Non-surgical management of knee osteoarthritis
The American Academy of Orthopaedic Surgeons (AAOS), an organization with about 39,000 members, puts out clinical practice guidelines for orthopedic surgeons. The AAOS has guidelines for the non-surgical management of knee osteoarthritis. These guidelines are not intended to substitute for sound clinical judgement. We will summarize the guidelines supported with moderate or strong evidence.
Rehabilitation, education, and wellness activity (strong evidence): Patients with symptomatic knee osteoarthritis should participate in programs that encourage strengthening, and low-impact aerobic activities. This can be done in the context of home exercises or supervised physical therapy that emphasize aerobic conditioning, strengthening, regular activity, and balance exercises.
Weight loss (moderate evidence): Weight loss for patients with BMI greater than or equal to 25 can result in clinical improvement in knee pain. A way to achieve this can be through diet and exercise. BMI is a measure of body fat based on height and weight.
Acupuncture; cannot recommend (strong evidence): The AAOS cannot recommend for the use of acupuncture for managing knee osteoarthritis pain. This recommendation is based on lack of efficacy and not the potential for harm.
Lateral wedge insoles (moderate evidence): The AAOS cannot suggest the use of lateral wedge insoles for patients with pain from arthritis in the inside of the knee. There is no significant improvement in pain, or function with the use of these insoles in patients with arthritis pain in the inside of the knee.
Glucosamine and Chondroitin; cannot recommend (strong evidence): The AAOS finds no evidence for important outcomes when comparing Glucosamine, Chondroitin (or both) to placebo. This recommendation is based on lack of efficacy and not because of potential harm.
NSAIDs (strong evidence): NSAIDs are non-steroidal anti-inflammatory drugs like Aleve and Advil that can be obtained over the counter. There are also prescription strength NSAIDs that are not available over the counter. These medications can provide pain relief, and can be used as first line agents for painful knee osteoarthritis.
Viscosupplementation; cannot recommend (strong evidence): This refers to the “gel injection/rooster’s comb” injection such as Synvisc, Monovisc etc. The AAOS cannot recommend using these injections based on lack of efficacy and not because of potential harm.
Needle lavage (moderate evidence): The AAOS cannot suggest the use of needle lavage for patients with painful knee osteoarthritis. It does not result in improvements in pain, stiffness, or swelling. Needle lavage refers to “cleaning out arthritis in the knee” procedures through a needle.
Arthroscopy with lavage; cannot recommend (strong evidence): This refers to “cleaning out arthritis in the knee” surgeries with arthroscopy. With strong evidence, the AAOS cannot recommend this procedure.
Dr. Oluwaseun Akinbo M.D. is an orthopedic surgeon at HaysMed. For more information, https://www.haysmed.com/oluwaseun-akinbo/