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EULAR evidence based recommendations for the management of hip osteoarthritis: report of a task force of the EULAR Standing Committee for International Clinical Studies Including Therapeutics (ESCISIT)
  1. W Zhang2,
  2. M Doherty2,
  3. N Arden3,
  4. B Bannwarth4,
  5. J Bijlsma5,
  6. K-P Gunther6,
  7. H J Hauselmann7,
  8. G Herrero-Beaumont8,
  9. K Jordan3,
  10. P Kaklamanis9,
  11. B Leeb10,
  12. M Lequesne11,
  13. S Lohmander12,
  14. B Mazieres13,
  15. E Martin-Mola14,
  16. K Pavelka15,
  17. A Pendleton16,
  18. L Punzi17,
  19. B Swoboda18,
  20. R Varatojo19,
  21. G Verbruggen20,
  22. I Zimmermann-Gorska21,
  23. M Dougados1
  1. 1Service de Rhumatologie B, Hospital Cochin, Paris, France
  2. 2Academic Rheumatology, University of Nottingham, Nottingham, UK
  3. 3Southampton General Hospital, MRC Environmental Epidemiology Unit, Southampton, UK
  4. 4Service de Rhumatologie, Hôpital Pellegrin, Bordeaux, France
  5. 5Department of Rheumatology and Immunology, University Hospital, Utrecht, The Netherlands
  6. 6Department of Orthopaedic Surgery, University of Dresden, Dresden, Germany
  7. 7Centre for Rheumatology and Bone Diseases, Clinic Im Park, University of Zurich, Zurich, Switzerland
  8. 8Rheumatology Department, Clinique de la Conception, Madrid, Spain
  9. 916 Anaperon Polemon, 11521, Athens, Greece
  10. 10Rheumatology, Stockerau Hospital, Stockerau, Austria
  11. 11Department of Rheumatology, Hôpital Léopold Bellan, 75014, Paris, France
  12. 12Department of Orthopaedics, Lund University Hospital, SE-22185, Lund, Sweden
  13. 13Service de Rheumatologie, Hospital de Rangueil, Toulouse, France
  14. 14Division de Rheumatologia, Hospital La Paz, Madrid, Spain
  15. 15Institute of Rheumatology, 12850, Praha 2, Czech Republic
  16. 16Rheumatology, Belfast City Hospital, Belfast, UK
  17. 17Department of Medical Sciences, University of Padova, Padova, Italy
  18. 18Orthopaedics, University of Erlangen-Nuremberg, Erlangen, Germany
  19. 19No32B 1400–107, Lisbon, Portugal
  20. 20Rheumatology Unit, UZRUG, Gent, Belgium
  21. 21Department of Rheumatology and Rehabilitation and Internal Medicine, Poznañ, University of Medical Sciences, Czerwca, Poland
  1. Correspondence to:
    Professor M Dougados
    Institute of Rheumatology, Hardy B, Hospital Cochin, 27, rue du Faubourg, Saint Jacques, 71054 Paris, France;


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.

  • 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
  • hips
  • osteoarthritis
  • recommendation

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