Nonsurgical Management of Osteoarthritis of the Knee-AAOS Guidelines
There's no cure for osteoarthritis as yet, but there are a number of treatments that can help ease symptoms and reduce the chances of your arthritis becoming worse.The main symptoms of osteoarthritis of the knee are: pain (particularly when you're moving your knee or at the end of the day – this usually gets better when you rest), stiffness (especially after rest – this usually eases after a minute or so as you get moving),crepitus, a creaking, crunching, grinding sensation when you move the joint,hard swellings (caused by osteophytes),soft swellings (caused by extra fluid in the joint).Drugs used for osteoarthritis of the knee include: painkillers (analgesics), non steroidal anti inflammatory drugs(NSAIDs), Capsaicin Cream and steroid injections.
The American Academy of Orthopaedic Surgeons in 2013 published clinical practice guideline on the Nonsurgical Management of Osteoarthritis of the Knee. Following are its major recommendations:
Conservative Treatments
Recommendation 1
The work group 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.(Strong)
Recommendation 2
The work group suggests weight loss for patients with symptomatic osteoarthritis of the knee and a body mass index (BMI) ≥25.(Moderate)
Recommendation 3A
The work group cannot recommend using acupuncture in patients with symptomatic osteoarthritis of the knee. (Strong)
Recommendation 3B
The work group is unable to recommend for or against the use of physical agents (including electrotherapeutic modalities) in patients with symptomatic osteoarthritis of the knee.(Inconclusive)
Recommendation 3C
The work group is unable to recommend for or against manual therapy in patients with symptomatic osteoarthritis of the knee. (Inconclusive)
Recommendation 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. (Inconclusive)
Recommendation 5
The work group cannot suggest that lateral wedge insoles be used for patients with symptomatic medial compartment osteoarthritis of the knee. (Moderate)
Recommendation 6
The work group cannot recommend using glucosamine and chondroitin for patients with symptomatic osteoarthritis of the knee. ( Strong)
Pharmacologic Treatments
Recommendation 7A
The work group recommends nonsteroidal anti-inflammatory drugs (NSAIDs; oral or topical) or Tramadol for patients with symptomatic osteoarthritis of the knee.(Strong)
Recommendation 7B
The work group is unable to recommend for or against the use of acetaminophen, opioids, or pain patches for patients with symptomatic osteoarthritis of the knee. (Inconclusive)
Procedural Treatments
Recommendation 8
The work group is unable to recommend for or against the use of intraarticular (IA) corticosteroids for patients with symptomatic osteoarthritis of the knee.(Inconclusive)
Recommendation 9
The work group cannot recommend using hyaluronic acid for patients with symptomatic osteoarthritis of the knee. (Strong)
Recommendation 10
The work group is unable to recommend for or against growth factor injections and/or platelet rich plasma for patients with symptomatic osteoarthritis of the knee. (Inconclusive)
Recommendation 11
The work group cannot suggest that the practitioner use needle lavage for patients with symptomatic osteoarthritis of the knee. (Moderate)
Surgical Treatments
Recommendation 12
The work group cannot recommend performing arthroscopy with lavage and/or debridement in patients with a primary diagnosis of symptomatic osteoarthritis of the knee.(Strong)
Recommendation 13
The work group is unable to recommend for or against arthroscopic partial meniscectomy in patients with osteoarthritis of the knee with a torn meniscus.( Inconclusive)
Recommendation 14
The practitioner might perform a valgus producing proximal tibial osteotomy in patients with symptomatic medial compartment osteoarthritis of the knee. (Limited)
Recommendation 15
In the absence of reliable evidence, it is the opinion of the work group not to use the free-floating (un-fixed) interpositional device in patients with symptomatic medial compartment osteoarthritis of the knee.(Consensus)
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