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Conservative treatment of coxarthrosis and gonarthrosis.

Stefan Tserovski, MD

In the scientific literature there is a large number of articles on the topic of conservative treatment of osteoarthritis of the hip and knee joint. There are a variety of treatment recommendations, but not all are evidence-based. The Australian Medical Council summarizes these recommendations and gives a confidence level for each.

The recommendation has a certain level of credibility relative to the scientific evidence on the subject.

  • Very high credibility
  • High credibility
  • Medium level of credibility
  • Low credibility


General recommendations

1st recommendation: lifestyle changes, diet and physical activity. Low credibility

2nd recommendation: Intra-articular injections

3rd recommendation: Multidisciplinary approach. Low fidelity

4th recommendation: Assessment of the patient by the general practitioner or attending physician.


Non-pharmacological treatment

5th recommendation: weight loss High credibilityHigh credibility

6th recommendation: exercises with your own weight on an exercise mat. High credibility

7th recommendation: HydrotherapyHigh credibility

8th recommendation: Multimodal physiotherapy Medium level of confidence Medium level of confidence

9th recommendation: Tai Chi. Medium level of credibility

10th recommendation: Self-treatment at home after training Medium credibility

11th recommendation: thermotherapy Medium degree of credibility.

12th recommendation: electrostimulation Medium degree of credibility

13th recommendation: Acupuncture Medium level of credibility

14th recommendation: taping the patella. Low credibility

15th recommendation: massage therapy Low credibility

16th recommendation: Telephone treatment. Low credibility

17th recommendation: Magnetic telephone therapy. Low credibility

18th recommendation: laser therapy. Low credibility

19th recommendation: treatment with leeches. Low credibility


Pharmacological treatment

20th recommendation: Paracetamol with a maximum dose of 4 g/day.Very high credibility.. While not as effective as nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen has a lower rate of side effects, particularly those related to the gastrointestinal tract.

21st recommendation: Oral therapy with NSAIDsHigh credibility          (NSAIDs) Short-term therapy with NSAIDs for the treatment of coxarthrosis and gonarthrosis has certain advantages. Therapy should be tailored to the age of the patient and concomitant diseases. Monitoring of blood pressure and renal function is required in elderly and disabled patients. In some cases, they should be prescribed in combination with proton pump inhibitors or COX-2 inhibitors.

22nd recommendation: Weak and strong opioids. Very high credibility

They are recommended for patients in whom arthroplasty is delayed or contraindicated. They are written as a last option.

Careful monitoring of the patient with "stepped" therapy

23rd recommendation: Intravenous injection with corticosteroids. - High credibility

24th Recommendation: Topical NSAIDs. medium. - Level of credibility

25th recommendation: Topical capsaicin. - Low credibility

26th recommendation: Oral chondroprotectors. - Medium level of credibility

27th recommendation: Glucosamine. - Medium level of credibility


No indication of therapeutic benefit

28th recommendation: orthoses, braces

29th recommendation: Electromagnetic fields

30th recommendation: Oral hyaluronic acid for arthrosis of the hip joint

31st recommendation: chondroitin sulfate

32nd recommendation: vitamins, herbs, dietary supplements

33rd recommendation: Therapeutic ultrasound

34th recommendation: cognitive therapy.


Stefan Tserovski completed his school education at the 91st German Language High School in 2009. In 2016 he graduated from Medical University - Sofia. In 2019 he defended a dissertation on "Surgical dislocation of the hip joint in children and adolescents". He is currently a specialist in "Orthopaedics and Traumatology" at USBALO "Prof. Boycho Boychev” and assistant at the Medical University - Sofia, where he is actively engaged in teaching. He is the author of over 20 scientific papers. The www.ortoped.bg team

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