Experts’ propositions developed through three Delphi rounds—order according to topic (general, non-pharmacological, pharmacological, invasive and surgical)
| No | Proposition |
|---|---|
| OA, osteoarthritis; NSAIDs, non-steroidal anti-inflammatory drugs; COX-2, cyclo-oxygenase-2; SYSADOA, symptomatic slow acting drugs for osteoarthritis. | |
| 1 | Optimal management of hip OA requires a combination of non-pharmacological and pharmacological treatment modalities |
| 2 | Treatment of hip OA should be tailored according to: |
| (a) Hip risk factors (obesity, adverse mechanical factors, physical activity, dysplasia) | |
| (b) General risk factors (age, sex, comorbidity, co-medication) | |
| (c) Level of pain intensity, disability, and handicap | |
| (d) Location and degree of structural damage | |
| (e) Wishes and expectations of the patient | |
| 3 | Non-pharmacological treatment of hip OA should include regular education, exercise, appliances (stick, insoles), and weight reduction if obese or overweight |
| 4 | Because of its efficacy and safety paracetamol (up to 4 g/day) is the oral analgesic of first choice for mild-moderate pain and, if successful, is the preferred long term oral analgesic |
| 5 | NSAIDs, at the lowest effective dose, should be added or substituted in patients who respond inadequately to paracetamol. In patients with increased gastrointestinal risk, non-selective NSAIDs plus a gastroprotective agent, or a selective COX-2 inhibitor (coxib) should be used |
| 6 | Opioid analgesics, with or without paracetamol, are useful alternatives in patients in whom NSAIDs, including COX-2 selective inhibitors (coxibs), are contraindicated, ineffective, and/or poorly tolerated |
| 7 | SYSADOA (glucosamine sulphate, chondroitin sulphate, diacerhein, avocado soybean unsaponifiable, and hyaluronic acid) have a symptomatic effect and low toxicity, but effect sizes are small, suitable patients are not well defined, and clinically relevant structure modification and pharmacoeconomic aspects are not well established |
| 8 | Intra-articular steroid injections (guided by ultrasound or x ray) may be considered in patients with a flare that is unresponsive to analgesic and NSAIDs |
| 9 | Osteotomy and joint preserving surgical procedures should be considered in young adults with symptomatic hip OA, especially in the presence of dysplasia or varus/valgus deformity |
| 10 | Joint replacement has to be considered in patients with radiographic evidence of hip OA who have refractory pain and disability |