Management of Osteoarthritis of the Hip:
Evidence-Based Clinical Practice Guideline
The American Academy of Orthopaedic Surgeons Board of Directors

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.

Quality of Evidence: High                      Strength of Recommendation: Strong


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.

Quality of Evidence: High

Strength of Recommendation: Moderate (Downgraded)


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.

Quality of Evidence: High

Strength of Recommendation: Moderate (Downgraded)



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.

Quality of Evidence: High

Strength of Recommendation: Moderate (Downgraded)
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.
Quality of Evidence: High          Strength of Recommendation: Strong

 

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.

Quality of Evidence: High

Strength of Recommendation: Strong


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.

Quality of Evidence: Low

Strength of Option: Moderate (Upgraded)


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.

Quality of Evidence: High

Strength of Recommendation: Moderate (Downgraded)

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.

Quality of Evidence: Low

Strength of Option: Limited

 

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.

Quality of Evidence: Low

Strength of Option: Limited

 

 

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.

Quality of Evidence: Consensus

Strength of Option: Consensus


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.

Quality of Evidence: Low

Strength of Option: Limited

 

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.

Quality of Evidence: Low

Strength of Option: Limited

 

 

 

 

 

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.

Quality of Evidence: Consensus

Strength of Option: Consensus

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.

Quality of Evidence: Low

Strength of Option: Consensus  (Downgraded)

NEURAXIAL VS. GENERAL ANESTHESIA

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.

Quality of Evidence: Low

Strength of Option: Limited

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.

Quality of Evidence: Low

Strength of Option: Limited

 

 

 

References:
The American Academy of Orthopaedic Surgeons Board of Directors December 1, 2023