Management of osteoarthritis of the knee

Summary points

• Osteoarthritis is a chronic disease; management should be patient centred and coordinated, with attention to modifiable risk factors and comorbidities

• Focus on conservative non-drug treatment, particularly exercise; for overweight or obese patients weight loss is recommended

• Management should be evidence based; do not use interventions with high cost and risk that outweigh their benefits

• Use paracetamol or non-steroidal anti-inflammatory drugs for pain relief, with due attention to precautions and contraindications

• Refer patients to a physiotherapist for exercise, manual therapy, and gait aids; orthotist for bracing; psychologist for cognitive behavioural therapy; and dietitian for nutritional advice

• Do not use arthroscopy for pain management; refer patients for joint replacement only when symptoms are severe and other treatments have failed

Sources and selection criteria

We used recently published clinical guidelines for the management of osteoarthritis of the knee from the Osteoarthritis Research Society International, American College of Rheumatology, National Institute for Health and Clinical Excellence, European League against Rheumatism, American Academy of Orthopaedic Surgeons, Royal Australian College of General Practitioners, and the Ottawa Panel. We also searched the Cochrane Database of Systematic Reviews (without time limits) and performed PubMed and Embase searches (January 2008 to March 2012) using the keywords “knee” and “osteoarthritis”. We selected high quality systematic reviews, meta-analyses, and large randomised controlled trials. When such studies were unavailable, we considered relevant small randomised controlled trials, cohort studies, and observational studies.