What are the AAOS recommendations for the treatment of hip osteoarthritis (OA)?

Updated: Jun 10, 2020
  • Author: Carlos J Lozada, MD; Chief Editor: Herbert S Diamond, MD  more...
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Answer

A 2017 guideline on management of hip osteoarthritis from the American Academy of Orthopaedic Surgeons (AAOS) place an emphasis on presurgical treatments to reduce pain and increase mobility and also highlight patient populations who may have greater risk associated with hip replacement surgery. [155] The guidelines found moderate strength evidence for the following risk issues [156] :

  • Practitioners may use risk assessment tools for predicting complications, assessing surgical risks, and educating patients about receiving total hip arthroplasty.

  • Obese patients may have lower absolute outcome scores, but similar levels of satisfaction and improvement in pain and function after total hip replacement compared with nonobese patients.

  • Increased age is associated with lower functional and quality-of-life outcomes after total hip replacement.

  • Mental health disorders, including depression, anxiety, and psychosis, are associated with decreased function, pain relief, and quality of life after total hip replacement.

The AAOS found strong evidence regarding the following management approaches [156] :

  • Nonnarcotic medications: Nonsteroidal anti-inflammatory drugs (NSAIDs) improve short-term pain, function, or both.
  • Corticosteroid injections provide short-term improvements in function and pain.
  • Hyaluronic acid injections are no better than placebo for improving function, stiffness, and pain.
  • Physical therapy improves function and decreases pain in mild to moderate hip osteoarthritis.

There was moderate strength evidence for the following [156] :

  • Postoperative physical therapy improves early function more than no physical therapy.
  • Glucosamine sulfate is no better than placebo for improving function, reducing stiffness, and decreasing pain.
  • Practitioners may use intravenous or topical tranexamic acid to reduce blood loss associated with total hip replacement surgery.
  • There are no clinically significant differences in patient-oriented outcomes for anterior vs posterior approaches in total hip replacement.

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