Abstract
Introduction
The mortality and serious side effects risk of both medical and surgical management of hip and knee osteoarthritis (OA) has been widely published. To date however, there are no studies comparing safety between the two treatment modalities. We aimed to systematically review the published evidence on the mortality and serious complications risk of the various treatments for hip and knee OA.
Methods
We searched for studies investigating the safety of arthroplasty, arthroscopy, opioids, non-steroidal anti-inflammatory drugs (NSAIDS), and paracetamol using PubMed, Score, Cochrane, PEDRO, and Google Scholar. The phrase “osteoarthritis treatment” was searched and then combined using Boolean connectors (“OR and “AND) with “serious complications” or “serious adverse events” or “mortality”. The quality of included studies was assessed based on the approach used by the AAOS in judging the quality of treatment studies.
Results
19 studies were included in the review. Mortality risk was highest for Naproxen HR = 3 (1.9; 4.6) and lowest for total hip replacement RR = 0.7 (0.7; 0.7). Highest serious gastrointestinal complication risk was reported for diclofenac 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 risk OR=2.32 (1.45; 3.71) whereas celecoxib had the lowest RR = 0.61 (0.4; 0.94). Celecoxib users had the highest cardiovascular (CV) complication risk OR=2.26 (1; 5.1) and the lowest was for tramadol RR = 1.1 (0.87; 1.4).
Discussion
Long term medical management of hip and knee OA particularly with NSAIDS may carry a higher mortality risk compared to surgery.
Conclusion
The practitioner and patient should carefully consider the risks of medications as well as surgery prior to commencing treatment. Treatment choice should also be tailored to the patient taking into account known GI, CVS, and renal co-morbidities.
