Guideline for the management of knee and hip osteoarthritis

Summary: Plain language

What is osteoarthritis?

Osteoarthritis (OA) is a chronic disease and the most common form of chronic arthritis. It is characterised by joint pain, stiffness and swelling, and mainly affects the hands, knees and hips. OA most frequently occurs in people aged >55 years, although younger people can also be affected. Risk factors for OA include joint injury, being overweight or obese, and older age. As the population ages, and increased rates of obesity, the number of Australians with OA is expected to rise from 2.2 million in 2015 to almost 3.1 million by 2030.

There is currently no cure for OA, but there are many treatments and approaches to managing the long-term symptoms of this disease. General practitioners (GPs) are often the first point of contact in the healthcare system for a person with OA. This guideline provides Australian GPs with advice and recommendations for the management of people with knee  and/or hip OA. The guideline has a strong focus on self-management and non-surgical treatments to improve the health of people with knee and/or hip OA. A summary of the key recommendations are below:

  • Regular exercise is important for relieving pain and improving function in people with knee and/or hip OA. For knee OA, land-based exercise such as muscle strengthening exercises, walking and Tai Chi are strongly recommended. Other land-based exercise that could be considered for some people with knee OA include stationary cycling and Hatha yoga. The best land-based exercise for people with hip OA could not be determined because of limited research. Aquatic exercise may be considered for some people with knee  and/or hip OA.
  • Weight management is strongly recommended for people with knee and/or hip OA who are overweight or obese.
  • Cognitive behavioural therapy (CBT) could be considered for some people, particularly in conjunction with exercise, and taking into account existing mental health conditions, personal preference, cost and access.
  • Heat packs or hot water bottles may be applied as a self-management strategy.
  • Using a cane or other devices (eg walker, crutches) may be appropriate for some people with knee and/or hip OA to help improve pain, mobility and balance.
  • A short course of manual therapy or massage could be considered for some people with knee and/or hip OA as an adjunct to lifestyle management.
  • Transcutaneous electrical nerve stimulation (TENS) that can be used at home may be appropriate for some people with knee and/or hip OA.
  • There is a conditional recommendation against the following treatments (refer to Section 3. Recommendations for an explanation on conditional recommendation)
    • therapeutic ultrasound
    • shockwave therapy
    • laser therapy
    • interferential therapy
    • footwear marketed for knee OA
    • cold therapy
    • valgus braces and lateral wedge insoles for medial knee OA
    • patellofemoral braces – kinesio taping.
  • Due to a lack of high-quality evidence, no recommendation can be made for the following
    • formal self-management programs
    • varus unloading braces and medial wedge insoles for lateral knee OA
    • shock-absorbing insoles
    • arch supports
    • patellar taping
    • pulsed electromagnetic/shortwave therapy.
  • Nonsteroidal anti-inflammatory drugs (NSAIDs; eg ibuprofen), taken orally at low doses for short periods are recommended for some people with knee and/or hip OA. Monitoring for possible adverse effects of the drugs is necessary.
  • Although there is no recommendation either for or against NSAIDs applied locally to the skin, it may be reasonable to trial topical NSAIDs for a short period, with monitoring of possible adverse effects, then discontinue use if not effective.
  • Although there is no recommendation either for or against paracetamol, it may be reasonable to trial paracetamol for a short period in some people with knee and/or hip OA, with monitoring of possible adverse effects, then discontinue use if not effective.
  • Corticosteroid injections could be offered for short-term symptom relief for some people with knee and/or hip OA, but care should be taken with repeated injections because of potential harm.
  • Duloxetine could be considered for some people with knee and/or hip OA when other forms of pain relief are inadequate.
  • There is a strong recommendation against the use of the following
    • oral and transdermal opioids
    • viscosupplementation injection for hip OA
    • doxycycline
    • strontium ranelate
    • interleukin-1 (IL-1) inhibitors – stem cell therapy.
  • There is a conditional recommendation against the use of the following
    • capsaicin for knee and/or hip OA
    • bisphosphonates
    • calcitonin
    • anti-nerve growth factor (NGF)
    • colchicine
    • methotrexate
    • viscosupplementation injection for knee OA
    • dextrose prolotherapy
    • omega 3 fatty acids – diacerein.
  • Due to a lack of high-quality evidence, no recommendation can be made for the following
    • injections of platelet-rich plasma (PRP)
    • nonsteroidal anti-inflammatory creams applied locally
    • capsaicin for hip OA
    • collagen
    • methylsulfonylmethane.
  • The following complementary and alternative therapies should not be offered
    • glucosamine and chondroitin nutraceuticals
    • vitamin D
    • acupuncture.
  • Due to a lack of high-quality evidence, no recommendations can be made about the following herbal supplements
    • avocado/soybean unsaponifiables (ASU)
    • Indian frankincense (Boswellia serrata extract)
    • turmeric
    • pine bark extract.

There is a strong recommendation against surgery such as arthroscopic lavage and debridement, meniscectomy and cartilage repair for people with knee OA, unless the person also has signs and symptoms of a ‘locked knee’.

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