Board Approves CPG on the Management of Osteoarthritis of the Hip

During its meeting on Monday, March 13, the AAOS Board of Directors appointed the chair of the 2018 Nominating Committee, adopted a Clinical Practice Guideline (CPG) on the Management of Osteoarthritis of the Hip, approved several information statements, and accepted or approved reports and plans from various groups. It also presented certificates to several retiring Board members and one council chair, whose terms end with the 2017 Annual Meeting, recognizing the efforts of those individuals on behalf of the Academy. AAOS CEO Karen Hackett, who retires next month, was recognized for her service as well.

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Members of the 2016–2017 AAOS Board of Directors take a break from their Monday meeting for a final group photo.

Nominating Committee chair and members
The AAOS Board appointed Past President Frederick M. Azar, MD, to serve as chair of the 2018 Nominating Committee. At the Association Business Meeting on Thursday, March 16, nominations for the other members of the 2018 Nominating Committee will be accepted from the fellowship. Six members will be elected by the fellowship after the Annual Meeting. The 2018 Nominating Committee will be responsible for selecting the slate of officers and other positions for the upcoming year.

CPG on the Management of Osteoarthritis of the Hip
Since 2006, the AAOS has been developing evidence-based CPGs to improve patient care. The AAOS Committee on Evidence-Based Quality and Value appoints work groups to develop guidelines as educational tools for orthopaedic surgeons. The work groups consist of AAOS physician members and members of other specialty organizations who define the scope of the guideline by developing recommendations and defining inclusion criteria for the literature search. The AAOS Guidelines Unit supports members with data analyses and pertinent methodologic information.

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AAOS President Gerald R. Williams Jr, MD, makes a point during the Board of Directors meeting on Monday, March 13.

The most recent CPG, Management of Osteoarthritis of the Hip, consists of 18 recommendations with varying overall strength of evidence. Among the recommendations with “strong” levels of evidence (evidence from two or more “high”-quality studies with consistent findings for recommending for or against an intervention) were the following:

Strong evidence supports that NSAIDs improve short-term pain, function, or both in patients with symptomatic osteoarthritis of the hip.

  • Strong evidence supports the use of intra-articular corticosteroids to improve function and reduce pain in the short-term for patients with symptomatic osteoarthritis of the hip.
  • Strong evidence does not support the use of intra-articular hyaluronic acid because it does not perform better than placebo for function, stiffness, and pain in patients with symptomatic osteoarthritis of the hip.
  • Strong evidence supports the use of physical therapy as a treatment to improve function and reduce pain for patients with osteoarthritis of the hip and mild to moderate symptoms.
  • Among the recommendations with “moderate” levels of evidence (evidence from two or more “moderate”-quality studies with consistent findings, or evidence from a single “High”-quality study for recommending for or against the intervention) were the following:
  • Moderate strength evidence supports that the practitioner could use risk assessment tools to assist in predicting adverse events, assessing surgical risks, and educating patients with symptomatic osteoarthritis of the hip undergoing total hip arthroplasty (THA).
  • Moderate strength evidence supports that obese patients with symptomatic osteoarthritis of the hip, when compared to non-obese patients, may achieve lower absolute outcome scores but a similar level of patient satisfaction and relative improvement in pain and function after THA.
  • Moderate strength evidence supports that increased age is associated with lower functional and quality of life outcomes in patients with symptomatic osteoarthritis of the hip undergoing THA.
  • Moderate strength evidence supports that mental health disorders, such as depression, anxiety, and psychosis, are associated with decreased function, pain relief, and quality of life outcomes in patients with symptomatic osteoarthritis of the hip who undergo THA.
  • Moderate strength evidence does not support the use of glucosamine sulfate because it did not perform better than placebo for improving function, reducing stiffness, and decreasing pain for patients with symptomatic osteoarthritis of the hip.
  • Moderate strength evidence supports that the practitioner could use intravenous or topical tranexamic acid for patients with symptomatic osteoarthritis of the hip who are undergoing THA as a part of the effort to reduce blood loss.
  • Moderate strength evidence supports that there were no clinically significant differences in patient-oriented outcomes related to the surgical approach for patients with symptomatic osteoarthritis of the hip undergoing THA.
  • Moderate evidence supports the use of postoperative physical therapy because it could improve early function to a greater extent than no physical therapy management for patients with symptomatic osteoarthritis of the hip who have undergone THA.

Additional business
The Board also addressed several other items requiring action.

Revisions to the AAOS Information Statement #1017—Patient-Physician Communication—and to Statement #1028—Communicating Adverse Events or Poor Outcomes—were approved.

An Information Statement on Radiation Safety was approved.

  • Revisions to the AAOS Long-Term Investment Policy were approved.
  • The final report of the Revenue Enhancement Project Team (including a recommendation to sunset the project team) was approved.
  • The Fellowship Accreditation Taskforce Report was accepted.
  • The Fragility Fracture Task Force Business Plan was approved.
  • The Exhibit Sponsorship Assistant Business Plan was approved.
  • The Revenue Enhancement Team Report was accepted.
  • Retiring board members and council chair recognized

At the conclusion of the meeting, AAOS President Gerald R. Williams Jr, MD, recognized the service of those board members and council chair whose terms end with the 2017 Annual Meeting: Chair of the Council on Advocacy Thomas C. Barber, MD; Member-at-Large Howard R. Epps, MD; Member-at-Large Daniel C. Farber, MD; Chair of the Board of Specialty Societies Brian G. Smith, MD; Chair of the Board of Councilors Lawrence S. Halperin, MD; and Past President David D. Teuscher, MD. Also recognized was departing Lay Member Ken Sowards, who received the rare honor of honorary membership in the AAOS.

In addition, members of the Board joined President Williams in recognizing AAOS CEO Karen L. Hackett, FACHE, CAE, who retires next month. “Karen, we appreciate all your efforts on behalf of the Academy over the past 14 years,” said Williams, “and we’ll miss you greatly.” Ms. Hackett received a standing ovation from all present.            

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