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1 Service de Rhumatologie B, Hospital Cochin, Paris, France
2 Academic Rheumatology, University of Nottingham, Nottingham, UK
3 Southampton General Hospital, MRC Environmental Epidemiology Unit, Southampton, UK
4 Service de Rhumatologie, Hôpital Pellegrin, Bordeaux, France
5 Department of Rheumatology and Immunology, University Hospital, Utrecht, The Netherlands
6 Department of Orthopaedic Surgery, University of Dresden, Dresden, Germany
7 Centre for Rheumatology and Bone Diseases, Clinic Im Park, University of Zurich, Zurich, Switzerland
8 Rheumatology Department, Clinique de la Conception, Madrid, Spain
9 16 Anaperon Polemon, 11521, Athens, Greece
10 Rheumatology, Stockerau Hospital, Stockerau, Austria
11 Department of Rheumatology, Hôpital Léopold Bellan, 75014, Paris, France
12 Department of Orthopaedics, Lund University Hospital, SE-22185, Lund, Sweden
13 Service de Rheumatologie, Hospital de Rangueil, Toulouse, France
14 Division de Rheumatologia, Hospital La Paz, Madrid, Spain
15 Institute of Rheumatology, 12850, Praha 2, Czech Republic
16 Rheumatology, Belfast City Hospital, Belfast, UK
17 Department of Medical Sciences, University of Padova, Padova, Italy
18 Orthopaedics, University of Erlangen-Nuremberg, Erlangen, Germany
19 No32B 1400–107, Lisbon, Portugal
20 Rheumatology Unit, UZRUG, Gent, Belgium
21 Department of Rheumatology and Rehabilitation and Internal Medicine, Poznañ, University of Medical Sciences, Czerwca, Poland
Correspondence to:
Correspondence to:
Professor M Dougados
Institute of Rheumatology, Hardy B, Hospital Cochin, 27, rue du Faubourg, Saint Jacques, 71054 Paris, France; maxime.dougados{at}cch.ap-hop-paris.fr
Objective: To develop evidence based recommendations for the management of hip osteoarthritis (OA).
Methods: The multidisciplinary guideline development group comprised 18 rheumatologists, 4 orthopaedic surgeons, and 1 epidemiologist, representing 14 European countries. Each participant contributed up to 10 propositions describing key clinical aspects of hip OA management. Ten final recommendations were agreed using a Delphi consensus approach. Medline, Embase, CINAHL, Cochrane Library, and HTA reports were searched systematically to obtain research evidence for each proposition. Where possible, outcome data for efficacy, adverse effects, and cost effectiveness were abstracted. Effect size, rate ratio, number needed to treat, and incremental cost effectiveness ratio were calculated. The quality of evidence was categorised according to the evidence hierarchy. The strength of recommendation was assessed using the traditional A–D grading scale and a visual analogue scale.
Results: Ten key treatment propositions were generated through three Delphi rounds. They included 21 interventions, such as paracetamol, NSAIDs, symptomatic slow acting disease modifying drugs, opioids, intra-articular steroids, non-pharmacological treatment, total hip replacement, osteotomy, and two general propositions. 461 studies were identified from the literature search for the proposed interventions of efficacy, side effects, and cost effectiveness. Research evidence supported 15 interventions in the treatment of hip OA. Evidence specific for the hip was strikingly lacking. Strength of recommendation varied according to category of research evidence and expert opinion.
Conclusion: Ten key recommendations for the treatment of hip OA were developed based on research evidence and expert consensus. The effectiveness and cost effectiveness of these recommendations were evaluated and the strength of recommendation was scored.
Abbreviations: ASU, avocado soybean unsaponifiable; CI, confidence interval; COX-2, cyclo-oxygenase-2; CS, chondroitin sulphate; CT, controlled trial; CV, cardiovascular; ES, effect size; GI, gastrointestinal; GS, glucosamine sulphate; HA, hyaluronic acid; ICER, incremental cost effectiveness ratio; NNT, number needed to treat; NSAIDs, non-steroidal anti-inflammatory drugs; QALY, quality of life year; OA, osteoarthritis; OR, odds ratio; PPI, proton pump inhibitor; RCT, randomised controlled trial; RR, relative risk; SYSADOA, symptomatic slow acting drugs for OA; THR, total hip replacement; VAS, visual analogue scale
Keywords: ESCISIT; EULAR; hips; osteoarthritis; recommendation
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