Hip Osteoarthritis: Guidelines From the American Academy of Orthopaedic Surgeons

Osteoarthritis of the hip affects 1 in 14 adults and accounts for 6% of physician clinic visits for osteoarthritis. Patients with hip and knee osteoarthritis have 20% excess mortality compared with age-matched controls. The American Academy of Orthopaedic Surgeons has published guidelines for management of hip osteoarthritis.

Physical Therapy

The American Academy of Orthopaedic Surgeons moderately recommends physical therapy as a treatment for mild to moderate hip osteoarthritis. Approximately one-half of studies demonstrated significant improvement in pain and function over control groups, but no studies suggested physical therapy worsened outcomes. Most studies only looked at a single component of physical therapy, and many failed to stratify patients by severity of arthritis.

Pain Medications

Nonsteroidal anti-inflammatory drugs consistently reduce pain in patients with hip osteoarthritis and are recommended when not contraindicated. Neither the guidelines nor available research supports one nonsteroidal anti-inflammatory drug over others. For patients with chronic kidney disease or cardiac disease, nonsteroidal anti-inflammatory drugs should be avoided. Although acetaminophen has not been studied in hip osteoarthritis, its use can be considered in the absence of liver disease.

Prescription opioids, such as tramadol, have not been studied in hip osteoarthritis, and their use is not recommended based on documented harm.

Injections

Intra-articular corticosteroid injections are moderately recommended because of demonstrated improvement in pain and function for up to 4 months. Corticosteroid injections may improve patient activity levels, satisfaction, and quality of life. The most common risks are infection and rapidly progressing arthritis.

In contrast, intra-articular hyaluronic acid injections should not be considered because studies have consistently shown no improvement in pain or function compared with placebo.

Patient Characteristics Influencing Response

Although obesity may increase the risk of adverse events with total hip arthroplasty (THA), these differences are only seen in higher obesity classes. Although patients with obesity may recover more slowly, have less postoperative physical activity, and achieve lower absolute function and satisfaction, these measures still improve after THA. Limited evidence suggests that poorly controlled diabetes may increase the risk of deep infection after THA.

Limited evidence suggests that current and previous smokers have higher risk of complications with THA, including peri-prosthetic joint infections.

Social determinants of health appear to influence outcomes after THA. Patients with higher socioeconomic status have lower mortality, readmission, length of stay, and complication rates. Patients with higher education levels have lower mortality and readmission rates. Patients cohabitating experience reduced infection, revision, and mortality rates. Rural patients experience increased length of stay and higher rates of dislocation, joint infection, and readmission compared with urban patients.