Recommendations for the management of hip and knee osteoarthritis: A systematic review of clinical practice guidelines

Alison J Gibbs¹, Bimbi Gray², Jason A Wallis³, Nicholas F Taylor⁴, Joanne L Kemp⁵, David J Hunter⁶, Christian J Barton⁵

Affiliations

¹ La Trobe Sports and Exercise Medicine Research Centre, La Trobe University, Bundoora, Australia; School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia; Physiotherapy Department, Eastern Health, Box Hill Hospital, 8 Arnold Street, Box Hill, 312 Victoria, Australia. Electronic address: A.Gibbs@latrobe.edu.au.
² Sydney Musculoskeletal Health, Kolling Institute, University of Sydney, Sydney, Australia; Department of Rheumatology, Royal North Shore Hospital, Sydney, NSW, Australia. Electronic address: bimbi.gray@scu.edu.au.
³ School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia; School of Public Health & Preventative Medicine, Monash University, Level 4/553 St Kilda Rd, Melbourne 3004, Australia; Physiotherapy Department, Cabrini Health, Malvern, Australia.
⁴ School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia; Allied Health Clinical Research Office, Eastern Health, Box Hill, Australia.
⁵ La Trobe Sports and Exercise Medicine Research Centre, La Trobe University, Bundoora, Australia; School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia.
⁶ Sydney Musculoskeletal Health, Kolling Institute, University of Sydney, Sydney, Australia; Department of Rheumatology, Royal North Shore Hospital, Sydney, NSW, Australia. Electronic address: david.hunter@sydney.edu.au.

PMID: 37394226
DOI: 10.1016/j.joca.2023.05.015

Free article

Recommendations for the management of hip and knee osteoarthritis: A systematic review of clinical practice guidelines

Alison J Gibbs et al. Osteoarthritis Cartilage. 2023 Oct.

Free article

. 2023 Oct;31(10):1280-1292.

doi: 10.1016/j.joca.2023.05.015. Epub 2023 Jun 30.

Authors

Alison J Gibbs¹, Bimbi Gray², Jason A Wallis³, Nicholas F Taylor⁴, Joanne L Kemp⁵, David J Hunter⁶, Christian J Barton⁵

Affiliations

¹ La Trobe Sports and Exercise Medicine Research Centre, La Trobe University, Bundoora, Australia; School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia; Physiotherapy Department, Eastern Health, Box Hill Hospital, 8 Arnold Street, Box Hill, 312 Victoria, Australia. Electronic address: A.Gibbs@latrobe.edu.au.
² Sydney Musculoskeletal Health, Kolling Institute, University of Sydney, Sydney, Australia; Department of Rheumatology, Royal North Shore Hospital, Sydney, NSW, Australia. Electronic address: bimbi.gray@scu.edu.au.
³ School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia; School of Public Health & Preventative Medicine, Monash University, Level 4/553 St Kilda Rd, Melbourne 3004, Australia; Physiotherapy Department, Cabrini Health, Malvern, Australia.
⁴ School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia; Allied Health Clinical Research Office, Eastern Health, Box Hill, Australia.
⁵ La Trobe Sports and Exercise Medicine Research Centre, La Trobe University, Bundoora, Australia; School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia.
⁶ Sydney Musculoskeletal Health, Kolling Institute, University of Sydney, Sydney, Australia; Department of Rheumatology, Royal North Shore Hospital, Sydney, NSW, Australia. Electronic address: david.hunter@sydney.edu.au.

PMID: 37394226
DOI: 10.1016/j.joca.2023.05.015

Abstract

Objectives: Guideline adherence for hip and knee osteoarthritis management is often poor, possibly related to the quality and/or inconsistent recommendations. This systematic review of hip and knee osteoarthritis guidelines aimed to appraise the quality and consistency in recommendations across higher-quality guidelines.

Methods: Eight databases, guideline repositories, and professional associations websites were searched on 27/10/2022. Guideline quality was appraised using the Appraisal of Guidelines for Research and Evaluation II (AGREE II tool) (six domains). Higher quality was defined as scoring ≥60% for domains 3 (rigour of development), 6 (editorial independence), plus one other. Consistency in recommendations across higher-quality guidelines was reported descriptively. This review was registered prospectively (CRD42021216154).

Results: Seven higher-quality and 18 lesser-quality guidelines were included. AGREE II domain scores for higher-quality guidelines were > 60% except for applicability (average 46%). Higher-quality guidelines consistently recommended in favour of education, exercise, and weight management and non-steroidal anti-inflammatory drugs (hip and knee), and intra-articular corticosteroid injections (knee). Higher quality guidelines consistently recommended against hyaluronic acid (hip) and stem cell (hip and knee) injections. Other pharmacological recommendations in higher-quality guidelines (e.g., paracetamol, intra-articular corticosteroid (hip), hyaluronic acid (knee)) and adjunctive treatments (e.g., acupuncture) were less consistent. Arthroscopy was consistently recommended against in higher-quality guidelines. No higher-quality guidelines considered arthroplasty.

Conclusion: Higher-quality guidelines for hip and knee osteoarthritis consistently recommend clinicians implement exercise, education, and weight management, alongside consideration of Non-Steroidal Anti-Inflammatory Drugs and intra-articular corticosteroid injections (knee). Lack of consensus on some pharmacological options and adjunctive treatments creates challenges for guideline adherence. Future guidelines must prioritise providing implementation guidance, considering consistently low applicability scores.

Keywords: Hip osteoarthritis; Knee osteoarthritis; Osteoarthritis; Practice guidelines; Systematic review.

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Conflict of interest statement

Declaration of Competing Interest AJG has received payments from La Trobe University for tutoring physiotherapists involved in GLA:D training. BG none to declare. JAW has received payments from La Trobe University for tutoring physiotherapists involved in GLA:D training. NFT none to declare. JLK is co-lead of the not-for-profit GLAD Australia programme, but receives no personal income support. JLK has received payments from La Trobe University for tutoring physiotherapists involved in GLA:D training. JLK receives an honorarium from BJSM as editor. DJH provides consulting advice on scientific advisory boards for Pfizer, Lilly, TLCBio, Novartis, Tissuegene, Biobone. CJB is co-lead of the not-for-profit GLAD Australia programme, but receives no personal income support. GLA:D is a not-for-profit initiative which trains and supports physiotherapists to implement guideline-based education and exercise therapy. CJB has received payments from La Trobe University for tutoring physiotherapists involved in GLA:D training.

Comment in

'Just do it' still applies when it comes to exercise, diet, and education for osteoarthritis.
White DK, Thoma LM. White DK, et al. Osteoarthritis Cartilage. 2023 Oct;31(10):1278-1279. doi: 10.1016/j.joca.2023.06.010. Epub 2023 Jul 3. Osteoarthritis Cartilage. 2023. PMID: 37406875 No abstract available.

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Recommendations for the management of hip and knee osteoarthritis: A systematic review of clinical practice guidelines

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Recommendations for the management of hip and knee osteoarthritis: A systematic review of clinical practice guidelines

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