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Hip OA Consensus and Protocols for Surgical and Non-Surgical Treatment Approaches Now Available

A multi-disciplinary panel of clinical experts has developed treatment protocol recommendations for three specific populations of patients suffering from Hip Osteoarthritis (OA), a progressive, degenerative, incurable disease that affects an estimated one in every four U.S. adults and is considered the most common arthritic condition of the hip. Characterized by degeneration of the articular cartilage, Hip OA often causes patients to experience pain and stiffness, leading to abnormal gait patterns. The prevalence of Hip OA is high among aging populations in developed nations, although it is also increasingly documented in younger, physically active patients, as well.

Watch to learn more about a non-invasive, biomechanical treatment option for hip osteoarthritis.

The expert consensus panel convened in February 2017, with nearly 20 OA experts from the U.S. and Canada participating in the two-day symposium. The event was co-chaired by Dr. Katherine Dec, Professor, Department of Physical Medicine & Rehabilitation and Orthopaedic Surgery at Virginia Commonwealth University and Dr. Axel Schulz, Össur’s Medical Director.

“Because a growing number of patients–especially increasingly younger individuals–are experiencing significant clinical and functional issues associated with Hip OA yet still seek to delay invasive hip replacement surgery as long as possible, we convened the expert panel to explore whether it made sense to add a novel, non-invasive, biomechanical approach to the Hip OA treatment spectrum,” said Dr. Dec.

According to Dr. Dec, the panel ultimately made specific recommendations according to patients’ clinical state (Acute, Subacute, and Ongoing) and three designated categories: Younger Hip OA Patients age 55 or less with clinically relevant symptoms; Active Demanding Hip OA Patients regardless of age who seek to continue their moderate to vigorous activity levels, and Older Hip OA Patients seeking to maintain or regain their former activity levels.

Recommended Core Treatment: Patient Education and Clinician-Guided Activity

The panel’s first recommendation was for a non-pharmacological core treatment approach, in which clinicians provide patient education and encourage activity and weight management that could help patients maintain a physically active lifestyle while still managing their pain.

“While the panel acknowledged that the impact of therapeutic exercise was still considered controversial, the consensus was that any therapeutic exercise approach should be directed by the patient’s physician or physiotherapist, to ensure correct form and timing of movement and muscle training rehabilitation,” said Dr. Schulz.

Cautious Pharmacological Treatments

Because meta-analyses on the use of acetaminophen indicated insignificant clinical effectiveness even in the short-term, the panel instead recommended prescribing oral NSAIDs (such as diclofenac or etoricoxib), which were found to provide effective pain relief in symptomatic hip OA patients. However, the panel recommended prescribing these only for short-term periods, due to their potential side effects related to cardiovascular, renal and gastrointestinal issues. Weak opioids also were considered beneficial but limited due to their considerable side effects.

The panel deemed intra-articular injections of corticosteroids reasonable—but only for patients with severe symptoms and joint inflammation as evidenced by capsular effusion detected via ultrasound—and image-guided administration, whether via ultrasound or fluoroscopy. The panel determined that current clinical practices of intra-articular injections of hyaluronic acid and/or platelet-rich plasma (PRP) did not yet merit recommendation until more clinical evidence could be provided confirming their respective efficacy.

Appropriate Biomechanical Modification

As pharmacological approaches provide limited solutions for Hip OA, the panel also considered biomechanical solutions. Unlike technologies for patients with knee OA, biomechanical modifications of the hip are uncommon, but the panel did evaluate the Unloader Hip from Össur, a unique brace intended to provide relief for patients with mild-to-moderate hip OA. Unloader Hip’s proprietary design is intended to improve patients’ mobility by using compression to encourage external rotation and abduction of the femoral head whenever the patient is walking.

“The Unloader Hip brace rotates the hip in the transverse and coronal plans, which clinicians theorize may help reduce the load on the affected joint by dispersing the load to an area of less worn cartilage during heel strike1. In field studies, the brace has been shown to improve activities of daily life in patients with mild to moderate Hip OA2,” said Dr. Schulz.

Because of Unloader Hip’s documented clinical benefits, the expert panel recommended that, instead of relying upon a patient’s age and OA stage as automatic criteria for hip bracing, Unloader Hip could be applicable to all three categories of patients suffering from mild-to-moderate Hip OA as a supplement to the recommended core treatment. The Unloader Hip brace was also recommended for patients with moderate-to-severe hip pain whose pain did not abate after initial recommended treatments. To read more about how Unloader Hip can be successfully incorporated into patient treatment, read Dr. Stitik’s case study here.

The panel also developed the first-ever Unloader Hip Brace Test, which included walking and handling assessments and completion of a self-administered questionnaire.

Copies of the expert panel’s published document, “Implication of a Hip Unloader Brace in Recommended Hip OA Management: Who, When and How?” are available to download here.

1 Nerot & Nicholls, Clinical study on the unloading effect of hip bracing on gait in patients with hip osteoarthritis. Prosthet Orthot Int. 2016 Apr 26.

2 Lindgren K. Presentation at OT World Conference 2016, Össur data on file.