The University of Southampton
University of Southampton Institutional Repository

OARSI recommendations for the management of hip and knee osteoarthritis, Part II: OARSI evidence-based, expert consensus guidelines

OARSI recommendations for the management of hip and knee osteoarthritis, Part II: OARSI evidence-based, expert consensus guidelines
OARSI recommendations for the management of hip and knee osteoarthritis, Part II: OARSI evidence-based, expert consensus guidelines
PURPOSE: To develop concise, patient-focussed, up to date, evidence-based, expert consensus recommendations for the management of hip and knee osteoarthritis (OA), which are adaptable and designed to assist physicians and allied health care professionals in general and specialist practise throughout the world.

METHODS: Sixteen experts from four medical disciplines (primary care, rheumatology, orthopaedics and evidence-based medicine), two continents and six countries (USA, UK, France, Netherlands, Sweden and Canada) formed the guidelines development team. A systematic review of existing guidelines for the management of hip and knee OA published between 1945 and January 2006 was undertaken using the validated appraisal of guidelines research and evaluation (AGREE) instrument. A core set of management modalities was generated based on the agreement between guidelines. Evidence before 2002 was based on a systematic review conducted by European League Against Rheumatism and evidence after 2002 was updated using MEDLINE, EMBASE, CINAHL, AMED, the Cochrane Library and HTA reports. The quality of evidence was evaluated, and where possible, effect size (ES), number needed to treat, relative risk or odds ratio and cost per quality-adjusted life years gained were estimated. Consensus recommendations were produced following a Delphi exercise and the strength of recommendation (SOR) for propositions relating to each modality was determined using a visual analogue scale.

RESULTS: Twenty-three treatment guidelines for the management of hip and knee OA were identified from the literature search, including six opinion-based, five evidence-based and 12 based on both expert opinion and research evidence. Twenty out of 51 treatment modalities addressed by these guidelines were universally recommended. ES for pain relief varied from treatment to treatment. Overall there was no statistically significant difference between non-pharmacological therapies [0.25, 95% confidence interval (CI) 0.16, 0.34] and pharmacological therapies (ES=0.39, 95% CI 0.31, 0.47). Following feedback from Osteoarthritis Research International members on the draft guidelines and six Delphi rounds consensus was reached on 25 carefully worded recommendations. Optimal management of patients with OA hip or knee requires a combination of non-pharmacological and pharmacological modalities of therapy. Recommendations cover the use of 12 non-pharmacological modalities: education and self-management, regular telephone contact, referral to a physical therapist, aerobic, muscle strengthening and water-based exercises, weight reduction, walking aids, knee braces, footwear and insoles, thermal modalities, transcutaneous electrical nerve stimulation and acupuncture. Eight recommendations cover pharmacological modalities of treatment including acetaminophen, cyclooxygenase-2 (COX-2) non-selective and selective oral non-steroidal anti-inflammatory drugs (NSAIDs), topical NSAIDs and capsaicin, intra-articular injections of corticosteroids and hyaluronates, glucosamine and/or chondroitin sulphate for symptom relief; glucosamine sulphate, chondroitin sulphate and diacerein for possible structure-modifying effects and the use of opioid analgesics for the treatment of refractory pain. There are recommendations covering five surgical modalities: total joint replacements, unicompartmental knee replacement, osteotomy and joint preserving surgical procedures; joint lavage and arthroscopic debridement in knee OA, and joint fusion as a salvage procedure when joint replacement had failed. Strengths of recommendation and 95% CIs are provided.

CONCLUSION: Twenty-five carefully worded recommendations have been generated based on a critical appraisal of existing guidelines, a systematic review of research evidence and the consensus opinions of an international, multidisciplinary group of experts. The recommendations may be adapted for use in different countries or regions according to the availability of treatment modalities and SOR for each modality of therapy. These recommendations will be revised regularly following systematic review of new research evidence as this becomes available.
methods, physicians, therapy, hip, Netherlands, review, quality-adjusted life years, education, injections, weight, muscle, exercise, cyclooxygenase 2, walking, osteoarthritis, report, size, odds ratio, evidence-based medicine, pain, research, risk, health, development
1063-4584
137-162
Zhang, W.
1c80d4f2-4ba8-41f6-85a6-a76a4d65dc9b
Moskowitz, R.W.
7dbef347-bbd1-4645-8c11-efb891de3d3c
Nuki, G.
9cec024d-7df7-4054-b47d-85e2ba4d0e92
Abramson, S.
75df3cc2-0d2f-444a-b037-f158fa049b8a
Altman, R.D.
5d8e4c70-1fc1-4c90-ba0c-807a37f38b1d
Arden, N.
23af958d-835c-4d79-be54-4bbe4c68077f
Bierma-Zeinstra, S.
d8bf8275-073f-445f-b8c3-e61a6d8df62d
Brandt, K.D.
0469447e-3193-4e2d-ae4e-e0a33fbdafe9
Croft, P.
8faa5d3f-d4d6-4b68-b7fa-b4b284768b41
Doherty, M.
e293e772-054b-48b4-99d0-20d412747fd6
Dougados, M.
5934dae5-3412-4fb4-a8cb-aa946eebdf13
Hochberg, M.
785e7c1f-2d2c-475c-8af2-9ef69acc7e7a
Hunter, D.J.
858ea3f1-f56d-4a1f-bac3-a82ca68e89e7
Kwoh, K.
5eeee521-439b-45b7-91dc-bae601206042
Lohmander, L.S.
49c49f6f-5140-43fc-a33c-d7f8120b6640
Tugwell, P.
088783e2-45ed-44ef-9b49-afb23e6445f8
Zhang, W.
1c80d4f2-4ba8-41f6-85a6-a76a4d65dc9b
Moskowitz, R.W.
7dbef347-bbd1-4645-8c11-efb891de3d3c
Nuki, G.
9cec024d-7df7-4054-b47d-85e2ba4d0e92
Abramson, S.
75df3cc2-0d2f-444a-b037-f158fa049b8a
Altman, R.D.
5d8e4c70-1fc1-4c90-ba0c-807a37f38b1d
Arden, N.
23af958d-835c-4d79-be54-4bbe4c68077f
Bierma-Zeinstra, S.
d8bf8275-073f-445f-b8c3-e61a6d8df62d
Brandt, K.D.
0469447e-3193-4e2d-ae4e-e0a33fbdafe9
Croft, P.
8faa5d3f-d4d6-4b68-b7fa-b4b284768b41
Doherty, M.
e293e772-054b-48b4-99d0-20d412747fd6
Dougados, M.
5934dae5-3412-4fb4-a8cb-aa946eebdf13
Hochberg, M.
785e7c1f-2d2c-475c-8af2-9ef69acc7e7a
Hunter, D.J.
858ea3f1-f56d-4a1f-bac3-a82ca68e89e7
Kwoh, K.
5eeee521-439b-45b7-91dc-bae601206042
Lohmander, L.S.
49c49f6f-5140-43fc-a33c-d7f8120b6640
Tugwell, P.
088783e2-45ed-44ef-9b49-afb23e6445f8

Zhang, W., Moskowitz, R.W., Nuki, G., Abramson, S., Altman, R.D., Arden, N., Bierma-Zeinstra, S., Brandt, K.D., Croft, P., Doherty, M., Dougados, M., Hochberg, M., Hunter, D.J., Kwoh, K., Lohmander, L.S. and Tugwell, P. (2008) OARSI recommendations for the management of hip and knee osteoarthritis, Part II: OARSI evidence-based, expert consensus guidelines. Osteoarthritis and Cartilage, 16 (2), 137-162. (doi:10.1016/j.joca.2007.12.013). (PMID:18279766)

Record type: Article

Abstract

PURPOSE: To develop concise, patient-focussed, up to date, evidence-based, expert consensus recommendations for the management of hip and knee osteoarthritis (OA), which are adaptable and designed to assist physicians and allied health care professionals in general and specialist practise throughout the world.

METHODS: Sixteen experts from four medical disciplines (primary care, rheumatology, orthopaedics and evidence-based medicine), two continents and six countries (USA, UK, France, Netherlands, Sweden and Canada) formed the guidelines development team. A systematic review of existing guidelines for the management of hip and knee OA published between 1945 and January 2006 was undertaken using the validated appraisal of guidelines research and evaluation (AGREE) instrument. A core set of management modalities was generated based on the agreement between guidelines. Evidence before 2002 was based on a systematic review conducted by European League Against Rheumatism and evidence after 2002 was updated using MEDLINE, EMBASE, CINAHL, AMED, the Cochrane Library and HTA reports. The quality of evidence was evaluated, and where possible, effect size (ES), number needed to treat, relative risk or odds ratio and cost per quality-adjusted life years gained were estimated. Consensus recommendations were produced following a Delphi exercise and the strength of recommendation (SOR) for propositions relating to each modality was determined using a visual analogue scale.

RESULTS: Twenty-three treatment guidelines for the management of hip and knee OA were identified from the literature search, including six opinion-based, five evidence-based and 12 based on both expert opinion and research evidence. Twenty out of 51 treatment modalities addressed by these guidelines were universally recommended. ES for pain relief varied from treatment to treatment. Overall there was no statistically significant difference between non-pharmacological therapies [0.25, 95% confidence interval (CI) 0.16, 0.34] and pharmacological therapies (ES=0.39, 95% CI 0.31, 0.47). Following feedback from Osteoarthritis Research International members on the draft guidelines and six Delphi rounds consensus was reached on 25 carefully worded recommendations. Optimal management of patients with OA hip or knee requires a combination of non-pharmacological and pharmacological modalities of therapy. Recommendations cover the use of 12 non-pharmacological modalities: education and self-management, regular telephone contact, referral to a physical therapist, aerobic, muscle strengthening and water-based exercises, weight reduction, walking aids, knee braces, footwear and insoles, thermal modalities, transcutaneous electrical nerve stimulation and acupuncture. Eight recommendations cover pharmacological modalities of treatment including acetaminophen, cyclooxygenase-2 (COX-2) non-selective and selective oral non-steroidal anti-inflammatory drugs (NSAIDs), topical NSAIDs and capsaicin, intra-articular injections of corticosteroids and hyaluronates, glucosamine and/or chondroitin sulphate for symptom relief; glucosamine sulphate, chondroitin sulphate and diacerein for possible structure-modifying effects and the use of opioid analgesics for the treatment of refractory pain. There are recommendations covering five surgical modalities: total joint replacements, unicompartmental knee replacement, osteotomy and joint preserving surgical procedures; joint lavage and arthroscopic debridement in knee OA, and joint fusion as a salvage procedure when joint replacement had failed. Strengths of recommendation and 95% CIs are provided.

CONCLUSION: Twenty-five carefully worded recommendations have been generated based on a critical appraisal of existing guidelines, a systematic review of research evidence and the consensus opinions of an international, multidisciplinary group of experts. The recommendations may be adapted for use in different countries or regions according to the availability of treatment modalities and SOR for each modality of therapy. These recommendations will be revised regularly following systematic review of new research evidence as this becomes available.

This record has no associated files available for download.

More information

Published date: February 2008
Keywords: methods, physicians, therapy, hip, Netherlands, review, quality-adjusted life years, education, injections, weight, muscle, exercise, cyclooxygenase 2, walking, osteoarthritis, report, size, odds ratio, evidence-based medicine, pain, research, risk, health, development

Identifiers

Local EPrints ID: 61640
URI: http://eprints.soton.ac.uk/id/eprint/61640
ISSN: 1063-4584
PURE UUID: e98d3818-ba67-4c8a-9a71-50a3c4136d90

Catalogue record

Date deposited: 09 Sep 2008
Last modified: 15 Mar 2024 11:27

Export record

Altmetrics

Contributors

Author: W. Zhang
Author: R.W. Moskowitz
Author: G. Nuki
Author: S. Abramson
Author: R.D. Altman
Author: N. Arden
Author: S. Bierma-Zeinstra
Author: K.D. Brandt
Author: P. Croft
Author: M. Doherty
Author: M. Dougados
Author: M. Hochberg
Author: D.J. Hunter
Author: K. Kwoh
Author: L.S. Lohmander
Author: P. Tugwell

Download statistics

Downloads from ePrints over the past year. Other digital versions may also be available to download e.g. from the publisher's website.

View more statistics

Atom RSS 1.0 RSS 2.0

Contact ePrints Soton: eprints@soton.ac.uk

ePrints Soton supports OAI 2.0 with a base URL of http://eprints.soton.ac.uk/cgi/oai2

This repository has been built using EPrints software, developed at the University of Southampton, but available to everyone to use.

We use cookies to ensure that we give you the best experience on our website. If you continue without changing your settings, we will assume that you are happy to receive cookies on the University of Southampton website.

×