Guideline sources The following summarized guidelines for the management of hip osteoarthritis are prepared by our editorial team based on guidelines from the American College of Rheumatology (ACR/AAHKS 2023), the American College of Rheumatology (ACR 2020), and the American Academy of Orthopaedic Surgeons (AAOS 2017). 1 2 3 Calculator Calculator Gurd and Wilson criteria for fat e Schonfeld's criteria for fat embol Guidelines 1. Medical management Non-opioid analgesics: As per ACR 2020 guidelines: Offer NSAIDs (topical and oral) in patients with hip OA. A https://web.pathway.md/diseases/recLpSfsK5Ex3P8PR 1/5 6/24/23, 12:44 PM Hip osteoarthritis Pathway Consider offering acetaminophen in patients with hip OA. C As per AAOS 2017 guidelines, offer NSAIDs to improve short-term pain, function, or both in patients with symptomatic hip OA. A Opioids: As per ACR 2020 guidelines: Consider offering tramadol in patients with hip OA. C Avoid using non-tramadol opioids in patients with hip OA. Consider offering non-tramadol opioid in certain circumstances, particularly when alternatives have been exhausted. D Duloxetine: consider offering duloxetine in patients with hip OA. C Agents with no evidence for benefit: As per ACR 2020 guidelines: Avoid using the following agents in patients with hip OA: colchicine vitamin D. D Do not use the following agents in patients with hip OA: bisphosphonates glucosamine chondroitin sulfate, and combination products containing glucosamine and chondroitin sulfate hydroxychloroquine methotrexate. D As per AAOS 2017 guidelines, avoid using glucosamine sulfate for improving function, reducing stiffness and decreasing pain in patients with symptomatic hip OA. D 2. Nonpharmacologic interventions Weight loss: advise losing weight in overweight and obese patients with hip OA. A Self-management programs: advise participating in self-efficacy and self-management programs in patients with hip OA. A Physical therapy: As per ACR 2020 guidelines: Advise exercising in patients with hip OA. A Consider advising balance exercises in patients with hip OA. C As per AAOS 2017 guidelines, offer physical therapy to improve function and reduce pain in patients with hip OA with mild-to-moderate symptoms. A Walking canes: advise using walking canes in patients with hip OA if the disease in one or both hips causes a sufficiently large impact on ambulation, joint stability, or pain. A https://web.pathway.md/diseases/recLpSfsK5Ex3P8PR 2/5 6/24/23, 12:44 PM Hip osteoarthritis Pathway Footwear: avoid using modified shoes, lateral and medial wedged insoles in patients with hip OA. D Cognitive behavioral therapy: consider offering CBT in patients with hip OA. C Alternative and complementary therapies: advise practicing Tai chi in patients with hip OA. A Show 2 more 3. Therapeutic procedures Intra-articular corticosteroids: As per ACR 2020 guidelines, administer intra-articular corticosteroid injections in patients with hip OA. A Show 2 more As per AAOS 2017 guidelines, administer intra-articular corticosteroid injections to improve function and reduce short-term pain in patients with symptomatic hip OA. A Other intra-articular injections: As per ACR 2020 guidelines: Avoid administering the following agents intra-articularly in patients with hip OA: botulinum toxin prolotherapy. D Do not administer the following agents intra-articularly in patients with hip OA: hyaluronic acid stem cells TNF inhibitors IL-1 receptor antagonists platelet rich plasma. D As per AAOS 2017 guidelines, do not administer intra-articular hyaluronic acid injections in patients with symptomatic hip OA. D Transcutaneous electrical nerve stimulation: do not perform transcutaneous electrical stimulation in patients with hip OA. D 4. Perioperative care Preoperative risk assessment: consider using risk assessment tools to assist in predicting adverse events, assessing surgical risks and educating patients with symptomatic hip OA undergoing total hip arthroplasty. C Preoperative physical therapy: consider offering preoperative physical therapy to improve early function in patients with symptomatic hip OA after total hip arthroplasty. C https://web.pathway.md/diseases/recLpSfsK5Ex3P8PR 3/5 6/24/23, 12:44 PM Hip osteoarthritis Pathway Intraoperative tranexamic acid: consider administering IV or topical tranexamic acid to reduce blood loss in patients undergoing total hip arthroplasty. C 5. Surgical interventions Total hip arthroplasty (timing): consider performing elective hip arthroplasty without delay, rather than delaying for 3 months, or for a trial of physical therapy, (Low) NSAIDs, intra-articular corticosteroid injections, viscosupplementation injections, or braces and/or ambulatory aids, in patients with radiographically moderate-to-severe OA with moderate-to-severe pain or loss of function eligible for elective total joint arthroplasty decided through a shared decision-making process and completed 1 trial of appropriate nonoperative therapy. (Very low). C Show 4 more Total hip arthroplasty (prognostic factors): Recognize that obesity is associated with the following outcomes in patients with symptomatic hip OA undergoing total hip arthroplasty: lower absolute outcome scores B similar levels of patient satisfaction B relative improvement in pain and function B increased rates of postoperative dislocation, superficial wound infection, and blood loss. B Show 4 more Total hip arthroplasty (surgical approach): recognize that there are no clinically significant differences in patient-oriented outcomes related to the surgical approach in patients with symptomatic hip OA undergoing total hip arthroplasty. B Anesthesia: consider performing neuraxial anesthesia over general anesthesia to reduce the rate of complications in patients with symptomatic hip OA undergoing total hip arthroplasty. C 6. Follow-up and surveillance Postoperative physical therapy: consider offering postoperative physical therapy to improve early function in patients with symptomatic hip OA undergone total hip arthroplasty. C References 1. No authors listed. Management of Osteoarthritis of the Hip: Evidence-Based Clinical Practice Guideline. AAOS. 2017 Mar 13. Open 2. Sharon L Kolasinski, Tuhina Neogi, Marc C Hochberg et al. 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee. Arthritis Care Res Hoboken). 2020 Feb;72 2 149 162. Open 3. American College of Rheumatology, American Association of Hip and Knee Surgeons. 2023 American College of Rheumatology ACR and American Association of Hip and Knee Surgeons AAHKS Clinical https://web.pathway.md/diseases/recLpSfsK5Ex3P8PR 4/5 6/24/23, 12:44 PM Hip osteoarthritis Pathway Practice Guideline for the Optimal Timing of Elective Total Hip or Knee Arthroplasty for Patients with Symptomatic Moderate to Severe Osteoarthritis or Osteonecrosis Who Have Failed Nonoperative Therapy. ACR. 2023 Mar 8. Open https://web.pathway.md/diseases/recLpSfsK5Ex3P8PR 5/5