A number of clinical practice guidelines for osteoarthritis have been published , including the Royal Australian College of General Practitioners ’ Guideline for the Management of Knee and Hip Osteoarthritis , 8 and those by the American College of Rheumatology / Arthritis , 9 the Osteoarthritis Research Society International guidelines , 10 and the American Academy of Orthopaedic Surgeons . 11 The consensus is that lifestyle factors are very important in managing osteoarthritis . Encouraging patients / clients to increase their exercise as pain permits and weight loss are two key components . 12 Regular exercise can help reduce pain and restore function for people suffering OA of the knee and hip . 13 The Royal Australian College of General Practitioners 8 strongly recommend muscle strengthening exercises , Tai Chi , walking , hatha yoga and riding a stationary bike for managing knee osteoarthritis . Waterbased exercise may also be helpful . Recommendations for hip OA could not be made because of limited research . However , water-based exercises may be considered .
If patients / clients with knee and / or hip osteoarthritis are overweight or obese , weight loss is strongly recommended . The target weight loss is 5 – 7.5 % of body weight , 8 although some authors have recommended a 10 % weight loss . 14
Teaching patients / clients how to self-manage their symptoms is also strongly supported by the evidence . Self-management programs involve teaching patients / clients about the pathophysiology of osteoarthritis , paincoping skills and goal-setting . 15
There is evidence supporting the use of pain-relieving medications during periods of exacerbation . 8 For example , nonsteroidal anti-inflammatory drugs ( NSAIDS ) may be useful for some people with knee and hip osteoarthritis if taken orally at low doses for short periods . Due to lack of evidence , no recommendation , either for or against , can be made for NSAIDS applied topically or for paracetamol , although they are likely to be useful for some people if used for short periods . Corticosteroid injections may be useful for short-term pain relief for hip and knee osteoarthritis but repeated injections are potentially harmful . The Royal Australian College of General Practitioners Guideline 8 also supports regularly reviewing medication , using topical hot and cold preparations and assistive devices like walking aids . Cognitive behavioural therapy ( CBT ) may also be useful , especially if used with exercise . 16
Therapies to avoid in the management of osteoarthritis
A number of therapies have a risk of harm that outweighs their potential benefits . These include therapeutic ultrasound , laser therapy , interferential therapy , footwear marketed for knee OA , and patellofemoral braces . 8 There is a strong recommendation against the use of oral and transdermal opioids , viccosupplementation injection for hip
Recommended
Conditionally recommended
OA and doxycycline . Transcutaneous electrical nerve stimulation ( TENS ) should generally not be used . 17 However , the RACGP makes a conditional recommendation for TENS use at home for some people with knee and / or hip OA . 8
Summary of recommendations for the treatment of osteoarthritis
Clinical practice guidelines for managing osteoarthritis vary slightly according to the availability of high-quality evidence at the time of guideline development . The following recommendations are taken from the most recently updated guidelines for managing osteoarthritis for knee and hip osteoarthritis . 9
• Weight loss , exercise , tai chi , and patient-directed activity programs can improve pain and function in knee and hip OA .
• In knee and hip OA , intra-articular corticosteroid injections and oral and
Table 1 . Clinical practice guidelines for knee and hip osteoarthritis ( adapted from the American College of Rheumatology guidelines 18 )
Conditionally recommended against
Strongly recommended against
Intervention Hand Knee Hip
Exercise |
Yes |
Yes * |
Yes * |
Weight loss |
No |
Yes |
Yes |
Self-management programs |
Yes |
Yes |
Yes |
Tai chi |
No |
Yes |
Yes |
Cane |
No |
Yes |
Yes |
Knee brace for tibiofemoral OA |
No |
Yes |
No |
1st carpometacarpal orthosis |
Yes |
No |
No |
Balance training |
No |
Yes |
Yes |
Cognitive behaviour therapy |
Yes |
Yes |
Yes |
Kinesiotaping |
Yes |
Yes |
No |
Acupuncture |
Yes |
Yes |
Yes |
Thermal intervention |
Yes |
Yes |
Yes |
Yoga |
Yes |
Yes |
No |
Other hand orthoses |
Yes |
No |
No |
Knee brace for patellofemoral OA |
No |
Yes |
No |
Oral NSAIDs |
Yes |
Yes |
Yes |
Modified shoes |
No |
Yes |
No |
Lateral and medial wedged insoles |
No |
Yes |
Yes |
Massage therapy |
No |
Yes |
Yes |
Manual therapy with / without exercise |
No |
Yes |
Yes |
Pulsed vibration therapy |
No |
Yes |
No |
Transcutaneous electrical nerve stimulation No Yes Yes
* Walking , strengthening , neuromuscular training , and aquatic exercise
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