Management of Osteoarthritis of the Hip
Publication Date: December 15, 2023
Last Updated: January 19, 2024
Summary of Recommendations
TRANEXAMIC ACID
High Quality evidence supports that tranexamic acid (TXA) should be considered for patients with symptomatic osteoarthritis of the hip who are undergoing total hip arthroplasty (THA) to reduce blood loss and the need for blood transfusions. (S, S)
2014753
POSTOPERATIVE PHYSICAL THERAPY
High quality evidence supports either formal physical therapy or unsupervised home exercise after total hip arthroplasty for symptomatic osteoarthritis of the hip. (S, M)
2014753
PHYSICAL THERAPY AS CONSERVATIVE TREATMENT
Physical therapy could be considered as a treatment for patients with mild to moderate symptomatic osteoarthritis of the hip to improve function and reduce pain. (S, M)
2014753
INTRAARTICULAR CORTICOSTEROID INJECTION
Intraarticular corticosteroids could be considered to improve function and reduce pain in the short-term for patients with symptomatic osteoarthritis of the hip. (S, M)
2014753
INTRAARTICULAR HYALURONIC ACID
Intraarticular hyaluronic acid should not be considered for treatment of symptomatic osteoarthritis of the hip as it does not improve function or reduce pain better than placebo. (S, S)
2014753
PHARMACOLOGICAL MANAGEMENT: NSAIDs
When not contraindicated, oral nonsteroidal anti-inflammatories (NSAIDs) should be used to reduce pain and improve function in the treatment of symptomatic hip osteoarthritis. (S, S)
2014753
CEMENTED VS. CEMENTLESS FEMORAL FIXATION
Low quality evidence suggests in older adult patients undergoing total hip arthroplasty for symptomatic osteoarthritis, cemented femoral stems could be considered as they are associated with a lower risk of periprosthetic fracture. (L, M)
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EXPOSURE APPROACH
High quality evidence supports that there are specific risks and benefits to each surgical approach and that there is not a preferred surgical approach for patients with symptomatic osteoarthritis of the hip undergoing total hip arthroplasty. (S, M)
2014753
BMI: ADVERSE EVENTS
Limited evidence suggests that elevated BMI may increase the risk of adverse events in patients undergoing total hip arthroplasty for symptomatic hip osteoarthritis. (L, L)
2014753
BMI: CLINICAL OUTCOMES
Limited evidence supports that patients with elevated BMI and symptomatic osteoarthritis of the hip may achieve lower absolute patient reported outcome scores but a similar degree of improvement in patient satisfaction, pain, function, and quality of life after total hip arthroplasty. (L, L)
2014753
PRESCRIPTION OPIOID AS CONSERVATIVE TREATMENT
In the absence of sufficient evidence, it is the opinion of the workgroup that oral opioids not be utilized for nonoperative treatment of symptomatic osteoarthritis of the hip. (C, C)
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DIABETES: ADVERSE EVENTS
Limited evidence suggests that patients with symptomatic osteoarthritis of the hip and poorly controlled diabetes may be at a higher risk for adverse events after total hip arthroplasty. (L, L)
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SOCIAL DETERMINANTS OF HEALTH
Limited evidence suggests that social determinants of health (e.g., education, income level, food desert, insurance type) may negatively impact length of stay, total cost of care, and mortality after total hip arthroplasty. (L, L)
2014753
PHARMACOLOGICAL MANAGEMENT: ACETAMINOPHEN
In the absence of sufficient evidence, it is the opinion of the workgroup that when not contraindicated, oral acetaminophen may be considered to improve pain and function in the treatment of symptomatic osteoarthritis of the hip. (C, C)
2014753
HIP-SPINE RELATIONSHIP
In the absence of sufficient evidence, it is the opinion of the workgroup that patients with osteoarthritis of the hip and stiff spine syndrome may be at increased risk of dislocation after total hip arthroplasty compared to patients without stiff spine syndrome. (L, C)
2014753
NEURAXIAL VS. GENERAL ANAESTHESIA
Limited evidence suggests that neuraxial anesthesia may be used to reduce adverse events in patients with symptomatic osteoarthritis of the hip undergoing total hip arthroplasty. (L, L)
2014753
TOBACCO
Limited evidence suggests that patients with symptomatic osteoarthritis of the hip who use tobacco products may be at an increased risk for adverse events after total hip arthroplasty. (L, L)
2014753
Title
Management of Osteoarthritis of the Hip
Authoring Organization
American Academy of Orthopaedic Surgeons
Publication Month/Year
December 15, 2023
Last Updated Month/Year
January 17, 2024
External Publication Status
Published
Country of Publication
US
Document Objectives
The scope of this guideline includes non-surgical treatment and surgical treatment with total hip arthroplasty of symptomatic OA of the hip. It does not provide recommendations for patients diagnosed with rheumatoid arthritis, OA of other joints, hip dysplasia, or other inflammatory arthropathies. It does not provide recommendations for surgical interventions less invasive than total hip arthroplasty.
Target Patient Population
Adult patients (ages 18 years and older) who have been diagnosed with OA of the hip and are undergoing treatment
Target Provider Population
Orthopaedic surgeons and other healthcare providers managing OA of the hip
Inclusion Criteria
Male, Female, Adult, Older adult
Health Care Settings
Ambulatory, Home health, Long term care, Outpatient
Intended Users
Nurse, nurse practitioner, occupational therapist, physical therapist, physician, physician assistant
Scope
Diagnosis, Assessment and screening, Treatment, Management, Rehabilitation
Diseases/Conditions (MeSH)
D015207 - Osteoarthritis, Hip
Keywords
hip osteoarthritis, total hip arthroplasty (THR), osteoarhtitis
Methodology
Number of Source Documents
192
Literature Search Start Date
June 5, 2015
Literature Search End Date
May 2, 2023