Abstract
Objective
To compare guideline recommendations for hip and knee osteoarthritis (OA) and their
level of evidence.
Data Sources
MEDLINE, Embase, the Cochrane Library, and websites of professional societies were
searched in June 2020 using keywords such as knee or hip osteoarthritis, degenerative
arthritis, guideline, and practice guideline.
Study Selection
General treatment guidelines for OA of the hip or knee published in English. After
461 abstracts were screened, 31 publications (17 guidelines from 10 professional societies)
were included for analysis.
Data Extraction
Three reviewers assessed the quality of the guidelines according to the Appraisal
of Guidelines for Research and Evaluation II tool. The rating of evidence and strength
of recommendation was extracted and standardized into the Grading of Recommendations
Assessment, Development, and Evaluation criteria.
Data Synthesis
Of the 17 guidelines included, 6 (35%) were of high quality, 10 (59%) of moderate
quality, and 1 (6%) of low quality. Guidelines published after 2017 were of good quality.
Although guidelines generally agreed on a nonsurgical multimodal concept, including
patient education, exercise, and weight loss in obese, some recommendations remained
vague and the level of evidence varied widely. In pharmacologic treatment, oral nonsteroidal
anti-inflammatory drugs were the mainstay for pain management. Guidelines published
after 2017 were more cautious in their recommendation for the use of paracetamol and
strong opioids. Disagreement was observed for chondroitin sulfate, glucosamine, and
intra-articular hyaluronic acid injections. Recommendations were conflicting for the
use of insoles, braces, and transcutaneous electrical stimulation. The main indications
for hip/knee arthroplasty were severe, persisting pain and loss of function despite
nonsurgical treatment. No guideline defined a minimum time of conservative treatment
before surgery.
Conclusions
We found a wide variation in evidence and strength of recommendations for OA treatment.
Recommendations on when to refer patients for surgery remained unclear.
Keywords
List of abbreviations:
AAOS (American Academy of Orthopedic Surgery), ACR (American College of Rheumatology), DoD (Department of Defense), DVA (Department of Veterans Affairs), IAHA (intra-articular injection of hyaluronic acid), LOE (level of evidence), NICE (National Institute for Health and Care Excellence), NSAID (nonsteroidal anti-inflammatory drug), OA (osteoarthritis), rec (recommendation), TENS (transcutaneous electrical nerve stimulation), THA (total hip arthroplasty), TKA (total knee arthroplasty), UKA (unicompartmental knee arthroplasty)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: August 16, 2021
Accepted:
July 4,
2021
Received in revised form:
June 4,
2021
Received:
March 10,
2021
Footnotes
Disclosures: none
Identification
Copyright
© 2021 The American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
