Clinical practice guidelines for osteoarthritis of the knee

Feb 26 2009

Osteoarthritis (OA) is known as the "wear and tear" arthritis. It can affect any joint in the body particularly after years of use.

A clinical practice guideline for the treatment of Osteoarthritis of the Knee was presented today at the 2009 Annual Meeting of the American Academy of Orthopaedic Surgeons (AAOS). The guideline was explicitly developed to include only treatments which are less invasive than knee replacement surgery.

The Guideline and Evidence Report recommends:

• Not performing an arthroscopic lavage if a patient only displays symptoms of osteoarthritis and no other problems like loose bodies or meniscus tears.

If those mechanical problems-such as loose bodies and meniscal tears - are present, then arthroscopy can be potentially beneficial. "The current science shows us that just washing out the joint does not decrease the patient's osteoarthritis symptoms and can expose the patient to additional risk," said John Richmond, MD, Chair of the AAOS O/A of the Knee, Guideline work group.

Other important recommendations include:

• Patients who are overweight, with a Body Mass Index (or BMI) greater than 25 should lose a minimum of five percent of their body weight.
• Patients should be encouraged to begin or increase their participation in low-impact aerobic fitness.

"These two recommendations are very important because patients can self manage the progression of their OA, and take more control of what their issues are," said Dr. Richmond. "As far as losing weight, this has the highest potential to actually slow the progression of the disease."

After a thorough analysis of the current scientific literature, the work group recommends against using the following treatments:

• Glucosamine and/or chondroitin sulfate or hydrochloride
• Needle lavage (aspiration of the joint with injection of saline)
• Custom made foot orthotics

The work group does suggest that patients with symptomatic OA of the knee receive one of the following analgesics for pain unless there are contraindications to this treatment:

• Acetaminophen (not to exceed 4 grams per day)
• Non-steroidal anti inflammatory drugs (NSAIDs)
• Intra-articular corticosteroids (for short term pain relief)

In addition, the clinical practice guideline does not recommend for or against the use of:

• Bracing
• Acupuncture
• Intra-articular hyaluronic acid

Osteoarthritis of the knee is a leading cause of physical disability. Some 33 million Americans are affected by osteoarthritis, but it most commonly occurs in people who are 65 years of age or older. OA of the knee can have a major effect on a person's ability to engage in daily activities, like walking or climbing stairs.

"The Academy created this clinical practice guideline to improve patient care for those suffering from osteoarthritis of the knee," stated Dr. Richmond. "This serves as a point of reference and educational tool for both primary care physicians and orthopaedic surgeons, streamlining possible treatment processes for this ever-so common ailment." While a wide range of treatment options are available, they should always be tailored to individual patients after discussions with their orthopaedic surgeons.

http://www.aaos.org/