OA Seminar Issues Protocol and Treatment Recommendations

A multidisciplinary panel of clinical experts has developed and released treatment protocol recommendations for three populations of patients suffering from hip osteoarthritis (OA).

Nearly 20 OA experts from the U.S. and Canada participated in the two-day symposium, which was sponsored by Össur, headquartered in Reykjavik, Iceland. The event was co-chaired by Katherine Dec, M.D. professor, Department of Physical Medicine & Rehabilitation and Orthopaedic Surgery at Virginia Commonwealth University and Axel Schulz, M.D., Össur’s Medical Director.

The panel issued specific recommendations as adjusted for each patients’ clinical state (acute, subacute, and ongoing) and three designated categories:

• Younger Hip OA Patients age 55 or less with clinically relevant symptoms;
• Active Demanding Hip OA Patients regardless of age who seek to continue their moderate to vigorous activity levels,
• Older Hip OA Patients seeking to maintain or regain their former activity levels.

According to the company’s press release on June 8; “The panel’s first recommendation was for a non-pharmacological core treatment approach, in which clinicians provide patient education and encourage activity and weight management that could help patients maintain a physically active lifestyle while still managing their pain.”

As for pharmacological treatments, the panel skipped acetaminophen and recommended oral NSAIDs (only for the short-term). Weak opioids also were considered beneficial but limited due to their considerable side effects.

The panel found intra-articular injections of corticosteroids to be “reasonable”—but only for patients with severe symptoms and joint inflammation as evidenced by capsular effusion detected via ultrasound—and image-guided administration, whether via ultrasound or fluoroscopy. As for hyaluronic acid and/or platelet-rich plasma (PRP) injections, the panel advised waiting for further evidence.

The panel evaluated the Unloader Hip from Össur, and determined that, “Because of Unloader Hip’s documented clinical benefits, the expert panel recommended that, instead of relying on a patient’s age and OA stage as automatic criteria for hip bracing, Unloader Hip could be applicable to all three categories of patients suffering from mild-to-moderate Hip OA as a supplement to the recommended core treatment. The Unloader Hip brace was also recommended for patients with moderate-to-severe hip pain whose pain did not abate after initial recommended treatments.”

Dr. Dec told OTW, “In our group discussions, determining the best practices for rehabilitation was difficult. There are various treatments that are non-invasive that help with pain, however, our goal was to also improve function. The entry point in the treatment for bracing was debated in the different types of patients.”

“Some of the most difficult topics to reconcile included bracing in the highly active patient, when to recommend use of the brace in the rehabilitation plan, and how to enhance compliance if bracing was selected. By focusing on function and pain relief, the consensus was easier to attain.”

Dr. Schulz commented to OTW, “The goal of the hip OA expert consensus was to provide a tool which helps medical professionals to select the right patient and to provide guidelines for when and how to use the Unloader Hip brace within an OA management concept for different patient types. The participants were given questionnaires with a follow-up with intense discussion on results. Experienced physicians discussed these questions in-depth and developed corresponding suggestions to achieve the best possible treatment outcome for the following hip OA patient groups: the younger patient, the active and demanding patient and the older patient.”