Authors

Dr Keran Sundaraj MBBS, MSc (Trauma), FRACS, FAOA

The American Academy of Orthopaedic Surgeons recently released a summary of recommendations for the treatment based on evidence-based medical research that is controlled for bias, transparent, and reproducible. The characteristics of studies that make strong evidence include:

• use of a placebo or control treatment

• sufficient numbers of subjects to determine if an actual difference exists

• use of appropriate reliable measurement tools

Recommended for the Treatment of Hip Osteoarthritis

Non-steroidal Anti-inflammatories (NSAIDs)

• Quality of evidence strong

• NSAIDs improve short-term pain, function, or both in patients with symptomatic hip osteoarthritis.

Intraarticular Steroids

• Quality of evidence strong

• Intraarticular injection of corticosteroids improves function and reduces pain in the short-term

Physical therapy

• Quality of evidence strong

• Physical therapy improves function and reduces pain for patients with mild to moderate symptoms.

Not Recommended for the Treatment of Osteoarthritis

Glucosamine Sulfate

• Quality of evidence moderate

• Glucosamine did not perform better than placebo for improving function, reducing stiffness, and decrease pain.

Hyaluronic acid

• Quality of evidence moderate

• Hyaluronic acid does not perform better than a placebo for function, stiffness, and pain.

Outcomes and Risk Factors for Complications in Patients Undergoing THR

Pre-operative Physical Therapy

• Quality of evidence limited

• Pre-op physical therapy improves early function.

Obesity (outcomes) 

• Quality of evidence is moderate.

• Obese patients may achieve lower outcome scores but with similar levels of patient satisfaction and relative improvement in pain and function.

Obesity (complications) 

• Quality of evidence is moderate.

• Obese patients have an increased risk of dislocation, superficial wound infection, and blood loss after total hip replacement.

Age (outcomes)

• Quality of evidence is moderate.

• Increased age is associated with lower functional and quality of life outcomes.

Age (mortality)

• Quality of evidence is limited.

• Increased age is associated with an increased risk of mortality.

Age (revision)

• Quality of evidence is limited.

• Younger age may be associated with a higher risk of revision.

Mental Health Disorders

• Quality of evidence is moderate.

• Mental health disorders (depression, anxiety, psychosis) is associated with decreased function, pain relief, and quality of life outcomes.

Tobacco Use

• Quality of evidence is limited.

• Patients who use tobacco are at increased risk for complications.

Tranexamic Acid

• Moderate

• Use of tranexamic acid (at the time of operation) will reduce blood loss

Approach

• Quality of evidence is moderate

• There is no clinically significant difference in patient-oriented outcomes related to the surgical approach (anterior, lateral, or posterior).

Post-operative Physical Therapy

• Quality of evidence is moderate

• Physical therapy post-operatively improves early function.