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Guideline for the management of knee and hip osteoarthritis

Summary of recommendations

Conditional recommendations for the intervention

Cognitive behavioural therapy (CBT) – Knee and/or hip

Recommendation

It may be appropriate to offer CBT for some people with knee and/or hip OA

Clinicians should consider whether CBT is appropriate, taking into account psychological comorbidities and personal preference. They should be cognisant of issues related to cost and access. It is recommended that CBT is combined with exercise to improve outcomes. CBT may be offered face-to-face or via online programs

Strength of recommendation

Conditional for recommendation

Quality of evidence

Low (knee)
Very low (hip)

Refer to full recommendation 

Stationary cycling and Hatha yoga – Knee

Recommendation

It may be appropriate to offer stationary cycling and/or Hatha yoga for some people with knee OA

Exercise has also been found to be beneficial for other comorbidities and overall health

Clinicians should prescribe an individualised exercise program, taking into account the person’s preference, capability and the availability of resources and local facilities. Realistic goals should be set. Dosage should be progressed with full consideration given to the frequency, duration and intensity of exercise sessions, number of sessions, and the period over which sessions should occur

Attention should be paid to strategies to optimise adherence. Referral to an exercise professional to assist with exercise prescription and to provide supervision either in person or remotely may be appropriate for some people

Strength of recommendation

Conditional for recommendation

Quality of evidence

Aquatic exercise/ hydrotherapy – Knee and/or hip

Recommendation

It may be appropriate to offer aquatic exercise/ hydrotherapy for some people with knee and/or hip OA. This will depend upon personal preference and the availability of local facilities

Strength of recommendation

Conditional for recommendation

Quality of evidence

Massage therapy – Knee and/or hip

Recommendation

It may be appropriate to offer a short course of massage therapy for some people with knee and/or hip OA. This should be considered only as an adjunctive treatment to enable engagement with active management strategies, and only for short term, cognisant of issues related to cost and access

Strength of recommendation

Conditional for recommendation

Quality of evidence

Weight management plus exercise – Knee and/or hip

Recommendation

It may be appropriate to offer a combination of weight management plus exercise for some people with knee and/or hip OA. For those who are overweight (BMI ≥25 kg/m2 ) or obese (BMI ≥30 kg/m2 ), a minimum weight loss target of 5–7.5% of body weight is recommended. It is beneficial to achieve a greater amount of weight loss given that a relationship exists between the amount of weight loss and symptomatic benefits. Weight loss should be combined with exercise for greater benefits. For people of healthy body weight, education about the importance of maintaining healthy body weight is essential

Strength of recommendation

Conditional for recommendation (combination weight management plus exercise)

Quality of evidence

Low (knee)
Very low (hip)

Refer to full recommendation 

Heat therapy – Knee and/or hip

Recommendation

It may be appropriate to offer local heat therapy (eg hot packs) as a self-management home strategy for some people with knee and/or hip OA. This should be considered only as an adjunctive treatment

Strength of recommendation

Conditional for recommendation

Quality of evidence

Assistive walking device – Knee and/or hip

Recommendation

It may be appropriate to offer an assistive walking device (eg cane) for some people with knee and/or hip OA, depending on a person’s preference and capability

Strength of recommendation

Conditional for recommendation

Quality of evidence

Low (knee)
Very low (hip)

Refer to full recommendation 

TENS – Knee and/or hip

Recommendation

It may be appropriate to offer TENS that can be used at home for some people with knee and/or hip OA. Clinicians need to provide sufficient instructions on selfuse, and consider individual accessibility and affordability

Strength of recommendation

Conditional for recommendation

Quality of evidence

Very low

Oral NSAIDs including COX-2 inhibitors – Knee and/or hip

Recommendation

It may be appropriate to offer oral NSAIDs for some people with knee and/or hip OA
It might be reasonable to trial oral NSAIDs at the lowest effective dose for a short period, then discontinue use if not effective. Clinicians also need to inform people, monitor and capture adverse events, especially gastrointestinal, renal and cardiovascular, which may be associated with use of NSAIDs

Strength of recommendation

Conditional for recommendation

Quality of evidence

Moderate

Duloxetine – Knee and/or hip

Recommendation

It may be appropriate to offer duloxetine for some people with knee and/or hip OA

Duloxetine currently does not have an indication via the TGA for OA, and should be considered as an investigational medication only. It could be considered for some people with knee and/or hip OA when other forms of pain relief are inadequate

Strength of recommendation

Conditional for recommendation

Quality of evidence

Moderate (knee)
Low (hip)

Corticosteroid injection – Knee and/or hip

Recommendation

It may be appropriate to offer an intra-articular corticosteroid injection for some people with knee and/or hip OA for short-term pain relief Clinicians need to be cautious of the potential harms of repeated use

Strength of recommendation

Conditional for recommendation

Quality of evidence

Very low

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