Clinical Evidence Handbook

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Osteoarthritis of the Hip



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Am Fam Physician. 2010 Feb 15;81(4):444-445.

This clinical content conforms to AAFP criteria for evidence-based continuing medical education (EB CME). See CME Quiz on page 415.

The hip is the second most common large joint to be affected with osteoarthritis (5 percent of persons older than 60 years, although few will need surgery).

  • Osteoarthritis is characterized by focal areas of damage to the cartilage surface of the bone, with remodeling of the underlying bone and mild synovitis, leading to pain, bony tenderness, and crepitus.

  • Osteoarthritis of the hip seems more likely in persons who are obese; who participate in sporting activities, such as running; or who have occupations requiring a heavy physical workload, such as farming or lifting heavy loads.

Oral nonsteroidal anti-inflammatory drugs (NSAIDs), including cyclooxygenase-2 inhibitors, reduce short-term pain in persons with osteoarthritis of the hip compared with placebo.

  • Long-term benefits of NSAIDs are not known, and they increase the risk of serious gastrointestinal adverse effects, including hemorrhage.

  • We found no evidence on the effects of oral nonopioid analgesics in persons with osteoarthritis of the hip.

  • Combined NSAIDs plus paracetamol may be no more effective than NSAIDs alone.

Chondroitin may reduce pain and improve function in persons with osteoarthritis of the hip, but glucosamine may not be effective in improving pain and function. However, few studies have been performed on these treatments.

The benefits of opioid analgesics, capsaicin, intra-articular injections, acupuncture, education to aid self-management, exercise, and physical aids remain unclear.

Total hip replacement reduces pain and improves function in persons with osteoarthritis of the hip, although we do not know which persons are likely to respond.

We do not know whether arthroscopic debridement, hip resurfacing, or osteotomy is effective in treating osteoarthritis of the hip.

Clinical Questions

What are the effects of nondrug treatments for osteoarthritis of the hip?

Unknown effectiveness

Acupuncture

Education to aid self-management

Exercise

Physical aids

What are the effects of drug treatments for osteoarthritis of the hip?

Beneficial

Oral NSAIDs (including cyclooxygenase-2 inhibitors) for short-term pain relief

Unknown effectiveness

Capsaicin

Chondroitin

Glucosamine

Intra-articular injections (hyaluronan or a corticosteroid)

Nonopioid analgesics (insufficient evidence to assess effects in persons with osteoarthritis of the hip)

Oral NSAIDs plus oral nonopioid analgesics or opioid analgesics (insufficient evidence to assess combination versus either intervention alone)

Opioid analgesics

What are the effects of surgical treatments for osteoarthritis of the hip?

Beneficial

Hip replacement

Unknown effectiveness

Arthroscopic debridement

Hip resurfacing

Osteotomy


NSAIDs = nonsteroidal anti-inflammatory drugs.

Clinical Questions

What are the effects of nondrug treatments for osteoarthritis of the hip?

Unknown effectiveness

Acupuncture

Education to aid self-management

Exercise

Physical aids

What are the effects of drug treatments for osteoarthritis of the hip?

Beneficial

Oral NSAIDs (including cyclooxygenase-2 inhibitors) for short-term pain relief

Unknown effectiveness

Capsaicin

Chondroitin

Glucosamine

Intra-articular injections (hyaluronan or a corticosteroid)

Nonopioid analgesics (insufficient evidence to assess effects in persons with osteoarthritis of the hip)

Oral NSAIDs plus oral nonopioid analgesics or opioid analgesics (insufficient evidence to assess combination versus either intervention alone)

Opioid analgesics

What are the effects of surgical treatments for osteoarthritis of the hip?

Beneficial

Hip replacement

Unknown effectiveness

Arthroscopic debridement

Hip resurfacing

Osteotomy


NSAIDs = nonsteroidal anti-inflammatory drugs.

Definition

Osteoarthritis is a heterogeneous condition for which the prevalence, risk factors, clinical manifestations, and prognosis vary according to the joints affected. It most commonly affects knees, hips, hands, and spinal apophyseal joints. It is characterized by focal areas of damage to the cartilage surfaces of synovial joints, and is associated with remodeling of the underlying bone and mild synovitis.

Osteoarthritis is variously defined by a number of clinical or radiologic features. Clinical features include pain, bony tenderness, and crepitus. When severe, there is often characteristic joint space narrowing and osteophyte formation, with visible sub-chondral bone changes on radiography.

The hip is the second most common large joint to be affected by osteoarthritis. It is associated with significant pain, disability, and impaired quality of life.

Incidence and Prevalence

Osteoarthritis is a common and important cause of pain and disability in older adults. Radiographic features are practically universal in at least some joints in persons older than 60 years, but significant clinical disease probably affects 10 to 20 percent of persons. Hip disease is not as prevalent as knee disease in persons older than 60 years (about 5 percent versus 10 percent). The actual impact that osteoarthritis has on an individual person is the result of a combination of physical (including comorbidities), psychological, cultural, and social factors, and this may influence research outcomes (e.g., if comorbidities are not accounted for in analysis).

Etiology

There is moderate evidence for a positive association between osteoarthritis of the hip and obesity; participation in sporting activities (including running); and vocational activities, particularly those involving a heavy physical workload, such as farming (especially for longer than 10 years) or lifting heavy loads (25 kg [55 lbs] or more). Only limited evidence exists for a positive association between the occurrence of osteoarthritis of the hip and participation in athletics or presence of hip dysplasia in older persons.

Prognosis

The natural history of osteoarthritis of the hip is poorly understood. Only a few persons with clinical disease of the hip will progress to requiring surgery.

Author disclosure: David Scott has received financial support from several pharmaceutical companies for attending international rheumatology conferences; has been involved in educational meetings supported by pharmaceutical companies; and has been an investigator in clinical trials of intra-articular hyaluronic acid, for which his department has received research funding.

editor's note: Paracetamol is called acetaminophen in the United States.

 

search date: May 2007.

Adapted with permission from Scott D. Osteoarthritis of the hip. Clin Evid Handbook. December 2009:398–399. Please visit http://www.clinicalevidence.bmj.com for full text and references.

This is one in a series of chapters excerpted from the Clinical Evidence Handbook, published by the BMJ Publishing Group, London, U.K. The medical information contained herein is the most accurate available at the date of publication. More updated and comprehensive information on this topic may be available in future print editions of the Clinical Evidence Handbook, as well as online at http://www.clinicalevidence.bmj.com (subscription required). Those who receive a complimentary print copy of the Clinical Evidence Handbook from United Health Foundation can gain complimentary online access by registering on the Web site using the ISBN number of their book.

A collection of Clinical Evidence Handbook published in AFP is available at http://www.aafp.org/afp/bmj.


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