Management of osteoarthritis of the knee (non-arthroplasty): AAOS Guideline
USA: The American Academy of Orthopaedic Surgeons has released a new guideline for the management of osteoarthritis of the knee (Non-Arthroplasty). The clinical practice guideline is based on a systematic review of published studies examining the non arthroplasty treatment of knee osteoarthritis in adults. It provides recommendations that will help practitioners to integrate the current evidence and clinical practice. This guideline is intended to be used by appropriately trained physicians and clinicians who manage the treatment of osteoarthritis of the knee.
This guideline, published in the Journal of the American Academy of Orthopaedic Surgeons is intended for use with adults (ages 17 years and older) who have been diagnosed by a trained healthcare provider with osteoarthritis of the knee and are undergoing treatment.
The scope of this guideline includes non-pharmacologic and pharmacologic interventions for symptomatic osteoarthritis of the knee as well as operative procedures less invasive than knee replacement (arthroplasty). It does not provide recommendations for patients diagnosed with rheumatoid arthritis, osteoarthritis of other joints, or other inflammatory arthropathies.
Key recommendations include:
- Lateral wedge insoles are not recommended for patients with knee osteoarthritis.
- Canes could be used to improve pain and function in patients with knee osteoarthritis.
- Brace treatment could be used to improve function, pain, and quality of life in patients with knee osteoarthritis.
- The following supplements may be helpful in reducing pain and improving function for patients with mild to moderate knee osteoarthritis; however, the evidence is inconsistent/limited, and additional research clarifying the efficacy of each supplement is needed – turmeric, ginger extract, glucosamine, chondroitin, vitamin D.
- Topical NSAIDs should be used to improve function and quality of life for treatment of osteoarthritis of the knee, when not contraindicated.
- Supervised exercise, unsupervised exercise, and/or aquatic exercise are recommended over no exercise to improve pain and function for treatment of knee osteoarthritis.
- Neuromuscular training (i.e. balance, agility, coordination) programs in combination with traditional exercise could be used to improve performancebased function and walking speed for the treatment of knee osteoarthritis.
- Self-management programs are recommended to improve pain and function for patients with knee osteoarthritis.
- Patient education programs are recommended to improve pain in patients with knee osteoarthritis.
- Sustained weight loss is recommended to improve pain and function in overweight and obese patients with knee osteoarthritis.
- Manual therapy in addition to an exercise program may be used to improve pain and function in patients with knee osteoarthritis.
- Massage may be used in addition to usual care to improve pain and function in patients with knee osteoarthritis.
- FDA-approved laser treatment may be used to improve pain and function in patients with knee osteoarthritis.
- Acupuncture may improve pain and function in patients with knee osteoarthritis.
- Modalities that may be used to improve pain and/or function in patients with knee osteoarthritis include: - Transcutaneous Electrical Nerve Stimulation (pain).
- Modalities that may be used to improve pain and/or function in patients with knee osteoarthritis include a) Percutaneous Electrical Nerve Stimulation (pain and function) and b) Pulsed Electromagnetic Field Therapy (pain).
- Extracorporeal shockwave therapy may be used to improve pain and function for the treatment of osteoarthritis of the knee.
- Oral NSAIDs are recommended to improve pain and function in the treatment of knee osteoarthritis when not contraindicated.
- Oral acetaminophen is recommended to improve pain and function in the treatment of knee osteoarthritis when not contraindicated.
- Oral narcotics, including tramadol, result in a significant increase of adverse events and are not effective at improving pain or function for the treatment of osteoarthritis of the knee.
- Hyaluronic acid intra-articular injection(s) is not recommended for routine use in the treatment of symptomatic osteoarthritis of the knee.
- Intra-articular (IA) corticosteroids could provide short-term relief for patients with symptomatic osteoarthritis of the knee.
- Platelet-rich plasma (PRP) may reduce pain and improve function in patients with symptomatic osteoarthritis of the knee.
- Denervation therapy may reduce pain and improve function in patients with symptomatic osteoarthritis of the knee.
- Arthroscopy with lavage and/or debridement in patients with a primary diagnosis of knee osteoarthritis is not recommended.
- Arthroscopic partial meniscectomy can be used for the treatment of meniscal tears in patients with concomitant mild to moderate osteoarthritis who have failed physical therapy or other nonsurgical treatments.
- High tibial osteotomy may be considered to improve pain and function in properly indicated patients with unicompartmental knee osteoarthritis.
- In the absence of reliable evidence, it is the opinion of the workgroup that the utility/efficacy of dry needling is unclear and requires additional evidence.
- In the absence of reliable or new evidence, it is the opinion of the workgroup not to use free-floating (un-fixed) interpositional devices in patients with symptomatic medial compartment osteoarthritis of the knee.
Reference:
American Academy of Orthopaedic Surgeons Management of Osteoarthritis of the Knee (Non-Arthroplasty) Evidence-Based Clinical Practice Guideline (3rd Edition). https://www.aaos.org/oak3cpg Published August 31, 2021.
