Clinical Practice Guideline Recommends Conservative Treatment for Hip OA Patients
A new clinical practice guideline (CPG) on the treatment of osteoarthritis of the hip from the American Academy of Orthopaedic Surgeons (AAOS) strongly recommends the use of conservative treatments to ease pain and improve mobility prior to total hip arthroplasty (THA), including intra-articular corticosteroid injections, physical therapy, and non-opioid medications.
The CPG does not recommend the use of hyaluronic acid or glucosamine sulfate to minimize osteoarthritis symptoms due to a lack of evidence supporting the efficacy of these treatments.
In addition, the CPG Work Group on the Treatment of Osteoarthritis of the Hip found no clinically significant differences in patient-oriented outcomes related to the surgical approach to THA.
The CPG Work Group also looked at various patient-related factors that could negatively impact outcomes of THA. They found the following:
- Patients with moderate obesity (a body mass index greater than 30) and severe osteoarthritis of the hip may have lower outcome scores following THA compared with non-obese patients. However, these patients have a similar level of satisfaction and relative improvement in pain and function after surgery.
- The evidence that patients who use tobacco products are at an increased risk for complications after THA is limited.
- Age was moderately associated with lower function and quality of life outcomes.
- Mental health disorders (depression, anxiety and psychosis) were associated with decreased function, pain relief and quality of life following surgery.
“These patients are still reasonable candidates for a treatment that we know is very effective,” said Robert H. Quinn, MD, AAOS Appropriate Use Criteria (AUC) Section Leader on the Committee on Evidence-Based Quality and Value.
“The use of risk assessment tools may help inform these patients, and their surgeons, about the potential for increased risk.”
Gregory Polkowski, MD, chair of the CPG Work Group on the Treatment of Osteoarthritis of the Hip, added that, “These topics were included in this CPG to establish current levels of evidence, and to highlight that future research needs to be conducted in these areas to better determine specifically how preoperative risk modification may affect the outcome of total hip arthroplasty surgery.”
With strong or moderate evidence, the CPG recommends:
- The use of risk assessment tools to assist in predicting patient complications, assessing surgical risks, and educating osteoarthritis patients who are undergoing THA.
- The use of corticosteroid injections to improve function and reduce pain “in the short-term” for patients with osteoarthritis of the hip.
- Physical therapy as a conservative treatment to reduce pain in patients with mild to moderate osteoarthritis of the hip.
- The use of non-opioid medications and, specifically, non-steroidal anti-inflammatory drugs, to improve short-term pain, function, or both in patients with symptomatic osteoarthritis of the hip.
- Postoperative physical therapy to improve early function in THA patients.
- The use of tranexamic acid, injected or administered at the surgical site, to minimize blood loss following THA.
Management of Osteoarthritis of the Hip: Evidence-Based Clinical Practice Guideline, published by the American Academy of Orthopaedic Surgeons, March 13, 2017.