The American Academy of Orthopaedic Surgeons (AAOS) has released a new clinical practice guideline (CPG) on the treatment of osteoarthritis of the hip .
The guideline does not support the use of glucosamine sulfate or intraarticular hyaluronic acid in the management of patients with hip osteoarthritis, saying available evidence shows neither performed better than placebo at improving function, reducing stiffness and decreasing pain. Instead, the guideline strongly recommends the use of pre-surgical treatments such as corticosteroid injections, physical therapy and non-narcotic medications, to reduce pain and improve function.
In relation to total hip replacement (THR), the AAOS says there are no clinically significant differences in patient-oriented outcomes with the anterior or posterior approach. It does point out that patients with moderate obesity and severe osteoarthritis may achieve poorer THR outcome, but have a similar level of satisfaction and relative improvement in pain and function after THR.
“These patients are still reasonable candidates for a treatment that we know is very effective. The use of risk assessment tools may help inform these patients, and their surgeons, about the potential for increased risk,” said Robert H. Quinn, AAOS Appropriate Use Criteria Section Leader on the Committee on Evidence-Based Quality and Value.