Treatment of Osteoarthritis of the Knee : AAOS guidelines

Osteoarthritis, commonly known as wear-and-tear arthritis, is a condition in which the natural cushioning between joints -- cartilage -- wears away. When this happens, the bones of the joints rub more closely against one another with less of the shock-absorbing benefits of cartilage. The rubbing results in pain, swelling, stiffness, decreased ability to move and, sometimes, the formation of bone spurs.

In the year 2013 American Academy of Orthopedic Surgeons came out with the clinical practice guidelines on "Treatment of Osteoarthritis of the Knee" which specified some of the less invasive approaches to the treatment of the disease than knee replacement

The major recommendation of the guidelines are as follows:-

1. The guidelines recommend 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. (Strong Recommendation)

2.Guidelines suggest weight loss for patients with symptomatic osteoarthritis of the knee and a BMI ≥ 25 (Strength of Recommendation: Moderate)

3a.The guideline cannot recommend using acupuncture in patients with symptomatic osteoarthritis of the knee. (Strength of Recommendation: Strong)

3b.The guideline is unable to recommend for or against the use of physical agents (including electrotherapeutic modalities) in patients with symptomatic osteoarthritis of the knee. (Strength of Recommendation: Inconclusive Description)

3c.The guideline is unable to recommend for or against manual therapy in patients with symptomatic osteoarthritis of the knee. (Strength of Recommendation: Inconclusive Description)

4.The guideline 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. (Strength of Recommendation: Inconclusive Description)

5.The Guideline cannot suggest that lateral wedge insoles be used for patients with symptomatic medial compartment osteoarthritis of the knee. (Strength of Recommendation: Moderate Description)

6.The guideline cannot recommend using glucosamine and chondroitin for patients with symptomatic osteoarthritis of the knee. (Strength of Recommendation: Strong Description)

7a.The guideline recommends nonsteroidal anti-inflammatory drugs (NSAIDs; oral or topical) or Tramadol for patients with symptomatic osteoarthritis of the knee. (Strength of Recommendation: Strong Description)

7b. The guideline is unable to recommend for or against the use of acetaminophen, opioids, or pain patches for patients with symptomatic osteoarthritis of the knee. (Strength of Recommendation: Inconclusive Description)

8.The guideline is unable to recommend for or against the use of intraarticular (IA) corticosteroids for patients with symptomatic osteoarthritis of the knee. (Strength of Recommendation: Inconclusive Description)

9.The guideline is unable to recommend using hyaluronic acid for patients with symptomatic osteoarthritis of the knee. (Strength of Recommendation: Strong Description)

10.The guideline is unable to recommend for or against growth factor injections and/or platelet rich plasma for patients with symptomatic osteoarthritis of the knee. (Strength of Recommendation: Inconclusive Description)

11. The guidelines cannot suggest that the practitioner use needle lavage for patients with symptomatic osteoarthritis of the knee. (Strength of Recommendation: Moderate Description)

12. The guidelines cannot recommend performing arthroscopy with lavage and/or debridement in patients with a primary diagnosis of symptomatic osteoarthritis of the knee. (Strength of Recommendation: Strong Description)

13.The guidelines were unable to recommend for or against arthroscopic partial meniscectomy in patients with osteoarthritis of the knee with a torn meniscus. (Strength of Recommendation: Inconclusive Description)

14.The practitioner might perform a valgus producing proximal tibial osteotomy in patients with symptomatic medial compartment osteoarthritis of the knee. (Strength of Recommendation: Limited Description)

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. (Strength of Recommendation: Consensus Description)

To read the full guideline click on the following link:

https://www.orthoguidelines.org/topic?id=1005