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Published by American Academy of Orthopaedic Surgeons · GRADE Evidence-to-Decision Framework
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Key Takeaways
Replaces the first edition completed in 2017. Adopts the GRADE Evidence-to-Decision Framework to incorporate additional factors into the strength of recommendations rather than relying solely on the rigidity of previous AAOS recommendation language stems.
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.
High quality evidence supports either formal physical therapy or unsupervised home exercise after total hip arthroplasty for symptomatic osteoarthritis of the hip.
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.
Intraarticular corticosteroids could be considered to improve function and reduce pain in the short-term for patients with symptomatic osteoarthritis of the hip.
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.
When not contraindicated, oral nonsteroidal anti-inflammatories (NSAIDs) should be used to reduce pain and improve function in the treatment of symptomatic hip osteoarthritis.
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.
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.
Limited evidence suggests that elevated BMI may increase the risk of adverse events in patients undergoing total hip arthroplasty for symptomatic hip osteoarthritis.
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.
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.
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.
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.
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.
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.
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.
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.
Clinical Topic
Osteoarthritis of the Hip
Objectives
To evaluate the current best evidence associated with treatment of symptomatic osteoarthritis of the hip in adults to help practitioners integrate evidence and clinical practice.
Target Patient Population
Adult patients (ages 18 years and older) who have been diagnosed by a trained healthcare provider with OA of the hip and are undergoing treatment.
Target Providers
Therapeutic Area
OrthopaedicsGuideline Scope
Inclusion Criteria
Exclusion Criteria
Care Settings
Special Populations
System: GRADE Evidence-to-Decision Framework
Evidence Distribution
Evidence Levels
Recommendation Strength
Contraindications
Difficulty
advanced
Learning Paths