Osteoarthritis of the hip and knee
EBM Guidelines
Feb 7, 2023 • Latest change Aug 8, 2024
Table of contents
Extract
- Exercise therapy and avoidance of overweight prevent the development of osteoarthritis of the hip and knee and reduce the pain and functional impairment caused by it.
- The efficacy of oral and intra-articular pharmacotherapy for reducing the symptoms of osteoarthritis is uncertain.
- Pharmacotherapy can be used to alleviate the pain caused by osteoarthritis, but long-term pharmacotherapy is associated with adverse effects.
- Surgical treatment can be used if pain is otherwise unmanageable or if osteoarthritis impairs the patient's functional ability significantly.
Linked evidence summaries
- Aquatic exercise appears to have some beneficial short-term effects for patients with hip and/or knee osteoarthritis while no long-term effects have been documented.B
- There is insufficient evidence to determine the effect of different types of intensity of exercise programs in patients with hip or knee osteoarthrosis.D
- Self -management programs may not relieve symptoms in patients with osteoarthritis compared with attention control or usual care.C
- Local cold may improve function of the knee joint in osteoarthritisC
- Transcutaneous electrical nerve stimulation might possibly be effective for pain relief in knee osteoarthritis, although the evidence is insufficient.D
- Mineral baths might possibly have beneficial effects compared to no treatment in patients with osteoarthritis, but the evidence is insufficient.D
- Topical diclofenac and ketoprofen solutions reduce pain better than placebo and equivalent to oral NSAIDs in osteoarthritis with fewer gastrointestinal events but diclofenac may cause skin irritation in some patients. At least some of the substantial placebo effects seen in longer duration studies derive from effects imparted by the NSAID carrier itself.A↑↑
- Arnica gel may improve symptoms of hand osteoarthritis as effectively as a gel containing non-steroidal anti-inflammatory drug, but with no better adverse event profile. Comfrey extract gel might possibly improve pain, and Capsicum extract gel might possibly not improve pain or function.C
- Oral or transdermal non-tramadol opioids have small to moderate short-term beneficial effects on pain and function in patients with osteoarthritis of the hip or knee as compared with placebo. The benefits are, however, outweighed by large increases in the risk of adverse events.A
- Tramadol alone or in combination with acetaminophen appears not to have have clinically important benefit on mean pain or function in people with osteoarthritis, although slightly more people in the tramadol group report an important improvement (defined as 20% or more). Adverse events may cause substantially more participants to stop taking tramadol.B
- Intra-articular corticosteroids may improve pain and function in the treatment of knee osteoarthritis in the short term (up to 6 weeks). Longer term benefits have not been confirmed.C
- Intra-articular hyaluronic acid might possibly have a small but clinically insignificant effect on pain in knee osteoarthritis, but the risk of adverse effects is increased.D
- Oral and intramuscular glucosamine might possibly be more effective than placebo for pain and functional impairment in symptomatic osteoarthritis but the evidence is inconsistent.D
- Chondroitin (alone or in combination with glucosamine) may be better than placebo in improving pain in participants with osteoarthritis (OA) in short-term (less than 6 months) studies.C
- Diacerein may have a minimal beneficial effect in osteoarthritic pain and may slow the progress of osteoarthritis in the hip, but this effect is of questionable clinical relevance. Possibility of severe diarrhoea and liver toxicity limit the use ov diacerein.C
- Oral herbal products like Boswellia serrata and avocado-soyabean unsaponifiables may improve symptoms and reduce pain in patients with osteoarthritis, but the clinical significance and long-term effects are uncertain.C
- Therapeutic exercise programmes can reduce pain and improve physical function among people with symptomatic hip OA.B
- Therapeutic exercise is effective in reducing pain, improving physical function and quality of life for people with osteoarhritis of the knee, but the effect is rather small.A
- Therapeutic ultrasound may be beneficial for patients with osteoarthritis of the knee.C
- Electrical stimulation may have statistically significant effects for pain in patients with osteoarthritis, but the clinical significance of the benefit is uncertain.C
- Arthroscopic debridement appears to have no benefit for undiscriminated knee osteoarthritis.B↓↓
- Joint lavage may not result in a relevant benefit for patients with knee osteoarthritis in terms of pain relief or improvement of function.C
- Valgus high tibial osteotomy (HTO) for medial compartment osteoarthritis of the knee may improve knee function and reduce pain, but there is no evidence whether an osteotomy is more effective than conservative treatment, or which specific surgical technique should be used.C
Search terms
Acetaminophen, Aid, Analgesics, Anti-Inflammatory Agents, Aquatic exercise, Arthrodesis, Arthroplasty, Arthroplasty, Replacement, Assistive device, Exercise, Hip, Knee, M15*, M16*, M17*, Orthopaedics, Osteoarthritis, Osteoarthritis, Hip, Osteoarthritis, Knee, Osteotomy, Physical Therapy Modalities, Physical and rehabilitation medicine, Sports, Surgery, hyaluronate, steroid-injections