AAOS Board of Directors Approves Three Clinical Practice Guidelines

The AAOS Board of Directors (BOD) approved two updates to Clinical Practice Guidelines (CPGs): an update to the 2017 AAOS CPG on the Management of Osteoarthritis of the Hip and a rapid update to the 2010 CPG on the Diagnosis and Treatment of Osteochondritis Dissecans (OCD). The BOD also approved the external endorsement of the American Association of Clinical Endocrinology’s (AACE’s) 2020 CPG on the Diagnosis and Treatment of Postmenopausal Osteoporosis.

Management of Osteoarthritis of the Hip
The 2023 CPG for the Management of Osteoarthritis of the Hip updated 14 of the 23 recommendations included in the 2017 CPG and resulted in three strong and five moderate recommendations for the treatment of hip osteoarthritis in adults. The update also included one moderate recommendation for the use of cemented femoral stems.

Additionally, nine options were formulated. Options are used when there is little conflicting evidence or no evidence on a topic. These included two new options on (a) the use of oral acetaminophen in the treatment of symptomatic osteoarthritis of the hip and (b) the risk of dislocation after total hip arthroplasty (THA) in patients with both osteoarthritis of the hip and stiff spine syndrome. Other options include two options on adverse events and patient-reported outcomes in patients with an elevated BMI undergoing THA as well as individual options against the use of oral opioids for the nonoperative treatment of symptomatic osteoarthritis of the hip, on the risk of adverse events in patients with poorly controlled diabetes following THA, on the impact of social determinants of health in patients after THA, on the use of neuraxial anesthesia versus general anesthesia in patients undergoing THA, and regarding the risk for adverse events in patients who use tobacco products following THA.

Representatives from the Hip Society, the American Physical Therapy Association, the American Association of Hip and Knee Surgeons, and the American College of Radiation participated in the development of this guideline.

To read more about the updates and rationale behind this new CPG, see “Newly Revised CPG Provides Guidance on Osteoarthritis of the Hip.”

Diagnosis and Treatment of Osteochondritis Dissecans
Additionally, the BOD approved a rapid update to the CPG on the Diagnosis and Treatment of OCD. This CPG was originally published in 2010; since then, new studies have been published. However, AAOS has determined that, at this time, those studies are not sufficient to warrant changing the guideline’s scope.

Due to the paucity of evidence, this CPG was approved to be updated utilizing the AAOS Rapid Updates Methodology. Using this methodology, three of the guideline’s recommendations were upgraded. First, the use of MRI in a patient with a known OCD lesion on a radiograph was upgraded from a limited to a high recommendation. The option of surgery for skeletally immature patients with salvageable, unstable OCD was upgraded from a consensus to a limited recommendation. Finally, the option of surgery for skeletally mature patients with salvageable, unstable OCD was also upgraded from a consensus to a limited recommendation.

This CPG also included 11 inconclusive recommendations that were not included in the updated CPG—as per the CPG Rapid Updates Methodology, inconclusive recommendations are not revisited. The inconclusive recommendations have been moved to Appendix XIV. Please visit aaos.org/quality to view the full AAOS CPG Rapid Update Methodology.

Postmenopausal Osteoporosis
Lastly, the 2020 AACE CPG for the Diagnosis and Treatment of Postmenopausal Osteoporosis was approved by the BOD for external endorsement. This guideline acknowledges the high risk of fractures in women resulting from menopause and covers diagnosis and treatment options. Additionally, this guideline clarifies who should be treated and discusses three additional medications that were recently approved by the FDA. To learn more, read the article “AAOS Endorses Endocrinology Association CPG on Postmenopausal Osteoporosis,” published in the January issue of AAOS Now.

All external guidelines that are presented for AAOS endorsement must undergo a review of the guideline’s development process to confirm that they meet AAOS requirements based on Institute of Medicine standards.

Please visit aaos.org/quality to review the CPG Standard Criteria for Endorsement Consideration.

Barbara Krause is a quality-improvement specialist for clinical quality and value at AAOS. She can be reached at krause@aaos.org.