OARSI

Specific recommendations for knee and hip osteoarthritis

• Treatment is based on a combination of pharmacological and non-pharmacological treatments.
• Patient education and an exercise programme are recommended. Self-management is vital.
• Regular telephone contact improves the patient's condition.
• Having recourse to a physiotherapist for learning appropriate exercises is useful.
• Regular exercise should be encouraged. For hip osteoarthritis balneotherapy can be beneficial.
• Overweight patients must lose weight.
• The use of a cane held in the hand opposite the painful joint or a walking frame (bilateral impairment) can be proposed.
• In an osteoarthritic knee, a knee brace can reduce pain and improve stability.
• In knee osteoarthritis, insoles can reduce pain and improve walking.
• Thermotherapy has a symptomatic effect.
• Transcutaneous electrical nerve stimulation can help control pain in the short-term.
• Acupuncture can have a symptomatic action.
• Paracetamol is the first-line analgesic.
• NSAIDs should be prescribed at the lowest effective dose and their long-term use should be avoided. In patients with increased risk of gastrointestinal problems, a coxib or a non-selective NSAID with gastroprotection should be considered but NSAIDs should be used with caution in patients with the risk of cardiovascular problems.
• In knee osteoarthritis, capsaicin and topical NSAIDs have a symptomatic effect.
• Corticosteroid injections can be used after failure of oral analgesics/NSAIDs and in patients with effusion of the knee.
• Injections of hyaluronic acid may be helpful.
• Glucosamine and/or chondroitin sulphate can have a symptomatic effect on knee osteoarthritis. If there is no response within 6 months, treatment should be stopped.
• Glucosamine sulphate and chondroitin could have a structural effect in knee osteoarthritis and diacerein in hip osteoarthritis.
• Opioids are useful in cases of refractory pain.
• Arthroplasty is considered in the event of failure of the medical treatment.
• A unicompartmental prostesis is effective strictly for unicompartmental osteoarthritis of the knee
• Conservative surgery may be considered in young people with hip osteoarthritis in the case of hip dysplasia. In young patients with knee osteoarthritis and unicompartimental impairment, tibial osteotomy delays having recourse to a prosthesis by ten years.
• Arthroscopic lavage with arthroscopic debridement is controversial.
• In young patients with knee osteoarthritis arthrodesis is a rescue procedure in case of failure of a prosthesis.

Bibliography
- Zhang W et al. OARSI recommendations for the management of hip and knee osteoarthritis, part I: critical appraisal of existing treatment guidelines and systematic review of current research evidence. Osteoarthritis Cartilage 2007; 15(9): 981-1000.
- Zhang W et al. OARSI recommendations for the management of hip and knee osteoarthritis, Part II: OARSI evidence-based, expert consensus guidelines. Osteoarthritis Cartilage 2008;16(2) : 137-62.
- Zhang W et al. OARSI recommendations for the management of hip and knee osteoarthritis Part III: changes in evidence following systematic cumulative update of research published through January 2009. Osteoarthritis Cartilage 2010; 18: 476-499.