Osteoarthritis (OA) is a common musculoskeletal condition that affects millions of Australians, with knee and hip OA being particularly prevalent. The Royal Australian College of General Practitioners (RACGP) provides evidence-based guidelines for managing OA, aiming to improve function, reduce pain, and enhance quality of life. In this post, we summarise the key recommendations from the RACGP guidelines on managing knee and hip OA, focusing on a multidisciplinary, patient-centred approach.
1. Early Diagnosis and Assessment
Early identification of OA is crucial for effective management. The RACGP recommends comprehensive assessments, including:
- Clinical history: Assessing symptoms such as joint pain, stiffness, and functional limitations, as well as risk factors.
- Physical examination: Key signs of OA include tenderness, limited range of motion, and crepitus.
- Imaging: While X-rays or MRI may confirm the diagnosis, they are not always necessary for initial assessment. The presence of symptoms and clinical signs often provides sufficient evidence of OA.
2. Non-Pharmacological Interventions
Non-pharmacological treatments are the first line of management for both knee and hip OA. The RACGP strongly recommends:
a) Exercise Therapy
Exercise is a cornerstone of OA management and has been shown to reduce pain, improve function, and increase joint mobility. The guidelines advocate for:
- Strengthening exercises (especially for the quadriceps in knee OA and hip abductors for hip OA) to support the affected joint and improve stability.
- Aerobic exercises like walking, swimming, or cycling to improve cardiovascular health and overall fitness.
- Range of motion exercises to maintain or restore joint flexibility.
Physical therapy, supervised by a physiotherapist, can be particularly beneficial for tailored exercise regimens.
b) Weight Management
For individuals who are overweight or obese, weight loss is strongly recommended. Even modest weight loss (e.g., 5-10% of body weight) can lead to significant reductions in pain and improve joint function.
c) Education and Self-Management
Education about OA and its progression is essential for empowering patients to manage their condition effectively. The RACGP guidelines stress the importance of providing information on:
- Joint protection strategies.
- Activity modification to prevent joint stress.
- The use of assistive devices, such as braces, walking aids, or orthotics.
Self-management strategies can significantly enhance patient outcomes by promoting active participation in care.
3. Pharmacological Interventions
While non-pharmacological treatments are the foundation, pharmacological therapies can be used to manage pain and inflammation. The RACGP guidelines outline several options:
a) Analgesics
- Paracetamol is recommended as a first-line analgesic due to its relatively low side effect profile. However, it should be used cautiously in patients with liver impairment.
- Nonsteroidal anti-inflammatory drugs (NSAIDs) (oral or topical) may be considered for short-term pain relief. Topical NSAIDs are often preferred for knee OA as they have fewer systemic side effects.
b) Opioids
Opioids should be considered a last resort due to their potential for addiction and side effects. The guidelines recommend using opioids only in very specific circumstances, and with close monitoring for misuse.
c) Intra-articular Injections
For patients with moderate-to-severe OA or when pain is not adequately controlled with oral medications, intra-articular corticosteroid or hyaluronic acid injections may provide temporary relief. The RACGP suggests that these injections be used sparingly, as they provide short-term symptom relief and do not alter the progression of the disease.
4. Surgical Interventions
In cases of severe OA where conservative management has failed, surgical options may be considered. The RACGP outlines surgical approaches such as:
- Total joint replacement: The most common surgery for advanced knee or hip OA, particularly when the patient's quality of life is severely impacted.
- Arthroscopy: This may be considered in cases of joint derangement or when there is a clear mechanical block to movement. This type of surgery is not commonly recommended.
- Osteotomy: Occasionally considered for younger patients with joint deformity, to realign the bones and reduce stress on the affected joint.
5. Multidisciplinary Care
Given the chronic nature of OA, management often requires a multidisciplinary approach. The RACGP encourages collaboration among healthcare providers, including general practitioners, physiotherapists, occupational therapists, dieticians, and orthopaedic surgeons. This team-based approach ensures comprehensive care that addresses the physical, emotional, and social aspects of the condition.
6. Management of Comorbidities
OA is often associated with other chronic conditions such as diabetes, hypertension, and cardiovascular disease. Managing these comorbidities alongside OA is essential for improving overall patient health and managing OA symptoms more effectively. The RACGP highlights the importance of regular screening and monitoring for these conditions in individuals with OA.
Conclusion
The RACGP guidelines for the management of knee and hip osteoarthritis emphasise a patient-centred, evidence-based approach, with a focus on non-pharmacological interventions as the cornerstone of care. Exercise therapy, weight management, and education are key components of the management plan. While pharmacological treatments and surgical options are available, they should be used judiciously and in conjunction with conservative management strategies.
For patients with knee or hip OA, working closely with a multidisciplinary team of healthcare professionals—including physiotherapists, general practitioners, and orthopaedic specialists—can significantly improve outcomes, reduce pain, and enhance the quality of life.
At Physio on Patterson, our team is committed to providing tailored physiotherapy interventions that align with these guidelines, helping you manage osteoarthritis effectively and maintain an active, healthy lifestyle. If you are living with knee or hip OA, contact us today to discuss how we can support your treatment plan.
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