Hip Osteoarthritis in 2025: What the New Clinical Guideline Means for Primary Care and MSK Pathways
Hip osteoarthritis is one of the most common causes of persistent pain and mobility loss in adults. It’s also a major driver of GP consultations, imaging requests, referrals and surgical pathways across the NHS.
The newly updated 2025 Clinical Practice Guideline for Hip Osteoarthritis, published in the Journal of Orthopaedic & Sports Physical Therapy, brings together the latest research on how clinicians should assess and manage hip OA.
But beyond the clinical detail, the guideline highlights something bigger.
Hip OA is not just a joint problem.
It is a pathway problem.
And primary care has a huge opportunity to manage it better.
Why Hip OA Matters for Primary Care
Hip osteoarthritis affects millions of adults globally and contributes significantly to healthcare utilisation, disability, and reduced quality of life.
In the NHS setting this often looks familiar:
Patients circulate between GP, imaging, orthopaedics and physiotherapy.
Pain persists.
Confidence drops.
And by the time patients reach surgical pathways, many have already lost years of mobility.
The new guideline reinforces a simple message.
Most hip OA should first be managed actively, not passively.
What the 2025 Guideline Actually Says
Several recommendations stand out.
1. Exercise remains the cornerstone of treatment
Individualised strengthening and mobility programmes receive the strongest level of recommendation.
Typical programmes involve progressive loading over 5 to 16 weeks, with sessions one to five times per week.
The goal is simple:
Restore movement
Improve strength
Improve function
This aligns closely with what many MSK clinicians already see in practice.
Movement works.
2. Manual therapy still has a role
The guideline supports joint mobilisation and soft tissue techniques alongside exercise.
These can help improve hip range of motion, reduce pain and improve function in mild to moderate hip OA.
But importantly, manual therapy is not the main treatment.
It supports movement.
3. Weight management and lifestyle matter
For patients with higher BMI, the guideline recommends collaboration with dietitians or medical teams to support weight reduction.
Even modest reductions of 5 to 7.5 percent body weight can improve symptoms and function.
This highlights the importance of integrated care across primary care, physiotherapy and lifestyle services.
4. Some traditional treatments are losing support
One notable update is the downgrading of therapeutic ultrasound, which now shows no meaningful benefit compared with placebo.
In other words, passive modalities alone are unlikely to change outcomes.
Active rehabilitation remains the priority.
What This Means for MSK Pathways
The real value of this guideline is not just clinical.
It challenges how we organise MSK care.
Many patients with hip OA currently move through fragmented pathways involving imaging, referrals and delayed rehabilitation.
Yet the evidence consistently points toward early, structured movement-based care.
This is where Primary Care MSK models such as First Contact Practitioners (FCPs) and Advanced Practice Physiotherapists (APPs) become critical.
When MSK clinicians are embedded in primary care, we can:
• Identify hip OA earlier
• Start rehabilitation earlier
• Reduce unnecessary imaging
• Support patient confidence
• Coordinate lifestyle interventions
The result is often fewer unnecessary referrals and better patient outcomes.
The Bigger Message
The 2025 guideline reinforces something clinicians already know.
Hip osteoarthritis is not simply “wear and tear”.
It is a condition of movement capacity.
Patients need help rebuilding confidence in movement, restoring strength, and staying active in daily life.
That work happens best in the community, not only in specialist clinics.
The HealthPlus Perspective
At HealthPlus we see hip osteoarthritis as a system opportunity.
An opportunity to:
Improve MSK access in primary care
Strengthen collaboration with GPs and PCNs
Focus on early movement-based care
Support community and lifestyle interventions
Because when pathways work well, patients don’t just receive treatment.
They regain mobility, independence and quality of life.
References:
– Koc TA Jr, Cibulka M, Enseki KR, Gentile JT, MacDonald CW, Kollmorgen RC, Martin RL. Hip Pain and Mobility Deficits-Hip Osteoarthritis: Revision 2025. J Orthop Sports Phys Ther. 2025 Nov;55(11):CPG1-CPG31. doi: 10.2519/jospt.2025.0301. PMID: 41165671.
– Hip Osteoarthritis: Guidelines From the American Academy of Orthopaedic Surgeons | AAFP
