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

J Orthop Surg (Hong Kong). 2018 May-Aug;26(3):2309499018808669. doi: 10.1177/2309499018808669.


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) = 3 (1.9, 4.6)) and lowest for total hip replacement (relative risk (RR) = 0.7 (0.7, 0.7)). Highest gastrointestinal complications were reported for diclofenac (odds ratio (OR) = 4.77 (3.94, 5.76)) and lowest for total knee replacement (HR = 0.6 (0.49, 0.75)). Ibuprofen had the highest renal complications (OR = 2.32 (1.45, 3.71)), whereas celecoxib had the highest cardiovascular risk (OR = 2.26 (1, 5.1)) and lowest was for tramadol (RR = 1.1 (0.87, 1.4)). Results show that medical management of hip and knee OA, particularly with non-steroidal anti-inflammatory drugs, may carry higher mortality compared to surgery. Careful consideration should be given to medical management taking into account known co-morbidities.

Keywords: arthroscopy; chondroitin sulphate; glucosamine; non-steroidal anti-inflammatory drugs (NSAIDS); opioids; osteoarthritis treatment safety; paracetamol; total hip replacement; total knee replacement.

Publication types

  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Anti-Inflammatory Agents, Non-Steroidal / therapeutic use*
  • Arthroplasty, Replacement, Hip / methods*
  • Arthroplasty, Replacement, Knee / methods*
  • Disease Management*
  • Humans
  • Osteoarthritis, Hip / therapy*
  • Osteoarthritis, Knee / therapy*


  • Anti-Inflammatory Agents, Non-Steroidal