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Guideline for the Management of Knee and Hip Osteoarthritis Second Edition

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Guideline for the Management of Knee and Hip Osteoarthritis Second Edition Guideline for the management of knee and hip osteoarthritis Second edition racgp.org.au Healthy Profession. Healthy Australia. Guideline for the management of knee and hip osteoarthritis. Second edition Disclaimer The information set out in this publication is current at the date of first publication and is intended for use as a guide of a general nature only and may or may not be relevant to particular patients or circumstances. Nor is this publication exhaustive of the subject matter. Persons implementing any recommendations contained in this publication must exercise their own independent skill or judgement or seek appropriate professional advice relevant to their own particular circumstances when so doing. Compliance with any recommendations cannot of itself guarantee discharge of the duty of care owed to patients and others coming into contact with the health professional and the premises from which the health professional operates. Whilst the text is directed to health professionals possessing appropriate qualifications and skills in ascertaining and discharging their professional (including legal) duties, it is not to be regarded as clinical advice and, in particular, is no substitute for a full examination and consideration of medical history in reaching a diagnosis and treatment based on accepted clinical practices. Accordingly, The Royal Australian College of General Practitioners Ltd (RACGP) and its employees and agents shall have no liability (including without limitation liability by reason of negligence) to any users of the information contained in this publication for any loss or damage (consequential or otherwise), cost or expense incurred or arising by reason of any person using or relying on the information contained in this publication and whether caused by reason of any error, negligent act, omission or misrepresentation in the information. Recommended citation The Royal Australian College of General Practitioners. Guideline for the management of knee and hip osteoarthritis. 2nd edn. East Melbourne, Vic: RACGP, 2018. The Royal Australian College of General Practitioners Ltd 100 Wellington Parade East Melbourne, Victoria 3002 Tel 03 8699 0414 Fax 03 8699 0400 www.racgp.org.au ABN: 34 000 223 807 ISBN: 978-0-86906-500-6 First edition (Guidelines for the non-surgical management of hip and knee osteoarthritis) published 2009 Second edition published July 2018 © The Royal Australian College of General Practitioners 2018 This resource is provided under licence by the RACGP. Full terms are available at www.racgp.org.au/ usage/licence. In summary, you must not edit or adapt it or use it for any commercial purposes. You must acknowledge the RACGP as the owner. We acknowledge the Traditional Custodians of the lands and seas on which we work and live, and pay our respects to Elders, past, present and future. Publication Approval The guideline recommendations on pages 5–12 of this document were approved by the Chief Executive Officer of the National Health and Medical Research Council (NHMRC) on 9 July 2018 under section 14A of the National Health and Medical Research Council Act 1992. In approving the guideline recommendations, NHMRC considers that they meet the NHMRC standard for clinical practice guidelines. This approval is valid for a period of five years. NHMRC is satisfied that the guideline recommendations are systematically derived, based on the identification and synthesis of the best available scientific evidence, and developed for health professionals practising in an Australian healthcare setting. This publication reflects the views of the authors and not necessarily the views of the Australian Government. Guideline for the management of knee and hip osteoarthritis Second edition Guideline for the management of knee and hip osteoarthritis Second edition iii About this guideline The Royal Australian College of General Practitioners (RACGP) first developed Guidelines for the non-surgical management of hip and knee osteoarthritis in 2009. Since then, there has been substantial progress in evaluating the effectiveness and safety of commonly used and new therapies for osteoarthritis (OA). The objective of this new guideline is to present the best available, current scientific evidence for OA interventions, covering all interventions other than joint replacement for the hip and knee. Target population and audience This guideline applies to all adults diagnosed with symptomatic OA of the hip and/or knee up until referral for joint replacement. While this guideline is intended primarily for use in the primary care setting by general practitioners (GPs), consideration of the relevance of this guideline was also given to other health professionals who treat people with OA. This is reflected in the multidisciplinary composition of the guideline development working group, including consumer representatives. Guideline for the management of knee and hip osteoarthritis iv Second edition Acronyms ACR American College of Rheumatology MSM methylsulfonylmethane AIHW Australian Institute of Health and Welfare NATSIHS National Aboriginal and Torres ASU avocado/soybean unsaponifiables Strait Islander Health Survey BMI body mass index NGF nerve growth factor CALD culturally and linguistically diverse NHMRC National Health and Medical Research Council CBT cognitive behavioural therapy NICE National Institute for Health CENTRAL Cochrane Database of Systematic and Care Excellence Reviews and Cochrane Central Register of Controlled Trials NPRS Numeric Pain Rating Scale CI confidence interval NSAID nonsteroidal anti-inflammatory drug CINAHL Cumulative Index to Nursing and Allied OA osteoarthritis Health Literature OARSI Osteoarthritis Research Society International COI conflict of interest OR odds ratio COX cyclooxygenase p75NTR 75 kDa neurotrophin receptor COX-2 cyclooxygenase-2 PBS Pharmaceutical Benefits Scheme CRP C-reactive protein PG prostaglandin CT computed tomography PHN Primary Health Network DALYs disability-adjusted life-years PICO patient/population/problem, intervention, DHA docosahexaenoic acid comparison/control, outcome DMOADs disease-modifying osteoarthritis drugs PPI proton-pump inhibitor DMSO dimethylsulfoxide PRAC Pharmacovigilance Risk Assessment Committee EMA European Medicines Agency PRP platelet-rich plasma EPA eicosapentaenoic acid RACGP The Royal Australian College ESR erythrocyte sedimentation rate of General Practitioners FGF fibroblast growth factor RCT randomised controlled trial GP general practitioner RR relative risk GRADE Grading of Recommendations SES socioeconomic status Assessment, Development and Evaluation SMD standardised mean difference HANDI Handbook of non-drug interventions SNRI serotonin and norepinephrine HOOS Hip Disability and Osteoarthritis reuptake inhibitor Outcome Score TEAE treatment-emergent adverse event ICTRP International Clinical Trials Registry Platform TENS transcutaneous electrical nerve stimulation IgG2 immunoglobulin G2 TGA Therapeutic Goods Administration IL-1 interleukin-1 TNF-alpha tumour necrosis factor alpha IPDAS International Patient Decision Aids Standards TrkA tyrosine kinase receptor KOOS Knee Injury and Osteoarthritis TRPV1 Transient Receptor Potential Vanilloid 1 Outcome Score VAS Visual Analog Scale MBS Medicare Benefits Schedule WHO World Health Organization MD mean difference WOMAC Western Ontario and McMaster MRI magnetic resonance imaging Universities Osteoarthritis Index MSC mesenchymal stem cell Guideline for the management of knee and hip osteoarthritis Second edition v Acknowledgements The update of the Guideline for the management of knee and hip osteoarthritis was supported by The Royal Australian College of General Practitioners (RACGP) and Medibank Better Health Foundation. The RACGP gratefully acknowledges the generous contribution of the working group members in the development of this guideline. Guideline development working group members Professor David Hunter, co-Chair, Guideline development working group; Florance and Cope Chair, Institute of Bone and Joint Research, Kolling Institute, University of Sydney, New South Wales; Rheumatologist, Royal North Shore Hospital, New South Wales Professor Kim Bennell, co-Chair, Guideline development working group; Director, Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, University of Melbourne, Victoria Professor Michael Austin, Associate Dean, School of Engineering, RMIT University, Victoria Professor Andrew Briggs, School of Physiotherapy and Exercise Science, Faculty of Health Sciences, Curtin University, Western Australia Professor Rachelle Buchbinder, Director, Monash Department of Clinical Epidemiology, Cabrini Hospital, Victoria; Professor, Department of Epidemiology and Preventive Medicine, Monash University, Victoria Dr Stephen Bunker, Clinical Research Advisor, Medibank Private Ltd Professor Peter Choong, Chair of Surgery and Head of Department of Surgery, University of Melbourne, St Vincent’s Hospital Melbourne, Victoria; Director of Orthopaedics, St Vincent’s Hospital Melbourne, Victoria; Chair, Bone and Soft Tissue Sarcoma Service, Peter MacCallum Cancer Centre Dr Dan Ewald, general practitioner, Lennox Head Medical Centre, New South Wales; Bullinah Aboriginal Health Service, Ballina, New South Wales; Adjunct Associate Professor, University of Sydney and Northern River University Centre for Rural Health, New South Wales; Lead clinical advisor, North Coast NSW PHN Professor Kieran Fallon, Professor of Sport and Exercise Medicine and Sport and Exercise
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