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Knee osteoarthritis treatment update: New clinical practice guideline

Knee osteoarthritis treatment update: New clinical practice guideline

Treatment for patients who have osteoarthritis (OA) of the knee always should be tailored to individual patients after they have had discussions with their physician, according to a new American Academy of Orthopaedic Surgeons (AAOS) guideline. In addition, the guideline recommends against performing an arthroscopic lavage if a patient displays only OA symptoms and no other problems, such as loose bodies and meniscus tears.

"Treatment of Osteoarthritis of the Knee," an evidence-based clinical practice guideline, was developed to include only treatments that are less invasive than knee replacement surgery. The guideline was based on a systematic review of the current scientific and clinical information on accepted approaches to diagnosis and treatment.

Other key recommendations in the AAOS guideline include the following:
•Overweight persons—those with a body mass index greater than 25 kg/m2—should lose a minimum of 5% of their body weight.
•Patients should be encouraged to start or increase participation in low-impact aerobic fitness exercises.
•Unless there are contraindications, patients with symptomatic knee OA should use analgesics for pain.

The recommendations are important because patients can self-manage the progression of their OA and take more control of it, according to the AAOS work group that developed them. Losing weight has the highest potential to slow disease progression, it was noted.

The AAOS created this clinical practice guideline to streamline possible treatment processes and serve as a point of reference and educational tool for both primary care physicians and orthopedic surgeons. Recommended analgesics include acetaminophen (not to exceed 4 g/d), NSAIDs, and intra-articular corticosteroids (for short-term pain relief). The work group recommended against use of glucosamine and chondroitin sulfate or chondroitin hydrochloride, needle lavage, and custom-made foot orthoses for treatment. Because of a lack of available evidence, the group did not offer recommendations for or against the use of bracing, acupuncture, and intra-articular hyaluronic acid.

The AAOS guideline reiterated that knee OA affects about 33 million Americans, especially those 65 years or older, and is a leading cause of physical disability. The key factors that affect the risk of knee OA identified in the guideline include heredity, age, weight, sex, injuries or trauma to the knee, posture, bone alignment, lack of aerobic exercise, and muscle weakness.

To see the full guideline and all supporting documentation, visit the AAOS Web site at www.aaos.org/guidelines. Or contact the organization at 6300 North River Road, Rosemont, IL 60018-4262; telephone: (847) 823-7186; fax: (847) 823-8125.

 
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