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22 Recommendations for Treatment of Knee Osteoarthritis

Focusing on Treatments Less Invasive Than Knee Replacement

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Updated July 22, 2010

Less Invasive Treatments for Knee Osteoarthritis

Knee pain can be particularly disconcerting as it affects your mobility and interferes with your ability to perform daily activities. Finding relief becomes a priority. There are so many treatment options -- where do you begin?

A summary of recommendations for the treatment of knee osteoarthritis has been provided by the American Academy of Orthopaedic Surgeons (AAOS). The guidelines focus on treatment options, which are less invasive than knee-replacement surgery.

The guidelines are not intended to override an assessment of your individual needs. In other words, your specific situation must be taken into account when you and your doctor decide on your course of treatment. The guidelines, though, do show you there is more than one approach to treating knee osteoarthritis -- and they help you learn some basics so you can discuss treatment options with your doctor.

22 Recommendations for Treatment of Knee Osteoarthritis

The recommendations pertain to patients having symptomatic knee osteoarthritis -- meaning, you have symptoms (such as joint pain, stiffness) -- not only x-ray evidence of knee osteoarthritis.

Patient Education and Lifestyle Modifications

1 - Your participation in self-management educational programs is encouraged, and you should modify your activities when possible to protect your joints (for example, walking is better for the joints than running).

2 - Regular telephone contact correlates with less knee pain -- possibly by promoting self-care. You can talk with anyone, not just a professional.

3 - If you are overweight (BMI, body mass index, greater than 25), you should lose a minimum of 5% of your body weight and maintain the lower weight through diet and exercise.

Rehabilitation

4 - You are encouraged to participate in low-impact aerobic fitness exercises.

5 - Range of motion and flexibility exercises are also important for good joint health and lessening osteoarthritis pain.

6 - Quadricep strengthening is recommended. Quadriceps are a group of four muscles that contract together to help lift up your hip and straighten your knee.

Mechanical Interventions

7 - Patellar taping is recommended for short-term relief of pain and improvement in function.

8 - Lateral heel wedges are not advised if you have medial compartment (the inner compartment of the knee) knee osteoarthritis.

9 - A knee brace for valgus deformity may or may not help if you have medial compartment knee osteoarthritis.

10 - A brace for valgus deformity with medial compartment knee osteoarthritis may or may not help relieve symptoms.

Complementary and Alternative Therapy

11 - The use of acupuncture may or may not relieve pain related to knee osteoarthritis.

12 - Glucosamine sulfate, chondoitin sulfate and glucosamine hydrochloride are not recommended by AAOS for symptomatic knee osteoarthritis.

Pain Relievers

13 - You should not use the following drugs because of allergy or previous adverse reaction -- acetaminophen (maximum dose 4g/day) or non-steroidal anti-inflammatory drugs (NSAIDs) are recommended for treating knee osteoarthritis.

14 - Use of one of the following analgesics is recommended for symptomatic knee osteoarthritis if you have increased gastrointestinal risk factors (comborbid conditions, history of peptic ulcers, history of gastrointestinal bleeding, concurrent use of corticosteroids, use of anticoagulants): acetaminophen (maximum dose 4g/day), topical NSAIDs, such as Voltaren gel, oral NSAIDs plus gastroprotective agent (such as Nexium) or COX-2 inhibitor (Celebrex).

Intra-articular Injections

15 - Intra-articular corticosteroids (injected in to the affected joint) are recommended for short-term pain relief of your affected knee joint.

16 - If you have mild-to-moderate symptomatic knee osteoarthritis, intra-articular hyaluronic acid may or may not relieve symptoms.

Needle Lavage

17 - Needle lavage (wash-out of the joint) is not recommended to treat symptomatic knee osteoarthritis.

Surgical Intervention

18 - Arthroscopy with debridement or lavage is not recommended to treat symptomatic knee osteoarthritis.

19 - Arthroscopic partial meniscectomy or loose body removal is a treatment option for symptomatic knee osteoarthritis, if you have signs and symptoms of a torn meniscus or loose body.

20 - Osteotomy of the tibial tubercle (bump on the front, upper part of the lower leg bone) may or may not help if you have patello-femoral osteoarthritis.

21 - Realignment osteotomy is a treatment option if you have symptomatic unicompartmental (one compartment of the knee) knee osteoarthritis with malalignment (misalignment of the joint, such as varus or valgus deformity).

22 - A free-floating interpositional device which compensates for lost cartilage should not be implanted if you have symptomatic unicompartmental knee osteoarthritis. is an example of an interpositional device that does not require cement or screws to hold it in place.

Point to Remember

These 22 recommendations from the AAOS are based on different levels of evidence and are offered only as guidelines to treat symptomatic knee osteoarthritis. They stop short of including knee replacement, which may ultimately be the best treatment option for you.

As always, discuss all treatment options with your doctor so the best course of treatment for you can be decided.

To understand the evidence behind the AAOS recommendations, you can read the full guideline.

Source:

Guideline on the Treatment of Osteoarthritis (OA) of the Knee. Richmond John MD et al. American Academy of Orthopedic Surgeons. 12/11/2008.
http://www.aaos.org/Research/guidelines/GuidelineOAKnee.asp

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