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Hip osteoarthritis

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Updated 2024 AAOS and 2024 AAFP guidelines for the management of hip osteoarthritis.

Guidelines

Key sources

The following summarized guidelines for the management of hip osteoarthritis are prepared by our editorial team based on guidelines from the American Academy of Family Physicians (AAFP 2024), the American Academy of Orthopaedic Surgeons (AAOS 2024), the American College of Rheumatology (ACR/AAHKS 2023), the European Society of Anaesthesiology and Intensive Care (ESAIC 2023), and the American College of Rheumatology (ACR ...
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Medical management

Non-opioid analgesics
As per AAOS 2024 guidelines:
Offer oral NSAIDs to reduce pain and improve function in patients with symptomatic hip OA, unless contraindicated.
A
Consider offering oral acetaminophen to improve pain and function in patients with symptomatic hip OA, unless contraindicated.
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  • Opioids

  • Duloxetine

  • Agents with no evidence for benefit

Nonpharmacologic interventions

Weight loss: as per ACR 2020 guidelines, advise losing weight in overweight and obese patients with hip OA.
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  • Physical therapy

  • Self-management programs

  • Walking canes

  • Footwear

  • CBT

  • Alternative and complementary therapies

Therapeutic procedures

Intra-articular corticosteroids: as per AAFP 2024 guidelines, consider administering intra-articular corticosteroid injections for the management of pain in patients with hip OA.
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  • Other intra-articular injections

  • Transcutaneous electrical nerve stimulation

Perioperative care

Anesthesia: as per AAOS 2024 guidelines, consider administering neuraxial anesthesia to reduce adverse events in patients undergoing total hip arthroplasty.
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  • Perioperative tranexamic acid

  • Postoperative physical therapy

Surgical interventions

Total hip arthroplasty, timing: as per AAHKS/ACR 2023 guidelines, consider performing elective hip arthroplasty without delay, rather than delaying for 3 months,
C
or for a trial of physical therapy,
C
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.
C
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  • Total hip arthroplasty (prognostic factors)

  • Total hip arthroplasty (technical considerations)