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.
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- Age: Peak incidence at initial diagnosis is 50–60 years of age.
- Sex: ♀ > ♂, especially in patients older than 50 years
Epidemiological data refers to the US, unless otherwise specified.
See also "Clinical features of osteoarthritis.” 
- Pain in the groin area and above the greater trochanter
- Increased contracture in the flexor, external rotation, and adduction position → antalgic gait
- Early signs: limited and painful internal rotation of the hip joint
- Pain on palpation: greater trochanter, groin
- Positive Thomas test
- Function: test for hip flexion contracture
- Position: supine
- Procedure: Examiner passively flexes the hip joint opposite to the affected side to a maximum to compensate lumbar lordosis.
- Positive test: If flexion contracture is present, the ipsilateral leg will simultaneously flex independently as a reflex.
- Function-limiting knee pain
- Knee swelling which increases on activity
- Mechanical instability, locking, catching sensation
- In case of patello-femoral osteoarthritis: positive Patellar grind test (pain on movement of the patella)
- Cartilage damage usually begins medially and may lead to genu varum (bowing of legs)
- Patient position: Obtain multiple views (e.g., anteroposterior, lateral) of the affected joints, if possible. 
- Supportive findings
Additional studies 
Consider to rule out complications and alternative diagnoses (e.g., fractures, infection), and for surgical planning. 
- Recommend nonpharmacological management for all patients (see “ ”).
- Initiate pharmacological therapy for pain management, as needed.
- Persistent symptoms despite appropriate conservative management: Refer to orthopedic surgery. 
Conservative management 
Nonpharmacological management 
- Weight loss (if overweight or obese) and exercise are recommended for all patients.
- Physical therapy and use of assistive devices (e.g., cane, knee braces) may help improve pain and mobility.
- There is limited evidence to support the routine use of oral supplements (e.g., fish oil, vitamin D, glucosamine, chondroitin sulfate) or orthotic insoles. 
- First line: NSAIDs
- Patients who cannot tolerate or do not improve with NSAIDs: See “ ” for alternative agents.
- Intraarticular glucocorticoid injection: Consider for local, short-term relief in patients with osteoarthritis of the hip and knee.
- Intraarticular hyaluronic acid: may be considered for osteoarthritis of the knee 
Pharmacotherapy should only be used as a short-term treatment in symptomatic patients; long-term therapy is associated with many adverse effects.
- Total or partial joint replacement may be considered for advanced joint destruction with pain and functional impairment not adequately controlled by conservative management. 
- Type of surgery depends on the joint involved and the extent of involvement; indications include:
- See also “Complications after 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. 
- May be considered to delay the development or worsening of osteoarthritis in young individuals (< 60 years of age) with unicompartmental osteoarthritis (e.g., due to trauma) 
- Types and indications include: