Treatment modalities for hip and knee osteoarthritis: A systematic review of safety

Abstract

Current guidelines on the management of hip and knee osteoarthritis (OA) do not compare safety of treatment modalities. We therefore systematically reviewed 20 studies investigating mortality and serious complications of both medical and surgical treatments for hip and knee OA using PubMed, Scopus, Web of Knowledge and Google Scholar. Mortality was the highest for naproxen (hazard ratio (HR) ¼ 3 (1.9, 4.6)) and lowest for total hip replacement (relative risk (RR) ¼ 0.7 (0.7, 0.7)). Highest gastrointestinal complications were reported for diclofenac (odds ratio (OR) ¼ 4.77 (3.94, 5.76)) and lowest for total knee replacement (HR ¼ 0.6 (0.49, 0.75)). Ibuprofen had the highest renal complications (OR ¼ 2.32 (1.45, 3.71)), whereas celecoxib had the highest cardiovascular risk (OR ¼ 2.26 (1, 5.1)) and lowest was for tramadol (RR ¼ 1.1 (0.87, 1.4)). Results show that medical management of hip and knee OA, particularly with non-steroidal antiinflammatory drugs, may carry higher mortality compared to surgery. Careful consideration should be given to medical management taking into account known co-morbidities.

Ibuprofen Safety at the Golden Anniversary: Are all NSAIDs the Same? A Narrative Review

“…Patients suffering dehydration are at elevated risk for a drug-associated renal adverse event from any NSAID [85]. In a systematic review of NSAID safety, ibuprofen had the highest rate of renal complications for treating hip and knee arthritis (compared with naproxen, diclofenac, and celecoxib) with an odds ratio of 2.32 (range 1.45-3.71) [86]. A cross-sectional study of 802 hip arthroscopy patients taking NSAIDs either alone or concomitantly with diuretics and/or an angiotensin-converting enzyme (ACE) inhibitor found NSAID use (any NSAID) had only a slight association with renal dysfunction (odds ratio 1.4, 95% confidence interval, 0.9-2.2) but was more likely to occur with NSAIDs having a halflife C 4 h (odds ratio 2.6, 95% confidence interval, 1.2-5.7).…”

Autologous Biologic Treatment with Fat, Bone Marrow Aspirate and Platelet Rich Plasma Is an Effective Alternative to Total Knee Arthroplasty for Patients with Moderate Knee Arthrosis

“…Nonsteroidal anti-inflammatory medicines (NSAID) drugs are also widely used, but have high toxicity rates [ 10 ]. Aweid [ 11 ] reported that chronic NSAID use for treatment of hip and knee osteoarthritis may have a higher mortality rate than joint replacement surgery. In our experience, they also tend to accelerate the path to TKA by masking pain, which allows patients to damage their joints more rapidly than they otherwise would.…”

Editorial Commentary: The Curious Incident of the Bone in the Soft Tissue: Is Heterotopic Ossification After Hip Arthroscopy an Interesting Finding or Is It a Complication?

“…3 In addition, although the PRECISION (Prospective Randomized Evaluation of Celecoxib Integrated Safety versus Ibuprofen or Naproxen) trial showed noninferiority of celecoxib to naproxen, 4 Celecoxib has fewer gastrointestinal effects than naproxen, and is (probably) just as safe from a cardiovascular standpoint, 4 but that is different than saying celecoxib is a benign drug. 6 Does prophylactic treatment justify the risks? As hip arthroscopy surgeons, are we succumbing to the vanity of having perfect-looking radiographs to the detriment of our patients?…”