Authors

Dr Keran Sundaraj MBBS, MSc (Trauma), FRACS, FAOA

The American Academy of Orthopaedic Surgeons recently released a summary of recommendations for the treatment based on evidence-based medical research controlled for bias, transparency, and reproducibility. The characteristics of studies that make strong evidence include:

• the use of a placebo or control treatment

• sufficient numbers of subjects to determine if an actual difference exists

• the use of appropriate reliable measurement tools

Recommended for the Treatment of Knee Osteoarthritis

Low impact aerobic exercise (e.g. cycling, swimming, walking, yoga) 

• Quality of evidence is Strong

• The quality of the supporting evidence is high. A significant benefit in 5 of 7 high strength studies

Weight Loss for those with BMI >25 

• Quality of evidence is Strong

• The quality of the supporting evidence is high. Beneficial in 3 of 3 studies

Non Steroidal Anti-inflammatory Drugs (NSAIDs) 

• Quality of evidence is Strong:

• Quality of evidence demonstrating effectiveness is high. E.g. Mobic, Naprosyn, Arcoxia, Celebrex, Voltaren, Nurofen.

Supervised Physiotherapy aimed at improving strength, balance and, flexibility. 

• Quality of evidence is Strong

• The quality of the supporting evidence is high. Not Recommended for the Treatment of Osteoarthritis

Not Recommended for the Treatment of Knee Osteoarthritis

Arthroscopy 

• Quality of evidence is strong

• No benefit over physical therapy and medical treatment in 3 of 3 studies

Glucosamine and Chondroitin, Fish Oil 

• Quality of evidence is strong

• No evidence of clinically important improvements over placebo in 21 studies

Acupuncture 

• Quality of evidence is strong

• No benefit over placebo in 10 studies

Hyaluronic Acid 

• Quality of evidence is strong

• The quality of the supporting evidence is high. No benefit is demonstrated over placebo. 14 studies

Lateral wedge insoles 

• Quality of evidence is Moderate:

• Potential harm exceeds the benefits. No improvement in 4 of 5 studies

Needle Lavage 

• Quality of evidence is strong

• Potential harm exceeds the benefits. No improvement in 2 of 2 studies

Electrotherapeutic modalities (electrical stimulation) 

• Quality of evidence is Inconclusive

• Lack of compelling evidence that results in an unclear balance between benefit and potential harm

Medial compartment unloader braces 

• Quality of evidence is strong

• Lack of compelling evidence that results in an unclear balance between benefit and potential harm

Corticosteroids 

• Quality of evidence is inconclusive

• Lack of compelling evidence that results in an unclear balance between benefit and potential harm

Growth factor injections or Platelet Rich Plasma, Stem Cells 

• Quality of evidence is Inconclusive

• Lack of compelling evidence that results in an unclear balance between benefit and potential harm