Osteoarthritis of the Hip

A Compendium of Evidence-based Information and Resources

October 2003

Table of Contents
Acknowledgments
Glossary of Terms
Copyright Notice
Contact Information

1. State of the Condition: (PDF 213 Kb)

Understanding the Disease of Osteoarthritis
- Etiology and Diagnosis
- Clinical Features of OA Hip
- Classification of OA
- Etiologic Classification: Primary Versus Secondary OA
- Primary OA
- Secondary OA
- Articular Classification: Joint Involvement
- OA Features Classification
- OA Hip Progression
Demographics of OA Hip
- Incidence of OA Hip
- Prevalence of OA Hip
Burden of OA Hip
- OA and OA Hip Inpatient Care
- Nontraditional OA Hip Care
- Impact of OA Hip on Physical Well-being
- Emotional Impact of OA Hip
- Cost to Society of OA Hip
Living with Osteoarthritis of the Hip
References

2. Treatment Options: (PDF 197 Kb)

Methodology and Validation
- Treatment Study Citation Methodology
- Citation Levels and Strength of Evidence Rating
OA Treatment Options Strength of Studies
Health and Behavior Modifications Treatments
- Patient Education
- Physical Therapy and Exercise
- Weight Loss
Pharmacologic Treatments
- Acetaminophen (simple analgesics)
- NSAID (non-selective)
- COX-2 Specific Inhibitors (selective subset of NSAIDs)
- Diacerein
- Opiate and Oxycodone Drugs
- Glucosamine and/or Chondroitin Sulfate
Intra-articular Treatment
- Corticosteroid Injections (Glucocorticoids)
- Hyaluronic Acid (HA) and similar hyaluronan preparations (eg, Synvisc)
Surgical Treatment
- Arthrodesis (Hip fusion)
- Osteotomy
- Pelvic Osteotomy
- Femoral Osteotomy
- Arthroscopy (including debridement and lavage/irrigation)
- Arthroplasty or Joint Replacement
- Cemented Total Hip Arthroplasty
- Cementless Total Hip Arthroplasty
Alternative Therapy
- Acupuncture
- Magnetic Pulse Therapy
Alternative Treatment Options Requiring Additional Studies
References

3. Evidence-Based Resources: (PDF 499 Kb)

Evidence-based Medicine and Practice
- The AAOS Evidence-Based Practice Position
Guidelines for Classification and Medical Management of Hip Pain, OA Hip, and Hip Joint Replacement
- Guideline Definition
- Patient-Centered Holistic Assessment
- Clinical Classification and Medical Management Guidelines
Hip Replacement Guidelines
Pharmacologic Treatment Guidelines
Pain Management Guidelines
Hip Replacement Physical Therapy Treatment Guideline
Quality of Care: Osteoarthritis and Hip
Quality Indicators (QIs)
- AHRQ Inpatient Quality Indicators
- Canada and Provinces Health Indicators
- Clinical Performance Measures
- RAND Health Osteoarthritic Treatment Performance Measures
- ACOVE Osteoarthritis and Pain Management Performance Measures
- American Medical Association/American Academy of Orthopaedic Surgeons
- Clinical Pathways in Total Joint Replacement
Outcomes Instruments: Evaluation and Assessment of Severity and/or Functional Status
- Site-Specific Instruments (Lower Limb/Hip)
- Disease-Specific Instruments (Arthritis)
- Arthroplasty Evaluation and Outcomes Indices
- General Health, Pain or Patient-Specific Assessments
- Comparisons Across Instruments
Selecting a Hip Instrument
- Diagnosis and Assessment
- Initial Consult and Referral Guidelines
- General Diagnosis and Assessment of Osteoarthritis
- Imaging Technologies
- Radiography and Joint Spacing Grading
- Computed Tomography (CT)
- Magnetic Resonance Imaging (MRI)
- Ultrasonography
- Bone Scans (Scintography) and Radioisotope
- Markers (Bio-, Molecular, Metabolic or Serum Markers)
Assessing Progression of Osteoarthritis
- Standard Clinical and Radiographic Methodology (AAOS, NIH, WHO)
- Clinical and Radiographic Terminology (CART) Recommendations for Hip Arthroplasty (Hip Society)
- Guidelines for Clinical Trials
- Task Force of the Osteoarthritis Research Society International (OARSI)
- Page 3 - 2 Copyright 2003 © American Academy of Orthopaedic Surgeons
- Phase III Clinical Trials in Osteoarthritis (OMERACT III)
- Clinical Trials Response Criteria for OA Hip and Knee (OARSI)
- Evaluation of Long-Term Course of Osteoarthritis (Expert Panel)
Additional Resources
References

4. Joint Replacement: (PDF 349 Kb)

Hip Joint Replacement Procedures and Patient Demographics
Hip Joint Replacement History
Considerations of Total Hip Replacement
- Indications for Total Hip Replacement
- Patient Selection Criteria for Primary THR
- Simultaneous vs Staged THR When Both Hips are Replaced
- Surgical Technique
- Implant Design and Materials
THR Success and Implant Survival
- Patient Improvements (Outcomes)
- THR Survival Rates and Implant Selection
- Summary Outcomes for Specific THR Implant Characteristics
Complications of Total Hip Replacement
- Mortality
- Infection
- Venous Thromboembolism
- Dislocation
- Loosening
- Wear
- Osteolysis
- Nerve Injuries
- Bone Fracture
- Heterotopic ossification
- Leg-length Discrepancy
- Pain and Stiffness
- Surgical Complications
- Other Complications
Revision Hip Replacement
- Bone Defect and Loss Classification Systems
- Femoral Classification Systems
- Acetabular Classification Systems
Additional Resources
References

Open a glossary of terms (PDF 48 Kb) for your reference while reading these documents.

Acknowledgments

AAOS Council:

Council on Research, Joshua J. Jacobs, MD, Chairman

AAOS Committee:

Evidence-Based Practice Committee, Michael J. Goldberg, MD, Chairman

Validation Panel:

Marc M. DeHart, MD, Hip and Knee Clinician, University of Texas Health Science Center at San Antonio, San Antonio, TX : AAOS
James E. Mullen, MD, South County Orthopedic Specialists, Arthritic Hip and Knee Surgery, Laguna Woods, CA : AAOS, AAHKS
Nathan J. Price, MD, Retired, Medical Director Total Joint Program, formerly Prince George’s Medical Center, Cheverly, MD, now retired : AAOS
James John Verner, MD, Division Chief, Center for Joint Replacement, Henry Ford Hospital, Detroit, MI : AAOS
James N. Weinstein, DO, Chair, Department of Orthopaedic Surgery, Dartmouth Medical School, Lebanon, NH : AAOS

Department:

Department of Research and Scientific Affairs, Marilyn Weisberg, MPH, Director

Research Staff:

Editorial Review:

Elaine Fiedler, Sharon O’Brien

Information:

Research Department

Copyright

The material presented in IMCA has been made available by the American Academy of Orthopaedic Surgeons for educational purposes only. This material is not intended to present the only, or necessarily best, methods or procedures for the medical situations discussed, but rather is intended to represent an approach, view, statement or opinion of the author(s) or producer(s), which may be helpful to others who face similar situations.

Copyright © 2003 American Academy of Orthopaedic Surgeons. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form, or by any means, electronic, mechanical, photocopying, recording, or otherwise, without prior written permission from the publisher.

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