Management of Osteoarthritis of the Hip

Publication Date: December 15, 2023
Last Updated: January 19, 2024

Summary of Recommendations

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. (S, S)
2014753

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. (S, M)
2014753

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. (S, M)
2014753

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. (S, M)
2014753

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. (S, S)
2014753

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. (S, S)
2014753

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. (L, M)
2014753

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. (S, M)
2014753

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. (L, L)
2014753

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. (L, L)
2014753

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. (C, C)
2014753

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. (L, L)
2014753

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. (L, L)
2014753

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. (C, C)
2014753

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. (L, C)
2014753

NEURAXIAL VS. GENERAL ANAESTHESIA

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. (L, L)
2014753

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. (L, L)
2014753

Recommendation Grading

Overview

Title

Management of Osteoarthritis of the Hip

Authoring Organization

American Academy of Orthopaedic Surgeons

Publication Month/Year

December 15, 2023

Last Updated Month/Year

January 17, 2024

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Document Objectives

The scope of this guideline includes non-surgical 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. It does not provide recommendations for surgical interventions less invasive than total hip arthroplasty. 

Target Patient Population

Adult patients (ages 18 years and older) who have been diagnosed with OA of the hip and are undergoing treatment

Target Provider Population

Orthopaedic surgeons and other healthcare providers managing OA of the hip

Inclusion Criteria

Male, Female, Adult, Older adult

Health Care Settings

Ambulatory, Home health, Long term care, Outpatient

Intended Users

Nurse, nurse practitioner, occupational therapist, physical therapist, physician, physician assistant

Scope

Diagnosis, Assessment and screening, Treatment, Management, Rehabilitation

Diseases/Conditions (MeSH)

D015207 - Osteoarthritis, Hip

Keywords

hip osteoarthritis, total hip arthroplasty (THR), osteoarhtitis

Supplemental Methodology Resources

Data Supplement, Methodology Supplement

Methodology

Number of Source Documents
192
Literature Search Start Date
June 5, 2015
Literature Search End Date
May 2, 2023