Table 2

 Experts’ propositions developed through three Delphi rounds—order according to topic (general, non-pharmacological, pharmacological, invasive and surgical)

OA, osteoarthritis; NSAIDs, non-steroidal anti-inflammatory drugs; COX-2, cyclo-oxygenase-2; SYSADOA, symptomatic slow acting drugs for osteoarthritis.
1Optimal management of hip OA requires a combination of non-pharmacological and pharmacological treatment modalities
2Treatment 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
3Non-pharmacological treatment of hip OA should include regular education, exercise, appliances (stick, insoles), and weight reduction if obese or overweight
4Because 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
5NSAIDs, 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
6Opioid 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
7SYSADOA (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
8Intra-articular steroid injections (guided by ultrasound or x ray) may be considered in patients with a flare that is unresponsive to analgesic and NSAIDs
9Osteotomy 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
10Joint replacement has to be considered in patients with radiographic evidence of hip OA who have refractory pain and disability