Osteoarthritis of the hip and knee

Last updated: September 6, 2022

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Osteoarthritis of the hip and knee is characterized by joint degeneration, which can lead to functional impairment. Although the exact etiology is unknown, risk factors include older age, overuse of the joint, obesity, previous injuries, and asymmetrically stressed joints. Patients often present with joint stiffness and pain, which can progress to severe pain and functional limitation. Osteoarthritis is a clinical diagnosis, supported by radiological findings. Initial management includes nonpharmacological measures such as weight loss, physical therapy, and the use of assistive devices (e.g., canes, braces), and short-term pharmacotherapy for pain management. If conservative measures do not improve the patient's quality of life and joint destruction is severe, surgical procedures such as arthroplasty may be indicated.

For more general information on osteoarthritis, see the respective article.

The risk of developing hip and knee osteoarthritis increases with age. [1][2]

  • Age: Peak incidence at initial diagnosis is 50–60 years of age.
  • Sex: > , especially in patients older than 50 years

Osteoarthritis is the most common disease of the hip joint in adults.

Epidemiological data refers to the US, unless otherwise specified.

See also "Clinical features of osteoarthritis.” [4]

Walking downhill is painful with knee osteoarthritis, whereas walking uphill is painful with hip osteoarthritis!

Osteoarthritis is a clinical diagnosis. Diagnostic studies may be indicated if there is clinical uncertainty or to exclude alternative diagnoses (see “Diagnosis of osteoarthritis” and “Differential diagnoses of inflammatory arthritis”). [5]

Plain radiography [5]

X-rays may appear normal in the early stages of osteoarthritis. The absence of radiological signs of osteoarthritis does not rule out osteoarthritis. [5]

Additional studies [5]

Consider to rule out complications and alternative diagnoses (e.g., fractures, infection), and for surgical planning. [5][6]

Approach [8]

Conservative management [5][9]

Pharmacotherapy should only be used as a short-term treatment in symptomatic patients; long-term therapy is associated with many adverse effects.

Surgery

Arthroplasty

Patients undergoing total joint replacement should receive perioperative antibiotic prophylaxis and VTE prophylaxis. Early postoperative physiotherapy can reduce the duration of hospitalization and improve pain and function. See “Perioperative considerations” in “Treatment of osteoarthritis” for details. [17]

Osteotomy

Arthroscopy

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  2. Arthritis - Arthritis Basics - Arthritis Types - Osteoarthritis. https://www.cdc.gov/arthritis/basics/osteoarthritis.htm. Updated: February 2, 2017. Accessed: May 5, 2017.
  3. West SG. Rheumatology Secrets. Hanley & Belfus ; 2002
  4. Magee DJ. Orthopedic Physical Assessment - E-Book. Elsevier Health Sciences ; 2014
  5. Katz JN, Arant KR, Loeser RF. Diagnosis and Treatment of Hip and Knee Osteoarthritis. JAMA. 2021; 325 (6): p.568. doi: 10.1001/jama.2020.22171 . | Open in Read by QxMD
  6. Jennings JM, Kleeman-Forsthuber LT, Bolognesi MP. Medial Unicompartmental Arthroplasty of the Knee. J Am Acad Orthop Surg. 2019; 27 (5): p.166-176. doi: 10.5435/jaaos-d-17-00690 . | Open in Read by QxMD
  7. Sinusas K. Osteoarthritis: diagnosis and treatment.. Am Fam Physician. 2012; 85 (1): p.49-56.
  8. Kolasinski SL, Neogi T, Hochberg MC, et al. 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee. Arthritis Care Res (Hoboken). 2020; 72 (2): p.149-162. doi: 10.1002/acr.24131 . | Open in Read by QxMD
  9. Management of Osteoarthritis of the Knee (Non-Arthroplasty) Evidence-Based Clinical Practice Guideline. https://www.aaos.org/oak3cpg. Updated: August 31, 2021. Accessed: June 17, 2022.
  10. Management of Osteoarthritis of the Hip Evidence-Based Clinical Practice Guideline. https://www.aaos.orog/oahcpg. Updated: March 13, 2017. Accessed: June 17, 2022.
  11. Douglas RJ. Corticosteroid injection into the osteoarthritic knee: drug selection, dose, and injection frequency. Int J Clin Pract. 2012; 66 (7): p.699-704. doi: 10.1111/j.1742-1241.2012.02963.x . | Open in Read by QxMD
  12. Trojian TH, Concoff AL, Joy SM, Hatzenbuehler JR, Saulsberry WJ, Coleman CI. AMSSM Scientific Statement Concerning Viscosupplementation Injections for Knee Osteoarthritis. Clin J Sport Med. 2016; 26 (1): p.1-11. doi: 10.1097/jsm.0000000000000274 . | Open in Read by QxMD
  13. American Academy of Orthopaedic Surgeons Management of Hip Fractures in Older Adults Evidence-Based Clinical Practice Guideline. https://www.aaos.org/hipfxcpg. Updated: December 3, 2021. Accessed: June 30, 2022.
  14. Schmitz PP, van Susante JLC, Somford MP. Low conversion rates toward total hip arthroplasty after hemiarthroplasty in patients under 75 years of age. Eur J Orthop Surg Traumatol. 2019; 29 (8): p.1687-1691. doi: 10.1007/s00590-019-02498-0 . | Open in Read by QxMD
  15. Surgical Management of Osteoarthritis of the Knee Evidence Based Clinical Practice Guideline. https://www.aaos.org/smoakcpg. Updated: September 4, 2015. Accessed: June 17, 2022.
  16. Rönn K, Reischl N, Gautier E, Jacobi M. Current Surgical Treatment of Knee Osteoarthritis. Arthritis. 2011; 2011 : p.1-9. doi: 10.1155/2011/454873 . | Open in Read by QxMD
  17. Anderson DR et al.. American Society of Hematology 2019 guidelines for management of venous thromboembolism: prevention of venous thromboembolism in surgical hospitalized patients. Blood Adv. 2019; 3 (23): p.3898-3944. doi: 10.1182/bloodadvances.2019000975 . | Open in Read by QxMD
  18. Katz JN, Earp BE, Gomoll AH. Surgical management of osteoarthritis. Arthritis Care & Research. 2010; 62 (9): p.1220-1228. doi: 10.1002/acr.20231 . | Open in Read by QxMD

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