[Guideline 'Diagnostics and treatment of osteoarthrosis of the hip and knee'].
In patients with osteoarthritis of the hip or knee, radiological examinations are only indicated in general practice if there is discrepancy between the history and the findings in the physical examination. The treatment of first choice is a combination of physiotherapy and oral analgesics. If paracetamol fails to reduce the pain sufficiently, NSAIDs can be prescribed. Glucosamine sulfate can be advised for a trial period of three months to reduce knee pain. Intra-articular high molecular hyaluronic acid, intra-articular glucocorticoids, and systemic NSAID's have a similar effect on reducing pain and improving function in the case of osteoarthritis of the knee. The choice of a hip prosthesis should be based on well-documented long term efficiency and the direct and indirect costs. For total knee replacement a cemented non-mobile bearing, posterior stabilised total condylar prosthesis is the first choice. Thromboembolic complications after total hip and knee replacement can be reduced by low molecular weight heparin, fondaparinux, coumarin derivatives, or, after knee replacement, intermittent pneumatic compression. A combination of systemic antibiotics and antibiotic loaded cement is recommended for the prevention of infection during joint replacement. During dental surgery in patients with joint prostheses one oral dose of amoxicillin-clavulinic acid is sufficient as antibiotic prophylaxis. This is only indicated in case of infection.
Swierstra
Bart A
BA
Sint Maartenskliniek, Orthopaediecentrum, Nijmegen, The Netherlands. b.swierstra@maartenskliniek.nl
Bijlsma
Johannes W J
JW
de Beer
Johannes J A
JJ
Kuijpers
Ton
T
D000700:Analgesics / Q000627:therapeutic use; D003131:Combined Modality Therapy; D006801:Humans; D009426:Netherlands; D009985:Orthopedics / Q000592:standards; D015207:Osteoarthritis, Hip / Q000175:diagnosis* / Q000628:therapy*; D020370:Osteoarthritis, Knee / Q000175:diagnosis* / Q000628:therapy*; D010146:Pain / Q000209:etiology / Q000517:prevention & control; D026741:Physical Therapy Modalities; D010818:Practice Patterns, Physicians'; D011788:Quality of Life; D016059:Range of Motion, Articular; D020127:Recovery of Function; D012219:Rheumatology / Q000592:standards*; D012955:Societies, Medical
D000700:Analgesics