Christensen et al 2007). The Ottawa Panel guidelines specifically recommend reducing weight prior to the implementation of weight-bearing exercise in order to maintain joint integrity and to avoid joint dysfunction (Brosseau et Bay 11-7085 al 2011). Incorporating weight management interventions into the management of osteoarthritis is challenging as it requires considerable time and effort on behalf of both the patient and the health provider. Furthermore, to be effective, the health provider needs to be cognisant of behavioural change techniques. Given the complexity of weight loss, physiotherapists should work with an interdisciplinary team including dietitians who have expertise in this area. Carrying loads increases the demands on the hip abductor muscles and consequently increases hip joint loading. Minimising the amount to be carried reduces load on the hip, as does carrying the item in the ipsilateral arm relative to the affected hip (Neumann 1999).