Evidence-based tailored conservative treatment of knee and hip osteoarthritis: between knowing and doing

Scand J Rheumatol. 2011 May;40(3):225-31. doi: 10.3109/03009742.2010.530611. Epub 2011 Jan 25.


Objective: Insufficient data are available on the efficacy of combined conservative interventions recommended by treatment guidelines for knee/hip osteoarthritis (OA). The aims of this observational cohort study were (i) to estimate the results of an evidence-based 12-week tailored multimodal conservative treatment protocol for patients with knee/hip OA and (ii) to identify predictors for response.

Methods: After obtaining data on previous OA-related interventions, multimodal treatment was offered to patients with knee and/or hip OA at a specialized outpatient clinic. Treatment with analgesics was tailored using a numeric rating scale (NRS) for pain, aiming for NRS ≤ 4. The following outcome measures were assessed: (i) the proportion of patients fulfilling OMERACT-OARSI (Outcome Measures in Rheumatoid Arthritis Clinical Trials/Osteoarthritis Research Society International) responder criteria and (ii) the proportion of patients with NRS pain ≤ 4 after 12 weeks.

Results: A total of 183 out of 299 patients was included. OMERACT-OARSI responder criteria were fulfilled at 12 weeks in 47% of patients; 39% reached NRS pain ≤ 4. The only independent predictor for response was the number of previously used non-steroidal anti-inflammatory drugs (NSAIDs). The majority of patients had not been exposed adequately to conservative treatment modalities for knee and/or hip OA in the past (81%).

Conclusion: Evidence-based multimodal conservative treatment using a standardized protocol for knee and/or hip OA is feasible and successful in 47% of patients. In general, response could not be predicted. Basic first-line recommended conservative treatment options have not been used adequately prior to referral to secondary care in the vast majority of patients.

MeSH terms

  • Analgesics / therapeutic use*
  • Chondroitin / administration & dosage
  • Cohort Studies
  • Dietary Supplements*
  • Evidence-Based Medicine
  • Female
  • Glucosamine / administration & dosage
  • Humans
  • Male
  • Middle Aged
  • Osteoarthritis, Hip / complications
  • Osteoarthritis, Hip / physiopathology
  • Osteoarthritis, Hip / therapy*
  • Osteoarthritis, Knee / complications
  • Osteoarthritis, Knee / physiopathology
  • Osteoarthritis, Knee / therapy*
  • Pain / drug therapy*
  • Pain / etiology
  • Pain / physiopathology
  • Pain Measurement
  • Physical Therapy Modalities*
  • Severity of Illness Index
  • Surveys and Questionnaires
  • Treatment Outcome


  • Analgesics
  • Chondroitin
  • Glucosamine