Osteoarthritis of the Knee-AAOS Guidelines

The American Academy of Orthopaedic Surgeons (AAOS) recently released its revised clinical practice guideline (CPG) on the treatment of osteoarthritis of the knee. The original guideline, as well as this revised version, was developed to include only treatments which are less invasive than knee replacement surgery.

Osteoarthritis(OA) is a common condition that is the leading cause of physical disability. It can affect any joint in the body particularly after years of use and is also known as "wear and tear" arthritis. It most commonly occurs in people who are 65 years of age or older.
The two primary changes recommended in the 2013 guidelines that differ from the 2009 CPG include:
• Acetaminophen: The recommended dosage was reduced from 4,000 mg to 3,000 mg a day. This is not a change made by AAOS specifically for OA patients, but an overall change made by the FDA since 2009 for individuals who use acetaminophen.
• Intra-articular Hyaluronic Acid (HA): Intra-articular hyaluronic acid is no longer recommended as a method of treatment for patients with symptomatic osteoarthritis of the knee.

Major Recommendations

1. The workgroup recommends that patients with symptomatic osteoarthritis of the knee participate in self-management programs, strengthening, low-impact aerobic exercises, and neuromuscular education; and engage in physical activity consistent with national guidelines.


2. The work group suggests weight loss for patients and a body mass index (BMI) ≥25 in patients with symptoms.


3. A)The workgroup cannot recommend using acupuncture in patients with symptomatic osteoarthritis of the knee. B)The work group is unable to recommend for or against the use of physical agents (including electrotherapeutic modalities) in these patients . C)The work group is unable to recommend for or against manual therapy in patients with symptomatic osteoarthritis of the knee.


4. The work group is unable to recommend for or against the use of a valgus directing force brace (medial compartment unloader) for patients with symptomatic osteoarthritis of the knee.


5. The workgroup cannot suggest that lateral wedge insoles be used for patients with symptomatic medial compartment osteoarthritis of the knee.


6. The workgroup cannot recommend using glucosamine and chondroitin for patients with symptomatic osteoarthritis of the knee.


7. A)The workgroup recommends nonsteroidal anti-inflammatory drugs (NSAIDs; oral or topical) or Tramadol for patients with symptomatic osteoarthritis of the knee. B)The work group is unable to recommend for or against the use of acetaminophen, opioids, or pain patches for these patients.


8. The work group is unable to recommend for or against the use of intraarticular (IA) corticosteroids for these patients with the symptom of the disease.


9. The workgroup cannot recommend using hyaluronic acid for these patients.


10. The work group is unable to recommend for or against growth factor injections and/or platelet rich plasma for these patients.


11. The workgroup cannot suggest that the practitioner use needle lavage for patients with symptomatic osteoarthritis of the knee.


12. The workgroup cannot recommend performing arthroscopy with lavage and/or debridement in patients with a primary diagnosis of symptomatic osteoarthritis of the knee.


13. The work group is unable to recommend for or against arthroscopic partial meniscectomy in these patients with a torn meniscus.


14. The practitioner might perform a valgus producing proximal tibial osteotomy in patients with symptomatic medial compartment osteoarthritis of the knee.


15. In the absence of reliable evidence, it is the opinion of the work group not to use the free-floating (un-fixed) inter positional device in patients with symptomatic medial compartment osteoarthritis of the knee.

In addition, One of the best ways for a patient to reduce his or her pain and realize better health is to be proactive like if a patient is overweight, losing weight is probably the best thing he or she can do to slow the progression of osteoarthritis of the knee. Although acupuncture continues to grow in popularity, the evidence did not support its use in patients with OA of the knee. Due to a lack of available research, the CPG is unable to recommend for or against the use of bracing, growth factor injections and/or platelet rich plasma, experts feel.