La Trobe Sports and Exercise Medicine Research Centre, La Trobe University, Bundoora, Australia; School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia; Physiotherapy Department, Eastern Health, Box Hill Hospital, 8 Arnold Street, Box Hill, 312 Victoria, Australia.
Sydney Musculoskeletal Health, Kolling Institute, University of Sydney, Sydney, Australia; Department of Rheumatology, Royal North Shore Hospital, Sydney, NSW, Australia.
Osteoarthritis Cartilage. 2023 Oct;31(10):1280-1292. doi: 10.1016/j.joca.2023.05.015. Epub 2023 Jun 30.
OBJECTIVES: Guideline adherence for hip and knee osteoarthritis management is often poor, possibly related to the quality and/or inconsistent recommendations. This systematic review of hip and knee osteoarthritis guidelines aimed to appraise the quality and consistency in recommendations across higher-quality guidelines. METHODS: Eight databases, guideline repositories, and professional associations websites were searched on 27/10/2022. Guideline quality was appraised using the Appraisal of Guidelines for Research and Evaluation II (AGREE II tool) (six domains). Higher quality was defined as scoring ≥60% for domains 3 (rigour of development), 6 (editorial independence), plus one other. Consistency in recommendations across higher-quality guidelines was reported descriptively. This review was registered prospectively (CRD42021216154). RESULTS: Seven higher-quality and 18 lesser-quality guidelines were included. AGREE II domain scores for higher-quality guidelines were > 60% except for applicability (average 46%). Higher-quality guidelines consistently recommended in favour of education, exercise, and weight management and non-steroidal anti-inflammatory drugs (hip and knee), and intra-articular corticosteroid injections (knee). Higher quality guidelines consistently recommended against hyaluronic acid (hip) and stem cell (hip and knee) injections. Other pharmacological recommendations in higher-quality guidelines (e.g., paracetamol, intra-articular corticosteroid (hip), hyaluronic acid (knee)) and adjunctive treatments (e.g., acupuncture) were less consistent. Arthroscopy was consistently recommended against in higher-quality guidelines. No higher-quality guidelines considered arthroplasty. CONCLUSION: Higher-quality guidelines for hip and knee osteoarthritis consistently recommend clinicians implement exercise, education, and weight management, alongside consideration of Non-Steroidal Anti-Inflammatory Drugs and intra-articular corticosteroid injections (knee). Lack of consensus on some pharmacological options and adjunctive treatments creates challenges for guideline adherence. Future guidelines must prioritise providing implementation guidance, considering consistently low applicability scores.
目的：髋膝关节骨关节炎管理的指南遵循情况通常较差，这可能与指南的质量和/或推荐意见不一致有关。本系统评价对髋膝关节骨关节炎指南进行了综述，旨在评估高质量指南中推荐意见的质量和一致性。
方法：于 2022 年 10 月 27 日在 8 个数据库、指南库和专业协会网站上进行了检索。使用评估指南研究与评价 II（AGREE II 工具）（六个领域）对指南质量进行评估。高质量定义为在领域 3（制定的严谨性）和 6（编辑独立性）中得分均≥60%，再加上另一个领域。报告高质量指南中推荐意见的一致性。本综述前瞻性注册（CRD42021216154）。
结果：纳入了 7 项高质量和 18 项低质量指南。高质量指南的 AGREE II 领域评分均>60%，除适用性（平均 46%）外。高质量指南一致推荐教育、运动和体重管理以及非甾体抗炎药（髋膝关节）和关节内皮质类固醇注射（膝关节）。高质量指南一致推荐不使用透明质酸（髋关节）和干细胞（髋关节和膝关节）注射。高质量指南中的其他药物治疗建议（如对乙酰氨基酚、关节内皮质类固醇（髋关节）、透明质酸（膝关节））和辅助治疗（如针灸）的一致性较差。关节镜检查在高质量指南中一致被推荐为禁忌。没有高质量的指南考虑关节置换术。
结论：髋膝关节骨关节炎的高质量指南一致推荐临床医生实施运动、教育和体重管理，同时考虑非甾体抗炎药和关节内皮质类固醇注射（膝关节）。一些药物选择和辅助治疗的共识性较差，给指南的遵循带来挑战。未来的指南必须优先提供实施指导，考虑到适用性评分普遍较低。
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