Treatment of Osteoarthritis of the Knee (Nonarthroplasty)

J Am Acad Orthop Surg, Vol 17, No 9, September 2009

John Richmond, MD (Chair), David Hunter, MD, PhD, Jay Irrgang, PT, PhD, ATC, Morgan H. Jones, MD, Bruce Levy, MD, Robert Marx, MD, MSc, FRCSC, Lynn Snyder-Mackler, PT, ATC, SCS, ScD, William C. Watters, III, MD, Robert H. Haralson, III, MD, MBA, Charles M. Turkelson, PhD, Janet L. Wies, MPH, Kevin M. Boyer, Sara Anderson, MPH, Justin St. Andre, MA, Patrick Sluka, MPH and Richard McGowan, MLS The clinical practice guideline was explicitly developed to include only treatments less invasive than knee replacement (ie, arthroplasty). Patients with symptomatic osteoarthritis of the knee are to be encouraged to participate in self-management educational programs and to engage in self-care, as well as to lose weight and engage in exercise and quadriceps strengthening. The guideline recommends taping for short-term relief of pain as well as analgesics and intra-articular corticosteroids, but not glucosamine and/or chondroitin. Patients need not undergo needle lavage or arthroscopy with débridement or lavage. Patients may consider partial meniscectomy or loose body removal or realignment osteotomy, as conditions warrant. Use of a free-floating interpositional device should not be considered for symptomatic unicompartmental osteoarthritis of the knee. Lateral heel wedges should not be prescribed for patients with symptomatic medial compartmental osteoarthritis of the knee. The work group was unable either to recommend or not recommend the use of braces with either valgus- or varus-directing forces for patients with medial unicompartmental osteoarthritis; the use of acupuncture or of hyaluronic acid; or osteotomy of the tibial tubercle for isolated symptomatic patellofemoral osteoarthritis.