AAOS updates hip osteoarthritis clinical management guidelines

The American Academy of Orthopedic Surgeons has issued updated clinical practice guidelines for the management of osteoarthritis of the hip. The guidance will supersede previous guidelines, released in 2017. 

New guidance updates 14 of 23 recommendations for the nonoperative treatment of hip osteoarthritis and offers options surrounding diabetes, BMI and prescription opioid treatment.

"This updated clinical practice guideline provides orthopedic surgeons with the most up to date evidence-based practices that they can use to best treat their patients with osteoarthritis of the hip. It outlines both modifiable risk factors as well as surgical techniques and their impact on postoperative outcomes," Charles Hannon, MD, senior associate consultant at the department of orthopedic surgery at Mayo Clinic and co-chair of the CPG workgroup, said in a Jan. 23 press release sent to Becker's. 

Six updates to know::

1. The recommendation that tranexamic acid should be considered for patients with symptomatic OA of the hip who are undergoing total hip arthroplasty to reduce blood loss and the need for blood transfusions.
2. A recommendation that oral nonsteroidal anti-inflammatories should be used to reduce pain and improve function in the treatment of symptomatic hip OA.
3. A moderate recommendation showing that intraarticular corticosteroids could be considered to improve function and reduce pain in the short term for patients with symptomatic OA of the hip.
4. A recommendation that intraarticular hyaluronic acid should not be considered for treatment of symptomatic OA of the hip as it does not improve function or reduce pain better than placebo.
5. A moderate recommendation for formal postoperative physical therapy or unsupervised home exercise after total hip arthroplasty for symptomatic OA of the hip.
6. A moderate recommendation for the use of cemented femoral stems in patients at risk for fracture such as patients with osteoporosis or elderly females.

The scope of the guidelines include nonsurgical 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, and it does not provide recommendations for surgical interventions less invasive than total hip arthroplasty.